Global biological threats to health: an imperative for collaboration.

Biological threats to health are challenging governments worldwide. National strategies for preventing and managing existing and emerging threats require significant collaboration across borders, sectors, services, agencies and professions. Perhaps most important are the partnerships of key national health leaders who can develop and foster these relationships. Government Chief Nursing Officers (CNOs) and Chief Medical Officers (CMOs), providing leadership in more than 100 countries worldwide, play crucial roles in addressing biological threats to health. However, much of this leadership is exercised without the benefit of strong collaborative relationships between these two key national leaders. Unfortunately, without functional partnerships between nurses and physicians at all levels, national and global capacity to address biological and other threats will be greatly compromised. For these reasons, the first ever global forum for CNOs and CMOs teams was hosted by the Lillian Carter Center for International Nursing in Atlanta, in June 2004. Representatives from 70 countries focused on biological threats in relation to three key purposes: (1) gaining shared scientific and practical knowledge; (2) developing and strengthening collaboration and partnerships among CNOs and CMOs; and, (3) creating a joint plan for advancing national preparedness. This article describes the content, process and outcomes of this historic meeting. Keywords: biological threats; Chief Nursing Officers; Chief Medical Officers; global health threats; Lillian Carter Center for International Nursing; national health planning The health challenges confronting nations worldwide have become increasingly more complex in the face of biological threats to health. Whether developed or developing, all countries are facing extremely difficult questions regarding how to prevent and manage existing and emerging biologically originated disease, disability, and death. Whether intended or natural, existing or emerging, biological threats to health have moved to the forefront of concern within and beyond country boundaries. The capacity of any nation to effectively address biological threats to health requires partnerships across borders, sectors, services, agencies, communities, and individuals. In addition, the partnerships between health professionals are particularly important. In the majority of countries worldwide, national government leadership also includes the leadership provided by physicians and nurses. Government chief nursing officers (CNOs) and chief medical officers (CMOs), or those holding similar titles, are found in over 100 countries around the world (secretariat for the Global Government Chief Nursing Officer's Network, the Lillian Carter Center for International Nursing, Emory University School of Nursing). Thus, a natural opportunity exists for partnerships at the highest levels in most of the world's countries. Unfortunately, there is little evidence to suggest that effective, ongoing partnerships between CNOs and CMOs are in place in most countries. This lack of ongoing partnerships between senior government nurses and physicians is apparent in the make-up of governmental delegations to the annual World Health Assembly. This year, only 25 of the 186 countries present had their CNO or other nurse leaders as part of their country delegations. Understanding the actual causes for the lack of CNO-CMO partnerships is hampered by lack of research relating to these questions. However, based on individual reports by CNOs and CMOs of their own experiences, the causes appear to be extremely complex and related to lack of time and resources, working style (the orientation of an individual to work exclusively with colleagues), structure of programs and activities and, perhaps most importantly, a lack of general awareness regarding the importance of such partnerships. These same individuals, however, have confirmed that the rise in the impact of biological threats to health has brought recent attention to the need for partnerships and the critical roles that nurses and physicians can play in addressing these challenges. …