USAID Global Health Security Framing Document.pdf

USAID’s Global Health Security Program Strengthening Capacity to Prepare the World for Emerging Infectious Disease Threats

OUR MISSION

The U.S. Agency for International Development (USAID) Global Health Security (GHS) Program seeks to prevent and mitigate the increasing occurrence and severity of epidemics, pandemics and other emerging infectious disease threats. We do this by partnering with countries, as well as global, regional, and local public and private sector organizations. These partnerships build and strengthen measurable, sustainable capacity while helping to develop and adopt evidence-based and innovative solutions to prevent, rapidly detect, effectively respond to, and ultimately recover from emerging infectious disease threats – whether naturally occurring, accidental, or deliberate.

Recognizing the connection between the health of the environment, animals and people, we implement the One Health approach. Our GHS program uses an integrated approach that is inclusive of four main efforts: strengthening capacity; responding to outbreaks and other health emergencies; bolstering the GHS architecture; and building resilience in concert with USAID’s broader global health programs. This program works with USAID’s health emergency response effort, which seeks to rapidly contain outbreaks and mitigate pandemics. It also seeks to support linkages among USAID GHS-funded efforts and other USAID programs, such as: COVID-19; PEPFAR; PMI; tuberculosis and antimicrobial resistance (AMR); Maternal and Child Health and Nutrition; and food security.

USAID’s GHS program is vital to U.S. national security, key to preparing the nation and the world for biological threats, and saves lives at home and around the world. Across our nation and around the world, millions of people have lost their lives and livelihoods because the world lacked capacity to prevent, detect, and respond to COVID-19 and other emerging infectious disease threats. Our work is instrumental to achieving the outcomes envisioned in the U.S. National Biodefense Strategy, U.S. National Security Strategy, and U.S. Global Health Security Strategy. It also directly builds on the broader mission of USAID, as the world's premier international development agency, to drive development results, advance U.S. national security and economic prosperity, and promote a path to partner country self-reliance and resilience. USAID is uniquely positioned to strengthen health security capacities and promote a One Health, whole-of-society approach to GHS due to its large network of Missions, community-based programs, links to local organizations, and broad-based, multi-sectoral development approach.

OUR GOAL & VALUES

Assist countries and regions to develop and sustain capacity to prevent, detect, and rapidly respond to emerging infectious disease threats. In achieving this goal, we will promote our values of inclusivity, gender equity, and equitable, locally-led development.

MAY 2023 1

https://docs.google.com/document/d/1-TAerzN6ww_p9eC9Z4GsIpx7w3syt3Nfv6egxftUF_M/edit?usp=sharing https://docs.google.com/presentation/d/15cveSO7-PbSJnB17ghMEOuHANF6bjpL3jbbuSmudsxU/edit#slide=id.g216d128a9e2_0_0 https://docs.google.com/presentation/d/15cveSO7-PbSJnB17ghMEOuHANF6bjpL3jbbuSmudsxU/edit#slide=id.g216d128a9e2_0_0 https://www.whitehouse.gov/wp-content/uploads/2022/10/National-Biodefense-Strategy-and-Implementation-Plan-Final.pdf https://www.whitehouse.gov/wp-content/uploads/2022/10/Biden-Harris-Administrations-National-Security-Strategy-10.2022.pdf https://trumpwhitehouse.archives.gov/wp-content/uploads/2019/05/GHSS.pdf https://trumpwhitehouse.archives.gov/wp-content/uploads/2019/05/GHSS.pdf https://www.usaid.gov/about-us/mission-vision-values#:~:text=Our%20Mission%3A%20On%20behalf%20of,%2C%20peaceful%2C%20and%20prosperous%20world.

OUR TARGET

USAID’s GHS program contributes to the United States’ commitment to assist at least 50 countries and use catalytic leadership to work with key donors and partners to support at least 50 additional countries to achieve “Demonstrated Capacity” (80% achievement on the WHO IHR monitoring scale) or comparable level in at least five technical areas critical to the country by 2025 (as measured by relevant health security assessments such as the Joint External Evaluation (JEE)). This commitment is consistent with the overarching target of the Global Health Security Agenda (GHSA) multilateral initiative and the G7’s goal to achieve the same objective (demonstrated capacity in five technical areas in 100 countries). The GHSA works to build collaborations that accelerate and advocate for the achievement of these capacities.

MEASURING PROGRESS

Our progress in achieving these goals will be measured through internationally accepted metrics, especially benchmarks within the JEE IHR monitoring tool, including countries’ ability to achieve the 7-1-7 outbreak detection and response goals for major outbreaks.1

OUR EXPANSION

For more than 15 years, USAID has been a leader in promoting sustainable, whole-of-government, whole-of-society, and One Health approaches to implement GHS. In recognition of the growing risk that biological threats pose to national and international security, USAID has significantly expanded its GHS program. With generous support from Congress, USAID is doubling the number of partner countries it supports in preventing, detecting, and responding to emerging infectious disease threats. In 2023 with FY2022 funds, USAID is already taking the unprecedented step of expanding its work to at least 50 countries across sub-Saharan Africa, Asia, the Middle East, Latin America and the Caribbean, and Europe and Eurasia. USAID’s vision is for every country to be capable of addressing health security gaps and responding to major outbreaks, epidemics, and pandemics.

USAID Missions, in close collaboration with interagency and U.S. country team partners, implementers, and other donors, are key to this effort, and work with national governments, global, regional, and local organizations, and the private sector to identify targeted areas of need, develop plans, and implement programs to achieve measurable and sustainable health security capacity. As a core element of program expansion, the USAID GHS Program will support countries to achieve demonstrated capacity in at least 5 key GHS technical areas in at least 50 countries by the end of 2025. In addition, USAID will help countries to achieve internationally accepted outbreak response timeliness metrics (such as 7-1-7) USAID will also support operational research to improve effectiveness.

1 7-1-7 is an international benchmark of no more than 7 days to detect a suspected outbreak, 1 day to notify public health authorities to start an investigation, 7 days to complete an initial response.

May 2023 2 https://www.who.int/publications-detail-redirect/9789240051980 https://globalhealthsecurityagenda.org/ https://globalhealthsecurityagenda.org/ https://resolvetosavelives.org/prevent-epidemics/7-1-7-early-disease-detection#:~:text=As%20a%20metric%2C%20Resolve%20to,to%20complete%20an%20initial%20response.

KEY AREAS OFWORK

USAID will work with countries to identify and address their highest priority gaps, with a special focus on specific JEE 3rd edition technical areas, listed below. Within the context of the JEE 3rd edition, USAID Missions will have flexibility to justify other JEE technical areas (e.g., immunization, border health, emergency operations, etc.) based on National Action Plans for Health Security and real-time gaps in preparedness.

Disease Surveillance, National Laboratory System, Human Resources, Antimicrobial Resistance, Zoonotic Disease, Biosafety and Biosecurity, Infection Prevention and Control, and Risk Communication and Community Engagement.

ACTIVITIES INCLUDE

● Achieve a whole-of-government, multi-sectoral national biosafety and biosecurity system in the human, animal and agriculture sectors; improve biological risk management training and reduce dual-use risks; mitigate biological proliferation and deliberate use threats; ensure safe transfer of biological agents; and bolster legislation, laboratory licensing and pathogen control measures.

(JEE technical areas: biosafety and biosecurity, national laboratory system, zoonotic disease)

● Strengthen early warning surveillance systems to detect events of significance; improve communication and collaboration across sectors; and improve capacity to analyze data. (JEE technical areas: zoonotic disease,disease real time surveillance)

● Strengthen workforce to prevent, detect, and respond to disease threats, including One Health workforce training. (JEE technical area: human resources, zoonotic disease)

● Strengthen infection prevention and control (IPC) programs that enable safe health care and essential services delivery in health facilities, food production and the community (including markets and farms) to prevent the transmission of disease and to reduce antimicrobial resistance. (JEE technical areas: IPC, AMR)

● Improve national response to combat AMR with a One Health approach, including surveillance capacity for AMR and antimicrobial use; prevent AMR in health care facilities, food production, and the community; and ensure appropriate use of antimicrobials, including quality assurance and stewardship in human and animal health. (JEE technical area: AMR)

● Improve risk communication and community engagement (RCCE), including activities to mitigate risk, encourage appropriate treatment seeking behavior, and promote interactive communication channels as well as community preparedness activities. (JEE technical area: RCCE)

● Improve national laboratory systems, including all relevant sectors and sub-national levels, particularly human and animal health; and ensure effective modern point-of-care and laboratory-based diagnostics, quality assurance, and safe and secure specimen collection and transport. (JEE technical areas: national laboratory system, biosafety and biosecurity)

● Minimize transmission of zoonotic diseases from animals to human populations; expand real-time infectious disease surveillance as part of integrated national surveillance systems; and understand

May 2023 3 https://www.cdc.gov/globalhealth/healthprotection/resources/fact-sheets/pdf/DGHP_NAPHS_Fact_Sheet-P.pdf drivers of infectious disease spillover and spread. (JEE technical areas: disease surveillance;

zoonotic disease)

U.S. GOVERNMENT COORDINATION

USAID’s GHS Program is proudly part of the United States whole-of-government approach to assist partners to strengthen national, local, and regional health systems to better prevent, detect, and respond to biological threats in a safe and secure manner, bolstered by programs and appropriations of the U.S.

Department of State, U.S. Department of Health and Human Services, U.S. Centers for Disease Control and Prevention, U.S. Agency for International Development, U.S. Department of Defense, U.S.

Department of Agriculture, and others. To accelerate progress, across the U.S. Government and with others, the Administration utilizes the coordinated whole-of-government effort in Executive Order 13747, Executive Order 13987, National Security Memorandum-1, and National Security Memorandum-15.

ENHANCING PARTNER COMMITMENTS, ONE HEALTH, HEALTH

SYSTEMS RESILIENCE, AND RAPID OUTBREAK RESPONSE

USAID’s GHS Program will build on the One Health approach. It will also directly support and link to other key investments supported by USAID and the U.S. Government in health systems, primary health care, HIV/AIDS, tuberculosis, malaria, food security and nutrition, and maternal and child health.

IN PARTICULAR, USAID WILL LEVERAGE ITS GHS PROGRAM TO:

● Achieve Faster Outbreak Response. The GHS program funds and manages the Outbreak Response Team (ORT), which is responsible for coordinating infectious disease outbreak responses and is part of the larger USAID Global Health Emergency Management System (GHEMS) to rapidly respond to health emergencies around the world - including infectious disease outbreaks, epidemics, pandemics, and health threats caused by natural disasters, conflicts, or political and economic upheavals. USAID will implement rapid surge capacity when responding to these emergencies with technical assistance, community-based programs, deployable staff, and essential commodities to help countries address a full spectrum of infectious disease responses—from limited to major outbreaks that exceed local capacity to interrupt and contain. This effort will link GHS Program resources to fill response gaps in country and regional preparedness for outbreaks, epidemics, and pandemics and serve as a focal point for intra- and interagency coordination and leadership. USAID will utilize the Emergency Reserve Fund for Infectious Diseases for outbreaks that meet the following conditions: the outbreak is an emerging health threat; the outbreak poses severe threats to human health; and it is in the U.S. national interest to respond. USAID’s GHS Program has been key to the global management of COVID-19, Ebola, Marburg, mpox, and avian influenza outbreak responses.

● Strengthen Multilateral GHS Investments and the Global Health Security Architecture. USAID builds on the U.S. Government’s commitment to assist 50 countries to galvanize other donors, partner governments, and development and private sector partners to catalyze assistance in an additional 50 countries to achieve demonstrated capacity in five GHS

May 2023 4 https://www.govinfo.gov/content/pkg/DCPD-201600752/pdf/DCPD-201600752.pdf https://www.govinfo.gov/content/pkg/DCPD-201600752/pdf/DCPD-201600752.pdf https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/20/executive-order-organizing-and-mobilizing-united-states-government-to-provide-unified-and-effective-response-to-combat-covid-19-and-to-provide-united-states-leadership-on-global-health-and-security/ https://www.whitehouse.gov/briefing-room/statements-releases/2021/01/21/national-security-directive-united-states-global-leadership-to-strengthen-the-international-covid-19-response-and-to-advance-global-health-security-and-biological-preparedness/ https://www.whitehouse.gov/briefing-room/presidential-actions/2022/10/18/national-security-memorandum-on-countering-biological-threats-enhancing-pandemic-preparedness-and-achieving-global-health-security/ https://www.whitehouse.gov/briefing-room/presidential-actions/2022/10/18/national-security-memorandum-on-countering-biological-threats-enhancing-pandemic-preparedness-and-achieving-global-health-security/ https://www.who.int/news/item/01-12-2021-tripartite-and-unep-support-ohhlep-s-definition-of-one-health#:~:text=The%20One%20Health%20definition%20developed,of%20people%2C%20animals%20and%20ecosystems.%20Show%20less technical areas by 2025. We implement the One Health approach working closely with the quadripartite organizations , recognizing no one sector can achieve this work alone. The new2

Pandemic Fund provides a unique opportunity for USAID’s GHS Program to leverage its resources further and faster. USAID works closely with Pandemic Fund co-investors and implementing entities to find synergies that will further accelerate the achievement of our core goals and target, especially at the country level. In addition, USAID’s GHS Program supports USAID’s partnership with the Coalition for Epidemic Preparedness Innovations (CEPI) and aligns with the work of Gavi and The Global Fund to strengthen systems for the equitable development and delivery of medical countermeasures during biological crises. USAID will continue to work closely with the GHSA multilateral initiative during its next phase of operation to spur progress at the country level and to promote multi-sectoral approaches to countering infectious disease threats.

● Advance Cross-Cutting Global Health Goals and Health Systems. The COVID-19 pandemic caused major setbacks in national health and development gains. USAID will leverage its GHS Program to reduce epidemic and pandemic shocks on country health systems, link national and regional initiatives that build horizontal, non-disease specific capacity, such as safe and secure laboratory and disease surveillance systems, public and animal health workforce, and platforms for procuring, deploying, and managing countermeasures and personnel in response to health emergencies. In particular, Missions and country teams will support linkages among USAID GHS-funded efforts and other core USAID activities, such as: COVID-19 preparedness and response; PEPFAR; PMI; tuberculosis; AMR; Maternal and Child Health and Nutrition; and food security.

2 The Quadripartite refers to: the Food and Agriculture Organization of the United Nations (FAO), United Nations Environment Programme (UNEP), World Health Organization (WHO) and World Organisation for Animal Health (WOAH).

May 2023 5 https://www.worldbank.org/en/programs/financial-intermediary-fund-for-pandemic-prevention-preparedness-and-response-ppr-fif/overview