Prioritizing Strategies for Building the Resilience of Public Health Systems to Disasters Across Multiple Communities and Countries

The COVID-19 pandemic highlighted the urgent need to strengthen public health systems.In response,the United Nations Disaster Risk Reduction(UNDRR) Public Health System Resilience Scorecard(Scorecard) was applied in workshops across multiple countries.The aim of our research was to explore the workshop findings to develop priority strategies for strengthening public health system resilience.We conducted a workshop from 14 to 16 March 2023,at the UNDRR Global Education and Training Institute in Incheon,Republic of Korea.A sequential modified Delphi method was utilized to develop a set of prioritized resilience strategies.These were drawn from 70 strategies identified from 13 distinct workshops in eight countries.After two surveys,23 strategies were finalized.Ten received ratings of "High" or Very High" from89% of participants.These related to the inclusion of public health risks in emergency plans,integrating multidisciplinary teams into public health,enabling local transport mechanisms,and improving the ability to manage an influx of patients.The Scorecard provides an adaptable framework to identify and prioritize strategies for strengthening public health system resilience.By leveraging this methodology,our study demonstrated how resilience strategies could inform disaster risk reduction funding,policies,and actions.

Coronavirus disease 2019 (COVID-19) pandemic: how countries shouldbuild more resilient health systems for preparedness and response

Objective: A resilient health system plays a crucial role in pandemic preparedness and response. Althoughthe World Health Organization (WHO) has required all states parties to strengthen core capacities to respondto public health emergencies under the International Health Regulations (2005), the actions of most countriesto combating coronavirus disease 2019 (COVID-19) has showed that they are not well-prepared. This crosssectionalstudy aimed to examine the health system resilience of selected countries and analyze their strategiesand measures in response to the COVID-19 pandemic.Methods: This study selected five countries including the Iran, Japan, Republic of Korea (South Korea), the U.K.,and the U.S., based on the severity of the national epidemic, the geographical location, and the developmentlevel. Cumulative number of death cases derived from WHO COVID-19 dashboard was used to measure theseverity of the impact of the pandemic in each country;WHO State Parties Self-Assessment Annual Reporting (SPAR)Scores and Global Health Security (GHS) Index were applied to measure the national health system resilience;and research articles and press materials were summarized to identify the strategies and measures adopted bycountries during response to COVID-19. This study applied the resilient health systems framework to analyzehealth system resilience in the selected countries from five dimensions, including awareness, diversity, selfregulation,integration and adaptation.Results: The SPAR Scores and GHS Index of the four developed countries, Japan, South Korea, the U.K. and theU.S. were above the global and regional averages;the SPAR Scores of Iran were above the global average whilethe GHI Index lain below the global average. In terms of response strategies, Japan, the U.K. and the U.S. investedmore health resources in the treatment of severe patients, while South Korea and Iran had adopted a strategyof extensive testing and identification of suspected patients. In terms of specific measures, all the five countriesadopted measures such as restrictions on entry and international travel, closure of schools and industries,lockdown and quarantine. Nevertheless, the effectiveness of implementing these measures varied acrosscountries, based on the response strategies.Conclusion: Although SPAR Scores and GHS Index have evaluated the national core capacities for preparednessand response, the actions to cope with the COVID-19 pandemic has revealed the fact that most countries stilldo not build resilient health systems in response to public health emergencies. Health system strengtheningand health security efforts should be pursued in tandem, as part of the same mutually reinforcing approach todeveloping resilient health systems.

Methods used in microbial forensics and epidemiological investigations for stronger health systems

This review discusses microbial forensics as an emerging science that finds application in protecting human health.It is important to distinguish naturally acquired infections from those caused by the intentional release of microorganisms to the environment.This information is crucial in formulating procedures against the spread of infectious diseases and prosecuting persons who may be involved in acts of biocrime,bioterrorism,or biowarfare.A comparison between epidemiological investigations and microbial forensic investigations is provided.In addition,a discussion on how microbial forensics strengthens health systems is included in this review.Microbial forensic investigations and epidemiologic examinations employ similar concepts and involve identifying and characterising the microbe of interest.Both fields require formulating an appropriate case definition,determining a pathogen’s mode of transmission,and identifying the source(s)of infection.However,the two subdisciplines differ in their objectives.An epidemiological investigation aims to identify the pathogen’s source to prevent the spread of the disease.Microbial forensics focuses on source-tracking to facilitate the prosecution of persons responsible for the spread of a pathogen.Both fields use molecular techniques in analysing and comparing DNA,gene products,and biomolecules to identify and characterise the microorganisms of interest.We included case studies to show methods used in microbial forensic investigations,a brief discussion of the public significance of microbial forensic systems,and a roadmap for establishing a system at a national level.This system is expected to strengthen a country’s capacity to respond to public health emergencies.Several factors must be considered in establishing national microbial forensic systems.First is the inherent ubiquity,diversity,and adaptability of microorganisms that warrants the use of robust and accurate molecular typing systems.Second,the availability of facilities and scientists who have been trained in epidemiology,molecular biology,bioinformatics,and data analytics.Human resources and infrastructure are critical requirements because formulating strategies and allocating resources in times of infectious disease outbreaks must be data-driven.Establishing and maintaining a national microbial forensic system to strengthen capacities in conducting forensic and epidemiological investigations should be prioritised by all countries,accompanied by a national policy that sets the legislative framework and provides for the system’s financial requirements.

Health and Risks:Integrating Health into Disaster Risk Reduction,Risk Communication,and Building Resilient Communities

In recent years,‘‘health’’has been recognized explicitly as both a determinant and an outcome of the human dimension of disaster risk reduction(DRR).Every disaster creates significant public health needs that can exceed local capacity to respond,resulting in excess mortality and morbidity.The European Union report on Science