Health security in 2014: Building on preparedness knowledge for emerging health threats

Ideas, information, and microbes are shared worldwide more easily than ever before. New infections, such as the novel infl uenza A H7N9 or Middle East respiratory syndrome coronavirus, pay little heed to political boundaries as they spread; nature pays little heed to destruction wrought by increasingly frequent natural disasters. Hospital-acquired infections are hard to prevent and contain, because the bacteria are developing resistance to the therapeutic advances of the 20th century. Indeed, threats come in ever-complicated combinations: a combined earthquake, tsunami, and radiation disaster; black outs in skyscrapers that require new thinking about evacuations and medically fragile populations; or bombings that require as much psychological profi ling as chemical profi ling. Response requires up-to-date laboratories with genetic sequencing capabilities for infectious agents and rapid detection methods for chemical and radiological threats, nimble medical and epi demiological response units, and an alert and prepared workforce. These complex and interconnected problems have spurred innovation across government to create interconnected solutions. Increasingly, the USA is building national capabilities to improve health security, which is defi ned as a state in which the nation and its people are prepared for, protected from, and resilient in the face of health threats. To ensure a nation’s health security entails preventing, protecting, mitigating, responding to, and recovering from all hazards that adversely aff ect health, requiring strengthening health and response systems at the local, state, and national levels. These capabilities are being built to address a wide range of hazards so that a strong base of readiness for any threat is developed. Public health advances that have resulted in a more resilient and prepared nation and that have led to such system strengthening at all levels of government have been described, and include improvement and coordination of public health infrastructure through the National Incident Management System (NIMS), expansion of the Strategic National Stockpile (SNS), upgrading of medical care and countermeasures capabilities, and improvement of laboratory expertise and capacity. We describe continued progress in the ongoing commitment to keep people in the USA healthy and safe (panel 1). In an emergency, capabilities from all sectors are used to mitigate the acute event. However, the public health consequences of an event are not always visible, and health expertise has historically been conspicuously absent from emergency management. Over the past decade, awareness has grown that health is part of almost every event; much progress has been made in emergency management to use public health expertise in planning, response, and recovery. This integration is core to national activities to promote health security. NIMS was established in 2004 as a comprehensive, systematic, principle-driven approach to management of emergencies of all causes and sizes. The Department of Health and Human Services (HHS) uses, supports, and promotes NIMS with local and state health departments through both the Centers for Disease Control and Prevention’s (CDC) Public Health Emergency Preparedness programme and the Offi ce of the Assistant Secretary of Preparedness and Response’s Hospital Preparedness Program to be used whether responding to daily incidents or natural disasters. As seen in the Boston Marathon bomb attack on April 15, 2013, these investments and use of NIMS are very worthwhile. In Boston, the city’s public health commission oversees citywide emergency response, requiring close integration of emergency response and public health. Immediately after the bombings, medical and health department personnel began treating more than 140 injured people, and coordinated hospital transportation for 90 people—all within 30 min. Boston’s health authorities credited their quick response to robust exercise and planning, the city’s strong interagency partnerships, and support from the state and federal government. This support included use of a capabilities-based approach to preparedness, with concrete measures of performance (panel 2). Part of the city’s training also included a seminar in 2009 with doctors from India, Spain, Israel, the UK, and Pakistan—countries that had managed blast injury terror attacks. On the day of the Boston Marathon bomb attack, local hospitals were able to draw from lessons learned in those and other exercises to respond with great speed and success. Additionally, HHS used a new Mental and Behavioural Health Concept of Operations to deploy federal mental health responders. This mental health framework is an integral part of eff orts throughout HHS to identify, study, and facilitate activities that promote resilience and recovery in communities across the nation. Public health information sharing has improved rapidly. So-called digital epidemiology has enabled practitioners and researchers to use electronic databases and information to enhance traditional surveillance methods. In 2012, HHS launched its Now Trending developer challenge to create programmes for health departments to monitor social media during an outbreak. The challenge Lancet 2014; 384: 93–97