Publications

How we share in the work of caring for one another during a pandemic is a common thread in the papers comprising this special feature. The collection itself represents another round of retrospection and forward thinking about ways to improve upon readiness and response for a catastrophic health event now that we have lived through the COVID-19 pandemic.

A tool for cross-sectoral prioritization of zoonotic diseases, and mapping of systems for One Health coordination.

Mass-gathering events are a public health challenge and have the potential to amplify the transmission of infectious diseases. During the COVID-19 pandemic, WHO and the Johns Hopkins Center for Health Security (Johns Hopkins University, Baltimore, MD, USA)—a WHO Collaborating Centre for Global Health Security—developed a global database of mass gatherings, which we continue to maintain. The purpose of this database is to monitor the planning and execution of mass-gathering events and to document the uptake of WHO-recommended policies by organisers; for example, the use of a risk-based approach.

At the onset of the COVID-19 pandemic, and to this day, US state, tribal, local, and territorial health departments lacked comprehensive case investigation and contact tracing (CI/CT) guidelines that clearly define the capabilities and capacities of CI/CT programs and how to scale up these programs to respond to outbreaks. This research aims to identify the capabilities and capacities of CI/CT programs and to develop a conceptual framework that represents the relationships between these program components.

Artificial intelligence (AI) systems, including foundation models such as large language models (LLMs), are rapidly becoming more powerful, and governments and industry are racing to better understand the potential benefits and risks of this technology.

The COVID-19 pandemic, while unfortunately notable for immense strain and death throughout the world, has also shown great promise in the development of medical countermeasures. As the global scientific community shifted almost entirely towards vaccines, diagnostics and therapeutics, new trial designs most significantly adaptive platform trials, began to be used with greater speed and broader reach. These designs allowed for deploying and investigating new therapeutics, repurposing currently existing therapeutics and flexibly removing or adding additional medications as data appeared in real-time. Moreover, public–private sector partnering occurred at a level not seen before, contributing greatly to the rapid development and deployment of vaccines.

Never before has the ability to rapidly detect and characterize any pathogen, be it known or novel, been so important to protecting global health. Pathogen agnostic tools, such as next-generation sequencing (NGS), enhance global biological defense and public health by addressing this exact need, but they must be deployed in a proactive manner to reach their full benefit. Using pathogen agnostic tools only during an outbreak is too retroactive and does not allow time for containment, particularly of a novel pathogen. In this commentary, we propose the development of national guidelines for a proactive, pathogen agnostic wastewater surveillance system in the United States with a focus on localities identified for risk of zoonoses and international ports of entry.

Large-scale epidemics in resource-constrained settings disrupt delivery of core health services, such as routine immunization. Rebuilding and strengthening routine immunization programs following epidemics is an essential step toward improving vaccine equity and averting future outbreaks. We performed a comparative case study analysis of routine immunization program recovery in Liberia and Haiti following the 2014-16 West Africa Ebola epidemic and 2010s cholera epidemic, respectively.

The Model State Indoor Air Quality Act (MSIAQA)¹ developed in collaboration with national advisors adopts science-based regulatory standards, such as testing, enhanced air filtration, system maintenance, and ventilation, to advance the public’s health and increase occupant productivity—ensuring that public indoor environments provide healthy air to breathe.

In late December 2019, novel human pneumonia cases were detected in Wuhan City, China. By February 2020, the disease was officially named coronavirus 19 (COVID-19),¹ and on March 11, 2020, the World Health Organization declared COVID-19 a pandemic.² As of March 30, 2022, the total number of deaths in the United States had reached 976,229 with nearly 80 million reported cases.

The COVID-19 pandemic may serve as a prime example of a 21st century public health emergency, an event accelerated and amplified by global interconnectedness, systemic fragility, and public misinformation. However, the United States continues to address this and other threats with distinctly 20th century information tools. This must change. Health emergency preparedness for modern threats requires rapid situational awareness, achieved only through common data elements, enforced information standards, investment in innovation, expert data analysis, and private sector engagement. To protect the health and safety of Americans, we must confront these challenges now and change the narrative of our future responses.

The proliferation of false and misleading health claims poses a major threat to public health. This ongoing “infodemic” has prompted numerous organizations to develop tools and approaches to manage the spread of falsehoods and communicate more effectively in an environment of mistrust and misleading information. However, these tools and approaches have not been systematically characterized, limiting their utility. This analysis provides a characterization of the current ecosystem of infodemic management strategies, allowing public health practitioners, communicators, researchers, and policy makers to gain an understanding of the tools at their disposal.

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

Improving indoor air quality (IAQ) will diminish routine exposure to airborne diseases,^1,2 limit outbreaks or epidemics,³ and lower risks of noninfectious respiratory conditions like asthma that affect the health of millions each year.⁴ Improving IAQ is also cost-effective. Proper ventilation and filtration in crowded public indoor settings can significantly reduce the costs of illness at a benefit-cost ratio ranging from 3:1 to 100:1,⁵ exceeding similar ratios for most other public health interventions.⁶

On May 24 and 25, 2023, the Johns Hopkins Center for Health Security (“the Center”) co-hosted a dialogue (“the dialogue”) with the Regional Centre for Biotechnology of the Department of Biotechnology in the Indian Ministry of Science and Technology, in Washington, DC, to discuss biosecurity issues of importance to both India and the United States. The dialogue aimed to increase knowledge of prevention and response efforts for natural, deliberate, and accidental biological threats in India and the US; share best practices and innovations; examine opportunities for partnership and collaboration; develop and deepen relationships among dialogue participants; and identify issues that should be elevated to the attention of Indian or US government officials.

The COVID-19 pandemic has caused approximately 20 million deaths worldwide (0.25% of the world's population) and brought health systems in many places to the brink of collapse. As tragic and consequential as this has been, future pandemics could be worse.

The Johns Hopkins Center for Health Security co-convened government officials and other stakeholders for a Southeast Asia Strategic Multilateral Biosecurity Dialogue meeting from April 26-28 in Cebu, Philippines. It was the first in-person meeting of this series since SARS-CoV-2 emerged in 2019. This is the meeting Report from the 2023 Dialogue Session. 

Early detection of novel pathogens can prevent or substantially mitigate biological incidents, including pandemics. Metagenomic next-generation sequencing (mNGS) of symptomatic clinical samples may enable detection early enough to contain outbreaks, limit international spread, and expedite countermeasure development. In this article, we propose a clinical mNGS architecture we call “Threat Net,” which focuses on the hospital emergency department as a high-yield surveillance location. We develop a susceptible-exposed-infected-removed (SEIR) simulation model to estimate the effectiveness of Threat Net in detecting novel respiratory pathogen outbreaks. Our analysis serves to quantify the value of routine clinical mNGS for respiratory pandemic detection by estimating the cost and epidemiological effectiveness at differing degrees of hospital coverage across the United States. We estimate that a biological threat detection network such as Threat Net could be deployed across hospitals covering 30% of the population in the United States. Threat Net would cost between $400 million and $800 million annually and have a 95% chance of detecting a novel respiratory pathogen with traits of SARS-CoV-2 after 10 emergency department presentations and 79 infections across the United States. Our analyses suggest that implementing Threat Net could help prevent or substantially mitigate the spread of a respiratory pandemic pathogen in the United States.