Biorisk management is fundamental to global health security

Biorisk management is fundamental to global health security | www.APHLblog.org

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 | www.APHLblog.org

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.

 

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New Lab Matters: Strengthening global health security

New Lab Matters: Strengthening global health security | www.APHLblog.org

The Global Health Security Agenda (GHSA) aims to assure all participating countries implement the revised WHO International Health Regulations so they are able to prevent, detect and respond to disease outbreaks in near real-time. APHL is using the lessons learned in-country through PEPFAR programs to strengthen global health security initiatives involving public health laboratories around the world.

In the fall issue of Lab Matters, our feature article takes a look at the progress toward more robust laboratory infrastructures in three countries.

Here are just a few of this issue’s highlights:

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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 | www.aphlblog.org

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.

Global Health Security Agenda

A man waiting in the airport watching a plane take off

The Plan for 2016: CDC and the President’s Global Health Security Agenda

2015 was a powerful reminder that a health threat anywhere is a health threat everywhere.  In 2016, CDC and partners are looking forward to continuing work on the President’s Global Health Security Agenda (GHSA), an initiative led by the Department of Health and Human Services.

In 2012, only 1 in 6 countries reported being fully prepared for disease outbreaks. As the Ebola epidemic in West Africa tragically demonstrated, it is often the countries with the fewest resources who are hit hardest by public health emergencies.  To better protect people everywhere, the United States has committed more than $1 billion over the next 5 years to help 31 countries better prepare for the health impacts of natural and man-made disasters.  More than half of this historic investment will focus on the continent of Africa to help prevent future outbreaks.

World map of pixels in gray and light gray
There are 31 GHSA countries: Bangladesh • Burkina Faso • Cameroon • Cambodia • Côte d’Ivoire • Democratic Republic of Congo • Ethiopia • Georgia • Ghana • Guinea • Haiti • India • Indonesia • Jordan • Kazakhstan • Kenya • Laos • Liberia • Malaysia • Mali • Mozambique • Pakistan • Peru • Rwanda • Senegal • Sierra Leone • Tanzania • Thailand • Uganda • Ukraine • Vietnam

Global Health Security Agenda Goals

The vision of GHSA is to stop disease outbreaks as quickly as possible.  Partners will work together to build a global network that can respond rapidly and effectively to disease outbreaks and help countries build their own capacity to prevent, detect, and respond to public health emergencies.

The GHSA focuses on accelerating progress toward a world safe from disease threats by supporting enhanced surveillance and biosecurity systems, immunization campaigns, and curtailing antimicrobial resistance. Establishing national laboratory and disease reporting systems will help detect threats early.  In addition to building epidemiologic and laboratory workforce capacity, GHSA also focuses on incident management system training and establishing emergency operations centers around the globe.

As President Obama said at the Global Health Security Agenda Summit in 2014, “We issued a challenge to ourselves and to all nations of the world to make concrete pledges towards three key goals:  prevent, detect, and respond.  We have to prevent outbreaks by reducing risks.  We need to detect threats immediately wherever they arise.  And we need to respond rapidly and effectively when we see something happening, so that we can save lives and avert even larger outbreaks.”

CDC’s Role in Global Health Security
CDC is improving preparedness and response internationally by building close relationships with ministries of health and other public health partners abroad to encourage public health and emergency management capacity building. The agency also provides GHSA countries with resources such as funds, administrative support, and dedicated personnel, including experts in emergency response, electronic surveillance systems, and specific health threats. CDC also links emergency response efforts to recovery efforts to ensure systems and processes that have been put in place for one response can be ready for the next public health emergency.A person is giving another person a vaccine.

Ebola has reminded us that  to protect its citizens, each country should be equipped with a core set of public health capabilities to detect a threat when it emerges, respond rapidly and effectively, and prevent it wherever possible. All countries need to be prepared, since disease monitoring and emergency response begin at the local level.  Local responses will be quicker, more efficient, and more cost-effective than responding from a great distance. However, epidemics do not stay within borders and are not the problem of individual countries or regions. GHSA is an important step toward helping build capacity in other countries and ensuring that when national capacities are overwhelmed, the world moves immediately and decisively to contain the outbreak.