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What Is Global Health Security, and How Is It Used in Disease Surveillance?

April 14, 2024

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A person in a lab coat looks through a microscope

In early 2020, news of a novel virus made headlines around the world. In the weeks and months after scientists first identified the COVID-19 coronavirus, the virus quickly spread around the world.

Epidemiologists have long understood that in our globally connected world, pathogens can easily spread across borders. Global health security aims to prevent pandemics and rapidly respond to infectious disease outbreaks across the globe.

Infectious diseases pose a complex threat. In the 21st century, the rate of outbreaks has increased. Changes in human behavior play a large role. Over 70 percent of epidemic-prone infectious diseases are transmitted from animals to humans, according to the U.S. Agency for International Development (USAID). Moreover, international trade and travel increase the rate at which diseases spread.

A humanitarian crisis can quickly spiral into a public health emergency. Epidemics can negatively impact overall community health and exacerbate health disparities. Promoting health security requires a multifaceted, international response. Epidemiologists, front-line healthcare workers, disaster management experts, and public health organizations must work together to track infectious diseases and improve public health outcomes.

What Is Global Health Security?

An infectious disease threat that begins in one part of the world can easily spread to other parts of the world. Global health security is what focuses on preventing, detecting, and responding to infectious disease threats.

Public health organizations around the world work together to monitor and respond to infectious diseases. In the U.S., the Centers for Disease Control and Prevention (CDC) leads national efforts to track pathogens, monitor outbreaks, and limit public health threats. The CDC coordinates with other national public health organizations and the World Health Organization (WHO) to promote global health.

As the CDC warns, an infectious disease can spread from a remote village to major cities on all continents in just 36 hours. Pathogens threatening one region threaten all regions.

An investment in global health security strengthens the global response to public health threats. Preventing the harmful impact of diseases and epidemics benefits everyone around the world.

The Major Risks to Global Health Security

Globalization has introduced new risks to health security. As contact between humans and wild animals increases, so does the risk of disease transmission. Global networks that cross oceans in a matter of hours spread diseases faster than ever before in history.

Similarly, public health triumphs have created new risks. Antibiotics have saved countless lives while also leading to drug-resistant pathogens. The world eradicated smallpox in the 1970s thanks to global vaccination and disease surveillance; however, research laboratories still house samples of the smallpox virus.

The following are the top global health security risks today, according to the CDC:

Emergence and spread of infectious diseases, such as the novel coronavirus identified in 2019
Globalization of trade and travel, allowing diseases to spread faster
Rise of drug-resistant pathogens, such as antibiotic-resistant E. coli
Risk of intentional or accidental release of dangerous pathogens

Disaster preparation requires an understanding of these risks. Disease surveillance systems can help public health organizations identify and respond to infectious disease threats.

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The Role of Disease Surveillance in Public Health

Disease surveillance plays a key role in global health security. As part of the broader effort to monitor public health threats, disease surveillance tracks and analyzes data related to infectious diseases.

For example, the CDC and WHO collect and evaluate data on disease outbreaks and their spread. The CDC’s Division of High-Consequence Pathogens and Pathology (DHCPP) monitors and tracks the most contagious and deadly pathogens. The WHO’s Health Emergencies Program conducts ongoing monitoring of high-threat diseases. Data from disease surveillance systems provide early warnings about potential public health threats.

Public health organizations see many benefits from disease surveillance, including tracking dangerous infectious diseases, limiting the spread of pathogens, and improving public health outcomes.

Tracking Dangerous Pathogens

Surveillance systems can track dangerous pathogens before they reach epidemic proportions. In the U.S., DHCPP uses surveillance networks and systems to monitor diseases such as anthrax, rabies, hantavirus, and other infectious diseases. In collaboration with the WHO and global public health organizations, DHCPP tracks pathogens to limit the harm caused by outbreaks.

In addition to tracking known pathogens, disease surveillance organizations such as DHCPP identify novel infectious diseases. They test unknown infectious agents to learn about potential public health threats. These early detection efforts made it possible to sequence COVID-19 within months of its emergence and develop a vaccine on an accelerated timeline.

Prevention of Disease Spread

By identifying impending outbreaks of infectious diseases, disease surveillance systems can prevent and limit the spread of these diseases. Disease surveillance systems investigate the spread of diseases to limit transmission.

Several techniques allow public health organizations to prevent the spread of diseases. First, these organizations must identify the pathogen responsible for outbreaks. Next, they track the source of outbreaks. Finally, organizations monitor disease transmission to implement prevention strategies or recommend other public health interventions.

Improving Public Health Outcomes

Ultimately, the goal of disease surveillance is to improve public health outcomes. Early warning systems allow public health organizations to limit the spread of diseases and reduce the harm of infectious diseases.

In addition to tracking pathogens and limiting the spread of diseases, public health surveillance is a powerful tool for policymakers. Organizations can more effectively plan ahead, set priorities, and improve public health outcomes based on disease surveillance data.

These organizations also evaluate the impact of different public health interventions. By analyzing and comparing interventions, public health organizations know which strategies have the greatest impact on public health.

The Pillars of Global Health Security

Promoting public health around the globe requires a multilateral response. While detection can identify outbreaks before they grow into epidemics, these efforts will falter without a strong response system. Similarly, rapid response efforts during public health emergencies cannot succeed without a robust health system.

The Global Health Security Index (GHS Index) assesses public health security globally and identifies six pillars of global health security, which follow:

Prevention. Protecting global health begins with preventing the spread of pathogens. This includes preventing the emergence of pathogens and the release of contained infectious diseases. During outbreaks, prevention also represents one of the most powerful public health tools, thus making it a pillar of global health security.
Detection. Disease surveillance systems emphasize tracking and monitoring public health threats. Each country uses different tools and agencies to detect the spread of pathogens. Surveillance, laboratory, and reporting systems play a central role in detection. Global health requires a coordinated effort by national public health organizations. Reporting threats and sharing information protect global public health.
Response. In addition to prevention and detection, rapid response is a key component of improving global health. Communication and coordination help organizations mobilize in response to public health emergencies. This pillar encompasses emergency preparedness, disaster response planning, and disaster communication.
Health systems. The ability of national health systems to respond to global health threats factors into public health security. During the COVID-19 pandemic, many health systems struggled with healthcare surge capacity and the availability of crucial medical supplies. Effective health systems help mitigate the risk of public health threats.
Compliance. Global health security depends on the compliance of members of the global community. This pillar addresses compliance with international norms for disease surveillance and public health promotion. It also covers public health financing and compliance with the best practices in emergency procedures.
Risk. Countries around the world face different risk environments when it comes to public health. These include vulnerabilities to biological threats, political and security risks, and infrastructure risks. This pillar addresses the unique infectious disease and health risks in different nations.

By creating benchmarks for each of these six pillars, the GHS Index identifies areas for improvement in the global effort to promote public health.

Emergency Preparedness and the Global Health Security Index

The Global Health Security Index creates benchmarks for health security and assesses the preparedness of 195 countries. Led by the Nuclear Threat Initiative (NTI) and the Johns Hopkins Center for Health Security (John Hopkins CHS), the GHS Index launched in October 2019.

Using the six pillars of global health security, the GHS Index regularly measures public health capacities. In 2021, the GHS Index divided these six categories into 37 indicators and 171 questions. These criteria prioritize preparedness, environmental risks, adherence to global public health norms, and the strength of the country’s health system.

This information identifies health security gaps at the national level. Countries can then invest in public health to prevent future outbreaks. For example, public health organizations and governmental agencies can use the GHS Index to identify areas for further investment and planning.

The GHS Index plans to conduct assessments every two to three years to track emergency preparedness.

GHS Index Scores

On the GHS Index, each country receives a score out of 100. In 2021, the global health average was 38.9. The GHS Index warns that this reveals severe weaknesses in global health security. Overall, the global average changed little from 2019 to 2021, in spite of countries investing in public health during the COVID-19 pandemic.

Further, in four of the six categories, the global health average fell below 40 out of 100. In the categories of prevention, detection, response, and health systems, the world remains unprepared for future epidemics.

Prevention was the lowest-scoring category on the 2021 GHS Index. A majority of countries did not pay significant attention to animal-to-human transmission in their national planning, disease surveillance, or reporting.

The U.S. GHS Index Scores

In 2021, the U.S. received a 75.9, ranking it No. 1 in the world. While the U.S. received high marks in prevention, health systems, and compliance, its score for response dropped by over 7 percent from 2019 to 2021.

In spite of receiving high marks overall, the U.S. GHS Index score declined slightly from 2019 to 2021. The largest declines came in preventing animal-to-human transmission, effectively communicating public health risks, and implementing trade and travel restrictions.

In comparison, Canada received 69.8; Mexico, 57; and Brazil, 51.2. Outside the Western Hemisphere, China received a 47.5; India, 42.8; Nigeria, 38; and Iraq, 24.

Recommendations From the 2021 GHS Index

In addition to assessing global health preparedness, the 2021 GHS Index identified numerous areas for improvement. The GHS Index recommended improvements aimed at the national, international, private sector, and philanthropic levels.

These recommendations cover everything from funding high-priority public health needs to partnering across sectors to improve transparency and data sharing.

Health Security Improvements for Countries

At the national level, countries can improve health security based on the following GHS Index recommendations:

Prioritize building and maintaining health security capacities, including consistent and adequate funding of health security priorities in the national budget.
Conduct regular assessments to identify and address capacity gaps and risk factors.
Improve transparency related to public health capacities and risk factors.
Conduct comprehensive COVID-19 pandemic reports to learn from the last pandemic and improve the response to future public health emergencies.

Health Security Improvements for International Organizations

International organizations such as the United Nations, the WHO, and the World Bank can use the 2021 GHS Index to improve health security in the following ways:

Identify countries that require support based on their GHS Index scores, particularly those with weaker health systems.
Share data with countries that focus on preparedness for infectious disease emergencies.
Supplement national efforts to monitor disease emergencies and improve rapid response assistance programs.
Coordinate with national and international organizations to reduce the risk of high-consequence biological events, including deliberate attacks.

Health Security Improvements for the Private Sector

Private sector organizations can invest in health security in the following ways:

Identify countries for public health partnerships focused on vulnerabilities cataloged in the 2021 GHS Index data.
Support private sector programs and resources that partner with governments to improve capacities.
Increase sustainable development and health security investments, particularly in the areas of research, development, and capacity building.

Health Security Improvements for Philanthropic Organizations

Philanthropic organizations can improve health security globally by investing in the following ways:

Create financing methods to support countries. The GHS Index suggests a health security matching fund or expansion of World Bank programs to invest in disease preparedness.
Prioritize resources based on national GHS Index scores. Investments in countries with low scores can make a greater impact on overall health security.
Advocate within countries to develop their health system capacity and improve disaster preparedness.

Public Health Strategies and the Global Health Security Agenda

The Global Health Security Agenda (GHSA) launched in 2014. A collaborative, international initiative, the GHSA aims to advance public health priorities and improve health security. More than 70 countries have agreed to the GHSA framework to promote health security.

GHSA members coordinate to improve prevention, detection, and response to infectious disease threats. The organization sets five-year benchmarks to strengthen public health systems and reduce the risk of outbreaks.

Participants are working toward the GHSA 2024 targets. These include the following:

Implementing sustainable financing mechanisms for health security
Collaborating across sectors to increase capacities
Improving information sharing between member countries
Strengthening accountability in member countries

As part of the GHSA, the U.S. is working with member countries to reach these targets. In particular, the CDC has worked closely with 19 partner countries in equatorial Africa and Asia.

The CDC has invested in laboratory systems to detect pathogens, support disease surveillance systems, and improve disease detection training. GHSA efforts led by the CDC have also funded emergency management and response systems that train professionals to run public health emergency operations centers.

Global Health Security Strategies

What strategies have the greatest impact on health security? According to the GHS Index, countries around the world need to improve their disaster surveillance and public health systems. Proven strategies can improve health security.

The CDC identifies several strategies to improve global health.

Surveillance systems. Countries around the globe must invest in disease surveillance systems that identify outbreaks before they spread.
Laboratory networks. Regional, national, and international laboratory networks must be able to test and identify pathogens. These labs should also identify new pathogens.
Front-line workforce development. Front-line workers, such as healthcare providers, need the tools to identify and contain outbreaks. Training on reporting also promotes global health.
Emergency management systems. Coordinated response efforts prevent outbreaks from spiraling into global public health emergencies. Strong emergency management systems are a critical global health security strategy.

Tools like the GHS Index and collaborative organizations like the GHSA indicate where countries must invest in public health. However, improving health security globally also requires experts with specialized knowledge and skills.

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