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

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Protecting Your Health at Work: A Brief Guide on Indoor Air Quality for Immunocompromised Individuals & Transplant Recipients

Protecting Your Health at Work: A Brief Guide on Indoor Air Quality for Immunocompromised Individuals & Transplant Recipients

Publication Type
Fact Sheet

The Model State Indoor Air Quality Act

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JAMA
Publication Type
Article

Breathing should not make people sick. The air inside buildings (where people spend 90% of their lives) is often unfiltered, improperly ventilated, and unhealthy. Poor indoor air quality (IAQ) poses heightened risks of airborne infections and preventable exposures to harmful pollutants. US residents have little control over unhealthy built environments such as in workplaces, schools, shops, theaters, and restaurants. Absent their use of a personal air quality monitoring device, most people do not even realize the health risks. The Model State Indoor Air Quality Act (MSIAQA)1 developed in collaboration with national advisors adopts science-based regulatory standards, such as testing, enhanced air filtration, system maintenance, and ventilation, to advance the public’s health and increase occupant productivity—ensuring that public indoor environments provide healthy air to breathe.

Authors

Reimagining Preparedness in the Era of COVID-19

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Health Security
Publication Type
Article

In late December 2019, novel human pneumonia cases were detected in Wuhan City, China. By February 2020, the disease was officially named coronavirus 19 (COVID-19),1 and on March 11, 2020, the World Health Organization declared COVID-19 a pandemic.2 As of March 30, 2022, the total number of deaths in the United States had reached 976,229 with nearly 80 million reported cases.

Authors
Laura Biesiadecki
Beth Hess
on behalf of the members of the 2022 Preparedness Summit Planning Committee

Data and Disasters: Essential Information Needed for All Healthcare Threats

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Health Security
Publication Type
Article

The COVID-19 pandemic may serve as a prime example of a 21st century public health emergency, an event accelerated and amplified by global interconnectedness, systemic fragility, and public misinformation. However, the United States continues to address this and other threats with distinctly 20th century information tools. This must change. Health emergency preparedness for modern threats requires rapid situational awareness, achieved only through common data elements, enforced information standards, investment in innovation, expert data analysis, and private sector engagement. To protect the health and safety of Americans, we must confront these challenges now and change the narrative of our future responses.

Authors
John L. Hick
Dan Hanfling
Paul D. Biddinger
James V. Lawler

Fighting the infodemic: the 4 i Framework for Advancing Communication and Trust

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BMC Public Health
Publication Type
Article

The proliferation of false and misleading health claims poses a major threat to public health. This ongoing “infodemic” has prompted numerous organizations to develop tools and approaches to manage the spread of falsehoods and communicate more effectively in an environment of mistrust and misleading information. However, these tools and approaches have not been systematically characterized, limiting their utility. This analysis provides a characterization of the current ecosystem of infodemic management strategies, allowing public health practitioners, communicators, researchers, and policy makers to gain an understanding of the tools at their disposal.

Authors
Annie Sundelson
Amelia Jamison
Noelle Huhn
Sarah-Louise Pasquino

Case Investigation and Contact Tracing in US State and Local Public Health Agencies: Sustaining Capacities and Applying Lessons Learned From the COVID-19 Pandemic and 2022 Mpox Outbreak

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Health Security
Publication Type
Article

The COVID-19 pandemic illuminated the lack of resources available to US state and local public health agencies to respond to large-scale health events. Two response activities that were notably underresourced are case investigation and contact tracing (CI/CT), which health agencies routinely employ to control and prevent the transmission of infectious diseases. However, the scale of contact tracing required during the COVID-19 pandemic exceeded available resources, even in high-capacity public health agencies

Authors
Alexandra Woodward
Model State Indoor Air Quality Act cover

Model State Indoor Air Quality Act

Publication Type
Report

Improving indoor air quality (IAQ) will diminish routine exposure to airborne diseases,1,2 limit outbreaks or epidemics,3 and lower risks of noninfectious respiratory conditions like asthma that affect the health of millions each year.4 Improving IAQ is also cost-effective. Proper ventilation and filtration in crowded public indoor settings can significantly reduce the costs of illness at a benefit-cost ratio ranging from 3:1 to 100:1,5 exceeding similar ratios for most other public health interventions.6

Authors
India–United States Track 1.5 Strategic Biosecurity Dialogue, Report from the Ninth Dialogue Session

India–United States Track 1.5 Strategic Biosecurity Dialogue, Report from the Ninth Dialogue Session

Publication Type
Meeting Report

On May 24 and 25, 2023, the Johns Hopkins Center for Health Security (“the Center”) co-hosted a dialogue (“the dialogue”) with the Regional Centre for Biotechnology of the Department of Biotechnology in the Indian Ministry of Science and Technology, in Washington, DC, to discuss biosecurity issues of importance to both India and the United States. The dialogue aimed to increase knowledge of prevention and response efforts for natural, deliberate, and accidental biological threats in India and the US; share best practices and innovations; examine opportunities for partnership and collaboration; develop and deepen relationships among dialogue participants; and identify issues that should be elevated to the attention of Indian or US government officials.

Authors
Rachael Brown
Andrea Lapp
Sarah Schneider-Firestone
Southeast Asia Strategic Multilateral  Biosecurity Dialogue, Meeting Report from the 2023 Dialogue Session

Southeast Asia Strategic Multilateral Biosecurity Dialogue, Meeting Report from the 2023 Dialogue Session

Publication Type
Meeting Report

The Johns Hopkins Center for Health Security co-convened government officials and other stakeholders for a Southeast Asia Strategic Multilateral Biosecurity Dialogue meeting from April 26-28 in Cebu, Philippines. It was the first in-person meeting of this series since SARS-CoV-2 emerged in 2019. This is the meeting Report from the 2023 Dialogue Session. 

Threat Net: A Metagenomic Surveillance Network for Biothreat Detection and Early Warning

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Health Security
Publication Type
Article

Early detection of novel pathogens can prevent or substantially mitigate biological incidents, including pandemics. Metagenomic next-generation sequencing (mNGS) of symptomatic clinical samples may enable detection early enough to contain outbreaks, limit international spread, and expedite countermeasure development. In this article, we propose a clinical mNGS architecture we call “Threat Net,” which focuses on the hospital emergency department as a high-yield surveillance location. We develop a susceptible-exposed-infected-removed (SEIR) simulation model to estimate the effectiveness of Threat Net in detecting novel respiratory pathogen outbreaks. Our analysis serves to quantify the value of routine clinical mNGS for respiratory pandemic detection by estimating the cost and epidemiological effectiveness at differing degrees of hospital coverage across the United States. We estimate that a biological threat detection network such as Threat Net could be deployed across hospitals covering 30% of the population in the United States. Threat Net would cost between $400 million and $800 million annually and have a 95% chance of detecting a novel respiratory pathogen with traits of SARS-CoV-2 after 10 emergency department presentations and 79 infections across the United States. Our analyses suggest that implementing Threat Net could help prevent or substantially mitigate the spread of a respiratory pandemic pathogen in the United States.

Authors
Siddhanth Sharma
Jaspreet Pannu
Sam Chorlton
Jacob L. Swett
David J. Ecker

Proposal for a national diagnostics action plan for the United States

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Health Policy OPEN
Publication Type
Article

Providing a definitive diagnostic test in a disease emergency is critical to limit pathogen spread, develop and deploy medical countermeasures, and mitigate the social and economic harms of a serious epidemic. While major accomplishments have accelerated test development, expanded laboratory testing capacity, and established widespread point-of-care testing, the United States does not have a plan to rapidly respond, to develop, manufacture, deploy, and sustain diagnostic testing at a national scale. To address this gap, we are proposing a National Diagnostics Action Plan that describes the steps that are urgently needed to prepare for future infectious disease emergencies, as well as the actions we must take at the first signs of such’ events.

Authors
Sujeet B. Rao
Susan Van Meter
Adam Borden

The Origins of Covid-19 — Why It Matters (and Why It Doesn’t)

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The New England Journal of Medicine
Publication Type
Perspective

When health emergencies arise, scientists seek to discover the cause — such as how a pathogen emerged and spread — because this knowledge can enhance our understanding of risks and strategies for prevention, preparedness, and mitigation. Yet well into the fourth year of the Covid-19 pandemic, intense political and scientific debates about its origins continue. The two major hypotheses are a natural zoonotic spillover, most likely occurring at the Huanan Seafood Wholesale Market, and a laboratory leak from the Wuhan Institute of Virology (WIV). It is worth examining the efforts to discover the origins of SARS-CoV-2, the political obstacles, and what the evidence tells us. This evidence can help clarify the virus’s evolutionary path. But regardless of the origins of the virus, there are steps the global community can take to reduce future pandemic threats.

Authors
Lawrence O. Gostin

BWC assurance: increasing certainty in BWC compliance

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The Nonproliferation Review
Publication Type
Article

Following the 2001 end to negotiations on a legally binding protocol, states parties to the 1972 Biological and Toxin Weapons Convention (BWC) developed entrenched positions about the necessity of treaty verification, hindering progress on treaty aims. The study described in this article was designed to facilitate dialogue on verification-related issues outside the context of those positions, using the term “assurance” to represent the degree of certainty that states parties are meeting their treaty obligations. From August 2020 to July 2021, the researchers conducted 36 interviews—16 with state-party delegations and 20 with independent experts, representing 20 countries. They performed mixed-methods analysis on the interviews, including quantitative metrics on qualitative interview content. Interviewees’ views on verification, compliance, and related concepts varied widely. Future efforts by states parties to achieve common understanding on these topics could facilitate concrete progress. While no single mechanism is sufficient to achieve verification or assess compliance, packages of mechanisms could increase assurance. Interviewees expressed general support for implementing assurance mechanisms, even in the absence of a comprehensive, legally binding protocol or verification regime, even among states parties for which that is the primary goal. Avenues to increase assurance among BWC stakeholders merit further discussion in the current intersessional program.

A Policy Analysis for the Integration of Primary Care, Public Health, and Community-Based Organizations in Public Health Emergencies: Interim Report

Publication Type
Report

The uniquely fragmented healthcare system of the United States is currently unable to adequately respond in a national emergency. Lessons From the COVID War: An Investigative Report documents how the US “met the 21st century COVID pandemic with structures mainly built for 19th century problems,” acknowledging that a new national health security enterprise is urgently needed. These findings are consistent with an earlier report, Integrating Primary Care and Public Health to Save Lives and Improve Practice During Public Health Crises: Lessons from COVID-19, in which the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health (CHS) detailed the challenges encountered during the pandemic and presented potential pathways for effectively addressing them. Experts and frontline workers interviewed for the report indicated that better integration of primary care (PC), public health (PH), and community-based organizations (CBOs) could have eased the burden on overstretched PH personnel and significantly leveraged PC’s trusted position and reach to amplify PH messaging, including information to support ill individuals and bolster testing and vaccination campaigns. If these coordinated activities had been effectively prepared for and implemented, they would have saved lives and reduced the pandemic’s health, economic, and societal impacts in the US.

 

View the report (PDF)

Authors

Mpox Considerations for the Radiology Nurse

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Journal of Radiology Nursing
Publication Type
Article

On July 23, 2022, the Director General of the World Health Organization declared a multicountry outbreak of mpox disease a Public Health Emergency of International Concern. Since this declaration, there have been thousands of cases detected in the United States. Although the outbreak has now waned, the virus is likely to continue transmitting at low levels across the United States among high-risk populations. Thus, it is critical for radiology nurses to be able to recognize mpox disease within the inpatient and outpatient settings, so that proper infection prevention and control precautions can be adhered to and so that patients can be referred for treatment.

Authors
Dominique Guillaume

How Infectious Disease Experts Impacted the Coronavirus Disease 2019 (COVID-19) Response: Lessons From the Front Lines

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Clinical Infectious Diseases
Publication Type
Article

In this article, we summarize findings from research conducted by the Johns Hopkins Center for Health Security and the Infectious Diseases Society of America to understand infectious disease (ID) workforce contributions to the coronavirus disease 2019 (COVID-19) response and their impacts. ID experts were found to have made diverse and unique contributions that went well beyond their usual responsibilities, with many spending several hours a week on these activities without additional compensation. These efforts were thought to not only build community resilience but also augment the ongoing public health response. Respondents also reported several hospital and clinical leadership roles taken on during the pandemic, such as developing protocols and leading clinical trials. We also make several policy recommendations, such as medical student debt relief and improved compensation, that will be needed to help fortify the ID workforce for future pandemics.

Authors
Daniel P. McQuillen

Response to the US Congress Request for Information (RFI) to reform and strengthen the Centers for Disease Control and Prevention (CDC), as submitted by the Johns Hopkins Center for Health Security

Publication Type
Report

The Johns Hopkins Center for Health Security developed this document in response to Representative Mariannette Miller-Meeks’ Request for Information (RFI) on how Congress can help to reform and strengthen the Centers for Disease Control and Prevention (CDC). The Johns Hopkins Center for Health Security believes that an adequately funded, appropriately authorized, and nimble CDC with a target mission is crucial to ensuring the public’s health and maintaining community resilience.

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.

Authors
Alexandra Phelan
Claire J. Standley