Health Security

Key Evidence: The detection of H1N1 influenza virus in Mexico in 2009, and subsequently throughout other countries in the Americas, benefited from the laboratory experience with measles and rubella in the region, leading to the rapid detection of and response to what eventually became a novel pandemic virus.

Key Evidence: Seasonal influenza programs can be cornerstones to pandemic preparedness and response. Using the 2009 WHO Vaccine Deployment Initiative as a case study, eligible countries with a seasonal influenza vaccine program were more ready to receive and use donated vaccines than those without a program. These findings suggest that robust seasonal influenza vaccine programs allow countries to test crucial regulatory and delivery systems that enhance pandemic preparedness while also reducing the substantial burden of seasonal influenza.

Key Evidence: The latest International Health Regulations (IHR) of the World Health Organization updated in 2005 contained several major changes compared to earlier versions. However, the need to report cases of cholera and yellow fever has remained along with an expansion of the concerned disease list. These diseases continue to be critical threats to national and international health security, making immunization against them a vital disease control approach.

Key Evidence: The development and successful implementation of a coordinated, multi-country plan in response to a wild polio outbreak in Syria and Iraq halted the outbreak within 6 months. The response, which involved strengthening acute flaccid paralysis surveillance and more than 70 synchronized mass polio vaccination campaigns in 8 Middle Eastern countries (reaching >27 million children), could serve as a model for responding to disease outbreaks in areas affected by conflict and political instability.

Key Evidence: Conflict in the Eastern Mediterranean Region impacted health infrastructure and compromised the success of the region’s measles elimination goal. At the same time that rates of migration and displacement skyrocketed, the number of measles cases in the region doubled, from 10,072 cases in 2010 to 20,898 in 2015.  

Key Evidence: In 2013 nearly all of the 175 cases of measles in the US could be traced back to international importations.

Key Evidence: The humanitarian emergency in Venezuela, and resulting collapse of its primary health care infrastructure, has caused measles and diphtheria to reemerge — disproportionately affecting indigenous populations — and spread to neighboring countries. This sets the stage for the potential reemergence of polio. The re-establishment of measles as an endemic disease in Venezuela (with >5,500 confirmed cases) and its spread to neighboring countries threaten the measles-free status.

Key Evidence: Measles cases in the US continue to occur due to importation of the disease. In 2009-2014, 74% of US measles cases were among US residents returning from overseas. Vaccinating US travelers with MMR vaccine before traveling internationally would be cost-effective or even cost-saving for those traveling to measles “hot spots”, especially if the travelers were previously unvaccinated or returning to US communities with varying MMR coverage rates. However, it would not be cost-effective for all US persons traveling overseas given the large numbers of travelers.

Key Evidence: TB and pneumococcal infections are two of 18 drug-resistant threats to US health security identified by the CDC in 2013 and are potentially vaccine-preventable. Most antibiotic resistant TB infections in the US occur in people born outside the US.