The Global Health Security Agenda (GHSA): 2020-2024
March 16, 2020
The Global Health Security Agenda (GHSA)
Introduction
measures for the disease and whether to declare a PHEIC.
Since 1980, outbreaks of emerging infectious diseases
The composition of this group varies per outbreak. The IHR
(EID) have been occurring with greater frequency and
Emergency Committee for Pneumonia Due to the Novel
causing higher numbers of human infections. Roughly 65%
Coronavirus 2019-nCoV, for example, is comprised of 15
of these outbreaks have been caused by zoonotic pathogens,
scientists from around the world, including Dr. Martin
involving pathogen spread from animals to humans, often
Cetron from the U.S. Centers for Disease Control and
through a vector, such as a mosquito. Each year, zoonotic
Prevention (CDC).
pathogens cause an estimated one billion cases of human
illness, including 15 million deaths. All the EID outbreaks
The WHO Director-General usually follows the advice of
that gained notoriety in the past two decades were caused
IHR emergency committees regarding PHEIC declarations.
by zoonotic pathogens: severe acute respiratory syndrome
Following a PHEIC declaration, countries take a number of
(SARS, 2002-2003), avian influenza H5N1 (Bird Flu,
actions, including heightening surveillance and reporting
2005), pandemic influenza H1N1 (Swine Flu, 2009),
incidence of the relevant disease to the WHO. Countries
Middle East respiratory syndrome coronavirus (MERS-
might also provide additional resources to WHO and/or for
CoV, 2013), Ebola (2014-2016), Zika (2015-2016), yellow
domestic outbreak response. Following the PHEIC
fever (2016), Ebola (2018-2020), and the novel coronavirus
declaration for COVID-2019, for example, U.S.
(COVID-2019) outbreak.
Department of Health and Human Services (HHS)
Secretary Alex Azar “declared a public health emergency
International Health Regulations
for the entire United States to aid the nation’s healthcare
In 1969, the World Health Assembly (WHA)—the
community in responding to 2019 novel coronavirus.” A
governing body of the World Health Organization
declaration can also enable WHO to access certain
(WHO)—adopted the International Health Regulations
emergency funding, such as those provided through the
(IHR) to stop the spread of six diseases through quarantine
United Nations (U.N.) Central Emergency Response Fund
and other infectious disease control measures. The WHA
(CERF) and the World Bank Pandemic Emergency
has amended the IHR several times, most recently in 2005.
Financing Facility (PEF) during an outbreak.
The 2005 edition, known as IHR (2005), provided
expanded means for controlling infectious disease
Global Health Security Agenda
outbreaks beyond quarantine. The regulations include a
IHR (2005) came into force in 2007 and mandated that
code of conduct for notification of and responses to disease
countries were to be in compliance by 2012. Despite the
outbreaks with pandemic potential, and carry the
mandate, only some 20% of countries reported to WHO
expectation that countries (and their territories) will build
having developed IHR (2005) core capacities in 2012.
the capacity, where lacking, to comply with the IHR. The
Many observers asserted the regulations needed a funding
regulations mandates that WHO Member States:
mechanism to help resource-constrained countries with
compliance. In 2014, WHO and the United States jointly
build and maintain core public health capacities for
launched the Global Health Security Agenda (GHSA), a
disease surveillance and response;
five-year (2014-2018) multilateral effort to accelerate IHR
collaborate with other Member States to provide or
(2005) implementation, particularly in resource-poor
facilitate technical assistance to help low-resource
countries lacking the capacity to adhere to the regulations.
countries develop and maintain public health capacities;
At the end of the first phase of GHSA, WHO found that
notify WHO of any event that may constitute a Public
more than 70% of surveyed countries were prepared to
Health Emergency of International Concern (PHEIC)
address a global pandemic. Regional disparities persist,
and respond to requests for verification of information
however, with about 55% of surveyed countries in sub-
regarding such event; and
Saharan Africa indicating they were prepared for a
follow WHO recommendations concerning public health pandemic in 2017, compared to almost 90% of surveyed
responses to the relevant PHEIC.
countries in the Western Pacific.
IHR (2005) does not have an enforcement mechanism,
In 2017, participating countries agreed to extend the GHSA
despite efforts by some to include one in the wake of
China’s delayed reporting of the 2002
through 2024 and expand membership to non-state actors.
-2003 SARS
In November 2018, the GHSA Steering Group released the
outbreak.
Global Health Security Agenda (GHSA) 2024 Framework,
also referred to as “GHSA 2024.” Whereas the first phase
Public Health Emergency of International Concern.
of GHSA lacked a clear governance structure, GHSA 2024
Following the emergence of a disease that might be deemed
“aimed to be strategic and streamlined, have clear
a PHEIC, WHO convenes an advisory group, known as the
governance and collaboration structures and processes,
IHR Emergency Committee, which reviews data to make
increase engagement of the broader GHSA community,
recommendations to the WHO Director-General on control
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The Global Health Security Agenda (GHSA)
measure progress, and enhance accountability for delivering
worldwide through the Emerging Pandemic Threats (EPT)
on commitments.” The GHSA is headed by a rotating Chair
program. The PREDICT project was launched in 2009 and
and is led by a Steering Group (comprised of 15 countries,
is a key part of EPT. The second phase of the project,
including the United States, plus non-governmental
PREDICT-2 (2015-2019), reportedly helped nearly 30
stakeholders), which provides strategic guidance and
countries detect and discover viruses of pandemic potential.
direction and tracks GHSA progress and commitments.
According to USAID, the project has:
Task Forces facilitate the monitoring and implementation of
detected more than 1,100 unique viruses, 931 of which
GHSA. Through GHSA, countries can also seek assistance
were novel viruses (such as Ebola and coronaviruses);
from participating donors to develop core IHR (2005)
sampled over 163,000 animals and people; and
capacities.
provided $207 million from 2009 through 2019.
U.S. Role in GHSA. The United States has played a
leading role in the development and implementation of the
USAID has responded to 42 outbreaks through PREDICT-
GHSA. In addition to co-launching the initiative with
2, which is slated to end in March 2020 (following a three-
WHO, then-President Barack Obama hosted a number of
month extension). The agency states that the next phase of
high-level meetings on GHSA, including one at which he
the PREDICT project is under design and procurement,
announced a U.S. commitment to invest more than $1
though it has provided no further details.
billion over five years to assist at least 30 countries reach
Issues for Congressional Consideration
GHSA targets. During the 2015 G-7 Summit, G-7 leaders
agreed to match the U.S. commitment, pledging support to
Funding. The inability of resource-constrained countries to
at least 60 countries. In 2016, President Obama signed an
contain disease outbreaks can threaten national and
executive order that, among other things, established the
international security. Emergency appropriations for
National Security Council as the Chair of a GHSA
outbreak responses (e.g., $5.4 billion for the 2014-16 Ebola
Interagency Review Council. The executive order described
outbreak, $1.8 billion for the 2016 Zika outbreak, and $8.3
the role and duties of 11 U.S. agencies and departments in
billion to date for the ongoing COVID-2019 outbreak)
implementing the GHSA.
dwarf annual pandemic preparedness appropriations (Table
1), which averaged $200 million annually from FY2017 to
In 2019, President Donald Trump issued the United States
FY2020. As infectious disease outbreaks occur with
Government Global Health Security Strategy, which
increased frequency and severity, Congress may consider
reaffirmed U.S. support for GHSA and maintained U.S.
the appropriate balance between outbreak response and
support for 17 GHSA-priority countries. The strategy also
pandemic preparedness funding.
maintained the governmental roles and duties outlined in
Table 1. U.S. Global Pandemic Preparedness Funding
the Obama-era executive order.
(current U.S.$ mil ions, FY17 enacted (E) to FY21 request (R))
U.S. Pandemic Preparedness Support
FY17E FY18E FY19E FY20E FY21R
All annual appropriations for global pandemic preparedness
counts towards U.S. financial support for GHSA. GHSA-
USAID
72.5
72.5
100.0
100.0
115.0
related funding through CDC aims to:
CDC
55.1
108.2
107.8
183.2
225.0
prevent avoidable catastrophes—by improving global Source: Congressional budget justifications and appropriations.
food and drug safety, addressing antimicrobial drug
Notes: Excludes emergency appropriations or funding from other
resistance, strengthening biosafety and biosecurity,
accounts. USAID funding from the pandemic influenza line of the
improving immunization capacity, and enhancing border
Global Health Programs (GHP) account and CDC funding from the
safety and security;
global health protection line of the Global Health account.
bolster early threat detection—by establishing a global Coordination and Oversight. The United States
laboratory network, improving disease surveillance and
government has generally relied on ad hoc interagency task
monitoring
systems,
training
and
deploying
forces to organize government responses to infectious
epidemiologists and laboratory scientists, creating a
disease outbreaks. Some have called for the creation of a
bioinformatics system, and developing and disseminating
permanent pandemic preparedness task force to regularly
novel diagnostic tools; and
coordinate pandemic preparedness efforts and stand ready
facilitate effective outbreak responses—by creating an to address global disease outbreaks. A bill introduced in the
interconnected global network of Emergency Operations
House, H.R. 2166, Global Health Security Act of 2019,
Centers, establishing rapid response teams worldwide,
aims to codify the GHSA Interagency Review Council
operating a global reagent resource, and developing
outlined in the Obama executive order. Among other things,
response communications and crisis planning and
the legislation would require the publication of an annual
management tools.
report on U.S. implementation of the GHSA. The
CDC expects low-income recipient countries to contribute
Congressional Budget Office (CBO) estimates that it would
at least 10% of program costs (in-kind or financial) during
cost $1 million over five years (FY2020-FY2024) to
the first year, and to contribute half of all spending in-
maintain the Council.
country by 2025, and for middle-income recipient countries
to contribute at least 10% in 2015 and 90% by 2025.
Tiaji Salaam-Blyther, Specialist in Global Health
IF11461
U.S. Agency for International Development (USAID)-
related work aims to improve pandemic preparedness
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The Global Health Security Agenda (GHSA)
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