Global Health Security Challenges and Policy Responses

The Health Hub’s first Community of Practice e-discussion concluded on the 8th of April 2016. If you would like to contribute further to this topic, please email the Health Hub Facilitation team at healthhub@commonwealth.int.


 

Summary Report Image

Click here to read the summary report

The recent outbreak of Ebola in West Africa, Zika in South America and the Cyclone in Fiji have each had significant health and economic impacts threatening global security.

This first Hub discussion allowed the Community of Practice to engage in a global conversation about the global health security challenges faced by Commonwealth countries and their citizens.

None of the recent outbreaks or environmental disasters were predicted, and global trends anticipate increasing frequency and scale of impacts from outbreaks, disasters and other environmental threats.

What is your view on how best we should strengthen health systems to ensure robust health security?

We are developing a Commonwealth Health Protection policy toolkit to present at the Commonwealth Health Ministers Meeting (CHMM) in May. How can this be strengthened to support policy?

Please find the draft copy of the policy toolkit here: Health Protection Policy Toolkit.

Discussion Themes:

As the discussion progresses it will develop its own themes which will eventually feed into a final document summarising the conversation. At present these themes are developing along the following lines:

Broadening of perspectives
Attention is drawn to the need to tackle Global Health Security by working beyond just the health field. Other sectors such as animal health, agriculture, trade, infrastructure and urban planning need to be engaged for collective action. This connects to the broader perspective of planetary health – a concept that integrates human health and environmental sustainability and which is timely in its relevance to Sustainable Development and the SDGs. Most emerging and re-emerging diseases are zoonotic in origin, whilst many of the key environmental risks come from ever advancing Climate Change and reducing Global Biodiversity, health leaders can only expect to tackle the scale of these broader issues by working in partnership with leaders in other fields to figure out how to maintain and advance global health and well-being in a sustainable way.

International Health Regulation (IHR) obligations
Health protection is coordinated at global level through the IHR (More information here: IHR Obligations), which aim to ‘to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade’. The draft Commonwealth Health Protection Policy Toolkit indicates how governments will fulfill these obligations. The toolkit also looks at the renewed drive by the international community to achieve Universal Health Coverage (UHC), as outlined in the Sustainable Development Goal 3 (Link here: SDG3), leading to increased recognition that health protection is an integral part of providing quality health care to populations.

• Would others like to comment on the feasibility of implementing IHR and wider health protection objectives in their own contexts?
• How can organisations and governments work collaboratively to best align the strengths of those with financial resources with those with the connections and motivations to carry out innovative work?
• How could a systems approach such as that suggested by the toolkit facilitate this process?

The need for a community of practice
A key objective taking this work forward will be to create a vibrant support network, a community of practice, which allows countries who might struggle to identify where to start, to seek advice, support, mentoring, and build long term partnerships in support of implementation
• Would others like to share experience of building such a community in their own countries, regions, professions?

Facilitating access to technical expertise is an area where key international and national organisations such as the Commonwealth could make a real difference.
In part, it is the recognition of this which lead to the creation of the Commonwealth health hub and its community of practice.
• How could access to technical expertise be further facilitated?
• Is the Commonwealth health hub a good place for this?

Development of a space where countries could access a reliable source of verified technical expertise as well as providing somewhere for those with proven skills to make themselves known be useful?
• Would a ‘network of networks’ be a good model to follow, would one central database be preferable or would some other model be a useful approach?
• Who would be best placed to host/fund something like this?

Submission of policy examples
So far Canada have provided their quarantine act
• Are others able to share examples from their countries?

Accessibility and affordability

Lack of adequate coverage either due to, eligibility criteria, or geographical constraints poses risks to public health as well as to the individuals concerned. These barriers need to be tackled in conjunction with comprehensive national awareness campaigns.
• Do others have experience with implementing national Health Protection policies or related programmes where they have had to consider accessibility and affordability?
• What criteria were used when writing such policies?
• Are there any lessons learned that you would like to share?

Previous Contributions:

8/4/16

Professor Vajira H. W. Dissanayake MBBS, PhD, FNASSL
Chairman of the Organising Committee (Commonwealth Medical Association, 24th Triennial Conference)
Director, Human Genetics Unit, University of Colombo
Sri Lanka

I have been following the contributions to this discussion with some interest. I am making this comment from the point of view of a representative of the medical profession, not a medical administrator, government official, or a policy maker. Concepts such as ‘global health security’, although discussed at government, inter-governmental level, and international organization levels are not concepts that the medical profession or other health care professionals at large are aware of or subscribe to.

Therefore if we are to operationalise these concepts then we have to take them to the people who can make the difference, i.e. doctors, nurses, and other health care professionals. The Commonwealth is ideally placed to do that because the Commonwealth family consists of not only the governments and inter-governmental agencies, but also professional associations such as the Commonwealth Medical Association, Commonwealth Nurses and Midwifes Federation, and other associations that represent the wider healthcare community.

These professional associations, are in fact working in almost all areas identified in the Commonwealth Health Protection Policy Toolkit. So it would be fantastic to get them to rally behind it so that they could be the advocates for widespread use of the toolkit around the Commonwealth (link here: Policy Toolkit). Then we can all work for a common cause. To do so we have to create awareness. The Commonwealth Medical Association as well as the leadership of other Commonwealth health related professional associations are meeting in Colombo, Sri Lanka from 14 to 16 October 2016 at the 24th Triennial Conference of the Commonwealth Medical Association [http://www.cma2016.org]. The Commonwealth Medical Association in collaboration with the Commonwealth Secretariat is planning several symposia at the conference to do just that, i.e. raise awareness, and perhaps also brainstorm on a plan of action for the future. I in my capacity as Chairman of the organising committee of the conference, look forward to hearing from other organisations and individuals who would like to contribute to this effort via email to vajirahwd@hotmail.com. I invite all those who are interested to contribute to this effort by participating in the conference.

Moderator’s Note [Stephen Dorey, The Commonwealth Secretariat]

Our thanks to Professor Dissanayake for his contribution.

It is always difficult to communicate a message to the very wide range of interested parties in health care. The Commonwealth Health Hub aims to provide a platform where policy makers, planners and health care workers can share lessons and good practice. Different groups will often require different forms of communication and achieving a ‘one size fits all’ approach is always going to be a challenge. The Health Hub is working on developing and piloting innovative new systems for communication to engage wider audiences across the Commonwealth.

Jack Woodall PhD
Co-founder & Assoc. Ed.
ProMED
One Health Initiative Autonomous pro bono Team

Just as traffic lights never go up at a dangerous intersection until there is a serious accident there, neither will prevention ever receive priority funding as long as countries place military spending ahead of health & education. It doesn’t matter how many cost-benefit studies show the huge savings in hospital costs, and avoidance of production losses due to illness, that can be made by preventive activities, countries place freedom from foreign domination provided by their national military strength above health.

Moderator’s Note [Stephen Dorey, The Commonwealth Secretariat]

Our thanks to Jack Woodall for his contribution which adds to the calls for attention to be focused on prevention over cure and to allocate sufficient funds to health and education.

Paulette Drakes (Mrs)
Health Educator
Barbados

Initial thoughts:

(I) Violence – devise ways to eradicate violence – in the home e.g. reducing the prevalence of toys created to promote violence; – in the environment e.g. restricting access to materials from which the toys or other equipment are made that cause damage to the environment of small and so-called ‘developing states’ which are cashed strapped and have difficulty maintaining a healthy environment; in protocols – WHO/UN or some such bodies need to have declarations that encourage countries to sign on to and be guided by the prevention of Domestic Violence in the home against women, men or children; neighbourhood violence; be careful of the World/Country leaders that are elected who advocate violence in its varying forms.

(II) Building Maintenance; – training – special programmes to train local people in proper and continuous building maintenance to reduce ‘sick building’ syndrome. Persons in this trade should HAVE to do continuing education and gain educational and perhaps practice credits in order to keep their job or receive promotion.

(III) Use the available science to show the effect on tourism and the attached limitations to world travel to help all persons see that what may be done in harm is done to all global persons. There is still the view among nationals that the ‘big countries’ wage subtle health & other wars on the so-called ‘small countries’. Some still believe that threats such as Ebola are scientifically manufactured and spread to countries that can least defend themselves against such threats so that the “big” pharmaceutical companies can come in and sell expensive drugs to make money and keep the “big” countries rich. After the DAMAGE, it is sometimes perceived that more companies come on the disguise of ‘helping’! This means that sometimes genuine efforts are perceived suspiciously.

Moderator’s Note [Stephen Dorey, The Commonwealth Secretariat]

Our thanks to Paulette Drakes for her contribution focusing on product and building regulations and the importance of using evidence based principles to guide development work. It is important that transparency and effective governance is maintained in order to prevent potentially damaging rumours and theories about motivations of actors, be they individuals, corporations or governments taking hold and simultaneously ensuring ethical and quality standards are maintained for the befit of all Commonwealth citizens.

Dr Stephen Battersby MBE
Independent Environmental Health & Housing Consultant

With increasing urbanisation pests come into closer contact with the human population and transmission of zoonotic diseases becomes more likely. On the Public Health Significance of Urban Pests see Bonnefoy X, Kampen H and Sweeney K (2008) published by WHO European Region (http://www.euro.who.int/__data/assets/pdf_file/0011/98426/E91435.pdf).

Moderator’s Note [Stephen Dorey, The Commonwealth Secretariat]

Our thanks to Dr Stephen Battersby for his contribution signposting to resources on the Public Health Significance of Urban Pests.

The Royal College of Anaesthetists
United Kingdom

The Royal College of Anaesthetists strongly feels that robust health security will only become a reality with organisations partnering together in a collaborative way. This could be through drawing on expertise, practical assistance and also funding to achieve clearly defined goals, for example being challenged by natural disasters. As highlighted within the Commonwealth Health Protection Policy Toolkit itself (link here: Policy Toolkit), health protection is one component of an effective public health system. It is important that all of the components work together to ensure the best results. This is well demonstrated in the Health Systems Policy Framework outlined on page 10 of the toolkit. Such a model, it is highlighted, would be easily transferrable and / or adapted to different countries and situations, acknowledging that there is no “one size fits all” approach to health security. Additionally, the development of / enhancement of governance and monitoring structures, undertaken in a collaborative way, would result in improvements in health security across the world.

Full contribution can be found here: Royal College of Anesthetists Contribution

Moderator’s Note [Stephen Dorey, The Commonwealth Secretariat]

Our thanks to the Royal College of Anaesthetists for their full and comprehensive contribution, of which a summary is provided above. Full details will be included in the final discussion report which will be distributed next week and can be found through the link above.

7/4/16

Dr Muhammad Wasif Alam, MD (USA); MSPH (USA)
Director Public Health and Safety Department
Dubai Health Authority – Head Quarter

We have failed to understand the meaning of “Prevention is better than cure” even after it was said hundreds of years ago. For much of it, I blame ourselves – the leaders of Public Health. Historically preventive health comes only to light when there is a catastrophe – a reactive rather than a proactive health solution. Outbreaks of emerging and re-emerging diseases, oil spills in the oceans killing millions of fish, deforestation and fire, zoonotic diseases etc. are tackled after the problem happens. The whole world is waiting to witness another catastrophe.

Time has come to use the top down approach, convincing and involving the political leaders, heads of state and ministers of health. No matter how many specialised hospitals and clinicians we produce, these will never decrease the global burden of disease (both communicable and non-communicable diseases). Investing in human life as a population approach and not as a case is a challenge that we have to overcome for the good of the most “ONE HEALTH”. The reasonable distribution of budgets for Public Health programmes may be the first motivation with meaningful action. We as Public Health leaders must join together to influence and lobby such that it happens.

David P. Kelly, MPH, MIM, MA
International Programme Manager, Office of Regulatory Affairs, Office of Global Regulatory Operation Operations and Policy, U.S. Food & Drug Administration*
DrPH candidate, London School of Hygiene & Tropical Medicine
*(David Kelly’s comments reflect his opinions only and not the positions of the U.S. Department of Health and Human Services/FDA)

The Role of Public Health Regulatory Agencies

The issues identified are all very important. A theme that is missing is the role of public health regulatory authorities in protecting and promoting public health. There needs to be more investment in public health regulatory capacity among middle- and lower-income countries. Activities could include: 1) improving import systems for foods, medicines and medical devices; 2) establishing systems for recalls of unsafe products; 3) setting up surveillance systems for adverse events and food-borne outbreaks; and 4) improving the inspection of food and medicinal product manufactures.

The last item is important because as manufactured products improve standards, this could result in more jobs – an economic determinant of health. If you have a job, you have better health.

The Commonwealth Secretariat is well-positioned to support public health regulatory capacity building by twinning regulatory authorities in upper-income countries with small states.

Moderator’s Note [Stephen Dorey, The Commonwealth Secretariat]

Our thanks to Dr. Muhammad Wasif Alam, and David P. Kelly for their contributions about the case for investing in prevention rather than cure and the need to have effective public health regulatory agencies.

The Commonwealth, including the Health Hub, has an important role to play in facilitating effective public health regulatory agencies through sharing information, best practice and governance arrangements as well as the important job of connecting key actors and resources to facilitate the often expensive process of setting up institutions.

As well as the focus on imports of food sand healthcare products and communicable and foodborne disease surveillance other important component of Public Health regulatory agencies is environmental protection, both for reasons of health security but also for reasons of social and economic resistance.

An effective approach to Global Health Security and health protection needs to ensure prevention is paramount whilst maintaining preparedness and response structures. Balancing these requires the systematic assessment of hazards and likelihoods to provide robust national risk registers to enable prioritisation of resources.

Topical to the issue of risk assessment and protecting health, the new Secretary General of the Commonwealth – Baroness Scotland – yesterday held a high level policy dialogue on Climate Change arguing that we need a Commonwealth plan to deliver on the Paris agreement made last year ‘No more excuses on decisive and effective climate action!’. More than 90 High Commissioners and climate change experts met to pinpoint the challenges facing governments in implementing the global agreement on climate change (COP21) and identified effective strategies to ensure its full implementation.

Further details of this meeting can be found at here: https://www.thecommonwealth-healthhub.net/high-level-policy-dialogue-climate-change-need-commonwealth-plan-deliver-paris-agreement/

5/4/16

Dr Paba Palihawadana
Chief Epidemiologist and National IHR Focal Point
Ministry of Health, Sri Lanka

Some discussion points:

– Conduct Commonwealth coordinated advocacy programmes regarding the importance of fully implementing International Health Regulations (IHR) for national policy makers.
– Develop a Commonwealth level forum to critically evaluated individual country progress in the implementation of IHR annually.
– Provide necessary funding and advisory support for the countries to strengthen critical IHR core capacities.
– Conduct extensive periodical reviews by independent reviewers regarding the degree of implementation of IHR and guide countries to identify gaps in the implementation of IHR and feasible solutions and guidance to address those identified gaps.
-Develop a Commonwealth level appraisal mechanism to encourage countries in compliance with IHR.

Moderator’s Note [Stephen Dorey, The Commonwealth Secretariat]

Our thanks to Dr Paba Palihawadana for the above discussion points on how to take forward obligations under the International Health Regulations.

The draft Commonwealth Health Policy Toolkit (link here: Health Policy Toolkit) indicates how governments can work towards fulfilling these obligations. The toolkit also looks at the renewed drive by the international community to achieve Universal Health Coverage (UHC) as outlined in the sustainable Development Goal 3 (SDG3), leading to increased recognition that health protection is an integral part of providing quality health care to populations.

Would others like to respond to any of the discussion points Dr Palihawadana provides, or comment on the feasibility of implementing these in their own contexts?
How could a systems approach such as that suggested by the toolkit facilitate this process?
How can organisations and governments work collaboratively to best align the strengths of those with financial resources with those with the connections and motivations to carry out innovative work?

4/4/16

Laura H. Kahn, MD, MPH, MPP
Research Scholar, Program on Science and Global Security
Woodrow Wilson School of Public and International Affairs, Princeton University
Co-Founder One Health Initiative

The global health community cannot address emerging zoonotic diseases alone. Many, if not most, of these diseases are zoonotic in origin. They are emerging, either directly or indirectly, from deforestation and environmental degradation for agriculture, specifically food animal production.

Global health leaders must work with agriculture leaders to figure out how to feed the world without unleashing disease after disease. If this approach is not taken, then we will be forever doomed to run after the fact, trying to put out fires rather than prevent them in the first place.

Moderator’s Note [Stephen Dorey, The Commonwealth Secretariat]

Our thanks to Laura Kahn for the above contribution.

Attention is drawn to the need to collaborate and develop partnerships beyond just the health field. Promed Mail from the International Society for Infectious Diseases, highlighted in the previous comment seeks to do exactly this through rapid global dissemination of information that affects human health, including diseases and toxins in animals and in plants grown for food and animal feed (http://www.promedmail.org/aboutus/).

When drawing up national policies which ministries other than health or public health do policy makers in the community engage with?

Similarly to those members in international NGOs and think thanks, who would you seek to speak to outside the health community when trying to tackle Global Health Security?

1/4/16

Mr John Wyn Owen
Senior Global Health Adviser
InterAction Council

Global health security is a global public health good and requires collective action connected to a broader perspective of planetary health – a concept that integrates human health and environmental sustainability.

COMSEC is well placed to:

1. Support the case to member states to prepare for global health emergencies as issues of national and global security, as well as addressing barriers to implementation of health protection services, including political, financial, and accountability will ensure a response capability.
2. Tackle antimicrobial resistance (AMR) as part of “One Health”.
3. Revisit the World Health Organisation programme “Health as a Bridge to Peace”, after all “sustainable development is not possible without peace and stability and the humanitarian emergencies created by war and conflict are overwhelming the international communities capacity to respond. It is by investing in more inclusive and peaceful societies and minimising risk of disasters we will be able to reduce the need for spending on humanitarian interventions” (Helen Clarke, UNDP).
4. Promote the science of implementing whole of society health engagement and health solutions and establish a Common Global Learning Network to share ideas for global health security, coupled with support for leadership development and governance OF and FOR health.

Moderator’s Note [Stephen Dorey, The Commonwealth Secretariat]

Thank you to John Wyn Owen for his contribution.

The connection is made between Global Health Security and the wider concept of ‘planetary health’. Within this a number of specific points are made about the potential role of the Commonwealth Secretariat (COMSEC), which would be useful to develop further.

We provide links to further reading on the ‘One Health’ concept, as well as the UN ‘Health as a Bridge to Peace Programme’:

One Health: http://www.onehealthinitiative.com/about.php

Links between Health Security, Promed mail and the One Health concept:

http://www.promedmail.org/aboutus/
http://www.onehealthinitiative.com/publications/ProMED%20article2.pdf

Health as a Bridge to Peace:

http://www.who.int/hac/techguidance/hbp/en/

Related to these points, we would also like to draw attention to the Health Hub plans for discussions later in the year looking at ‘Health Systems Strengthening and Anti-Microbial Resistance (AMR)’ and the ‘Role of Health in Preventing Violence’.

29/3/16

Mr Patrick Lansana
Information/Media Officer
Public Health National Emergency Operations Centre (PHNEOC) SL
Sierra Leone

Accessibility and affordability of health services are key in order to strengthen health systems in the world. Case study Sierra Leone, where the government provide free health coverage for children under five years of age, pregnant women and lactating mothers. The majority of the country’s population does not fall under those three categories.

1. People that do not fall under the free healthcare categories and can not afford the cost for health services will turn to quack nurses and doctors or may turn to traditional healers, which they believe are cheaper.
2. The absence of health facilities in some areas also push locals of such communities to turn to quack nurses and doctors or traditional healers.
3. Media and communication are key instruments to strengthen a health system. They help greatly to increase demand for health services.

In order to strengthen the health system we must:

– Build more health facilities in rural townships.
– Expand the “Free Health Care” to every citizens of a country.
– Ensure that health promotion messages should be regularly distributed through the media and in community engagements.

Moderator’s Note [Stephen Dorey, The Commonwealth Secretariat]

Thank you to Patrick Lansana for his contribution to the discussion.

Patrick highlights the importance of accessibility and affordability in delivering effective health systems. Lack of adequate coverage either due to eligibility criteria or geographical constraints poses risks to public health as well as to the individuals concerned. Patrick suggests these barriers need to be tackled in conjunction with comprehensive national health promotion campaigns.

Some of these topics are likely to come up in the next hub discussion looking at Sustainability of Funding Universal Health Coverage (UHC), however there are obvious health security implications associated with this topic.

Do others have experience with implementing national Health Protection policies or related programmes where they have had to consider accessibility and affordability?
What criteria were used when writing such policies?
Are there any lessons learned that you would like to share?

18/3/16

Ms Élaine Chatigny
Director General, Communications 
Public Health Agency of Canada

I noted the comment on challenges finding health protection policies and legislation as part of the health security discussion, so I would like to share Canada’s Quarantine Act, link: Canada Quarantine Act.

The purpose of the Act is to protect public health by taking comprehensive measures to prevent the introduction and spread of communicable diseases. The act authorises the Minster of Health to establish quarantine stations and quarantine facilities anywhere in Canada, and to designate various officers including quarantine officers, environmental health officers and screening officers. The Act authorises measures that can be taken in respect of international travellers, or other persons at an entry or departure point, who have or might have a communicable disease (one that poses a risk of significant harm to public health). It also authorises measures that can be taken in respect of conveyances arriving in or departing from Canada, and cargo on those conveyances, which could be the source of a communicable disease.

Moderator’s Note [Stephen Dorey, The Commonwealth Secretariat]

Our thanks to Élaine for sending Canada’s Quarantine Act. This is attached to the email and also available here: Canada Quarantine Act.

Do others have similar examples they would like to share or suggestions for similar legislation?
What strengths would a law like Canada’s bring to your own country or region?

16/3/16

Dr Quentin Sandifer

Cyfarwyddwr Gweithredol ar Gyfer Gwasanaethau lechyd Cyhoeddus, lechyd Cyhoeddus Cymru
Executive Director of Public Health Services and Medical Director, Public Health Wales

Global Health Security is a very important and topical issue and a great first topic for the health hub discussions. As a representative of Public Health Wales I have just returned from a mission to Sierra Leone with the Commonwealth aiming to test out the draft health protection policy toolkit. This involved a series of meetings held with the health ministry and other government departments as well as international partners including WHO, the Chinese CDC and Public Health England (PHE). These meetings looked at the challenges and experiences with health protection in the country, priorities for health professionals, system strengthening and coordination of policy.

The key challenges identified included the sustainability of resources and capacity of the workforce, multiple donors with differing agendas to coordinate and fragmentation of health systems.

A number of outcomes were identified from the meetings including:
– The development of an initial draft of a health protection policy toolkit for sierra Leone
– Feedback on the Commonwealth health protection toolkit which can be shared with other countries
– Identification of next steps in the process for taking forward polices around health protection, Universal Health Coverage (UHC) and health systems strengthening

It was a very productive and useful mission which should lead to tangible outcomes for the Sierra Leonean health system as a whole and more specifically the health protection component of this.

As a wider comment to add to the discussion it is worth noting that during the development of the Commonwealth health protection policy toolkit a search for national health policies was undertaken. This found a number of examples in the fields of Non-Communicable Diseases (NCDs) and UHC, but very little on the topics of health protection and health systems. It would be interesting to see if others have national policies they are aware of which could be shared through the hub?

Public health Wales is a part of the National Health Service (NHS) in Wales and provides professional independent public health and services to protect and improve the health and well being of the population of Wales.

Moderator’s Note [Stephen Dorey, The Commonwealth Secretariat]

Thank you for this contribution Quentin. Identification of tangible challenges and actions is a really useful contribution to the discussion.

Do others have examples of work they have been involved in to try to develop or strengthen their health protection systems or improve health security in your own countries?

The difficulty finding examples of health protection policies is also interesting to hear about. If others have examples of national policies they want to send to the hub we will be very happy to post these on the site as a resource for other policy makers and planners to use.

11/3/16

Dr Neil Squires

Chair, Faculty of Public Health Global Health Committee

Deputy Director Workforce, North of England Region, Public Health England

Many thanks for sight of the tool kit, which looks like an excellent resource. My comments relate to the level of support that needs to be in place, in addition to the on-line materials, in order to help countries apply the procedures set out in the tool kit.

It is excellent that the economic consequences of global health threats are acknowledged at the start of the tool kit document. The huge financial costs of failing to respond rapidly or at sufficient scale to global health threats provides the most powerful argument for investing in prevention, promotion, protection and people. However, we all recognise that the reality in most countries (including the UK), is that public health budgets are often sacrificed to immediate health care needs and there is generally an under-investment in public health. Support to help health leaders make the economic case for public health action will be critically important for the successful implementation of the tool kits advice.

It will also be important that countries have access to technical expertise, to help in the interpretation and application of the tool kits, enabling countries to draw down technical support from experts with relevant experience, and to learn from technical expertise across the Commonwealth as they move forward with strengthening their systems. It would be very useful for the Commonwealth Secretariat to begin to identify a database of technical expertise, that might be mobilised to support countries apply the tool kit. This might be something that Public Health England, with its increased responsibility for supporting global action to increase compliance with the IHR might be asked to support. It is also an area where the UK Faculty of Public Health could be asked to identify experts who might provide time to support country programmes.

A key objective taking this work forward will be to create a vibrant support network, a community of practice, which allows countries who might struggle to identify where to start, to seek advice, support, mentoring, and build long term partnerships in support of implementation. Such a network could facilitate exchange of experience between countries and hopefully use communication technology effectively to provide virtual support and linkages for cost effective help, rather than necessarily placing a heavy demand on short term experts flying in to offer support. The Faculty of Public Health would be very interested to work closely with the Commonwealth Secretariat, perhaps drawing on resources such as the Global Health Exchange, to develop a technical support mechanism to support use of the tool kit.

Moderator’s Note [Stephen Dorey, The Commonwealth Secretariat]

We extend our thanks to Neil Squires for making the first contribution to the discussion on Global Health Security.

Neil highlights the issue of the level of support that needs to be in place in order to help countries apply the procedures set out in the tool kit as well as the need to assist health leaders in making the economic case for public health action.

Facilitating access to technical expertise is a key area where the Commonwealth and other key international and national organisations could make a real difference. In part, it is the recognition of this which lead to the creation of the Commonwealth health hub and its community of practice.

What do you think?

Would development of a space where countries could access a reliable source of verified technical expertise as well as providing somewhere for those with proven skills to make themselves known be useful?

Would a ‘network of networks’ be a good model to follow, would one central database be preferable or would some other model be a useful approach?

Who might host/fund something like this?

We welcome your views…