Skip to main content
Our Work

Completed Projects


The Composite of Post-Event Well-Being (COPEWELL) is an evidence-based model and collection of tools that fosters a community-wide understanding and sparks cross-sector dialogue about the complex nature of community resilience as it pertains to disasters. It uses data-driven tools to assess community functioning and predict resilience, and provides resources that communities can utilize to address identified gaps to improve community functioning before, during, and after disasters.

COPEWELL website includes data-driven tools for practitioners to use flexibly in ways that meet the needs of their communities. COPEWELL tools were developed in collaboration with on-the-ground users and stakeholders who implemented COPEWELL in their communities and reported back on valuable modifications:

  1. COPEWELL Framework: A whole-of-community framework that helps communities understand resilience and the factors that influence it
  2. Computational Model & Data: A county-level model of community functioning and resilience, which uses publicly available data and produces “heat maps” to aid visualization of findings
  3. Self-Assessment Tools: A set of tools (“COPEWELL Rubrics”) that communities can use to assess their own functioning and resilience
  4. Resources for Change: A set of curated intervention strategies tied to the framework to help communities strengthen their functioning and resilience
  5. COPEWELL In Practice: A variety of resources and examples developed by COPEWELL Communities, where components of COPEWELL have been applied to their work to meet specific needs.

The COPEWELL project team is a multi-disciplinary group of researchers and subject matter experts representing a many different fields. More information about COPEWELL Leadership can be found here.

Project supported by: Centers for Disease Control and Prevention and Johns Hopkins University


COVID-19 Testing Toolkit

The COVID-19 Testing Toolkit provided information about the different types of COVID-19 tests with emergency use authorization (EUA) as well as what testing services were available, how they worked, and what was known about their accuracy. The Toolkit provided resources for employers or decision makers to develop testing strategies to fit their testing needs.

All testing services published in this resource were verified to use COVID-19 tests that have EUA from the US Food and Drug Administration (FDA). We only included testing services that specify the exact test used, that the used test has EUA, and that the service had a working website to which we could direct individuals.

The COVID-19 Testing Toolkit featured a selector tool so that employers or decision makers could pick a reputable testing service (ie, one that used FDA EUA tests) to incorporate in planning efforts.

The Toolkit and the resources on the website were developed by the Johns Hopkins Center for Health Security. This project was funded by Lyda Hill Philanthropies and the Gordon and Betty Moore Foundation.

Project team lead: Gigi Gronvall, PhD

Project team: Amanda K. Mui, MPH; Rachel West, PhD; Clint Haines, MS; Sruthi Katakam

Project supported by: Lyda Hill Philanthropies and the Gordon and Betty Moore Foundation

Outbreak Observatory
Outbreak Observatory logo

Center staff and trusted, vetted colleagues with relevant expertise collaborated with frontline public health officials to document operational challenges, successes, and lessons from outbreak and epidemic responses in the US and abroad. The absence of dedicated mechanisms to identify, document, and disseminate operational challenges associated with outbreak response can result in a failure to consistently collect and analyze valuable, ephemeral data that are crucial for improving outbreak response and resource planning. By capturing and analyzing these data, Outbreak Observatory grew the evidence base pertaining to the health, socioeconomic, and political implications of outbreaks and epidemics and the operational challenges and requirements associated with preventing, detecting, and responding to emerging communicable disease threats.

The project team collaborated with local practitioners involved in outbreak response to co-author analyses of lessons to fill gaps in existing health security literature, with a principal focus on the operational aspects of outbreak response. Outbreak Observatory shared key takeaways broadly with practitioners, policymakers, and the public—including via peer-reviewed literature—to support efforts to strengthen health security preparedness and response in their own communities.

Project dates: February 2017 — March 2022

Project team lead: Jennifer Nuzzo, DrPH

Project team: Carolina Andrada, BA; Divya Hosangadi, MSPH; Noelle Huhn, MSPH; Christopher Hurtado, MHS; Elena Martin, MPH; Diane Meyer, RN, MPH; Lucia Mullen, MPH; Christina Potter, MSPH; Matthew Shearer, MPH; Michael Snyder, MALD; Marc Trotochaud, MSPH

Project supported by: Open Philanthropy Project

Global Health Security Index
2021 Global Health Security Index cover

In partnership with the Nuclear Threat Initiative and the Economist Intelligence Unit, the Center developed the Global Health Security Index to assess a country’s technical, financial, socioeconomic, and political capabilities to prevent, detect, and rapidly respond to epidemic threats with international implications, whether naturally occurring, deliberate, or accidental.

The index drew from internationally-accepted technical assessments including the World Health Organization’s International Health Regulations Joint External Evaluation and the World Organization for Animal Health’s Performance of Veterinary Services Pathway. It also incorporated other important factors, such as countries’ overall health system strength, commitment to global norms, and the risk environment.

The index framework will be piloted in four countries to determine what adjustments, if any, need to be made before it can be scaled up significantly. The Center and its partners will use the framework to assess, collect, and analyze data on a country-by-country-basis, with the ultimate goal of informing improvements to vital global health security capabilities needed to prevent loss of live, political and economic instability, and undue restrictions on trade, travel, and human rights.

Project team lead: Jennifer Nuzzo, DrPH

Project team: Sanjana Ravi, MPH; Diane Meyer, RN, MPH; Lucia Mullen, MPH; Lane Warmbrod, MS, MPH

Project supported by: Open Philanthropy Project; Nuclear Threat Initiative


Preferred reporting items for epidemic forecasting and prediction research: the EPIFORGE 2020 statement

The importance of infectious disease epidemic forecasting and prediction research has been underscored across decades of communicable disease outbreaks. Epidemic forecasts are valuable for seasonal pathogens, for example influenza and dengue [1-3], in addition to international health public emergencies and other epidemics such as the Zika, chikungunya, and Ebola virus epidemics [4-9]. Most recently, the Coronarvirus Disease 2019 (COVID-19) pandemic has illustrated the importance of robust, transparent epidemic forecasting and prediction research for risk communication, decision-making, preparedness, and response [10,11]. Arguably, predictions form an essential part of the scientific method itself [12].

Other fields of medical research, such as clinical trials and systematic reviews, have widely used study reporting checklists e.g. the CONSORT and PRISMA guidelines [13]. Such checklists improve the interpretation, evaluation, and reproduction by others scientists and stakeholders, including public health decision-makers,journal editors, and journal reviewers. Indeed, many journals mandate that reporting checklists are completed prior to manuscript submission and publication, which has led to demonstrable improvements in study reporting [14,15]. Although principles for policy-driven communication of models for neglected tropical disease programs have recently been discussed [16], a recent systematic review noted no reporting guidelines exist specifically for epidemic forecasting and prediction research [17]. The need for epidemic forecasting reporting guidelines is underscored by a review of Zika forecasting and prediction research which noted methodological reproducibility, accessibility, and incorporation of uncertainty in these published predictions varied [8].

To address this gap, we developed the EPIFORGE checklist, the first known set of epidemic forecasting reporting guidelines. This checklist was developed through a well-established process for developing guidelines for research reporting, involving a Delphi process and broad consultation with an international panel of infectious disease modelers and model end-users [18,19]. The objectives of these guidelines are to improve the consistency, reproducibility, comparability, and quality of epidemic forecasting reporting. Here we describe our guidelines development process and the resulting checklist. The EPIFORGE checklist is not designed to advise scientists how to perform epidemic forecasting and prediction research, but rather serve as a set of standards to ensure critical aspects of these studies are reported in a standardized way.

View the Epiforge project page

Gene Drives
Report cover, Gene Drives

Gene drives are an emerging biotechnology being explored to mitigate the burden of several problems that have not been fully addressed by other measures, such as malaria and invasive species management. Gene drives, a type of genetic tool, are capable of altering the genetics of large portions of wild populations with relatively few resources. Once released, the movement of the gene drive through a population is almost entirely out of the control of humans. While this enables us to address problems without investing as many resources as other interventions require, it also poses several risks. There are several uncertainties surrounding gene drives and how they may behave.

This project assesses the risks and benefits of gene drives and identifies key challenges to regulating this unique class of tools. A literature review and interviews with key experts informed this project, which includes an assessment of the technology’s risks and potential benefits, relevant policy gaps, technical reviews of the different types of gene drives, and recommendations for governance. The findings are published in a report with the goal of guiding policy makers at the national and international level of different needs in regulating gene drives. Several recommendations for building regulatory frameworks are suggested, including the development of a registry of gene drive development and release.

Project team lead: Michael Montague, PhD

Project team: Lane Warmbrod, MS, MPH; Amanda K. Mui, MPH; Rachel West, PhD; Georgia Ray

Project supported by: Open Philanthropy Project

Resources: Gene Drives: Pursuing Opportunities, Minimizing Risk (final report)
Summary of Gene Drives: Pursuing Opportunities, Minimizing Risk (PDF)

Date completed: May 18, 2020

Collective Intelligence for Disease Prediction
Disease Prediction project logo

The Center for Health Security has developed a global disease prediction platform to leverage the “wisdom of the crowd” in order to make predictions about outbreaks and other disease-related events.  The project is intended to understand more about the validity of collective intelligence to provide public health leaders with forecasting data to help inform decisions on preparedness and response policies and interventions.

During an outbreak, real-time predictive information can help health security leaders make timely decisions about infectious disease preparedness, response policies, and potential interventions. However, disease surveillance can be slow to provide clear information. Accurate forecasts about disease outcomes, may supplement traditional surveillance and modeling efforts, increasing the capacity of public health professionals in outbreak response.

The Disease Prediction Platform uses information from current disease outbreaks to develop questions with resolutions that would be valuable for decision makers. Participant forecasters provide their predictions on the probability that a certain range of outcomes will occur. The research team then analyzes the collective forecast and develops policy implications and other conclusions.

Project team lead: Tara Kirk Sell, PhD

Co-PI: Crystal Watson, DrPH

Project team: Sanjana Ravi, MPH; Lane Warmbrod, MS; Marc Trotochaud, MPH; Elena Martin, MPH; Sarah Attreed

Project supported by: Open Philanthropy Project

Vaccine Platforms: State of the Field and Looming Challenges
Report cover, Vaccine Platforms

To date, the pharmaceutical response to emerging infectious diseases and bioterrorism has been characterized by a “one bug, one drug” approach, where specific medical countermeasures—effective vaccines and therapeutics—are developed, manufactured, and deployed. However, over the past several years, platform technologies have been developed that could make it possible for multiple vaccines to be more rapidly produced from a single system. Such an approach may have major benefits for pandemic preparedness.

To further characterize these technologies and concretize their value, the Center completed a project that explored the state of the art with respect to vaccine platforms, identified promising platform technologies, addressed regulatory challenges, and assessed the promise of vaccine technologies with a view to pandemic preparedness.

Project team lead: Amesh Adalja MD

Project team: Thomas Ingelsby MD, Anita Cicero JD, Matthew Watson BS

Project supported by: Open Philanthropy Project

Resources: Vaccine Platforms: State of the Field and Looming Challenges (final report)

Date completed: April 2019

Mobilizing Allies for Global Catastrophic Biological Risks
Report cover, Risk Communication Strategies

The Center researched the basis for a common language that would affirm Global Catastrophic Biological Risks (GCBR) as a legitimate object of concern, a foundation necessary to move the field forward and mobilize allies.

To name and frame the problem of GCBRs, the Center’s project team interviewed an interdisciplinary group of thought leaders about GCBR attributes and impacts, opportunities for intervention, and challenges in communicating these details. The team performed a literature review and interviewed more subject-matter experts to derive lessons learned from other times in history when communities needed to be alerted to the possibility of an existential threat.

Analyzing these inputs, the project team then drafted recommendations on how to communicate about GCBRs in ways that catalyze action by influencers, policymakers, and the public, thus guiding the emerging field of GCBR reduction. A plausible and persuasive argument about GCBRs can help motivate previously agnostic or unconvinced audiences to learn more and to work toward finding solutions.

Project team lead: Monica Schoch-Spana, PhD

Project team: Sanjana Ravi, MPH; Diane Meyer, RN, MPH; Christopher Hurtado, MHS; Kirsten Moore-Sheeley PhD

Project supported by: Open Philanthropy Project

Resources: Risk Communication Strategies for the Very Worst of Cases (final report)

Date completed: March 2019

Public Health Impacts of Extended Power Interruptions: Scenario scoping, public health responses, and health priorities

The electrical power grid is an integral part of 21st century life, with nearly all facets of everyday activities depending on electricity. Yet, the energy grid is at risk: It has become a prime target for cyberattacks and is vulnerable to naturally occurring outages due to weather events and disasters. The health consequences of crippled electrical power infrastructure could potentially be significant. The health system, many water utilities, communication systems, and others are dependent on the functioning of the electrical grid, which, if threatened, could cause cascading health impacts. Health impacts are likely to increase in frequency and severity as outages increase in length. Research is needed to identify the particular pathways by which power outages directly or indirectly (eg, via disruption of other services that require power to operate) affect public health, and the actions that can be taken to reduce vulnerability and hasten recovery.

Although optimal restoration of electric power service following an event has been an active area of research, maximization of restoration of service is often measured by number of customers or amount of electric load served. However, consideration of public health consequences and, in particular, supply chains for essential services and products that depend on electricity could result in very different sequences of actions, in terms of which distribution circuits are energized and which power plants restarted.

This research project is a joint research project with faculty members in the Johns Hopkins University Department of Environmental Health and Engineering, with a particular emphasis on encouraging multidisciplinary collaboration between engineering and public health faculty. The project seeks to determine the health-focused priorities for power recovery and public health response actions to manage long-term power outages in order to reduce morbidity and mortality from electrical power grid failure. Findings and recommendations from this work could be used to improve emergency response planning by utilities and public agencies across the nation to be used in small and more frequent outages as well as large-scale potentially catastrophic events. This work will provide an important foundation for future inquiry into the relationship between electrical power grid resiliency and public health.

Project team lead: Tara Kirk Sell, PhD

Project team: Amanda K. Mui, MPH; Elena Martin, MPH; Thomas Inglesby, MD

Engineering project team: Benjamin Hobbs, PhD; Puneet Chitkara, PhD; Umesh Korde, PhD; Kenming Xu

Project supported by: Chaomei Chen and Yu Wu

Iraq Implementers Conference

The Center conducted a 3-day virtual, multidisciplinary train-the-trainer course to develop a cadre of more than a dozen private sector physicians, scientists, laboratorians, and other health professionals in Iraq to prevent and detect outbreaks of especially dangerous pathogens.

The course focused on priority diseases that pose a security threat in Iraq, such as anthrax, brucellosis, and highly pathogenic influenza, which have been identified as particular areas of concern by the Biosecurity Engagement Program (BEP) in the State Department. Training modules included content on biorisk management and secure, safe, and effective sample collection, storage, and transportation. The course also included a module focused on the development of scenario exercises that can be used by course participants in their home institutions. These scenarios can be used to assess the mastery of course material and provide a tool to gauge the readiness of the Iraqi private sector health workforce. The scenarios address operational as well as regional and national strategic considerations, and identify future needs to bolster biosecurity preparedness in Iraq.

Project team lead: Gigi Kwik Gronvall, PhD

Project team: Crystal Watson, DrPH, MPH; Matthew Watson; Matthew Shearer, MPH; Amesh Adalja, MD; Caitlin Rivers, PhD, MPH; Christopher Hurtado, MHS; Marc Trotochaud, MSPH; Lane Warmbrod, MS, MPH

Project supported by: CRDF Global; US Department of State, Office of Cooperative Threat Reduction

Technologies to Address Global Catastrophic Biological Risks

This project is an exploration of extant and emerging technologies that have the potential to radically alter the trajectory of Global Catastrophic Biological Risks (GCBR). Through extensive research and interviews with internationally recognized experts in the field, the Center has identified technologies that, with strategic investment over the next decade, might significantly reduce these severe human, animal and plant infectious disease events that pose a catastrophic risk to humanity.

Traditional approaches to early identification, surveillance, and response in epidemics are often too slow or limited in scope to prevent disease from spreading and having serious consequences for affected populations. Consequently, technological interventions to address GCBRs will need to improve disease detection, surveillance, and characterization, and increase response speed and global response reach to help avoid the emergence and geographic spread and/or reduce severity.

The Center looked for emerging technologies as well as those already in wide use for other purposes but have not yet been directed at the problem of severe infectious disease emergencies. Technologies were of interest if they addressed any stage of a GCBR event; however, the project’s primarily focus was identifying technologies that can be applied to mitigate the impact of a severe pandemic once the pandemic is underway.

Project team lead: Crystal Watson, DrPH, MPH; Matthew Watson; Tara Kirk Sell, PhD, MA

Project team: Caitlin Rivers, PhD; Matthew Shearer, MPH; Christopher Hurtado, MHS

Project supported by: Open Philanthropy Project

Resources: Technologies to Address Global Catastrophic Biological Risks (final report)

Date completed: October 9, 2018

Clade X Tabletop Exercise

The Center hosted a pandemic tabletop exercise in Washington, D.C., in May 2018. The goal of this exercise (“Clade X”) was to illustrate high-level strategic decisions and policies that the United States and the world will need to pursue in order to diminish the consequences of a severe pandemic. It addressed a pressing current concern, present plausible solutions, and be experientially engaging.

Visit the Clade X web page

Clade X was designed for national decision-makers in the thematic biosecurity tradition of the Center’s two previous exercises, Dark Winter (2001) and Atlantic Storm (2005). The day-long exercise simulated a series of Cabinet meetings among prominent players who previously occupied similar leadership positions in past Presidential administrations. Players were presented with a scenario that highlighted unresolved real-world policy issues that could be solved with sufficient political will and attention now and into the future.

Lessons learned from Clade X will be shared broadly to raise awareness of key pandemic prevention and response challenges.

Project team leads: Eric Toner, MD

Project team: Tom Inglesby, MD; Anita Cicero, JD; Randy Larsen USAF (retired); Crystal Watson, DrPH, MPH; Gigi Kwik Gronvall, PhD; Jennifer Nuzzo, DrPH, SM; Monica Schoch-Spana, PhD; Tara Kirk Sell, PhD, MA; Amesh Adalja, MD; Caitlin Rivers, PhD, MPH; Christopher Hurtado, MHS; Diane Meyer RN, MPH; Sanjana Ravi, MPH; Matthew Shearer, MPH; Michael Snyder, MALD; Matthew Watson; Richard E. Waldhorn, MD; Jackie Fox; Andrea Lapp; Nick Alexopulos; Julia Cizek

Project supported by: Open Philanthropy Project

A Framework to Analyze the Pandemic Potential of Pathogens
Report cover, The Characteristics of Pandemic Pathogens

Pandemic pathogens are often drawn from lists of known pathogens based on historical outbreaks, their pathogenicity, and expert opinion. In this project, the Center aimed to create a new lens by which to view this problem by developing a framework to analyze elements of potential pandemic pathogens and provide a means to augment preparedness activities for human infectious disease emergencies.

The project team conducted a literature review of prior work done on this issue and then moved to distilling the essential features of historically high impact infectious disease outbreaks that nonetheless did not cross a global catastrophic threshold (e.g., Black Death, the 1918 influenza pandemic, the HIV pandemic, the tuberculosis pandemic). In addition, non-human major infectious disease events were studied.

The team informed and enhanced its research through interviews with international infectious disease experts, paleontologists, physicists, virologists, astrobiologists, mycologists, and parasitologists. Once drafted, the initial new framework was assessed and critiqued by a group comprised of select interviewees and other experts. After the group’s feedback was considered and incorporated, the project team published a report describing the framework and will brief leaders in the scientific, policy, public health preparedness, and national security communities.

Project team lead: Amesh Adalja, MD

Project team: Eric Toner, MD; Matthew Watson

Project supported by: Open Philanthropy Project

Resources: A Framework to Analyze the Pandemic Potential of Pathogens (final report)

Date completed: May 2018

Persuasive Communications about Risks from and Response to Zika
Image of Zika virus, a mosquito overtop a map

The Center conducted in-depth research on public health communication efforts for the Zika outbreak and developed evidence-informed recommendations intended to provide strategic input and communication approaches for senior health officials at the state and federal level to be used in future public health emergencies.

The Center studied Zika communication practices, messages, and impacts through a multi-step process of environmental scan, expert interviews, news media content analysis, review of call center data, deliberative public sessions/focus groups, and message development with audience testing. The multi-faceted approach established a research-based platform from which to launch this inquiry (environmental scan), gathered information on current and innovative communication practices (expert interviews), examined current messages existent in the news media (news media content analysis), collected data on public questions about Zika and response efforts (analysis of CDC-INFO – CDCs national information center - data), developed a greater understanding of public views and values (deliberative sessions/focus groups), and tested sample messages that resonate with the American public (message testing).

Based on this research and collaborative work with CDC scientific staff, the Center prepared practical advice for senior health officials regarding their strategy for communicating risks and response activities during future health emergencies in ways intended to strengthen public support and understanding.

Project team lead: Tara Kirk Sell, PhD, MA

Project team: Crystal Watson, DrPH, MPH; Monica Schoch-Spana, PhD; Sanjana Ravi, MPH; Diane Meyer, RN, MPH

Project supported by: Centers for Disease Control and Prevention

Resources: Frequency of Risk-Related News Media Messages in 2016 Coverage of Zika Virus (published in Risk Analysis)

Date completed: Feb. 28, 2019

Developing a Health Systems Resilience Checklist and Implementation Guide

The Center is creating a resilience checklist and implementation guide that health systems can use to assess whether they are prepared to maintain essential functions during an emergency.

Faced with a major disaster or infectious disease outbreak, the people and organizations that promote, restore, and maintain a community’s health should be able to successfully treat the sick and protect the well. Doing so requires skilled clinicians, fully staffed and equipped healthcare facilities, public health monitoring and case management, clinical care research and protocols, and numerous other capabilities and capacities assessed in detail by the Center’s checklist. There is currently no overarching international assessment framework that addresses the resources within health systems necessary for treating patients, or that considers the interdependence of health systems with other sectors (eg, critical infrastructure, supply chains, regulations and other legal protections). The Center’s resilience checklist will fill these gaps.

The project team's work will be informed by themes gleaned from a comprehensive review of relevant literature and key takeaways from dozens of interviews with experts in healthcare preparedness, health systems strengthening, global health security, epidemic response and management, and community and health system resilience. The team plans to pilot a draft checklist in partnership with a host country in late 2018 before finalizing the checklist and companion implementation guide for wide distribution in early 2019.

Project team lead: Jennifer Nuzzo, DrPH

Project team: David Bishai, MD, PhD, professor in the Johns Hopkins Bloomberg School of Public Health; Eric Toner, MD; Diane Meyer, RN, MPH; and Michael Snyder, MA.

Project supported by: Rockefeller Foundation


Global Health Security Agenda Ministerial Meeting in Uganda

The Center is partnering with the Georgetown Center for Global Health Science and Security to host a panel discussion on benefits of and strategies for incorporating the non-governmental sector into the next phase of the Global Health Security Agenda (GHSA). The panel discussion will take place at the GHSA Ministerial Meeting in Uganda in October 2017.

GHSA is an international initiative to advance a world safe and secure from infectious disease threats, to bring together nations from all over the world to make new, concrete commitments, and to elevate global health security as a national leaders-level priority. It was launched as a 5-year effort in 2014 and has grown to include nearly 50 nations, international organizations, and non-governmental stakeholders. Planning is already underway for its next phase, and the Center hopes key takeaways from the panel discussion will inform decision making on future GHSA priorities—specifically, how the non-governmental sector (e.g., academic researchers, non-profits, philanthropies, and private-sector organizations) can contribute to growing GHSA’s momentum and achievements to date.

Project team lead: Jennifer Nuzzo, DrPH

Project team: Anita Cicero, JD

Project supported by: Open Philanthropy Project


Recent work by the Center, germane to contributions NGOs can make to GHSA:

Date completed: Oct. 27, 2017

Workshop on National Biodefense Strategy
Congressional Seminar on "What is Needed Now to Prepare for Major Health Emergencies"
Flu on Call

Project supported by: The Oak Ridge Institute for Science and Education

Analyzing the Impact of the Affordable Care Act on Surveillance of Critical Diseases and Examining Ways to Enhance Direction and Control Activities

Project supported by: Robert Wood Johnson Foundation

Improving Security Through International Biosafety Norms

Project supported by: Naval Postgraduate School, Project on Advanced Systems and Concepts for Countering WMD

Measuring and Motivating Health Department Excellence at Community Engagement in Preparedness

Project supported by: de Beaumont Foundation

Ensuring Appropriate Public Use of Medical Countermeasures through Effective Emergency Communications

A Communication Casebook for FDA and its Public Health Partners

Image of different pills scattered on a surface in reds, pinks, whites, and yellows

How the US Food and Drug Administration (FDA) and other US government officials convey information about medical countermeasures (MCMs) will affect uptake, compliance, and ultimately survival in the aftermath of a natural disease emergency or a chemical, biological, radiological, or nuclear (CBRN) attack. Moreover, effective communication regarding MCMs has the potential to strengthen psychological resilience as well as engender public trust in science, government, and public health.

In 2014-2016, the UPMC Center for Health Security undertook an in-depth project to provide evidence-informed advice to the FDA about communication issues inherent in the emergency use of MCMs. During that initiative, the Center engaged in research, analysis, and deliberation with an expert working group that included top scholars in risk and crisis communication and leading figures in the MCM enterprise. A major outcomes of the project was the “best practices” oriented text, How to Steward Medical Countermeasures and Public Trust in an Emergency: A Communication Casebook for FDA and Its Public Health Partners. The full casebook, along with its individual chapters, are available for download.

The purpose of the casebook was to provide FDA and other officials who deliver public health information with real world inspired opportunities for reflective learning on the principles of effective MCM emergency communication. The casebook critically examined communication dilemmas about MCMs in the context of the 2015-215 Ebola outbreak, the 2011 Fukushima nuclear accident, the 2009-10 H1N1 influenza pandemic, and the 2001 anthrax  letter attacks, recommending specific action items for the FDA to help mitigate comparable issues in the future. The Ebola and anthrax cases underscored, for example, the need for sensitivity regarding historical conflicts between public health and minority communities, and the importance of taking steps – both before and during an emergency – to address any public anxiety around discrimination and human experimentation in the context of MCM clinical trials.

Read the full Casebook (PDF)

Download the Enhanced Accessibility PDF.

Chapter One: Introduction

How FDA and other US government officials convey information about medical countermeasures (MCMs) will affect uptake, compliance, and ultimately survival in the aftermath of a natural disease emergency or a chemical, biological, radiological, or nuclear (CBRN) attack. Moreover, effective communication regarding MCMs has the potential to strengthen psychological resilience as well as engender public trust in science, government, and public health. The purpose of this casebook is to provide FDA and other officials who deliver public health information with “real world” inspired opportunities for reflective learning on the principles of effective MCM communication and on the wider contexts that influence the development, delivery, and consumption of accurate, timely, and meaningful MCM information in an emergency. Communication successes will better enable FDA to fulfill its regulatory role and activities and “facilitate the development of and access to safe, effective, and quality MCMs” to counter CBRN and emerging infectious disease threats (for more on FDA’s MCM-related mission, activities, and collaborators, see Appendix A)

Read Chapter 1: Introduction

Chapter Two: West Africa Ebola Epidemic

In late 2013, an Ebola outbreak began in Guinea, quickly growing to become the largest Ebola epidemic on record. Widespread transmission occurred in Guinea, Liberia, and Sierra Leone with imported cases and limited transmission occurring in other countries, including the United States. The absence of approved medical countermeasures (MCMs) and a severely limited supply of investigational drugs—in early stages of development and with limited production capacity—compounded delays in the global response to the epidemic. Several of the major communications challenges for the West Africa Ebola epidemic concerned the development, testing, and use of investigational MCMs. Questions arose in the media, public, government, and even the scientific community regarding the status of individual—often highly publicized—MCMs, specifically calling for increased transparency for the testing, approval, and production processes; challenging traditional requirements for testing; and questioning allocation of limited supplies of these products in the context of the growing Ebola epidemic.

Read Chapter 2: Ebola


Chapter Three: Fukushima Nuclear Accident Of 2011

The Tohoku earthquake in Japan caused a series of tragic and cascading disasters in Japan, including the release of radiological materials from the Fukushima Daiichi Nuclear Power Plant. The vast majority of the nuclear release affected only Japan, and as a result, no medical countermeasures were recommended in the US. However, despite messages to the public by health authorities not to purchase, stockpile, or administer potassium Iodide (KI), some consumers still sought out the radiation countermeasure. Additionally, when KI was not available, some consumers attempted to acquire potassium from other sources even though these sources were ineffective and/or not approved by the FDA. The adverse effects of such behaviors were the potential occurrence of negative side effects from taking unnecessary or unapproved products. Additionally, in the event of a future emergency requiring KI for a limited proportion of the population, demand for KI by those who would receive no benefit may prevent those who need KI from accessing it.

Read Chapter 3: Fukushima


Chapter Four: The H1N1 Influenza Pandemic Of 2009-2010

The H1N1 outbreak of 2009-2010 was the result of a novel flu strain. The response to H1N1 was multifaceted and involved multiple governmental organizations. In particular, at the beginning of the outbreak FDA instituted an H1N1 management system to coordinate a response, which included creating seven teams to address specific public health needs related to H1N1. While FDA’s response to H1N1 was thus far-reaching, in relation to communication several components of FDA’s response could have been enhanced: communicating about vaccine production including responding to concerns that the vaccine was risky, rushed through production, or untested; being more transparent about the vaccine manufacturing process generally including reasons why vaccine production might be delayed; strengthening collaboration with other health entities to overcome disparities in MCM uptake; and finally, in conjunction with CDC, clarifying the use of new MCMs/new uses of approved MCMs to both healthcare providers and the public.

Read Chapter 4: H1N1 Influenza


Chapter Five: 2001 Anthrax Letters

The dissemination of Bacillus anthracis via the US Postal Service (USPS) in 2001 represented a new public health threat, the first intentional exposure to anthrax in the United States. The attacks resulted in 22 cases of anthrax—eleven inhalational and eleven cutaneous—five of which were fatal.1 Public health officials faced the challenge of communicating risk during rapidly evolving circumstances in response to terrorist attacks that affected numerous states and Washington, DC. A total of 21 USPS facilities were contaminated in the attacks, and 32,000 potentially exposed persons initiated post-exposure prophylaxis.2 These attacks followed closely after those of September 11th, further complicating the challenge of addressing a new threat in a nation still recovering from a traumatic event.3,4,5 Conflicting public health guidance across different government jurisdictions and changing directives about prophylaxis undermined public confidence in health authorities’ handling of the crisis and in the recommended personal protective actions, particularly among affected minority populations.

Read Chapter 5: Anthrax Letters

A Community Checklist for Health Sector Resilience Informed by Natural Disasters
SPARS Pandemic Risk Communication Exercise Scenario

This is a training exercise, based on a fictional scenario. It is a teaching and training resource for public health and government officials so that they can practice responses and better protect the public’s health. Read more.

Report cover, SPARS Pandemic Scenario

The Center’s SPARS Pandemic exercise narrative comprises a futuristic scenario that illustrates communication dilemmas concerning medical countermeasures (MCMs) that could plausibly emerge in the not-so-distant future. Its purpose is to prompt users, both individually and in discussion with others, to imagine the dynamic and oftentimes conflicted circumstances in which communication around emergency MCM development, distribution, and uptake takes place. While engaged with a rigorous simulated health emergency, scenario readers have the opportunity to mentally “rehearse” responses while also weighing the implications of their actions. At the same time, readers have a chance to consider what potential measures implemented in today’s environment might avert comparable communication dilemmas or classes of dilemmas in the future.

The self-guided exercise scenario for public health communicators and risk communication researchers covers a raft of themes and associated dilemmas in risk communications, rumor control, interagency message coordination and consistency, issue management, proactive and reactive media relations, cultural competency, and ethical concerns. To ensure that the scenario accounts for rapid technological innovation and exceeds the expectations of participants, the Center’s project team gleaned information from subject matter experts, historical accounts of past medical countermeasure crises, contemporary media reports, and scholarly literature in sociology, emergency preparedness, health education, and risk and crisis communication.

The scenario is hypothetical; the infectious pathogen, medical countermeasures, characters, news media excerpts, social media posts, and government agency responses are entirely fictional.

Project team lead: Monica Schoch-Spana, PhD

Project team: Matthew Shearer, MPH; Emily Brunson, PhD, associate professor of anthropology at Texas State University; Sanjana Ravi, MPH; Tara Kirk Sell, PhD, MA; Gigi Kwik Gronvall, PhD; Hannah Chandler, former research assistant at the Center

Date completed: October 2017


Public Health and Community Pharmacy Partnerships
Report cover, NACDS, Serving the Greater Good: Public Health and Community Pharmacy Partnerships

The Center conducted a study to determine how public health in the United States can best be bolstered by engaging with community pharmacy in the near-term future. For the purpose of this study, community pharmacy is defined as the collective group of US independent and chain pharmacies (e.g., traditional drug stores, grocery stores with pharmacies, mass merchants with pharmacies).

To frame the analysis, the Center examined 3 specific areas of growing public health need to determine how community pharmacy could serve the public’s health: the national opioid crisis, antibiotic resistance, and pandemic and emergency preparedness and response. The study team performed a literature review; held a day-long meeting of experts, including those from state medical associations, preparedness entities, community pharmacies, public health agencies, nonprofit organizations, and academia; and conducted additional consultations with pharmacy, preparedness, and public health experts.

The final report presents the Center’s policy judgment regarding the role of community pharmacy in public health and the areas for which the role of pharmacy should be expanded in the near term.

Project team lead: Gigi Kwik Gronvall, PhD

Project team: Matthew Shearer, MPH; Amesh Adalja, MD; Ashley Geleta, MS, former research assistant

Project supported by: National Association of Chain Drug Stores

Date completed: October 2017

Resources: Serving the Greater Good: Public Health and Community Pharmacy Partnerships (PDF)

Making Disasters Less Disastrous: Public Health, Healthcare Executives and Emergency Management Working Together

Project supported by: Centers for Disease Control and Prevention

Innovative Non‐traditional Approaches to Antimicrobial Resistance

Project supported by: Biomedical Advanced Research and Development Authority

Health Sector Resilience Checklist for Highly Infectious Diseases
Redesigning Disaster Health in a Time of Change: Inculcating a Culture of Resilience within a Culture of Health
Pre-Implementation of Taiwan's Participation in the Global Health Security Agenda

The Global Health Security Agenda (GHSA) is an effort to promote international security from infectious disease threats. Several countries participating in the GHSA have volunteered to have their capacities for effective prevention, detection, and response be assessed by international teams using a new GSHA assessment tool and to make the results of their assessments public. Taiwan endorses the principles contained in the Global Health Security Agenda and although it is not officially participating in the GHSA assessment process, it has elected to contract with an external party to conduct an assessment of Taiwan using the same tool as that being used by the GHSA. 

Purpose: To assess the progress of Republic of China (Taiwan) toward the “Protect, Detect, and Respond” goals of Global Health Security Agenda and to showcase the findings


  • Assess Taiwan’s capability for infectious disease prevention and control using the latest available GHSA assessment tool;
  • Focus particular attention on Taiwan’s progress in tuberculosis (TB) elimination;
  • Convene a one-day long international symposium on Taiwan and the GHSA in the Washington, DC area;
  • Compile the papers from the symposium, along with other invited papers related to the GHSA, into a special issue of a respected peer–reviewed journal;
  • Prepare a final report containing the findings of the independent GHSA assessment of Taiwan and make it public in collaboration with the Taiwan Center for Disease Control (Taiwan CDC)

Goals: BSPH-CHS will conduct an assessment of Taiwan’s health security using the most currently available version of the assessment tool to be used by countries participating in the Global Health Security Agenda country assessments and concurrently assess Taiwan’s TB control programs.

Meetings/Reports/Events: The team will visit Taiwan in March to begin the assessment process and will return to complete the formal assessment during the summer.

Project lead: Eric Toner

Project team: Eric Toner, Anita Cicero, Jennifer Nuzzo, Tara Kirk Sell, Matthew Shearer

Project supported by: Centers for Disease Control, Taiwan

Rad Resilient City Initiative

The Rad Resilient City Initiative offers a practical, step-by-step approach for cities and regions to follow in designing and implementing a fallout preparedness program that will protect people after a nuclear detonation.

Everywhere You Look: Select Agent Pathogens

As part of its Select Agent Program, the USG regulates 80+ pathogens, nearly all of which are found in nature and cause disease outbreaks with some regularity. We mapped disease outbreaks caused by select agent pathogens worldwide in the 22-month period between January 1, 2009, and October 31, 2010. This interactive map allowed you to explore those outbreaks by country and by pathogen.

Date completed: October 31, 2010

Protecting Building Occupants from Exposure to Biological Threats

This project provides practical steps for reducing the risk of exposure to harmful pathogens after an aerosol release of a biological weapon. Learn more about protecting building occupants from biological threats.

How to Lead During Bioattacks with the Public's Trust and Help

This project offers guidance for government and health officials on anticipating and averting governing pitfalls that arise during epidemics. View the leadership guide here.