GLOBAL HEALTH RISK FRAMEWORK

Governance for
Global Health

__________

WORKSHOP SUMMARY

Alison Mack, Megan R. Snair, and Eileen R. Choffnes, Rapporteurs

Forum on Microbial Threats

Board on Global Health

Institute of Medicine

THE NATIONAL ACADEMIES PRESS

Washington, DC

www.nap.edu

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This activity was supported by Grant No. 10002589 from The Bill & Melinda Gates Foundation, Grant No. 10002593 from the Ford Foundation, Grant No. 10002605 from the Gordon and Betty Moore Foundation, Grant No. 10002606 from Mr. Ming Wai Lau, a grant from the Paul G. Allen Family Foundation, Grant No. 10002603 from The Rockefeller Foundation, Contract No. 10002604 with the U.S. Agency for International Development, and Grant No. 10002596 from the Wellcome Trust.

The Forum on Microbial Threats is supported by Contract No. 10001261 with the Alfred P. Sloan Foundation; a grant from the American Society for Microbiology; a grant from the Infectious Diseases Society of America; Contract No. 1001740 with the Johnson & Johnson Family of Companies Foundation; Contract No. 10002502 with the Merck Company Foundation; a grant from Sanofi Pasteur; a grant from the Skoll Global Threats Fund; Contract No. 10000792 with the Uniformed Services University of the Health Sciences; Contract No. 8008 with the U.S. Agency for International Development; Contract Nos. 10001249 and 10001936 with the U.S. Department of Defense; Contract Nos. 10002125, 10002270, and 10002642 with the U.S. Department of Health and Human Services; Contract No. 10002574 with the U.S. Department of Homeland Security; Contract No. 10002338 with the U.S. Department of Justice; and Contract No. 10002578 with the U.S. Department of Veterans Affairs.

Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-38104-8
International Standard Book Number-10: 0-309-38104-5
Digital Object Identifier: 10.17226/21854

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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2016. Global health risk framework: Governance for global health: Workshop summary. Washington, DC: The National Academies Press. doi: 10.17226/21854.

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PLANNING COMMITTEE ON GLOBAL HEALTH
RISK FRAMEWORK: A WORKSHOP ON
GOVERNANCE FOR GLOBAL HEALTH¹

LAWRENCE GOSTIN, Professor of Global Health Law, Georgetown University

DAVID HEYMANN, Chairman, Public Health England

JAMES M. HUGHES, Professor of Medicine and Public Health, Emory University

LONNIE J. KING, Dean, College of Veterinary Medicine, Ohio State University

DAVID RELMAN, Professor of Immunology and Microbiology, Stanford University

MIRTA ROSES PERIAGO, Latin American and Caribbean Representative, The Global Fund to Fight AIDS, Tuberculosis and Malaria

OYEWALE TOMORI, President, Nigerian Academy of Science

IOM Staff

EILEEN CHOFFNES, Project Director (until November 2015)

MEGAN REEVE SNAIR, Program Officer (from November 2015)

RACHEL PITTLUCK, Research Associate (from March 2016)

DAVID GARRISON, Senior Program Assistant (from November 2015)

JOANNA ROBERTS, Senior Program Assistant (until September 2015)

__________________

¹ The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.

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FORUM ON MICROBIAL THREATS¹

DAVID A. RELMAN (Chair), Stanford University, Palo Alto, CA

JAMES M. HUGHES (Vice Chair), Emory University, Atlanta, GA

LONNIE J. KING (Vice Chair), College of Veterinary Medicine, Ohio State University, Columbus

KEVIN ANDERSON, Science and Technology Directorate, U.S. Department of Homeland Security, Washington, DC

MICHAEL BELL, Walter Reed Army Institute of Research, Silver Spring, MD

ENRIQUETA C. BOND, QE Philanthropic Advisors, Marshall, VA

LUCIANA BORIO, Office of Counterterrorism and Emerging Threats, Office of the Commissioner, U.S. Food and Drug Administration, Silver Spring, MD

ROGER G. BREEZE, Lawrence Livermore National Laboratory, Livermore, CA

ARTURO CASADEVALL, The W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

ANDREW CLEMENTS, Pandemic Influenza and Other Emerging Threats Unit, U.S. Agency for International Development, Washington, DC

PETER DASZAK, EcoHealth Alliance, New York, NY

JEFFREY S. DUCHIN, Communicable Disease Epidemiology & Immunization Section for Public Health–Seattle & King County, WA

MARK B. FEINBERG, Chief Public Health and Science Officer, Merck & Co., Inc.

AARON M. FIROVED, Office of Health Affairs, U.S. Department of Homeland Security, Washington, DC

JACQUELINE FLETCHER, Oklahoma State University, Stillwater

CLAIRE FRASER, Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore

JENNIFER GARDY, British Columbia Centre for Disease Control, Vancouver, Canada

JESSE L. GOODMAN, Center on Medical Product Access, Safety, and Stewardship, Georgetown University, Washington, DC

EDUARDO GOTUZZO, Instituto de Medicina Tropical–Alexander von Humboldt, Universidad Peruaña Cayetano Heredia, Lima, Peru

___________________

¹ The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.

CAROLE A. HEILMAN, Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD

DAVID L. HEYMANN, Public Health England, London

STEPHEN A. JOHNSTON, Center for Innovations in Medicine, Biodesign Institute, Arizona State University, Tempe

KENT E. KESTER, Translational Science & Biomarkers, Sanofi Pasteur, Swiftwater, PA

GERALD T. KEUSCH, Boston University School of Public Health, MA

RIMA F. KHABBAZ, Centers for Disease Control and Prevention, Atlanta, GA

MARK KORTEPETER, Uniformed Services University of the Health Sciences, Bethesda, MD

STANLEY M. LEMON, University of North Carolina at Chapel Hill

EMIL P. LESHO, Walter Reed Army Institute of Research, Silver Spring, MD

MARGARET McFALL-NGAI, University of Wisconsin–Madison

EDWARD McSWEEGAN, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD

PAULA J. OLSIEWSKI, Alfred P. Sloan Foundation, New York, NY

JULIE PAVLIN, Armed Forces Health Surveillance Center, Silver Spring, MD

GEORGE POSTE, Complex Adaptive Systems Initiative, Arizona State University-SkySong, Scottsdale

DAVID RIZZO, University of California, Davis

GARY A. ROSELLE, Veterans Health Administration, Cincinnati, OH

JANET SHOEMAKER, Office of Public Affairs, American Society for Microbiology, Washington, DC

JAY P. SIEGEL, Johnson & Johnson, Radnor, PA

MARY E. WILSON, Harvard School of Public Health, Harvard University, Cambridge, MA

EDWARD H. YOU, Federal Bureau of Investigation, Washington, DC

IOM Staff

EILEEN R. CHOFFNES, Scholar and Director

JOANNA ROBERTS, Senior Program Assistant

PATRIcK W. KELLEY, Director, Board on Global Health

BOARD ON GLOBAL HEALTH¹

THOMAS C. QUINN (Chair), Johns Hopkins University School of Medicine, Baltimore, MD

JO IVEY BOUFFORD, New York Academy of Medicine, New York, NY

GARY DARMSTADT, Stanford School of Medicine, Stanford University, Stanford, CA

JACOB A. GAYLE, Medtronic Foundation, Minneapolis, MN

GLENDA E. GRAY, South African Medical Research Council, Diepkloof, South Africa

MARGARET A. HAMBURG, National Academy of Medicine, Washington, DC

STEPHEN W. HARGARTEN, Global Health Program, Medical College of Wisconsin, Milwaukee

CLARION JOHNSON, ExxonMobil Corporation, Fairfax, VA

ALAN I. LESHNER, American Association for the Advancement of Science, Washington, DC

MYRON M. LEVINE, Center for Vaccine Development, University of Maryland School of Medicine, Baltimore

GUY H. PALMER, School for Global Animal Health, Washington State University, Pullman, WA

ANNE C. PETERSEN, University of Michigan, Ann Arbor

DAVID VLAHOV, University of California, San Francisco, Schools of Nursing and Medicine

IOM Staff

ALLISON L. BERGER, Senior Program Assistant

PATRICK W. KELLEY, Director, Board on Global Health

__________________

¹ The National Academies of Sciences, Engineering, and Medicine’s boards do not review or approve individual products. The responsibility for the content of the workshop summary rests with the workshop rapporteurs and the institution.

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Reviewers

This workshop summary has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published workshop summary as sound as possible and to ensure that the workshop summary meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary:

ENRIQUETA BOND, Burroughs Wellcome Fund

MARGARET A. HAMBURG, National Academy of Medicine

DAVID HEYMANN, London School of Hygiene & Tropical Medicine and Chatham House

JAMES M. HUGHES, Emory University

MIRTA ROSES PERIAGO, Pan American Health Organization (Retired)

Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this workshop summary was overseen by MELVIN WORTH. He was responsible for making certain that an independent examination of this workshop summary was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this workshop summary rests entirely with the rapporteurs and the institution.

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Acknowledgments

The National Academies of Sciences, Engineering, and Medicine staff and planning committee thank Dr. Jeremy Farrar and his staff at the Wellcome Trust for graciously hosting and supporting Global Health Risk Framework: A Workshop on Governance for Global Health in London, England, in September 2015. Their assistance in the planning and execution of the workshop in a short time frame is gratefully appreciated.

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Contents

ACRONYMS AND ABBREVIATIONS

1 INTRODUCTION

The Global Health Risk Framework Initiative

Meeting Objectives

Organization of the Report

2 NEED FOR GLOBAL HEALTH RISK GOVERNANCE

Defining Governance for Global Health

Diversification of Global Health

Strengthening Existing Systems

3 LESSONS FROM PAST OUTBREAKS

SARS and the 2005 Revision of the IHR

The IHR and the 2009 H1N1 Influenza Pandemic

West Africa Ebola Outbreak, 2014-2015

Organization and Coordination of Global Health Actors

4 CHALLENGES FOR FRAGILE STATES

Elements of Governance for Public Goods

Sustaining Health Systems in the Face of Evolving Threats

Contributors to Declining Health Systems

5 CHALLENGES IN DESIGN OF GOVERNANCE FOR GLOBAL HEALTH

World Health Organization

Roles and Responsibilities of Global Health Actors

6 ELEMENTS OF A GOVERNANCE FRAMEWORK

Overview of Global Health Security

WHO Regional Office Roles

Role of National-Level Governance

Role of Local Humanitarian Organizations

Role of Public–Private Partnerships

7 COMPARING HYPOTHETICAL MODELS OF GOVERNANCE FOR GLOBAL HEALTH

Model 1: A Reformed WHO

Model 2: WHO Plus

Model 3: An Executive Agency

Model 4: A Separate Agency

Considerations Across Hypothetical Models

8 CLOSING COMMENTS

Convergence on Elements of a Successful Model

Decision Making in Health Emergencies

Measurement and Accountability

APPENDIXES

A References

B Glossary

C Statement of Task

D Workshop Agenda

E Workshop Speaker Biographies

F Forum on Microbial Threats Member Biographies

Acronyms and Abbreviations