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Publications

Our publications keep professionals informed on the most important developments and issues in health security and biosecurity.

Showing 1 - 20 of 38 results

Pandemic Exercises: Lessons for a New Era in Pandemic Preparedness

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Health Security
Publication Type
Commentary

We led the last large-scale exercise conducted by the Johns Hopkins Center for Health Security before the COVID-19 pandemic. Despite COVID-19, pandemic exercises are more necessary than ever to prevent the loss of hard-fought gains achieved during COVID-19, keep policymakers from assuming all pandemics will be like COVID-19, and encourage continued engagement from policymakers in strengthening health resilience rather than returning to a cycle of panic and neglect.

The Resurgence of Mpox in Africa

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JAMA
Publication Type
Article

A rapidly growing mpox outbreak is heightening concern over a potential multicountry epidemic or even a new pandemic. This year alone, there have been more than 17 000 suspected (2863 confirmed) cases of mpox across the African continent, with the majority in the Democratic Republic of the Congo (DRC).

Risk-based management of international sporting events during the COVID-19 pandemic

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Bull World Health Orga
Publication Type
Article

Mass gatherings include a diverse range of events such as sporting competitions, religious ceremonies, entertainment activities, political rallies and cultural celebrations, which have important implications for population well-being. However, if not managed properly, these events can amplify health risks including those related to communicable diseases, and place undue strain on health systems in host countries and potentially in attendees’ home countries, upon their return.

Authors
Albis Francesco Gabrielli
Amaia Artazcoz Glaria
Maria Borodina
Ninglan Wang

Learnings from COVID-19 for future respiratory pathogen pandemic preparedness: a summary of the literature

Publication Type
Report

A scoping literature review of learnings from the coronavirus disease 2019 (COVID-19) pandemic was commissioned by WHO to inform operational priorities for future respiratory pathogen pandemic preparedness. The learnings are grouped according to WHO’s subsystems for health emergency preparedness, response and resilience. Key takeaway messages include: 1) Preparedness works; 2) Health is everyone’s business; 3) No one is safe until everyone is safe; and 4) Response must be agile and adaptive. The review will support pandemic planners at all levels to develop and update preparedness and response plans.

COVID-19 has left the world less prepared for an influenza pandemic

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Nature Medicine
Publication Type
Commentary

Prior to 2020, most pandemic preparedness efforts centered on influenza. Some countries, such as Aotearoa (New Zealand)1, were able to successfully adapt national pandemic influenza plans to the response to COVID-19, and global influenza surveillance systems were harnessed for SARS-CoV-2 (ref. 2). It is now critical that nations and the international community implement lessons learned from COVID-19 back into influenza preparedness3. This task is particularly urgent given both the emergence of a number of influenza spillover threats and exhausted and depleted public health systems globally.

A Public Health Systems View of Risk Communication About Zika

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Public Health Reports
Publication Type
Article

The spread of Zika virus throughout Latin America and parts of the United States in 2016 and 2017 presented a challenge to public health communicators. The objective of our study was to describe emergency risk communication practices during the 2016-2017 Zika outbreak to inform future infectious disease communication efforts.

Authors
Laura E. Pechta
Dale A. Rose
Keri M. Lubell
Michelle N. Podgornik

Risk and the Republican National Convention: Application of the Novel COVID-19 Operational Risk Assessment

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Disaster Medicine and Public Health Preparedness
Publication Type
Article

The United States Centers for Disease Control and Prevention and the World Health Organization broadly categorize mass gathering events as high risk for amplification of coronavirus disease 2019 (COVID-19) spread in a community due to the nature of respiratory diseases and the transmission dynamics. However, various measures and modifications can be put in place to limit or reduce the risk of further spread of COVID-19 for the mass gathering. During this pandemic, the Johns Hopkins University Center for Health Security produced a risk assessment and mitigation tool for decision-makers to assess SARS-CoV-2 transmission risks that may arise as organizations and businesses hold mass gatherings or increase business operations: The JHU Operational Toolkit for Businesses Considering Reopening or Expanding Operations in COVID-19 (Toolkit). This article describes the deployment of a data-informed, risk-reduction strategy that protects local communities, preserves local health-care capacity, and supports democratic processes through the safe execution of the Republican National Convention in Charlotte, North Carolina. The successful use of the Toolkit and the lessons learned from this experience are applicable in a wide range of public health settings, including school reopening, expansion of public services, and even resumption of health-care delivery.

Authors
David Callaway
Jeff Runge
Lisa Rentz
Kevin Staley
Michael Stanford

Building the global vaccine manufacturing capacity needed to respond to pandemics

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Vaccine
Publication Type
Article

Among the most pressing issues in preparing for the global response to a pandemic are the design, development, manufacture, and dissemination of vaccines. In 2018 and 2019, we conducted 48 interviews with prominent leaders in public health, pandemic preparedness, vaccine design, and vaccine manufacturing about how they would respond to a sudden, urgent need to manufacture 2 billion or more doses of vaccine. Little did we know that this scenario would become a dire global challenge a few months later with the onset of COVID-19. The response to this pandemic has shown that when leading vaccine manufacturers are fully engaged in a global response, it might be possible for them to manufacture substantial doses of vaccine on timelines faster than previously envisioned. It is now hoped that hundreds of millions of doses of vaccine will start to be produced sometime in the end of 2020 or the start of 2021, and that billions of doses of vaccine could be produced in the months that follow. Whether these timelines can be met or not, it is crucial now, while the world is fully attuned to the terrible consequences of pandemics, to begin preparing the system of global manufacturing for future pandemics. The following insights and recommendations are taken from our interviews with leading experts and our own analysis.

Authors
Matthew Watson
Lauren Richardson
Nancy Connell
COVID-19 and the US Criminal Justice System: Evidence for Public Health Measures to Reduce Risk

COVID-19 and the US Criminal Justice System: Evidence for Public Health Measures to Reduce Risk

Publication Type
Report

Since its recognition as a pandemic in early 2020, novel coronavirus disease 2019 (COVID-19) has touched nearly every corner of US society. However, some populations and environments have been affected far more severely than others. Vulnerable populations—especially those subject to structural racism, discrimination due to disability, and financial insecurity—tend also to be particularly susceptible to the economic consequences of and severe disease and death from COVID-19. In addition, the institutions, industries, and systems that are fundamentally important to our lives and our democracy have, in some cases, become places where severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreads readily if allowed to gain a foothold. In these places, it can be difficult to prevent the introduction of the virus or control the spread of SARS-CoV-2 once it is introduced.

Report cover for Interim Framework for COVID-19 Vaccine Allocation and Distribution in the United States

Interim Framework for COVID-19 Vaccine Allocation and Distribution in the United States

Publication Type
Report

The COVID-19 pandemic will continue for the foreseeable future, but widespread vaccination could hasten its end. At least 165 candidate vaccines for the SARS CoV-2 virus are in development around the world and there is hope that one or more of these candidates will soon be shown to be sufficiently safe and effective to achieve emergency use authorization in the United States. When a vaccine has been authorized for use, it will initially be in limited supply. During this period of scarcity, a plan is needed for how to allocate and distribute the limited supply—which groups should be prioritized to receive the vaccine first and which groups can wait until later. This difficult and potentially contentious topic is being actively discussed in the United States by the Advisory Committee on Immunization Practices (ACIP) of the US Centers for Disease Control and Prevention (CDC) and the National Academy of Medicine (NAM), as well as globally at the World Health Organization (WHO) and elsewhere. The purpose of this report is to offer an additional ethics framework for use in making decisions about allocation of SARS-CoV-2 vaccine during this initial period of scarcity in the United States and make related suggestions about vaccine distribution. Our approach takes into account considerations of medical risk, public health, ethics and equity, economic impact, and logistics. We note where our approach aligns or differs from the 2018 CDC guidance for vaccine allocation in a severe influenza pandemic, which is the most recent pandemic vaccine guidance from the US government.

Authors
Carleigh Krubiner
Justin Bernstein
Matthew Watson
Divya Hosangadi
Nancy Connell
Elizabeth L Daugherty-Biddison
Alan Regenberg
Resetting Our Response: Changes Needed in the US Approach to COVID-19

Resetting Our Response: Changes Needed in the US Approach to COVID-19

Publication Type
Report

The impact of the COVID-19 pandemic in the United States has been profound. Despite initial declines in cases in May 2020 following implementation of stringent stay-at-home orders, cases are resurging in most states. The number of deaths has been rising in many states, with hospitalization rates for COVID-19 now again matching or exceeding numbers seen at the peak in New York City in March and April. Hospitals are under pressure or approaching a crisis in many places around the country. This resurgence is stressing many sectors of society, from businesses to education to health care. Unlike many countries in the world, the United States is not currently on course to get control of this epidemic. It’s time to reset.

This brief report describes concrete policy actions at the federal, state, and local levels that are needed to get control of the COVID-19 pandemic in the United States.

Updated WHO COVID-19 Mass Gatherings Risk Assessment Tools

Publication Type
Report

The Johns Hopkins Center for Health Security, a World Health Organization (WHO) Collaborating Centre on Global Health Security, has worked with WHO on the development of various tools and technical guidance for mass gatherings in the context of COVID-19. The primary aim of this partnership is to encourage stakeholders to use a risk-informed decision-making process when planning for mass gatherings and, specifically, to identify and mitigate the risk of spreading COVID-19 during the mass gathering. This process includes conducting risk assessments to determine the overall risk of disease spread connected to a mass gathering.

In view of the current COVID-19 pandemic, WHO, with the support of the Center and other members of the Novel Coronavirus-19 Mass Gatherings Expert Group, has developed a series of risk assessment tools and other resources for generic as well as sports- and religious-specific mass gatherings. These risk assessment tools include a risk evaluation, mitigation, and communication strategy to aid host countries and organizers of mass gatherings in assessing the specific risk of COVID-19 to their event. A training course has also been created that provides a brief overview of mass gathering planning during COVID-19 and walks users through the use of the risk assessment tools.

Resources for mass gathering planning in the context of COVID-19 can be found at the following link after selecting “COVID-19: Mass Gatherings” from the drop down menu.

Mass Gathering Risk Assessment Tools

  1. WHO Mass Gathering COVID-19 Risk Assessment Tool – Generic Events (revised July 10, 2020). Link / Excel Tool
  2. WHO Mass Gathering COVID-19 Risk Assessment Tool – Sports Events (revised July 10, 2020). Link / Excel Tool
  3. WHO Mass Gathering COVID-19 Risk Assessment Tool – Religious Events (revised July 10, 2020). Link / Excel Tool
Authors
on behalf of the WHO Novel Coronavirus-19 Mass Gatherings Expert Group

Risk-Informed Decision Making: More Critical Today Than Ever Before

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Health Security
Publication Type
Commentary

Decision making under uncertainty can be paralyzing for any leader trying to choose the best way forward. In the COVID-19 pandemic, uncertainty is deep; while we learn more every day, information gaps—including those related to viral transmission dynamics, the human immune response, the effectiveness of public health interventions like social distancing, and the future trajectory of COVID-19 spread—continue to be barriers to leaders making evidence-based decisions about protective actions.

Covid-19 Planning Guide and Self-Assessment for Higher Education

COVID-19 Planning Guide and Self-Assessment for Higher Education

Publication Type
Report

Globally, institutions of higher education are facing unprecedented challenges related to Coronavirus Disease (COVID-19). The resulting academic, financial, ethical, and operational questions are complex and high-stakes. The COVID-19 pandemic may represent an inflection point, fundamentally altering how we work, socialize, and learn. The authors of this toolkit collectively believe that our institutions need near-term tools to ensure continuity through this pandemic as well as methods for rethinking the basic assumptions and values of their institutions.

Authors
David Long
David Graves
Jack Burton
Christina Kim
Judith Eaton
Digital Contact Tracing for Pandemic Response: Ethics and Governance Guidance book cover

Digital Contact Tracing for Pandemic Response: Ethics and Governance Guidance

Publication Type
Book

As public health professionals around the world work tirelessly to respond to the COVID-19 pandemic, it is clear that traditional methods of contact tracing need to be augmented in order to help address a public health crisis of unprecedented scope. Innovators worldwide are racing to develop and implement novel public-facing technology solutions, including digital contact tracing technology. These technological products may aid public health surveillance and containment strategies for this pandemic and become part of the larger toolbox for future infectious outbreak prevention and control.

Authors
Katelyn Esmonde
Amelia Hood
Brian Hutler
Alan Regenberg
Matthew Watson
Operational Toolkit for Businesses Considering Reopening or Expanding Operations in COVID-19

Operational Toolkit for Businesses Considering Reopening or Expanding Operations in COVID-19

Publication Type
Report

This operational toolkit has been developed to help business owners who are considering reopening or expanding their operations to determine their establishments’ risk of transmission of COVID-19 and how to reduce it.

As displayed in the figure below, the Operational Toolkit consists of 3 parts: an instruction manual; a business risk worksheet; and an assessment calculator.

Operational Toolkit for Businesses

As some governments begin to lift strict public health measures and move into the next phase of their outbreaks of COVID-19, local, state, and federal authorities are planning for the gradual reopening of businesses and resumption of economic activity. While planning for a staged approach to business resumption must be coordinated by local, state, and federal authorities, individual organizations should start planning for how they will restart or expand their operations so that modification and mitigation measures will already be in place when work can resume and the new ”business as usual” can commence.

This operational toolkit allows business leaders to work through a 4-stage process to obtain an overall risk score for their business and to identify considerations for reducing both operational and individual level risks posed by COVID-19. The overall score represents the inherent risk of exposure to COVID-19 that may occur in a business and possible changes to daily operations and policies that can lower the inherent risk of exposure. This toolkit is intended to provide businesses with a starting point in their planning to reopen or expand their operations by identifying their risk levels for contributing to the spread of COVID-19 and providing them with a list of mitigation measures to implement that will increase the safety of their employees, clients, customers, and community. 

The 3 parts of the Operational Toolkit include:

  1. An Instruction Manual (PDF)
    Instructions that explain how to complete the 4-stage Business Risk Worksheet and Assessment Calculator.
     
  2. A Business Risk Worksheet (PDF)
    A 4-stage step-by-step worksheet for you to report and understand your business’s overall risk of spreading COVID-19 and how your business operations can be made safer.
     
  3. An Assessment Calculator (XLSX)
    An Excel spreadsheet you will fill out to receive a calculated risk score and a modification score.

Enabling Emergency Mass Vaccination: Innovations in Manufacturing and Administration During a Pandemic

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Vaccine
Publication Type
Article

The global reach of infectious disease pandemics typically necessitates a similarly ubiquitous public health intervention: mass vaccination. The development and large-scale deployment of a vaccine requires substantial investment and a coalition of stakeholders to undertake research and development (including phase I to III clinical trials), manufacturing, and widespread administration. Recent efforts by national and international funders and researchers to advance the state of vaccinology for pandemics and other infectious disease emergencies have focused largely on expediting the R&D phase1. There has been comparatively less attention paid to modernizing, optimizing, and therefore accelerating other aspects of the vaccine enterprise—namely, manufacturing, distribution, and administration. The current COVID-19 pandemic plainly underscores the need to vastly accelerate mass vaccination in every phase.

Authors
Divya Hosangadi
Lane Warmbrod
Matthew Watson
Nancy Connell
Public Health Principles for a Phased Reopening During COVID-19: Guidance for Governors report cover

Public Health Principles for a Phased Reopening During COVID-19: Guidance for Governors

Publication Type
Report

As the COVID-19 pandemic continues to progress, most jurisdictions have implemented physical distancing measures to reduce further transmission, which have contributed to reductions in numbers of new cases. As chains of transmission begin to decline, along with new COVID-19 cases, there will need to be decisions at the state level about how to transition out of strict physical distancing measures and into a phased reopening

A National Plan to Enable Comprehensive COVID-19 Case Finding and Contact Tracing in the US

A National Plan to Enable Comprehensive COVID-19 Case Finding and Contact Tracing in the US

Publication Type
Report

In order to save lives, reduce COVID-19’s burden on our healthcare system, ease strict social distancing measures, and confidently make progress toward returning to work and school, the United States must implement a robust and comprehensive system to identify all COVID-19 cases and trace all close contacts of each identified case. It is estimated that each infected person can, on average, infect 2 to 3 others. This means that if 1 person spreads the virus to 3 others, that first positive case can turn into more than 59,000 cases in 10 rounds of infections.

Authors
James Blumenstock
Michael Fraser

National coronavirus response: A road map to reopening

Publication Type
Report

This report provides a road map for navigating through the current COVID-19 pandemic in the United States. It outlines specific directions for adapting our public-health strategy as we limit the epidemic spread of COVID-19 and are able to transition to new tools and approaches to prevent further spread of the disease. We outline the steps that can be taken as epidemic transmission is brought under control in different regions. These steps can transition to tools and approaches that target those with infection rather than mitigation tactics that target entire populations in regions where transmission is widespread and not controlled. We suggest measurable milestones for identifying when we can make these transitions and start reopening America for businesses and families.

Authors
Scott Gottlieb
Mark McClellan
Lauren Silvis