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Rapid population growth, urbanization, and the growing challenges faced by the urban poor require redefining the paradigm for public health interventions in the 21st century, creating new approaches that take urban determinants of health into consideration. The widening disparity between the urban poor and the urban rich further exacerbates health inequities. Existing tools for global governance of urban health risks fall short, particularly in the lack of formal mechanisms to strengthen collaboration and communication among national and municipal agencies and between their local and international non-governmental partners. There is also a clear disconnect between governance strategies crafted at the international level and implementation on the ground. The challenge is to find common ground for global goods and municipal needs, and to craft innovative and dynamic policy solutions that can benefit some of the poorest citizens of the global urban network.

This white paper results from research supported by the Naval Postgraduate School's Project on Advanced Systems and Concepts for Countering Weapons of Mass Destruction (PASCC) via Grant No 244-13-1-0025 awarded by the NAVSUP Fleet Logistics Center San Diego. The views expressed in this report do not necessarily reflect the official policies of the Naval Postgraduate School nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government. ; In 2005, the United States and the other Member States of the World Health Organization (WHO) agreed to a new approach to global health security. Recognizing that international agreements rooted in the nineteenth century no longer sufficiently addressed the health threats posed by novel, emerging, and reemerging pathogens such as severe acute respiratory syndrome (SARS) and highly pathogenic H5N1 avian influenza, the World Health Assembly (WHA) adopted the revised International Health Regulations [IHR (2005)].1 The revised IHR entered into force in June 2007. IHR (2005) obligate the now- 196 States Parties to develop the core capacities required to detect, assess, report, and respond to public health emergencies of international concern. The regulations cover biological, chemical, radiological/nuclear, and other threats to public health, regardless of origin (naturally, accidentally, or deliberately released).

Cooperative bioengagement efforts, as practiced by U.S. government-funded entities, such as the Defense Threat Reduction Agency's Cooperative Biological Engagement Program, the State Department's Biosecurity Engagement Program, and parallel programs in other countries, exist at the nexus between public health and security. These programs have an explicit emphasis on developing projects that address the priorities of the partner country as well as the donor. While the objectives of cooperative bioengagement programs focus on reducing the potential for accidental or intentional misuse and/or release of dangerous biological agents, many partner countries are interested in bioengagement as a means to improve basic public health capacities. This article examines the extent to which cooperative bioengagement projects address public health capacity building under the revised International Health Regulations and alignment with the Global Health Security Agenda action packages.

Cooperative bioengagement efforts, as practiced by U.S. government-funded entities, such as the Defense Threat Reduction Agency's Cooperative Biological Engagement Program, the State Department's Biosecurity Engagement Program, and parallel programs in other countries, exist at the nexus between public health and security. These programs have an explicit emphasis on developing projects that address the priorities of the partner country as well as the donor. While the objectives of cooperative bioengagement programs focus on reducing the potential for accidental or intentional misuse and/or release of dangerous biological agents, many partner countries are interested in bioengagement as a means to improve basic public health capacities. This article examines the extent to which cooperative bioengagement projects address public health capacity building under the revised International Health Regulations and alignment with the Global Health Security Agenda action packages.

Early detection of emerging disease events is a priority focus area for cooperative bioengagement programs. Communication and coordination among national disease surveillance and response networks are essential for timely detection and control of a public health event. Although systematic information sharing between the human and animal health sectors can help stakeholders detect and respond to zoonotic diseases rapidly, resource constraints, and other barriers often prevent efficient cross-sector reporting. The purpose of this research project was to map the laboratory and surveillance networks currently in place for detecting and reporting priority zoonotic diseases in Jordan in order to identify the nodes of communication, coordination, and decision-making where health and veterinary sectors intersect, and to identify priorities and gaps that limit information sharing for action. We selected three zoonotic diseases as case studies: highly pathogenic avian influenza (HPAI) H5N1, rabies, and brucellosis. Through meetings with government agencies and health officials, and desk research, we mapped each system from the index case through response – including both surveillance and laboratory networks, highlighting both areas of strength and those that would benefit from capacity-building resources. Our major findings indicate informal communication exists across sectors; in the event of emergence of one of the priority zoonoses studied, there is effective coordination across the Ministry of Health and Ministry of Agriculture. However, routine formal coordination is lacking. Overall, there is a strong desire and commitment for multi-sectoral coordination in detection and response to zoonoses across public health and veterinary sectors. Our analysis indicates that the networks developed in response to HPAI can and should be leveraged to develop a comprehensive laboratory and surveillance One Health network.

Early detection of emerging disease events is a priority focus area for cooperative bioengagement programs. Communication and coordination among national disease surveillance and response networks are essential for timely detection and control of a public health event. Although systematic information sharing between the human and animal health sectors can help stakeholders detect and respond to zoonotic diseases rapidly, resource constraints and other barriers often prevent efficient cross-sector reporting. The purpose of this research project was to map the laboratory and surveillance networks currently in place for detecting and reporting priority zoonotic diseases in Jordan in order to identify the nodes of communication, coordination, and decision-making where health and veterinary sectors intersect, and to identify priorities and gaps that limit information-sharing for action. We selected three zoonotic diseases as case studies: highly pathogenic avian influenza (HPAI) H5N1, rabies, and brucellosis. Through meetings with government agencies and health officials, and desk research, we mapped each system from the index case through response – including both surveillance and laboratory networks, highlighting both areas of strength and those that would benefit from capacity-building resources. Our major findings indicate informal communication exists across sectors; in the event of emergence of one of the priority zoonoses studied there is effective coordination across the Ministry of Health and Ministry of Agriculture. However, routine formal coordination is lacking. Overall, there is a strong desire and commitment for multi-sectoral coordination in detection and response to zoonoses across public health and veterinary sectors. Our analysis indicates that the networks developed in response to HPAI can and should be leveraged to develop a comprehensive laboratory and surveillance One Health network.

In the wake of the 2014–2016, West Africa Ebola virus disease (EVD) outbreak, the Government of Guinea recognized an opportunity to strengthen its national laboratory system, incorporating capacity and investments developed during the response. The Ministry of Health (MOH) identified creation of a holistic, safe, secure, and timely national specimen referral system as a priority for improved detection and confirmation of priority diseases, in line with national Integrated Disease Surveillance and Response guidelines. The project consisted of two parts, each led by different implementing partners working collaboratively together and with the Ministry of Health: the development and approval of a national specimen referral policy, and pilot implementation of a specimen referral system, modeled on the policy, in three prefectures. This paper describes the successful execution of the project, highlighting the opportunities and challenges of building sustainable health systems capacity during and after public health emergencies, and provides lessons learned for strengthening national capabilities for surveillance and disease diagnosis.