Global health security: where is the data to inform health system strengthening?

Abimbola S, et al. BMJ Glob Health 2017;2:e000481. doi:10.1136/bmjgh-2017-000481 The Ebola outbreak in West Africa (2013– 2016) triggered a renewed interest and sense of urgency about global health security. A surge of reports and publications ensued, examining various aspects of emerging infectious disease outbreaks. In 2016, Olivero and colleagues published a biogeographical approach mapping favourable conditions that facilitated the Ebola outbreak, in terms of environmental factors and the presence of potential host animals. Constructing biological vulnerability maps has value to guide preparations for future emerging infectious disease outbreaks, especially in low-income and middle-income countries. But perhaps more important is the need to develop similar ‘vulnerability maps’ to capture the ability of health systems to prevent or respond to major infectious disease challenges. Without a health system vulnerability map, or the public availability of the data to generate it, efforts to achieve global health security in relation to emerging infectious disease outbreaks will likely be limited and post hoc, rather than pre-emptive and strategic. Unfortunately, the revived interest in global health security has not been matched with commensurate action. In 2014, the G7 (Group of Seven) endorsed the Global Health Security Agenda (GHSA), a partnership of governments and international organisations with the goal of accelerating the achievement of the core disease outbreak preparedness and response capacities as required by the International Health Regulations, but progress has been limited. Formal assessment of countries’ compliance with International Health Regulations is done through a Joint External Evaluation process. As part of this process, governments essentially assess themselves, followed by an independent international validation of the self-reported assessment. So far, 53 countries have initiated this Joint External Evaluation process. However, despite WHO reports that 43 Joint External Evaluation missions have been completed to date, including six GHSA-supported assessments completed in 2015, just 23 completed evaluation reports are publicly available online. This exercise is limited in terms of the number of countries covered and the speed with which it is rolled out, but more importantly the evaluations are neither objectively quantifiable nor readily tracked and the relevant measures are only evaluated at the national level. Performance at the subnational level may be as, if not more, important. Indeed, as argued by Glassman and Lofgren (2016), “If we are serious about preventing the spread of emerging infectious diseases..., generating hard data on system performance—not just a rough qualitative approximation—is key to making this global effort successful.” It is important to have a regularly updated database of national and subnational data on key criteria that reflect countries’ preparedness and response capacity to disease outbreaks. For this editorial, we examined the extent to which there is publicly available data on health system input and performance that could inform the judgement as to whether countries are adequately prepared for infectious disease outbreaks or have sufficient response capacity. To do this, we searched online databases to assess which information would be readily available if there was an event that threatened regional/global health security originating in any given country. We included a measure of trust in governments because trust in government has featured prominently in analyses highlighting limitations of national response to the West African Ebola outbreak. We also included factors related to existing accessibility of services (in terms of financial protection, availability of human resources for health, availability of drugs and supplies and quality of service delivery), because effective utilisation of, and trust in, healthcare services is essential to facilitate early case detection. Together with the quality of existing surveillance systems, we considered these elements to be the major determinants of early outbreak recognition Global health security: where is the data to inform health system strengthening?