The Global Health Security Agenda (2014-2019) and International Health Regulations (2005)
Updated December 19, 2014
The Global Health Security Agenda and International
Health Regulations
Introduction
ongoing Ebola outbreak in West Africa. The lack of
significant improvements in the core public health
In recent years, a succession of new and reemerging
capacities since the adoption of IHR (2005), slow response
infectious diseases have caused outbreaks and pandemics
by the international community when presented with an
that have affected thousands of people worldwide: Severe
identified PHEIC, and inconsistent public health actions in
Acute Respiratory Syndrome (SARS, 2003), Avian
light of recommendations issued through IHR (2005)
Influenza H5N1 (2005), Pandemic Influenza H1N1 (2009),
technical advisory mechanisms has called into question the
Middle East Respiratory Syndrome coronavirus (MERS-
global commitment to IHR (2005).
CoV, 2013), and the ongoing Ebola outbreak in West
Africa. In 2005, the World Health Assembly (WHA), the
Slow responses by the international community to the Ebola
governing body of the World Health Organization (WHO),
outbreak and lackluster progress in implementing IHR
amended the International Health Regulations (IHR) to
(2005) have deepened support for the Global Health
Security Agenda (GHSA), a global effort to accelerate IHR
expand the scope of the IHR from the original three
implementation.
diseases (cholera, plague, and yellow fever) to include
new, emergent, and re-emergent diseases, as well as
Overview
other non-infectious disease agents;
define core public health preparedness and response
Announced in February 2014 by former HHS Secretary
capacities necessary for ensuring global capacity to
Kathleen Sebelius and WHO Director-General Margaret
detect, assess, report, and respond to public health
Chan, the GHSA is aimed at accelerating IHR (2005)
threats; and
implementation, particularly in resource-poor countries that
lack the capacity to comply with the regulations.
designate national points of contacts to ensure adherence
to the regulations. The Department of Health and
The agenda is led by governments, private partners, and
Human Services (HHS) is the U.S. point of contact.
non-governmental (NGO) groups who have committed to
The regulations, referred to as IHR (2005) to reflect the
lead or contribute to advancing the GHSA. Eleven Action
date in which they were amended, describe measures to be
Packages outline a specific set of actions to be taken to
taken to strengthen global capacity to respond to public
achieve GHSA targets and objectives within five years.
health events with potential international impact. The IHR
Each Action Package focuses on a particular element of
(2005) includes provisions that call for all WHO Member
infectious disease control. These include
States to
1. antimicrobial resistance;
notify WHO of any event that may constitute a Public
2. zoonotic diseases;
Health Emergency of International Concern (PHEIC)
and respond to requests for verification of information
3. biosafety and biosecurity;
regarding such events;
4. immunizations;
follow WHO recommendations concerning appropriate
5. national laboratory systems;
public health responses to the relevant PHEIC;
6. surveillance systems;
build and maintain core public health capacities for
7. disease reporting;
disease surveillance and response; and
8. workforce development;
collaborate with other Member States to provide or
9. emergency operations centers;
facilitate the delivery of technical assistance in support
10. linking public health with law and conducting
of developing and maintaining core public health
multi-sectoral rapid responses; and
capacities among all Member States.
11. medical countermeasures and personnel
Global commitment to the regulations have been
deployment.
questioned, as IHR (2005) implementation has been
The United States has committed to lead the Action
sluggish. As of June 2014, approximately 20% of countries
Package on national laboratory systems and to contribute
worldwide had fully implemented the regulations. The
toward five others (indicated by italics). By the end of
majority of countries worldwide, especially resource-poor
September, more than 40 countries had committed to the
states, do not have the capacity to implement the IHR
GHSA and others are expected to join.
(2005) without additional assistance, as evidenced by the
inability of Guinea, Sierra Leone, and Liberia to contain the
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The Global Health Security Agenda and International Health Regulations
Though there is no specific budget for the GHSA, the
operating a global reagent resource, and developing
strategy offers a coordinated mechanism through which
response communications and crisis planning and
donors can target technical and financial aid for various
management tools.
Action Packages. At the same time, the GHSA provides a
In an effort to build sustainability, CDC has incorporated
structure through which countries can seek assistance in
cost-sharing mechanisms into the GHS program. Low-
developing core public health capacities, as described in
income recipient countries will reportedly contribute at
IHR (2005). Resources for supporting GHSA
least 10% of total program costs (in-kind or financial)
implementation are provided directly by donors to
during the first year, and contributions are expected to
participating countries seeking aid.
average half of all spending in-country by 2025. Middle-
U.S. Policy
income recipient countries will reportedly contribute at
least 10% in 2015, and contribution levels are planned to
The United States has played a leading role in the
reach 90% by 2025.
development and implementation of the GHSA. President
Barack Obama has prioritized the GHSA and has ensured
The FY2015 Consolidated Appropriations Act did not
high-level support for the initiative. In September, the
specify funding for the GHS program but included $1.2
United States hosted the fourth meeting on the GHSA,
billion to HHS for international Ebola activities, including
which was attended by the President, members of his
$597 million for CDC to establish and strengthen National
Cabinet, and top White House Officials. During the
Public Health Institutes (NPHIs) and global health security.
meeting, countries committed to take concrete steps toward
implementing the GHSA and Administration officials
Budgetary requests for ongoing USAID pandemic
announced that the United States would help at least 30
preparedness programs could also be used to advance the
countries achieve the GHSA objectives over the next five
GHSA. In FY2015, USAID requested $50 million for
years.
pandemic preparedness efforts, roughly 31% less than the
FY2014 level. The FY2015 Consolidated Appropriations
U.S. Funding for GHSA Relevant
Act provided $72.5 million for related efforts.
Activities
Issues for Congressional Consideration
In the absence of a specific budget for the GHSA, it is not
possible to determine how much the United States has spent
Congressional support for strengthening weak health
or will spend on advancing the effort. For FY2015, the
systems around the world has grown in recent months,
Administration has requested funds for the GHSA as part of
prompted in large part by the West African Ebola outbreak.
the regular budget request as well as in an emergency
It remains to be seen whether this support will be extended
funding request for Ebola. The FY2015 Congressional
to the GHSA. The Administration has requested that
Budget Justification (CBJ) for the Centers for Disease
Congress fund GHSA activities through both regular
Control and Prevention (CDC) included $100 million for
appropriations and the emergency Ebola request. Experts
“global public health protection,” $45 million of which
agree that the global spread of the Ebola outbreak has
would be for establishing a Global Health Security (GHS)
demonstrated the threat weak health systems in foreign
program to
nations pose to the international community. There is some
debate, however, about whether the emergency Ebola
improve the capacity of 10 countries to manage
request is the appropriate mechanism for funding health
emerging threats, detect disease outbreaks, and respond
system strengthening efforts like the GHSA. At issue is
to global epidemics and other health emergencies;
whether addressing a long-term problem (weak health
build capacities for testing new pathogens globally; and
systems) should be funded through a short-term mechanism
(emergency appropriations). Approaches for supporting the
accelerate the development of new diagnostics tests.
GHSA raise other questions as well:
According to the CBJ, the GHS program “will be part of”
U.S. implementation of the Global Health Security Agenda.
coordination and oversight—U.S. Government (USG)
Key objectives of the GHS program include
implementation of the GHSA is carried out by several
U.S. agencies and departments. The White House
prevention of avoidable catastrophes—improving
regularly convenes interagency meetings, though there
global food and drug safety, addressing antimicrobial
is no formal mechanism for doing so. What agency, if
drug resistance, strengthening biosafety and biosecurity,
any, should coordinate these efforts over the five-year
improving immunization capacity, and enhancing border
period to avoid duplication of efforts and ensure
safety and security;
efficient and effective use of U.S. resources? How will
the Administration integrate and report on each agency’s
early threat detection—establishing a global laboratory
contribution to the GHSA?
network, improving disease surveillance and monitoring
systems, training and deploying epidemiologists and
measurement—USG implementation of the GHSA is
laboratory scientists, creating a bioinformatics system,
carried out by several agencies through a number of
and developing and disseminating novel diagnostic
existing programs. The Administration would also like
tools; and
to develop a new program at CDC specifically for the
GHSA. What relationship, if any, will the new Global
effective outbreak responses—creating an
Health Security program have with ongoing USG global
interconnected global network of Emergency Operations
health programs? How will the United States distinguish
Centers, establishing rapid response teams worldwide,
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The Global Health Security Agenda and International Health Regulations
progress made in achieving GHSA Action Packages from
other related bilateral efforts? What mechanisms, if any,
have been established to measure agency-specific
contributions to the GHSA?
Tiaji Salaam-Blyther, Specialist in Global Health
IF10022
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