Health Security最新文献

Community resilience, a system's ability to maintain its essential functions despite disturbance, is a cornerstone of public health preparedness. However, as currently practiced, community resilience generally focuses on defined neighborhood characteristics to describe factors such as vulnerability or social capital. This ignores the way that residents of some neighborhoods (as "essential workers") were required during the COVID-19 pandemic to sacrifice their wellbeing for the sake of others staying at home in more affluent neighborhoods. Using the global care chain theory, we analyze the way that the resilience of affluent neighborhoods depends on siphoning off the labor of other, less affluent neighborhoods, creating what we call the parasitic nature of resilience. We argue that understanding this neighborhood interdependence-and accounting for its parasitic nature-should be prioritized by public health authorities to prevent unintentional harm in future pandemics. Otherwise, any public health emergency response that relies on this labor (as did the COVID-19 pandemic response) depends on exploitative practices that produce the very disparities the response is trying to address. We explore the theoretical grounding and practical effects of this idea to provide the preparedness enterprise with an initial set of theoretical tools to move from a model of community resilience to one of community renewal. The community renewal model is based on an underlying ethics of care, in which systems are redesigned to become more prosocial during a public health response. We believe this model can more successfully address the tragic inequities in labor and health outcomes that we see during public health emergencies.

As disasters increase in frequency and severity, so too does the health impact on affected populations. Disasters exacerbate the already challenging health information-sharing landscape. A reduced capacity to access and share patient information may have negative impacts on providers' ability to care for patients individually and to address disaster health outcomes at the population level. Between October 2018 and July 2019, we conducted 21 semistructured interviews with physicians experienced in providing healthcare during disasters to understand the challenges related to patient information sharing in disaster responses. Key informants noted challenges with patient information management-including accessing, sharing, and transferring information-and that it was a barrier to providing effective clinical care in disasters. Three major areas were identified as challenges: (1) lack of systematic mechanisms for patient information sharing during disaster handoffs, (2) lack of access to a patient's past medical history, and (3) population-level impacts of patient information-sharing breakdowns in disasters. Reducing barriers to effective patient information sharing is a critical need during disasters. Requirements generally fall to overburdened clinicians, and novel solutions that ease this responsibility and leverage existing infrastructure should be explored. Work conducted during the COVID-19 pandemic may inform new solutions. Integrated approaches that support information sharing in real time will improve patient care at the individual level and can support operational improvements to current and future disaster responses.

Stanford Vax Crew, one of the largest medical-student-led vaccination programs in the United States, serves as a case study of a successful community-university partnership that adapted its existing operations to enable COVID-19 vaccine distribution. It offers a model for agile, community-centered vaccination campaigns that harness diverse stakeholder strengths to promote vaccine access and uptake in underserved communities. This case study aims to outline the history and structure of the community-university partnership model developed through Stanford Vax Crew, describe key observations of factors that contributed to the scalability of the model, and provide experience-based recommendations for future community-university collaborations.

Veterinary personnel are an essential yet often underappreciated workforce, critical for zoonotic disease prevention and response efforts that impact human health. During the early COVID-19 pandemic, the veterinary workforce supported emergency responses by promoting zoonotic disease risk communication, sharing animal health expertise, and boosting laboratory surge capacity against SARS-CoV-2 in animals and people. However, small animal veterinary workers (SAVWs), similar to healthcare workers, faced organizational challenges in providing clinical care to family pets, including those susceptible to SARS-CoV-2. We analyzed a cross-sectional survey of 1,204 SAVWs in the United States to assess veterinary clinic adaptations and their associations with SAVWs' self-perceived readiness, willingness, and ability to respond to the COVID-19 pandemic as a workforce. SAVWs who worked fewer hours than before the pandemic (ready, OR 0.59; willing, OR 0.66; able, OR 0.52) or used personal protective equipment less frequently for protection in the clinic (ready, OR 0.69; willing, OR 0.69; able, OR 0.64) felt less ready, willing, and able to respond to COVID-19. SAVWs working remotely felt less ready (OR 0.46) but not less willing or able to respond to COVID-19. Lastly, SAVWs with dependents felt less ready (OR 0.67) and able (OR 0.49) to respond to COVID-19 than SAVWs without dependents. Our findings highlight the importance of proactively managing work schedules, having access to personal protective equipment, and addressing caregiving concerns to enhance SAVW preparedness and response outcomes. SAVWs are knowledgeable, motivated personnel who should be integrated into local public health emergency preparedness and response plans, supporting a One Health framework that unites multidisciplinary teams to respond to future zoonotic disease threats.

The COVID-19 pandemic illuminated the lack of resources available to US state and local public health agencies to respond to large-scale health events. Two response activities that were notably underresourced are case investigation and contact tracing (CI/CT), which health agencies routinely employ to control and prevent the transmission of infectious diseases. However, the scale of contact tracing required during the COVID-19 pandemic exceeded available resources, even in high-capacity public health agencies. For both routine outbreak response and epidemic preparedness, health agencies must have CI/CT program capacities in place prior to the detection of an outbreak to be ready to respond. Our research builds on previous work to identify the baseline CI/CT capacities needed in US state and local public health agencies to respond to any type of outbreak. Fifteen public health officials representing 10 public health agencies and 4 experts in CI/CT were interviewed about various aspects of their CI/CT program during the COVID-19 pandemic. The interviews coincided with the beginning of the 2022 mpox epidemic. Discussions on CI/CT during that response were collected to augment the interviews, where possible. Findings revealed that CI/CT capacities were underresourced prior to and during the pandemic, as well as during the mpox outbreak, even after substantial additional resourcing and efforts to scale up. Moreover, state and local health agencies encountered challenges in pivoting their COVID-19 CI/CT capacities for the mpox response, suggesting that CI/CT programs should either be designed with flexibility in mind, or should allow for specialization based on the pathogen's mode of transmission and the population at risk. Federal, state, and local health agency staff and officials should consider lessons learned from this research to plan for readily scalable and sustainable CI/CT programs to ensure readiness for future outbreaks.