ABSTRACTOutbreak response, as a technical and specialized field of practice, is struggling to kee... more ABSTRACTOutbreak response, as a technical and specialized field of practice, is struggling to keep pace with the evolving dynamics of modern public health emergencies. Extensive scholarship across disciplines and epidemics has highlighted the importance of early action, the costs associated with delayed mobilization, the necessity of effective preparedness plans for complex crises, and the growing need for response to operate in spite of both uncertain information and social disruptions. Here, we present and analyze a new dataset of 235 different multisectoral activities that comprise outbreak preparedness and response. We explore the conditions under which these activities are applicable, including different phases of response, different operating circumstances, and different disease etiologies, and find that the core activities required for outbreak response largely apply across etiology and scale, but are more substantial during the early phases of response. To validate this fram...
As the COVID-19 pandemic unfolded in the spring of 2020, governments around the world began to im... more As the COVID-19 pandemic unfolded in the spring of 2020, governments around the world began to implement policies to mitigate and manage the outbreak. Significant research efforts were deployed to track and analyse these policies in real-time to better inform the response. While much of the policy analysis focused narrowly on social distancing measures designed to slow the spread of disease, here, we present a dataset focused on capturing the breadth of policy types implemented by jurisdictions globally across the whole-of-government. COVID Analysis and Mapping of Policies (COVID AMP) includes nearly 50,000 policy measures from 150 countries, 124 intermediate areas, and 235 local areas between January 2020 and June 2022. With up to 40 structured and unstructured characteristics encoded per policy, as well as the original source and policy text, this dataset provides a uniquely broad capture of the governance strategies for pandemic response, serving as a critical data source for fut...
As the COVID-19 pandemic unfolded in the spring of 2020, governments around the world began to im... more As the COVID-19 pandemic unfolded in the spring of 2020, governments around the world began to implement policies to mitigate and manage the outbreak. Significant research efforts were deployed to track and analyse these policies in real-time to better inform the response. While much of the policy analysis focused narrowly on social distancing measures designed to slow the spread of disease, here, we present a dataset focused on capturing the breadth of policy types implemented by jurisdictions globally across the whole-of-government. COVID Analysis and Mapping of Policies (COVID AMP) includes nearly 50,000 policy measures from 150 countries, 124 intermediate areas, and 235 local areas between January 2020 and June 2022. With up to 40 structured and unstructured characteristics encoded per policy, as well as the original source and policy text, this dataset provides a uniquely broad capture of the governance strategies for pandemic response, serving as a critical data source for fut...
The COVID-19 pandemic has highlighted critical gaps in global capacity to prevent, detect, and re... more The COVID-19 pandemic has highlighted critical gaps in global capacity to prevent, detect, and respond to infectious diseases. To effectively allocate investments that address these gaps, it is first necessary to quantify the extent of the need, evaluate the types of resources and activities that require additional support, and engage the global community in ongoing assessment, planning, and implementation. Which investments are needed, where, to strengthen health security? This work aims to estimate costs to strengthen country-level health security, globally and identify associated cost drivers. The cost of building public health capacity is estimated based on investments needed, per country, to progress towards the benchmarks identified by the World Health Organization’s Joint External Evaluation (JEE). For each country, costs are estimated to progress to a score of “demonstrated capacity” (4) across indicators. Over five years, an estimated US$124 billion is needed to reach “demo...
Objective: In 2020, the COVID-19 pandemic overburdened the US health care system because of exten... more Objective: In 2020, the COVID-19 pandemic overburdened the US health care system because of extended and unprecedented patient surges and supply shortages in hospitals. We investigated the extent to which several US hospitals experienced emergency department (ED) and intensive care unit (ICU) overcrowding and ventilator shortages during the COVID-19 pandemic. Methods: We analyzed Health Pulse data to assess the extent to which US hospitals reported alerts when experiencing ED overcrowding, ICU overcrowding, and ventilator shortages from March 7, 2020, through April 30, 2021. Results: Of 625 participating hospitals in 29 states, 393 (63%) reported at least 1 hospital alert during the study period: 246 (63%) reported ED overcrowding, 239 (61%) reported ICU overcrowding, and 48 (12%) reported ventilator shortages. The number of alerts for overcrowding in EDs and ICUs increased as the number of COVID-19 cases surged. Conclusions: Timely assessment and communication about critical factor...
The World Health Organization (WHO) notifies the global community about disease outbreaks through... more The World Health Organization (WHO) notifies the global community about disease outbreaks through the Disease Outbreak News (DON). These online reports tell important stories about both outbreaks themselves and the high-level decision making that governs information sharing during public health emergencies. However, they have been used only minimally in global health scholarship to date. Here, we collate all 2,789 of these reports from their first use through the start of the Covid-19 pandemic (January 1996 to December 2019), and develop an annotated database of the subjective and often inconsistent information they contain. We find that these reports are dominated by a mix of persistent worldwide threats (particularly influenza and cholera) and persistent epidemics (like Ebola virus disease in Africa or MERS-CoV in the Middle East), but also document important periods in history like the anthrax bioterrorist attacks at the turn of the century, the spread of chikungunya and Zika vir...
C OVID-19 has caused a moment of reckoning for the international community. For decades, experts ... more C OVID-19 has caused a moment of reckoning for the international community. For decades, experts in national security, public health, and global health security have warned of pandemic risk and recommended strategies to prevent and mitigate infectious disease outbreaks. Working across governments, international organizations, and the private and nonprofit sectors, these experts issued threat assessments, assessed capability gaps, developed pandemic preparedness plans, and created global frameworks to mitigate and manage biological risk. With over 6 million lives lost to COVID-19 as of March 17, 2022, 1 there is a need to assess how governments and organizations translated knowledge into preparedness efforts. Many studies have analyzed governments' responses to COVID-19 and previous outbreaks, 2-4 but few have attempted to link these efforts to the warnings and recommendations of pandemic experts. 5 Identification and analysis of myriad publications that reflect prepandemic activity may offer clues to both best practices and missed opportunities for infectious disease preparedness. However, such deconstruction of how the pandemic unfolded in the context of the actions that preceded it requires access to a wide swath of information not immediately available in any single location. As a result, individuals and groups working on after-action reviews or codifying lessons learned for system improvement are often working without the full evidence base that could optimize their work. Access to the large yet fragmented body of global health security work is paramount to provide a historical picture of efforts to prevent and prepare for biological threats. Particularly in the context of COVID-19, it will be essential to undertake after-action review, address gaps in preparedness, and craft forward-looking strategies informed by past lessons. To support these efforts, we developed Health Security Net, 6 a centralized repository of expert-curated global health security resources. Health Security Net contains more than 2,000 collated and annotated resources, which are publicly available online at healthsecuritynet.org.
IntroductionThe Global Fund to Fight AIDS, TB, and Malaria (the Global Fund) pivoted investments ... more IntroductionThe Global Fund to Fight AIDS, TB, and Malaria (the Global Fund) pivoted investments to support countries in their response to the COVID-19 pandemic. Recently, the Global Fund’s Board approved global pandemic preparedness and response as part of their new six-year strategy from 2023-2028.MethodsPrior research estimated that US$124 billion is required, globally, to build sufficient country-level capacity for health security, with US$76 billion needed over an initial three-year period. Action-based cost estimates generated from that research were coded as directly, indirectly, or unrelated to systems strengthening efforts applicable to HIV, TB, and/or malaria.ResultsOf approximately US$76 billion needed for country level capacity-building over the next three-year allocation period, we estimate that US$66 billion is needed in Global Fund-eligible countries, and over one-third relates directly or indirectly (US$6 billion and US$21 billion, respectively) to health systems str...
Following the identification of the Omicron variant of the SARS-CoV-2 virus in late November 2021... more Following the identification of the Omicron variant of the SARS-CoV-2 virus in late November 2021, governments worldwide took actions intended to minimize the impact of the new variant within their borders. Despite guidance from the World Health Organization advising a risk-based approach, many rapidly implemented stringent policies focused on travel restrictions. In this paper, we capture 221 national-level travel policies issued during the three weeks following publicization of the Omicron variant. We characterize policies based upon whether they target travelers from specific countries or focus more broadly on enhanced screening, and explore differences in approaches at the regional level. We find that initial reactions almost universally focused on entry bans and flight suspensions from Southern Africa, and that policies continued to target travel from these countries even after community transmission of the Omicron variant was detected elsewhere in the world. While layered test...
During an influenza pandemic, healthcare facilities are likely to be filled to capacity, leading ... more During an influenza pandemic, healthcare facilities are likely to be filled to capacity, leading to delays in seeing a provider and obtaining treatment. Flu on Call is a collaborative effort between the US Centers for Disease Control and Prevention and partners to develop a toll-free telephone helpline to reduce the burden on healthcare facilities and improve access to antivirals for people who are ill during an influenza pandemic. This study tested the feasibility of Flu on Call during a 1day simulation using a severe pandemic scenario. Trained volunteer actors placed calls to the helpline using prepared scripts that were precoded for an expected outcome (''disposition'') of the call. Scripts represented callers who were ill, those calling for someone else who was ill, and callers who were only seeking information. Information specialists and medical professionals managed the calls. Results demonstrated that Flu on Call may effectively assist callers during a pandemic, increase access to antiviral prescriptions, and direct patients to the appropriate level of care. Overall, 84% of calls exactly matched the expected call disposition; few calls (2%) were undermanaged (eg, the caller was ill but not transferred to a medical professional or received advice from the medical professional that was less intensive than what was warranted). Callers indicated a high level of satisfaction (83% reported their needs were met). Because of the high volume of calls that may be received during a severe pandemic, the Flu on Call platform should evolve to include additional triage channels (eg, through internet, chat, and/or text access).
Resilience is the ability of a community to respond to and recover from disaster. The characteris... more Resilience is the ability of a community to respond to and recover from disaster. The characteristics of a community that impact resilience include demographic statistics, built infrastructure, the natural environment, economic robustness, and community planning efforts and can number in the hundreds. Critically, these characteristics are not often linked to the hazards to which a community is at risk, limiting the ability of a community to make risk-informed, targeted investment decisions. To help communities prioritize investments in resilience, we describe here a method to define hazard-specific risk based on hazard impacts, correlated with the resilience characteristics aligned with community priorities, and rank these investments based on their relative benefit. Using flood as the proof-ofprinciple hazard, we describe a method and corresponding decision support tool, in development through an effort funded by the US Department of Homeland Security Science and Technology Directo...
How does the use of criminal law affect disease-fighting efforts, particularly in a pandemic? Thi... more How does the use of criminal law affect disease-fighting efforts, particularly in a pandemic? This longstanding question for governments around the world is felt acutely in the context of the COVID-19 and HIV pandemics. Many countries have laws and policies that criminalise behaviours, making same-sex relationships, illicit drug use, and sex work illegal. Meanwhile, some countries have enshrined gender- and rights-protective institutions in law. Under the global AIDS strategy of the last five years, national AIDS response efforts in countries have focused on reaching people living with HIV with testing and antiretroviral treatment to suppress the HIV virus, preventing mortality and HIV transmission. At the end of this 5-year push, this article provides an ecological analysis of whether those countries with criminalising legal environments achieved more or less success. In countries where same-sex relationships were fully criminalised, the portion of people living with HIV who knew t...
Law and policy differences help explain why, as HIV-related science has advanced swiftly, some co... more Law and policy differences help explain why, as HIV-related science has advanced swiftly, some countries have realised remarkable progress on AIDS while others see expanding epidemics. We describe the structure and findings of a new dataset and research platform, the HIV Policy Lab, which fills an important knowledge gap by measuring the HIV-related policy environment across 33 indicators and 194 countries over time, with online access and visualisation. Cross-national indicators can be critical tools in international governance—building social power to monitor state behaviour with the potential to change policy and improve domestic accountability. This new and evolving effort collects data about policy through review of legal documents, official government reports and systematic review of secondary sources. Alignment between national policy environments and global norms is demonstrated through comparison with international public health guidance and agreements. We demonstrate subst...
Flood risk planning and emergency response at community levels rely on fast access to accurate in... more Flood risk planning and emergency response at community levels rely on fast access to accurate inundation models that identify geographic areas, assets, and populations that may be flooded. However, limited flood modelling resources are available to support these events and activities. We present a computationally-efficient flood model for facilitating rapid risk analysis across a wide range of scenarios and decision support to operational, crisis action, local flood-fight, and community planning efforts. Our flood depth regression method converts publicly-available river stage heights to flood depths, then downscales the depths from gage locations onto high resolution National Hydrography Dataset flowlines and estimates areas and depths of flooding by subtraction of the National Elevation Dataset from modelled water surface elevations. We demonstrate proof-of-principle analyses for historic 2009 Red River of the North flooding in the United States, achieving comprehensive mainstem flood estimation for the length of the river and depth accuracy of 1.4 ft (0.4 m) compared to gage observations, remote sensing, and higher-resolution hydrologic models. We
Managing infectious disease requires rapid and effective response to support decision making. The... more Managing infectious disease requires rapid and effective response to support decision making. The decisions are complex and require understanding of the diseases, disease intervention and control measures, and the disease-relevant characteristics of the local community. Though disease modeling frameworks have been developed to address these questions, the complexity of current models presents a significant barrier to community-level decision makers in using the outputs of the most scientifically robust methods to support pragmatic decisions about implementing a public health response effort, even for endemic diseases with which they are already familiar. Here, we describe the development of an application available on the internet, including from mobile devices, with a simple user interface, to support on-the-ground decision-making for integrating disease control programs, given local conditions and practical constraints. The model upon which the tool is built provides predictive analysis for the effectiveness of integration of schistosomiasis and malaria control, two diseases with extensive geographical and epidemiological overlap, and which result in significant morbidity and mortality in affected regions. Working with data from countries across sub-Saharan Africa and the Middle East, we present a proof-of-principle method and corresponding prototype tool to provide guidance on how to optimize integration of vertical disease control programs. This method and tool demonstrate significant progress in effectively translating the best available scientific models to support practical decision making on the ground with the potential to significantly increase the efficacy and cost-effectiveness of disease control.
Countries, philanthropies, and private sector organizations have been actively investing in globa... more Countries, philanthropies, and private sector organizations have been actively investing in global health security around the world. However, despite the coordinated approach to funding within the Global Health Security Agenda, there is currently no well-established method to track the commitment and disbursal of funds for global health security from funders to recipients or to identify the activities supported by existing funding initiatives. To address this need, we developed the Global Health Security Tracking Dashboard. This interactive, publicly available, Web-based dashboard maps the flow of funds from funder to recipient and categorizes the target efforts of those funds, allowing users to identify patterns of influence and success in health security funding implementation. The dashboard provides an evidence-based approach for defining targets for future funding by identifying the areas in which funds have not yet been effectively allocated, showcasing successes, and providing a source of information to promote mutual accountability.
ABSTRACTOutbreak response, as a technical and specialized field of practice, is struggling to kee... more ABSTRACTOutbreak response, as a technical and specialized field of practice, is struggling to keep pace with the evolving dynamics of modern public health emergencies. Extensive scholarship across disciplines and epidemics has highlighted the importance of early action, the costs associated with delayed mobilization, the necessity of effective preparedness plans for complex crises, and the growing need for response to operate in spite of both uncertain information and social disruptions. Here, we present and analyze a new dataset of 235 different multisectoral activities that comprise outbreak preparedness and response. We explore the conditions under which these activities are applicable, including different phases of response, different operating circumstances, and different disease etiologies, and find that the core activities required for outbreak response largely apply across etiology and scale, but are more substantial during the early phases of response. To validate this fram...
As the COVID-19 pandemic unfolded in the spring of 2020, governments around the world began to im... more As the COVID-19 pandemic unfolded in the spring of 2020, governments around the world began to implement policies to mitigate and manage the outbreak. Significant research efforts were deployed to track and analyse these policies in real-time to better inform the response. While much of the policy analysis focused narrowly on social distancing measures designed to slow the spread of disease, here, we present a dataset focused on capturing the breadth of policy types implemented by jurisdictions globally across the whole-of-government. COVID Analysis and Mapping of Policies (COVID AMP) includes nearly 50,000 policy measures from 150 countries, 124 intermediate areas, and 235 local areas between January 2020 and June 2022. With up to 40 structured and unstructured characteristics encoded per policy, as well as the original source and policy text, this dataset provides a uniquely broad capture of the governance strategies for pandemic response, serving as a critical data source for fut...
As the COVID-19 pandemic unfolded in the spring of 2020, governments around the world began to im... more As the COVID-19 pandemic unfolded in the spring of 2020, governments around the world began to implement policies to mitigate and manage the outbreak. Significant research efforts were deployed to track and analyse these policies in real-time to better inform the response. While much of the policy analysis focused narrowly on social distancing measures designed to slow the spread of disease, here, we present a dataset focused on capturing the breadth of policy types implemented by jurisdictions globally across the whole-of-government. COVID Analysis and Mapping of Policies (COVID AMP) includes nearly 50,000 policy measures from 150 countries, 124 intermediate areas, and 235 local areas between January 2020 and June 2022. With up to 40 structured and unstructured characteristics encoded per policy, as well as the original source and policy text, this dataset provides a uniquely broad capture of the governance strategies for pandemic response, serving as a critical data source for fut...
The COVID-19 pandemic has highlighted critical gaps in global capacity to prevent, detect, and re... more The COVID-19 pandemic has highlighted critical gaps in global capacity to prevent, detect, and respond to infectious diseases. To effectively allocate investments that address these gaps, it is first necessary to quantify the extent of the need, evaluate the types of resources and activities that require additional support, and engage the global community in ongoing assessment, planning, and implementation. Which investments are needed, where, to strengthen health security? This work aims to estimate costs to strengthen country-level health security, globally and identify associated cost drivers. The cost of building public health capacity is estimated based on investments needed, per country, to progress towards the benchmarks identified by the World Health Organization’s Joint External Evaluation (JEE). For each country, costs are estimated to progress to a score of “demonstrated capacity” (4) across indicators. Over five years, an estimated US$124 billion is needed to reach “demo...
Objective: In 2020, the COVID-19 pandemic overburdened the US health care system because of exten... more Objective: In 2020, the COVID-19 pandemic overburdened the US health care system because of extended and unprecedented patient surges and supply shortages in hospitals. We investigated the extent to which several US hospitals experienced emergency department (ED) and intensive care unit (ICU) overcrowding and ventilator shortages during the COVID-19 pandemic. Methods: We analyzed Health Pulse data to assess the extent to which US hospitals reported alerts when experiencing ED overcrowding, ICU overcrowding, and ventilator shortages from March 7, 2020, through April 30, 2021. Results: Of 625 participating hospitals in 29 states, 393 (63%) reported at least 1 hospital alert during the study period: 246 (63%) reported ED overcrowding, 239 (61%) reported ICU overcrowding, and 48 (12%) reported ventilator shortages. The number of alerts for overcrowding in EDs and ICUs increased as the number of COVID-19 cases surged. Conclusions: Timely assessment and communication about critical factor...
The World Health Organization (WHO) notifies the global community about disease outbreaks through... more The World Health Organization (WHO) notifies the global community about disease outbreaks through the Disease Outbreak News (DON). These online reports tell important stories about both outbreaks themselves and the high-level decision making that governs information sharing during public health emergencies. However, they have been used only minimally in global health scholarship to date. Here, we collate all 2,789 of these reports from their first use through the start of the Covid-19 pandemic (January 1996 to December 2019), and develop an annotated database of the subjective and often inconsistent information they contain. We find that these reports are dominated by a mix of persistent worldwide threats (particularly influenza and cholera) and persistent epidemics (like Ebola virus disease in Africa or MERS-CoV in the Middle East), but also document important periods in history like the anthrax bioterrorist attacks at the turn of the century, the spread of chikungunya and Zika vir...
C OVID-19 has caused a moment of reckoning for the international community. For decades, experts ... more C OVID-19 has caused a moment of reckoning for the international community. For decades, experts in national security, public health, and global health security have warned of pandemic risk and recommended strategies to prevent and mitigate infectious disease outbreaks. Working across governments, international organizations, and the private and nonprofit sectors, these experts issued threat assessments, assessed capability gaps, developed pandemic preparedness plans, and created global frameworks to mitigate and manage biological risk. With over 6 million lives lost to COVID-19 as of March 17, 2022, 1 there is a need to assess how governments and organizations translated knowledge into preparedness efforts. Many studies have analyzed governments' responses to COVID-19 and previous outbreaks, 2-4 but few have attempted to link these efforts to the warnings and recommendations of pandemic experts. 5 Identification and analysis of myriad publications that reflect prepandemic activity may offer clues to both best practices and missed opportunities for infectious disease preparedness. However, such deconstruction of how the pandemic unfolded in the context of the actions that preceded it requires access to a wide swath of information not immediately available in any single location. As a result, individuals and groups working on after-action reviews or codifying lessons learned for system improvement are often working without the full evidence base that could optimize their work. Access to the large yet fragmented body of global health security work is paramount to provide a historical picture of efforts to prevent and prepare for biological threats. Particularly in the context of COVID-19, it will be essential to undertake after-action review, address gaps in preparedness, and craft forward-looking strategies informed by past lessons. To support these efforts, we developed Health Security Net, 6 a centralized repository of expert-curated global health security resources. Health Security Net contains more than 2,000 collated and annotated resources, which are publicly available online at healthsecuritynet.org.
IntroductionThe Global Fund to Fight AIDS, TB, and Malaria (the Global Fund) pivoted investments ... more IntroductionThe Global Fund to Fight AIDS, TB, and Malaria (the Global Fund) pivoted investments to support countries in their response to the COVID-19 pandemic. Recently, the Global Fund’s Board approved global pandemic preparedness and response as part of their new six-year strategy from 2023-2028.MethodsPrior research estimated that US$124 billion is required, globally, to build sufficient country-level capacity for health security, with US$76 billion needed over an initial three-year period. Action-based cost estimates generated from that research were coded as directly, indirectly, or unrelated to systems strengthening efforts applicable to HIV, TB, and/or malaria.ResultsOf approximately US$76 billion needed for country level capacity-building over the next three-year allocation period, we estimate that US$66 billion is needed in Global Fund-eligible countries, and over one-third relates directly or indirectly (US$6 billion and US$21 billion, respectively) to health systems str...
Following the identification of the Omicron variant of the SARS-CoV-2 virus in late November 2021... more Following the identification of the Omicron variant of the SARS-CoV-2 virus in late November 2021, governments worldwide took actions intended to minimize the impact of the new variant within their borders. Despite guidance from the World Health Organization advising a risk-based approach, many rapidly implemented stringent policies focused on travel restrictions. In this paper, we capture 221 national-level travel policies issued during the three weeks following publicization of the Omicron variant. We characterize policies based upon whether they target travelers from specific countries or focus more broadly on enhanced screening, and explore differences in approaches at the regional level. We find that initial reactions almost universally focused on entry bans and flight suspensions from Southern Africa, and that policies continued to target travel from these countries even after community transmission of the Omicron variant was detected elsewhere in the world. While layered test...
During an influenza pandemic, healthcare facilities are likely to be filled to capacity, leading ... more During an influenza pandemic, healthcare facilities are likely to be filled to capacity, leading to delays in seeing a provider and obtaining treatment. Flu on Call is a collaborative effort between the US Centers for Disease Control and Prevention and partners to develop a toll-free telephone helpline to reduce the burden on healthcare facilities and improve access to antivirals for people who are ill during an influenza pandemic. This study tested the feasibility of Flu on Call during a 1day simulation using a severe pandemic scenario. Trained volunteer actors placed calls to the helpline using prepared scripts that were precoded for an expected outcome (''disposition'') of the call. Scripts represented callers who were ill, those calling for someone else who was ill, and callers who were only seeking information. Information specialists and medical professionals managed the calls. Results demonstrated that Flu on Call may effectively assist callers during a pandemic, increase access to antiviral prescriptions, and direct patients to the appropriate level of care. Overall, 84% of calls exactly matched the expected call disposition; few calls (2%) were undermanaged (eg, the caller was ill but not transferred to a medical professional or received advice from the medical professional that was less intensive than what was warranted). Callers indicated a high level of satisfaction (83% reported their needs were met). Because of the high volume of calls that may be received during a severe pandemic, the Flu on Call platform should evolve to include additional triage channels (eg, through internet, chat, and/or text access).
Resilience is the ability of a community to respond to and recover from disaster. The characteris... more Resilience is the ability of a community to respond to and recover from disaster. The characteristics of a community that impact resilience include demographic statistics, built infrastructure, the natural environment, economic robustness, and community planning efforts and can number in the hundreds. Critically, these characteristics are not often linked to the hazards to which a community is at risk, limiting the ability of a community to make risk-informed, targeted investment decisions. To help communities prioritize investments in resilience, we describe here a method to define hazard-specific risk based on hazard impacts, correlated with the resilience characteristics aligned with community priorities, and rank these investments based on their relative benefit. Using flood as the proof-ofprinciple hazard, we describe a method and corresponding decision support tool, in development through an effort funded by the US Department of Homeland Security Science and Technology Directo...
How does the use of criminal law affect disease-fighting efforts, particularly in a pandemic? Thi... more How does the use of criminal law affect disease-fighting efforts, particularly in a pandemic? This longstanding question for governments around the world is felt acutely in the context of the COVID-19 and HIV pandemics. Many countries have laws and policies that criminalise behaviours, making same-sex relationships, illicit drug use, and sex work illegal. Meanwhile, some countries have enshrined gender- and rights-protective institutions in law. Under the global AIDS strategy of the last five years, national AIDS response efforts in countries have focused on reaching people living with HIV with testing and antiretroviral treatment to suppress the HIV virus, preventing mortality and HIV transmission. At the end of this 5-year push, this article provides an ecological analysis of whether those countries with criminalising legal environments achieved more or less success. In countries where same-sex relationships were fully criminalised, the portion of people living with HIV who knew t...
Law and policy differences help explain why, as HIV-related science has advanced swiftly, some co... more Law and policy differences help explain why, as HIV-related science has advanced swiftly, some countries have realised remarkable progress on AIDS while others see expanding epidemics. We describe the structure and findings of a new dataset and research platform, the HIV Policy Lab, which fills an important knowledge gap by measuring the HIV-related policy environment across 33 indicators and 194 countries over time, with online access and visualisation. Cross-national indicators can be critical tools in international governance—building social power to monitor state behaviour with the potential to change policy and improve domestic accountability. This new and evolving effort collects data about policy through review of legal documents, official government reports and systematic review of secondary sources. Alignment between national policy environments and global norms is demonstrated through comparison with international public health guidance and agreements. We demonstrate subst...
Flood risk planning and emergency response at community levels rely on fast access to accurate in... more Flood risk planning and emergency response at community levels rely on fast access to accurate inundation models that identify geographic areas, assets, and populations that may be flooded. However, limited flood modelling resources are available to support these events and activities. We present a computationally-efficient flood model for facilitating rapid risk analysis across a wide range of scenarios and decision support to operational, crisis action, local flood-fight, and community planning efforts. Our flood depth regression method converts publicly-available river stage heights to flood depths, then downscales the depths from gage locations onto high resolution National Hydrography Dataset flowlines and estimates areas and depths of flooding by subtraction of the National Elevation Dataset from modelled water surface elevations. We demonstrate proof-of-principle analyses for historic 2009 Red River of the North flooding in the United States, achieving comprehensive mainstem flood estimation for the length of the river and depth accuracy of 1.4 ft (0.4 m) compared to gage observations, remote sensing, and higher-resolution hydrologic models. We
Managing infectious disease requires rapid and effective response to support decision making. The... more Managing infectious disease requires rapid and effective response to support decision making. The decisions are complex and require understanding of the diseases, disease intervention and control measures, and the disease-relevant characteristics of the local community. Though disease modeling frameworks have been developed to address these questions, the complexity of current models presents a significant barrier to community-level decision makers in using the outputs of the most scientifically robust methods to support pragmatic decisions about implementing a public health response effort, even for endemic diseases with which they are already familiar. Here, we describe the development of an application available on the internet, including from mobile devices, with a simple user interface, to support on-the-ground decision-making for integrating disease control programs, given local conditions and practical constraints. The model upon which the tool is built provides predictive analysis for the effectiveness of integration of schistosomiasis and malaria control, two diseases with extensive geographical and epidemiological overlap, and which result in significant morbidity and mortality in affected regions. Working with data from countries across sub-Saharan Africa and the Middle East, we present a proof-of-principle method and corresponding prototype tool to provide guidance on how to optimize integration of vertical disease control programs. This method and tool demonstrate significant progress in effectively translating the best available scientific models to support practical decision making on the ground with the potential to significantly increase the efficacy and cost-effectiveness of disease control.
Countries, philanthropies, and private sector organizations have been actively investing in globa... more Countries, philanthropies, and private sector organizations have been actively investing in global health security around the world. However, despite the coordinated approach to funding within the Global Health Security Agenda, there is currently no well-established method to track the commitment and disbursal of funds for global health security from funders to recipients or to identify the activities supported by existing funding initiatives. To address this need, we developed the Global Health Security Tracking Dashboard. This interactive, publicly available, Web-based dashboard maps the flow of funds from funder to recipient and categorizes the target efforts of those funds, allowing users to identify patterns of influence and success in health security funding implementation. The dashboard provides an evidence-based approach for defining targets for future funding by identifying the areas in which funds have not yet been effectively allocated, showcasing successes, and providing a source of information to promote mutual accountability.
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Papers by Ellie Graeden