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Since the inception of gene synthesis technologies, there have been concerns about possible misuse. Using gene synthesis, pathogens—particularly small viruses—may be assembled "from scratch" in the laboratory, evading the regulatory regimes many nations have in place to control unauthorized access to dangerous pathogens. Progress has been made to reduce these risks. In 2010, the US Department of Health and Human Services (HHS) published guidance for commercial gene synthesis providers that included sequence screening of the orders and customer screening. The industry-led International Gene Synthesis Consortium (IGSC) was formed in 2009 to share sequence and customer screening methods, and it now includes the major international gene synthesis providers among its members. Since the 2010 HHS Guidance was released, however, there have been changes in gene synthesis technologies and market conditions that have reduced the efficacy of these biosecurity protections, leading to questions about whether the 2010 HHS Guidance should be updated, what changes could make it more effective, and what other international governance efforts could be undertaken to reduce the risks of misuse of gene synthesis products. This article describes these conditions and recommends actions that governments should take to reduce these risks and engage other nations involved in gene synthesis research. Since the inception of gene synthesis technologies, there have been concerns about possible misuse. Using gene synthesis, pathogens can be assembled "from scratch" in the laboratory, evading the regulatory regimes many nations have in place. Progress has been made to reduce these risks, but there have been changes in gene synthesis technologies and market conditions that have reduced the efficacy of the existing biosecurity protections. This article describes these conditions and recommends actions that governments should take to reduce these risks and engage other nations involved in gene synthesis research. [ABSTRACT FROM AUTHOR]

Clade X was a day-long pandemic tabletop exercise conducted by the Johns Hopkins Center for Health Security on May 15, 2018, in Washington, DC. In this report, we briefly describe the exercise development process and focus principally on the findings and recommendations that arose from this project. [ABSTRACT FROM AUTHOR]

The Johns Hopkins Center for Health Security is working to analyze and deepen scientific dialogue regarding potential global catastrophic biological risks (GCBRs), in a continuation of its mission to reduce the consequences of epidemics and disasters. Because GCBRs constitute an emerging policy concern and area of practice, we have developed a framework to guide our work. We invited experts from a variety of disciplines to engage with our underlying concepts and assumptions to refine collective thinking on GCBRs and thus advance protections against them. [ABSTRACT FROM AUTHOR]

The article discusses the Track 2 dialogue between Singapore and the U.S. biosecurity initiated and facilitated by the University of Pittsburgh Medical Center (UPMC) Center for Health Security in 2014 which was subsequently expanded to include Indonesia and Malaysia in 2015.

The article offers information on the banning travel to stop Ebola outbreak transmission in Dallas and New York. It mentions that the public health agencies including the World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC) opposed the travel bans. It mentions that travel bans lead to complete isolation.

The importance of health security in the United States has been highlighted by recent emergencies such as the H1N1 influenza pandemic, Superstorm Sandy, and the Boston Marathon bombing. The nation's health security remains a high priority today, with federal, state, territorial, tribal, and local governments, as well as nongovernment organizations and the private sector, engaging in activities that prevent, protect, mitigate, respond to, and recover from health threats. The Association of State and Territorial Health Officials (ASTHO), through a cooperative agreement with the Centers for Disease Control and Prevention (CDC) Office of Public Health Preparedness and Response (OPHPR), led an effort to create an annual measure of health security preparedness at the national level. The collaborative released the National Health Security Preparedness Index (NHSPI™) in December 2013 and provided composite results for the 50 states and for the nation as a whole. The Index results represent current levels of health security preparedness in a consistent format and provide actionable information to drive decision making for continuous improvement of the nation's health security. The overall 2013 National Index result was 7.2 on the reported base-10 scale, with areas of greater strength in the domains of health surveillance, incident and information management, and countermeasure management. The strength of the Index relies on the interdependencies of the many elements in health security preparedness, making the sum greater than its parts. Moving forward, additional health security-related disciplines and measures will be included alongside continued validation efforts. The Association of State and Territorial Health Officials (ASTHO), through a cooperative agreement with the CDC Office of Public Health Preparedness and Response (OPHPR), led an effort to create an annual measure of health security preparedness at the national level: the National Health Security Preparedness Index (NHSPI™). The Index shows current levels of state-level health security preparedness in a consistent format and provides actionable information to drive decision making as we continue to improve the nation's health security. [ABSTRACT FROM AUTHOR]

The authors suggest health security resolutions for the forthcoming New Year celebrations in the U.S. for the year 2014. Several resolutions discussed include rise in supports for public health and hospital preparedness programs, more technological inclusions in the sector of health security and more efficient monitoring of diseases and health management systems.

Natural disasters, infectious disease epidemics, terrorism, and major events like the nuclear incident at Fukushima all pose major potential challenges to public health and security. Events such as the anthrax letters of 2001, Hurricanes Katrina, Irene, and Sandy, severe acute respiratory syndrome (SARS) and West Nile virus outbreaks, and the 2009 H1N1 influenza pandemic have demonstrated that public health, emergency management, and national security efforts are interconnected. These and other events have increased the national resolve and the resources committed to improving the national health security infrastructure. However, as fiscal pressures force federal, state, and local governments to examine spending, there is a growing need to demonstrate both what the investment in public health preparedness has bought and where gaps remain in our nation's health security. To address these needs, the Association of State and Territorial Health Officials (ASTHO), through a cooperative agreement with the Centers for Disease Control and Prevention (CDC) Office of Public Health Preparedness and Response (PHPR), is creating an annual measure of health security and preparedness at the national and state levels: the National Health Security Preparedness Index (NHSPI). “In the past year, I have been struck by how important measurement is to improving the human condition. You can achieve incredible progress if you set a clear goal and find a measure that will drive progress toward that goal. …” —Bill Gates1“What gets measured gets done.” —Peter Drucker2 [ABSTRACT FROM AUTHOR]

Even amidst the devastation following the earthquake and tsunami in Japan that killed more than 20,000 people, it was the accident at the Fukushima Daiichi nuclear power plant that led the country's prime minister, Naoto Kan, to fear for “the very existence of the Japanese nation.” While accidents that result in mass radiological releases have been rare throughout the operating histories of existing nuclear power plants, the growing number of plants worldwide increases the likelihood that such releases will occur again in the future. Nuclear power is an important source of energy in the U.S. and will be for the foreseeable future. Accidents far smaller in scale than the one in Fukushima could have major societal consequences. Given the extensive, ongoing Nuclear Regulatory Commission (NRC) and industry assessment of nuclear power plant safety and preparedness issues, the Center for Biosecurity of UPMC focused on offsite policies and plans intended to reduce radiation exposure to the public in the aftermath of an accident. This report provides an assessment of Japan's efforts at nuclear consequence management; identifies concerns with current U.S. policies and practices for “outside the fence” management of such an event in the U.S.; and makes recommendations for steps that can be taken to strengthen U.S. government, industry, and community response to large-scale accidents at nuclear power plants. [ABSTRACT FROM AUTHOR]

In recent years, improved biosurveillance has become a bipartisan national security priority. As has been pointed out by the National Biosurveillance Advisory Subcommittee and others, building a national biosurveillance enterprise requires having strong biosurveillance systems at the state and local levels, and additional policies are needed to strengthen their biosurveillance capabilities. Because of the foundational role that state and local health departments play in biosurveillance, we sought to determine to what extent state and local health departments have the right capabilities in place to provide the information needed to detect and manage an epidemic or public health emergency—both for state and local outbreak management and for reporting to federal agencies during national public health crises. We also sought to identify those policies or actions that would improve state and local biosurveillance and make recommendations to federal policymakers who are interested in improving national biosurveillance capabilities. [ABSTRACT FROM AUTHOR]

A biography is presented of Donald Ainslee Henderson, a pioneering leader in the efforts of the World Health Organization in the global eradication campaign of small pox, which includes information on his career, accomplishments, and family.

As the U.S. prepares to respond this fall and winter to pandemic (H1N1) 2009, a review of the 1957-58 pandemic of Asian influenza (H2N2) could be useful for planning purposes because of the many similarities between the 2 pandemics. Using historical surveillance reports, published literature, and media coverage, this article provides an overview of the epidemiology of and response to the 1957-58 influenza pandemic in the U.S., during which an estimated 25% of the population became infected with the new pandemic virus strain. While it cannot be predicted with absolute certainty how the H1N1 pandemic might play out in the U.S. this fall, lessons from the 1957-58 influenza pandemic provide useful and practical insights for current planning and response efforts. [ABSTRACT FROM AUTHOR]

After 9/11 and the 2001 anthrax letters, it was evident that our nation's healthcare system was largely underprepared to handle the unique needs and large volumes of people who would seek medical care following catastrophic health events. In response, in 2002 Congress established the Hospital Preparedness Program (HPP) in the U.S. Department of Health and Human Services (HHS) to strengthen the ability of U.S. hospitals to prepare for and respond to bioterrorism and naturally occurring epidemics and disasters. Since 2002, the program has resulted in substantial improvements in individual hospitals' disaster readiness. In 2007, the HHS Office of the Assistant Secretary for Preparedness and Response (ASPR) contracted with the Center for Biosecurity of the University of Pittsburgh Medical Center to conduct an assessment of U.S. hospital preparedness and to develop tools and recommendations for evaluating and improving future hospital preparedness efforts. One of the most important findings from this work is that healthcare coalitions—collaborative groups of local healthcare institutions and response agencies that work together to prepare for and respond to emergencies—have emerged throughout the U.S. since the HPP began. This article provides an overview of the HPP and the Center's hospital preparedness research for ASPR. Based on that work, the article also defines healthcare coalitions and identifies their structure and core functions, provides examples of more developed coalitions and common challenges faced by coalitions, and proposes that healthcare coalitions should become the foundation of a national strategy for healthcare preparedness and response for catastrophic health events. [ABSTRACT FROM AUTHOR]

This article reviews the history and structure of the National Disaster Medical System (NDMS), with an emphasis on its definitive care component. NDMS's capacity to handle very large mass casualty events, such as those included in the National Planning Scenarios, is examined. Following Hurricane Katrina, Congress called for a reevaluation of NDMS. In that context, we make three key suggestions to improve NDMS's capacity to respond to large mass casualty disasters: (1) increase the level of engagement by the private (i.e., nonfederal) healthcare system in preparedness and response efforts; (2) increase the reliance on regional hospital collaborative networks as part of the backbone of the NDMS system; and (3) develop additional, alternative patient transportation systems, linked to the overall NDMS patient tracking effort, to decrease the sole reliance on DoD long-haul air transport in medical evacuation. [ABSTRACT FROM AUTHOR]

This article presents a notional scheme of global surveillance and response to infectious disease outbreaks and reviews 14 international surveillance and response programs. In combination, the scheme and the programs illustrate how, in an ideal world and in the real world, infectious disease outbreaks of public health significance could be detected and contained. Notable practices and achievements of the programs are cited; these may be useful when instituting new programs or redesigning existing ones. Insufficiencies are identified in four critical areas health infrastructure; scientific methods and concepts of operation; essential human, technical, and financial resources; and international policies. These insufficiencies challenge global surveillance of and response to infectious disease outbreaks of international importance. This article is intended to help policymakers appreciate the complexity of the problem and assess the impact and cost-effectiveness of proposed solutions. An assessment of the potential contribution of appropriate diagnostic tests to surveillance and response is included. [ABSTRACT FROM AUTHOR]

Vaccines are the cornerstone of the management of an infectious disease outbreak and are the surest means to defuse pandemic and epidemic risk. Because a platform vaccine technology can be leveraged for multiple uses - both for emerging as well as routine infectious diseases - a platform can be a means of achieving economies of scale and lowering the risk of ventures in emerging infectious diseases. [Extracted from the article]

The authors comment on antimicrobial resistance (AMR) as a global health problem. Particular focus is given to the prevalence of AMR infection in the U.S. and Europe, as well as launch of the Global Health Security Agenda (GHSA) in 2014. Topics discussed include multidrug-resistant infections in hospitals and nusing homes, threat posed by AMR to the foundation of modern healthcare, and decline in the number of new antimicrobials.

The authors comment on the U.S. Global Health Security (GHS) agenda which was launched in collaboration with the World Health Organization (WHO), the Food and Agriculture Organization (FAO), and the World Organisation for Animal Health (OIE). The authors say that the agenda aims to coordinate action among the agencies and organized on antimicrobial resistance, food safety, laboratory biosafety and biosecurity. They add that the agenda is dedicated to the detection of biological threats.

Medicine for Policymakersis a Journal column that provides decision makers with brief explanations of the meaning and implications for biosecurity of clinical issues. The articles describe, for a nonmedical audience, hospital practices, medical challenges, healthcare delivery issues, and other topics of current interest. Readers may submit ideas to the column's editor, Amesh A. Adalja, MD, through the Journal's editorial office atjfox@upmc-biosecurity.org. [ABSTRACT FROM AUTHOR]

The author reflects on the establishment of the journal and explore its aim of reducing public health consequences of biological threats. Also mentioned is the journal's title transformation from "Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science" to "Health Security." Highlighted are range of issues on public health threats and interventions including Ebola virus disease pandemic, enterovirus D68 strain and spreading Chikungunya outbreak.

An introduction is presented which discusses various topic within the issue including implementation of the global health security agenda (GHSA), components of GHSA and objectives of GHSA to counter major infectious disease threat and promote global health security as an international priority.

This article describes issues related to the engagement of hospitals and other community partners in a coordinated regional healthcare preparedness and response effort. The report is based on interviews with public health and hospital representatives from 13 regions or states across the country. It aims to identify key ingredients for building successful regional partnerships for healthcare preparedness as well as critical challenges and policy and practical recommendations for their development and sustainability. [ABSTRACT FROM AUTHOR]