Biorisk management is fundamental to global health security

Biorisk management is fundamental to global health security |

By Samantha Dittrich, manager, Global Health Security Agenda, APHL

Over the past 60 years, the number of new diseases per decade has increased nearly fourfold. Since 1980, the number of outbreaks per year has more than tripled. These alarming trends have serious implications for human and animal health as well as severe and lasting economic consequences in affected areas.

In order to address these human health threats, a One Health approach is needed. One Health recognizes that the health of people is connected to the health of animals and the environment, and calls for interdisciplinary collaboration and communication in healthcare and public health practice. With the Global Health Security Agenda (GHSA) in progress, the One Health approach is more important than ever before, and partners must come together to accelerate progress towards a world safe and secure from infectious disease threats.

Inside public health laboratories around the world, scientists handle dangerous pathogens while testing human, animal and environmental specimens for disease. But these pathogens aren’t just confined to laboratory vials and storage tubes: they travel. Often diseases originate in local communities where samples are collected at healthcare facilities that are not equipped to safely and securely handle them. Blood, stool and even animal carcasses may be stored at clinics or emergency operations centers for hours or even days before the samples are transported to laboratories, often on via methods that lack the security requirements for safe sample handling, storage and disposal.

  • Safe handling of pathogens in a laboratory or public health setting by scientists or clinicians is biosafety. Simply put, biosafety is keeping yourself (the public health laboratory professional) safe from laboratory mishaps.
  • Keeping dangerous pathogens secure and out of the hands of someone who may want to use them intentionally to harm others is biosecurity.

Biosafety and biosecurity are fundamental parts of the GHSA. Laboratory biorisk management means instituting a culture of rigorous assessment of the risks posed by infectious agents and toxins and deciding how to mitigate those risks. It involves a range of practices and procedures to ensure the biosecurity, biosafety and biocontainment of those infectious agents and toxins. Threats posed by deliberate release (aka, bioterrorism) and accidental release of infectious agents from a laboratory can happen anytime and anywhere. To mitigate the risks, it is critical that we are prepared to prevent, detect and respond to these threats.

Biorisk management is fundamental to global health security |

As a partner in the GHSA, APHL collaborates with ministries of health worldwide to develop effective national laboratory systems. One of the ways we do that is by providing guidance to our global partners to reduce laboratory biosafety and biosecurity risk. All laboratories – whether they test human, animal or environmental specimens – should develop and maintain biorisk management systems tailored to their unique operations and risks. There is no one-size-fits-all biorisk management system.

Most recently, APHL drafted a Biorisk Management Framework as a tool for partners in Ghana. The Framework offers a comprehensive, systematic approach to laboratory biorisk management. It includes a list of essential elements Ghanaian laboratories can use to assess their operations and better integrate and enhance biosafety and biosecurity programs, whether it is a human, veterinary or environmental laboratory.

In the coming months, APHL will work with partners from public health laboratories, local hospitals, and the veterinary and research communities to discuss a comprehensive, standardized approach to the development of a national Biorisk Management Framework. The goal of this One Health effort is to reduce laboratory biosafety and biosecurity risk.

Preventing the next outbreak will require a One Health approach with close collaboration among the health, animal, agriculture, defense, security, development and other sectors. APHL will be there as a partner, advisor and sounding board for countries working to better manage laboratory biosafety and biosecurity risk.


The post Biorisk management is fundamental to global health security appeared first on APHL Lab Blog.

10 Ways CDC Gets Ready For Emergencies

Dr. Stephen Redd, Director, Office of Public Health Preparedness and Response
Dr. Stephen Redd, Director, Office of Public Health Preparedness and Response

One of the best parts of my job is the opportunity to learn from a wide range of experiences. We have an obligation to not only respond to emergencies today, but to prepare for tomorrow by learning from the past. Our work extends to households affected by disease, communities ravaged by disasters, and U.S. territories battling new and changing threats. In fact, all over the world – we try to get ahead of, and manage, complex responses that touch many lives through ever changing circumstances. In an ideal world the health in every community would be at a level that would make recovery and reliance easier. The reality is that emergencies happen in all kinds of environments and populations.

The Public Health Preparedness and Response National Snapshot is our annual report that gives us an opportunity to showcase the work that we and our state partners do. The report reminds us that no matter how big the emergency, we need to work together to respond to the best of our ability—with the cards we are dealt.

Here are 10 ways CDC’s Office of Public Health Preparedness and Emergency Response worked to keep people safer in 2016 that can inform our work going forward.

1) Four Responses at Once: An Unprecedented Challenge

CDC experts continue to provide 24/7 monitoring, staffing, resources, and coordination in response to natural disasters, terrorist attacks, and infectious disease threats. In early 2016, CDC managed four public health emergencies at the same time through our Emergency Operations Center :

  • Ebola
  • Flint, Michigan, Water Quality
  • Zika Virus
  • Polio Eradication

See us in action:

2) A Complex Threat: Zika Hits the U.S.

CDC scientists and responders were activated in CDC’s Emergency Operations Center, where they combed through research, developed and distributed diagnostic tests, and provided on-the-ground mosquito control and education to protect people at higher risk for the virus, including pregnant women and infants.

3) Right Resources, Right Place, Right Time

CDC’s Strategic National Stockpile is ready to send critical medical supplies quickly to where they are needed most to save lives. The stockpile is the nation’s largest supply of life-saving pharmaceuticals and medical supplies that can be used in a public health emergency if local supplies run out.

Last year, we helped conduct 18 full-scale exercises and provided training for 2,232 federal and state, local, tribal, and territorial emergency responders to ensure that systems for delivering medicines are functioning well before they are needed in an actual emergency. We continue to work with our federal, state, local, and commercial partners to make sure every step of the medical supply chain – from manufacture to delivery – is coordinated.

4) State and Local Readiness

CDC connects with state and local partners to provide support and guidance, helping every community get ready to handle emergencies like floods, hurricanes, wildfires, or disease outbreaks.

This year, we created a new process to evaluate how well state and local jurisdictions can plan and execute a large-scale response requiring the rapid distribution of critical medicines and supplies. Through this program, we conducted assessments of 487 state and local public health departments. The information from these assessments will be used to help improve the ability to get emergency supplies quickly to those who need them most.

5) Cutting-Edge Science to Find and Stop Disease

To protect lifesaving research, CDC experts in biosafety and biosecurity conducted approximately 200 laboratory inspections and thousands of assessments of those who handle dangerous select agents and toxins like anthrax, plague, and ricin to keep these materials safe, secure, and out of the hands of those who might misuse them.

CDC’s Laboratory Response Network (LRN)l also develops and deploys tests to combat our country’s most pressing infectious and non-infectious health issues, from Ebola to Zika virus to opioid overdose. The network connects over 150 labs to respond quickly to high priority public health emergencies.

6) Protecting Our Most Vulnerable

CDC supports efforts all across the country to help those who may not be able to help themselves when a crisis strikes. Some populations, like children, older adults, and others with functional and access needs may need extra help during and after an emergency.

From planning for the 69 million children who may be in school when disaster strikes to the millions of Americans who need to make sure prescriptions are filled, medical equipment is working, and help arrives even if power is out and roads are blocked, it’s up to us to protect our most vulnerable in emergencies.

7) Emergency Leaders: The Future of Incident Response

When every minute counts, we need people who have the knowledge to step in and take immediate action. Learning and using a common framework like the CDC Incident Management System helps responders “speak the same language” during an event and work more seamlessly together.

CDC experts train leaders from around the world—25 countries in 2016—through an innovative, four-month fellowship based at our Atlanta headquarters. Lessons learned from this course were put to work immediately to head off an outbreak of H5N1 influenza in Cameroon.

8) The Power of Preparedness: National Preparedness Month

Throughout September, CDC and more than 3,000 organizations—national, regional, and local governments, as well as private and public organizations— supported emergency preparedness efforts and encouraged Americans to take action.

The theme for National Preparedness Month 2016 was “The Power of Preparedness.” During our 2016 campaign , we recognized the successes of countries and cities who have seen the direct benefits of being prepared, looked at innovative programs to help children and people with disabilities get ready for emergencies, and provided tips for home and family on making emergency kits.

9) Health Security: How is the U.S. Doing?

As part of the Global Health Security Agenda, teams of international experts travel to countries to report on how well public health systems are working to prevent, detect, and respond to outbreaks. In May, a team made a five-day visit to the U.S. to look at how well we’re doing.

In the final report, the assessment team concluded that, “the U.S. has extensive and effective systems to reduce the risks and impacts of major public health emergencies, and actively participates in the global health security system.” They recognized the high level of scientific expertise within CDC and other federal agencies, and the excellent reporting mechanisms managed by the federal government.

10) Helping YOU Make a Difference

Get a flu shot. Wash your hands. Make a kit. Be careful in winter weather. Prepare for your holidays. Be aware of natural disasters or circulating illnesses that may affect you or those you care about. There are many ways to prepare, and in 2016 we provided the latest science and information to empower every one of us to take action.

Every person needs knowledge to prepare their home, family, and community against disease or disaster before an emergency strikes. Whether it’s how to clean mold from a flooded home, how to wash your hands the right way, or how to use your brain in emergencies, our timely tips and advice put the power of preparedness in your hands. From the hidden dangers of hurricanes to the heartbreaking dangers of flu, there are steps we can all take to stay safe every day as we work toward a healthy and protected future.

For more ways we are helping protect America’s health, check out the new National Preparedness Snapshot.

To find out more about the issues and why this work matters, visit our website.


One Health and the Global Health Security Agenda must go hand in hand

One Health and the Global Health Security Agenda must go hand in hand |

By Samantha Dittrich, manager, Global Health Security Agenda, APHL

Did you know that most infectious diseases are caused by pathogens transferred between animals and humans? At least 75% of emerging and re-emerging diseases are either zoonotic or vector-borne. What’s more, animal health can directly affect food security and economic stability.

The One Health approach to disease control recognizes that human, animal and environmental health are connected. As a collaborative effort, One Health brings together multiple disciplines and sectors locally, nationally and globally to prevent, detect and respond to emerging and re-emerging infectious diseases.

We’ve seen how infectious disease epidemics pose a health security threat not only at the local level but also globally. Severe acute respiratory syndrome (SARS), avian influenza H5N1, Ebola and Zika are examples of pathogens that caused major outbreaks that had tremendous impacts on human, animal and economic health across the globe. Future threats are likely to arise as the global population continues to grow, the demand for food becomes greater and microbes become increasingly resistant to treatments such as antibiotics.

Though One Health isn’t a new concept, it is now more critical than ever before. A key component to the Global Health Security Agenda (GHSA) is strengthening One Health capacity to prevent, detect and respond to zoonotic diseases before they become a human public health risk. To do this, there must be a concerted global effort to work across multiple disciplines and through different sectors of government. One way this will be accomplished is through the GHSA Zoonotic Disease Action Package, one of 11 Action Packages aimed at achieving GHSA objectives and targets. The GHSA Zoonotic Disease Action Package specifically focuses on actions to minimize the transmission of zoonotic diseases from animals into human populations.

Governmental support for One Health objectives is expected to enhance countries’ ability to meet international health standards and improve the quality of human and animal health systems. For example, the World Health Organization (WHO) International Health Regulations (IHR) and the World Organization for Animal Health (OIE) Performance of Veterinary Services pathway develop government standards aimed at protecting human and animal health respectively. Their work strengthens reporting and communication between human and animal health sectors during zoonotic disease events, and improves the compatibility of existing animal and human diagnostics and surveillance systems.

As a collaborator in the GHSA, APHL is providing country support to strengthen laboratory systems by reviewing current capabilities, employing high quality laboratory processes and developing systems that foster communication and appropriate integration between laboratory and epidemiology functions. APHL staff are working in Uganda, Vietnam and Tanzania to incorporate One Health strategies into their National Laboratory Strategic Plans, and is making plans to support review of Tanzania’s National Laboratory Policy Review and development of its operational plan as well as development of Kenya’s operational plan and Indonesia’s National Strategic Plan development. APHL has also provided country support for laboratory antimicrobial resistance (AMR) assessments to determine current capacity for reliably detecting AMR. As APHL expands its GHSA work to other countries, the Association will continue to work across human and animal public health systems to deliver a One Health approach that strengthens national laboratory systems.

When Preparation Meets Opportunity: Cameroon Gets a Jump on Outbreak Response


When Dr. Aristide Abah stepped off the plane that brought him from Atlanta back to his home in Cameroon, there was no time to waste. An outbreak of H5N1 flu threatened the country, and it was up to Dr. Abah to lead the response.

Fortunately, he was prepared.

Dr. Abah had just spent four months at CDC headquarters as part of CDC’s Public Health Emergency Management Fellowship, which invites public health experts from all over the world to learn how to organize an emergency response in their country.

A deadly threat

In Cameroon, H5N1 was raging in poultry, putting people at risk. The virus can spread to people who come into contact with infected birds, and the result can be devastating. An estimated 60% of people who get the disease, die.

A swarm of activity took place around Cameroon’s response: culling chickens, contact tracing, delivering Tamiflu to people who needed it, providing personal protective equipment (PPE) to workers, and more. The country faced challenges; with over 500 sets of PPE needed each day, animal health workers ran out and had to repurpose supplies that were never used for the 2014 Ebola outbreak.

If they were to stop the deadly virus from spreading to humans, the country needed to act fast and be efficient. For Dr. Abah – and for Cameroon’s public health emergency operations center – it was time to put some newfound knowledge to the test.

From fellowship to field

Dr. Abah leads Cameroon H5N1 response
Dr. Abah leads Cameroon’s H5N1 response

Dr. Abah returned home from his fellowship on a Sunday night. On Tuesday, he stepped in as Incident Manager for the response. On Wednesday, he walked around the room and put nameplates at every desk.

This simple action served two important purposes.

The first was to make sure everyone knew their designated roles. In an emergency, we use an organizational structure called an Incident Management System to assign specific roles and responsibilities to every person. This ensures that everyone knows exactly what they and others are doing.

Nameplates also meant that everyone had an assigned seat, so that people who worked on the same tasks sat near each other. When information has to travel fast, proximity is priceless.

After he organized the people, Dr. Abah organized their time. He set up a system that gave everyone an allotted number of minutes to speak at meetings. He even appointed a timekeeper to help stay on track. “As you may or may not know,” joked Kerre Avery, a CDC Emergency Management Specialist who works closely with Cameroon, “it’s the French custom to talk a lot.”

Dr. Abah also improved the way information traveled, both within the response and outside it.  He adopted the CDC template for daily update slides and situation reports in the EOC, and added a communications team to the incident management structure to help get critical messages out to the public.

For Dr. Abah, these were the opening steps of a wider plan to respond to the crisis. During his fellowship, he had learned the critical importance of planning and organization. “For me, the planning was key,” he said. “I now know that we can’t do anything without a plan.”

Knowledge can’t wait                                                                  

When Dr. Abah first learned of the H5N1 outbreak, he had not yet completed his fellowship, but he knew that the lessons he was learning would help his colleagues back home. He set up an internet-based platform so they could all see and benefit from the lessons. He also reached out with new ideas: “I wanted to speak to higher management,” he said. “I told them they had to have an Incident Manager [in the EOC].”

Cameroon was already getting better and better at responding to health threats. A year ago, it took the country eight weeks to activate their public health emergency operations center in response to a cholera outbreak. Several months later, when Lassa fever erupted, they had reduced their response time to a week. By the time H5N1 appeared in local poultry, it took the country less than 24 hours to activate the PHEOC.

Cameroon’s recent improvements – including their investment in sending Dr. Abah to the fellowship – are all part of a worldwide effort to better prevent, detect, and respond to public health emergencies. And their efforts in preparedness are paying off: during the latest outbreak, there were zero transmissions of H5N1 to humans.

Inspiring lessons

The lessons the Public Health Emergency Management Fellowship teaches are designed to be applied to virtually any crisis situation. Since the 2013 inaugural class, CDC has hosted 39 fellows from 25 countries, giving them important education they can take back and use in their home countries.

While in the U.S., Dr. Abah was particularly inspired by a visit to meet Dr. Nicole Lurie, the Assistant Secretary for Preparedness and Response in Washington, D.C. Her advice to him summarizes perhaps the most important lessons from the fellowship.

“I keep in my memories three words of advice from Dr. Lurie.” Dr. Abah recalls. “Never give up, stay connected, and get better.”

The Public Health Emergency Management Fellowship is implemented by CDC’s Division of Emergency Operations. The program helps countries meet the goals of the Global Health Security Agenda, including having an emergency operations center that can respond within two hours of a public health emergency.

Learn More

 Read our other National Preparedness Month blogs:

Using the Law to Prepare for Global Health Emergencies

CDC country office sign in Liberia

Countries need to be prepared to handle emergencies. Having the right laws in place is an important part of the preparation.

When laws are not clearly defined, responders can have a hard time figuring out what to do during a public health emergency and who has the authority to take action. When a deadly disease outbreak hits, this can have devastating consequences.

Liberia knows firsthand what can happen when laws don’t match the needs in the field. Their experience with the recent Ebola epidemic exposed gaps in legal authority during the response. This is one reason why Liberia’s government recently reached out to the GHSA Public Health Law Project. The project team is helping them document issues that could be improved by updating Liberia’s public health law, which was last fully revised in 1976.

Advancing the Global Health Security Agenda

Bucket of bleach for washing of hands before entering public buildings and entering counties
Ebola preventive measures in Liberia: Buckets of chlorine solution to wash hands before entering public buildings and entering counties.

The GHSA Public Health Law Project takes a close look at how the law can help (or hinder) countries as they prepare to handle public health emergencies through the Global Health Security Agenda (GHSA). Right now, over 50 countries around the world are working through the GHSA to improve their ability to prevent, detect, and rapidly respond to infectious disease threats. The GHSA Public Health Law Project currently covers nearly half of the GHSA countries. The team helps analyze the laws of a country and provides training to country officials to help them understand the importance of law as a public health tool.

The team begins its work by gathering information about existing laws and talking to experts about how public health law works in their country. In Liberia, the team found that people felt unclear about their roles during the Ebola response. As one country health official told the team, “There is confusion about roles in an emergency and enforcement. What is the role of the police? The ministry of health? The military? [This] needs to be better defined.”

Public Health Law in Liberia

Before the CDC team arrived in Liberia, the Ministry of Health’s Legal Counsel were already taking the lead to help modernize the law. This is a massive undertaking that the Government of Liberia hopes to accomplish as soon as possible.

The Liberian Ministry of Health’s (MOH) Legal Counsel and CDC’s Country Office Director invited the CDC project team to help them reach this goal through research and analysis of where there may be gaps in the law. The project team worked with a team from the University of North Carolina’s School of Government, who were invited for public health law support by Liberia’s Chief Medical Officer.

CDC Public Health Law team
From Left to Right: Jeff Austin (University of North Carolina), Emily Rosenfeld (CDC), Akshara Menon (CDC), Tomik Vobah and Aimee Wall (University of North Carolina)

Liberia will be able to use the information gathered by the team as they update their public health law. Once the laws are updated, the next step is making sure people are aware of them. A county health official laid out the problem he saw in Liberia: “Fundamentally, what is wrong is that the public health law is not widely known.” This official had been a practicing doctor for 11 years, but he had only read Liberia’s public health law for the first time two weeks prior to talking with the team.

Planning for the Future

The GHSA Public Health Law Project is being done collaboratively between CDC’s Center for Global Health and the Public Health Law Program. The project is compiling the laws from these countries into a single, searchable database to give a more complete picture of the legal landscape relating to the GHSA. The legal data obtained from this project will be a valuable resource when countries want to update their public health laws.

This initial legal mapping phase is only the beginning. What is really vital is how countries will use this information to help guide their work. The law can be an effective tool in meeting global health security goals and protecting people’s health — not only when a crisis hits, but every day.

APHL is a proud partner in the Global Health Security Agenda

Today President Obama announced the United States and 30 other nations have committed to join together to achieve the targets of the Global Health Security Agenda (GHSA).  APHL is proud to be a key partner in the effort to make the world safe from infectious disease threats.

APHL is working closely with US federal agencies as well as domestic agencies within African and Asian partner nations to achieve the following GHSA targets:

  • Countering antimicrobial resistance
  • Preventing the emergence and spread of zoonotic disease
  • Advancing a whole-of-government national biosafety and biosecurity system in every country
  • Establishing a national laboratory system
  • Strengthening real-time biosurveillance
  • Advancing timely and accurate disease reporting
  • Establishing a trained global health security workforce
  • Establishing emergency operations centers

APHL in Africa
Guinea, Kenya, Liberia, Sierra Leone, Tanzania, Uganda

To address the limited laboratory capacity and capability in many African nations, we are currently partnering with the African Society of Laboratory Medicine (ASLM) to provide technical and management assistance for design, development and implementation of the African Public Health Laboratory Network (APHLN).  Working with ASLM, APHL will convene stakeholders to develop the operational rules for the network, support laboratory accreditation and set goals for national public health laboratories. We will leverage existing laboratory models, notably the US Laboratory Response Network (LRN), to design an effective laboratory network for the continent.

As our GHSA work moves forward, APHL is also planning to initiate laboratory assessments, inventory and review of laboratory policies, training and mentoring of laboratory staff, support for development of biosafety facilities, and review of specimen referral systems, quality management system programs and capacity for detecting anti-microbial resistance.

APHL in Asia
India, Indonesia, Vietnam

In Asia, APHL is working directly with ministries of health and other national health officials to develop laboratory systems capable of safely and accurately detecting and characterizing pathogens causing epidemic disease. Lucy Maryogo-Robinson, APHL’s global health director, is traveling to partner countries in southeast and central Asia to plan activities under GHSA. In November she traveled with an APHL team to Vietnam to discuss projects to expand APHL’s longstanding relationship with that country.  Ongoing development of informatics systems and strengthening of capacity to respond to infectious diseases will be priorities.

APHL joins partners in Sierra Leone to strengthen lab capacity in Ebola’s wake

This week a team of APHL staff and consultants traveled to Freetown, Sierra Leone where they will join US federal and Sierra Leonean partners to launch a year-long project to support and strengthen the country’s laboratory system in the aftermath of the Ebola crisis. This initiative builds on APHL’s longstanding relationships with laboratory and public health partners in Sierra Leone. We are proud of these relationships; proud of our partners, staff and consultants; and eager to begin this critical work.

In addition to its project work in Sierra Leone, on October 15-16 APHL staff – in collaboration with the World Health Organization’s Regional Office for Africa and the African Society for Laboratory Medicine (ASLM) – will participate in the Regional Global Health Security Agenda (GHSA) Consultation for Laboratory Strengthening, a two-day meeting focused on developing resilient laboratory networks in Africa. This meeting will bring partners together to initiate and build consensus around an inclusive roadmap framework for the implementation of the Global Health Security Agenda across Africa.

Who is going?

APHL Staff: Scott Becker, executive director; Lucy Maryogo-Robinson, global health director; Ralph Timperi, senior advisor of laboratory practice & management

APHL global health consultants: Alpha Diallo, Paul Jankauskas, Kim Lewis and Jocelyn Isadore

What are the objectives of APHL’s work in Sierra Leone?

– APHL global health consultants will provide technical assistance to the Ministry of Health (MOHS) and National AIDS Secretariat of Sierra Leone in coordination with the Centers for Disease Control and Prevention (CDC) to strengthen laboratory infrastructure and capacity. This support will entail guidance on implementation of the National Laboratory Strategic Plan, mentoring and participation in the laboratory technical working group, and mentoring and training for the Central Public Health Reference Laboratory staff, all with the goal of strengthening lab capacity in Sierra Leone.

APHL joins partners in Sierra Leone to strengthen lab capacity in Ebola’s wake |– APHL, in collaboration with CDC Division of Global HIV/AIDS and the MOHS of Sierra Leone, will assist in the development and implementation of a National Laboratory Strategic Plan for the MOHS. APHL will conduct a range of activities to build capacity for testing at the Central Public Health Reference Laboratory and to develop a team of laboratory scientists who can conduct reference testing services and provide training to other laboratories in the MOHS network. A National Surveillance Strategic Plan will detail linkages between epidemiology and laboratory.

– APHL will support the laboratory science staff at the Central Public Health Reference Laboratory through training and mentoring in testing methods, quality systems, laboratory management and accreditation. APHL will expand staff knowledge and increase the number of staff at the Central Public Health Reference Laboratory in order to increase testing volume and the range of tests.

– APHL will work to strengthen laboratory management and move the Central Public Health Reference Laboratory towards accreditation. APHL will review the National Laboratory Strategic Plan to assess Sierra Leone accreditation goals, and work towards accreditation through training, mentoring and implementation of improvement projects.