Health Security

In Japan, the Infectious Disease Control Law designates certain institutions across the country as medical institutions for infectious diseases, with the role to respond to and prepare for epidemic or pandemic infections. Since the early stages of the COVID-19 pandemic, these designated medical institutions have provided clinical care to patients with COVID-19. While these institutions primarily handle clinical care, they are also well poised to conduct rigorous clinical research that is needed to address future health emergencies. The COVID-19 pandemic highlighted the importance of clinical research as a medical countermeasure through its role in the development of effective novel vaccines and therapeutics. Under the Japanese system, designated medical institutions that cared for patients with COVID-19 had the privilege to access the earliest cases and were uniquely positioned to contribute to scientific evidence. Based on this understanding, we conducted a nationwide survey and analyzed data from 100 designated medical institutions to better understand their experiences and involvement in clinical research during the COVID-19 pandemic and their readiness and willingness to conduct clinical research in a future health emergency. While quite a few institutions showed willingness to participate in infectious disease research in the event of a future health emergency, it was evident that many would require additional expertise and financial support to facilitate such research. Our analysis suggests that further capacity development, empowerment for clinical research, and a strong collaborative network across stakeholders are required to improve pandemic response and preparedness in Japan.

The spread of bacteria that cause illness is a critical problem facing the restaurant industry worldwide. These bacteria can proliferate in various restaurants areas through airborne transmission mechanisms, increasing the risk of food contamination. In this study, our aim was to detect the presence of potential foodborne pathogenic bacteria—Escherichia coli, Staphylococcus aureus, and aerobic bacteria—in aerosols of different restaurants zones in Riyadh city in the Kingdom of Saudi Arabia. We focused on 3 important zones: preparation (Zone A), food packaging (Zone B), and handwashing (Zone C). The bacteria of interest were isolated, identified, and characterized by using selective media, biochemical, and antibiotic susceptibility tests. The results showed that all 40 of the studied restaurants were contaminated with aerobic bacteria, with a total count of 3,978 colony-forming units (CFU) in Zone C, 1,323 in Zone B, and 525 in Zone A. E coli was identified as the most prevalent illness-causing bacteria in Zone A-derived aerosols (721 CFU), while S aureus had the highest occurrence in aerosols in Zone C (528 CFU). Pertaining to the antibiotic resistance phenotype of assessed isolates, our findings revealed that Zone C-derived E coli isolates showed resistance ranging from 25% to 100% toward 8 of the 15 tested antibiotics. S aureus isolates originating from Zone B exhibited between 25% and 75% resistance to 2 antibiotics, while isolates from Zone C showed resistance ranging from 5.88% to 47.05% to 4 antibiotics. Findings from this study illustrate that restaurants’ aerosols are highly contaminated with different antibiotic-resistant bacteria, which increases the risk of food poisoning and threats food security.

In this study, we identify facilitators and barriers to COVID-19 vaccination in Nairobi, Kenya, using the modified 5 Cs model for vaccine hesitancy. We conducted 33 in-person interviews in Nairobi, Kenya. Participants were recruited using convenience sampling by a member of the research team who resides in Nairobi and speaks Swahili. Interviews were audio recorded and transcripts were analyzed using thematic analysis. The modified 5 Cs model for vaccine hesitancy was applied to create a codebook prior to analysis. Participants cited misinformation, lack of trust in the science behind the vaccine, and concerns about side effects as reasons for not receiving the COVID-19 vaccine. Facilitators for choosing to receive the vaccination included concerns about the severity of COVID-19, vaccination requirements for school and employment, and communication from the government. This study is the first to organize facilitators and barriers to COVID-19 vaccine uptake in Kenya using the 5 Cs model of vaccine hesitancy. Our findings suggest that to improve vaccine uptake in Kenya, interventions should inform the public about the vaccine’s safety and reduce misinformation.

When patient demand exceeds hospital capacity in certain scenarios, such as natural disasters, terrorist attacks, or staffing shortages, the rapid discharge of patients identified through reverse triage methodologies can create surge capacity. The evaluation of this concept has been documented in numerous resources and studies, but current tools tend to be extensive and siloed, which may make them difficult to use during emergencies. To prepare the largest municipal healthcare system in the United States for situations requiring rapid patient discharge, NYC Health + Hospitals/Central Office Emergency Management sought to develop a short, synthesized, and user-friendly plan. After consulting experts and reviewing existing peer-reviewed articles, gray literature, and internal facility documents, the team created a 7-page rapid action checklist that synthesizes important content. The Risk-based, Abbreviated, Patient Identification Discharge (RAPID) tool was successfully used during a resident labor action in May 2023, illustrating that its utility may extend beyond the system in which it was used. Future work should be done to validate and improve upon this tool.

Labor actions by healthcare workers are increasing in frequency and quantity, particularly throughout the United States. Regardless of their cause and size, these strikes could disrupt normal hospital operations and impact patient access to care, quality of care, and costs. Strikes resemble other large-scale incidents like natural disasters, pandemics, or terrorist attacks by shrinking a hospital’s capacity to care for patients, forcing hospitals to pursue logistically complicated actions such as finding replacement providers, and impacting nearby facilities due to patient offloading. In contrast to these incidents, however, strikes are unique because they come with advance notice, reduce capacity by precise amounts with predictable provider losses, occur during defined periods, and do not necessarily increase demand for patient care. To maximize efficiency and minimize disruption in response to strikes, hospitals must properly plan ahead and successfully execute their plans. In this article, we recount the experience of a 2023 resident strike at NYC Health + Hospitals/Elmhurst in New York City and describe 6 core strategies that the facility implemented to maintain quality care: strike aversion and planning, increasing coverage, decreasing demand, internal and external messaging, external partnerships, and demobilization. We also provide a planning template that other hospitals can use to prepare for and respond to healthcare provider strikes.

The information in this article was first presented as a poster, “Healthcare Labor Action Preparedness and Response” at the Preparedness Summit, March 25-28, 2024, in Cleveland, Ohio.

The study team conducted a cross-sectional study among medical laboratory staff (MLS) and veterinary laboratory staff (VLS) employed in laboratories affiliated in Vietnam to assess the current biorisk management (BRM) training situation and to identify MLS and VLS training needs. A total of 283 laboratory staff members, comprising 168 MLS and 115 VLS, completed the questionnaire. Over two-thirds (68.7%) of the respondents possessed more than 5 years of laboratory experience, with 71.4% operating within high levels of laboratory biosafety. Results showed that more MLS had undergone BRM training, but higher scores were observed for VLS in terms of addressing their organizational reputation and other types of biorisk within their biorisk system. Training needs on BRM among both MLS and VLS were confirmed to be high across all BRM areas measured, with most respondents expressing the need for training or retraining. The study underscores the necessity to enhance both the quantity and quality of BRM training in Vietnam. Consequently, it strongly advocates for the development of a standardized national training program on BRM, aimed at ensuring the effectiveness of training activities.

Student interview teams provided essential surge capacity for the conduct of routine enteric disease surveillance and outbreak activities during the COVID-19 pandemic response, for states with that resource available. This case study describes how student interview teams based in Colorado and Washington supported enteric disease interviewing for public health agencies in Nebraska, Wyoming, Kansas, and California, and demonstrates the feasibility and value of interstate student interview team work to provide enteric and other communicable disease surge capacity. In collaboration with their respective state health agencies, the Colorado School of Public Health Enteric Disease Interview Team (EDIT) and the University of Washington Student Epidemic Action Leaders (SEAL) team amended scopes of work and procedures for hiring and onboarding, training, work management and engagement, communication, and evaluation to offer enteric disease interviewing support to the Nebraska Department of Health and Human Services, the Wyoming Department of Health, the Kansas Department of Health and Environment, and the California Department of Public Health. EDIT was assigned 467 enteric interviews in Nebraska, 193 in Wyoming, and 33 in Kansas; and the SEAL team was assigned 133 interviews from 26 clusters in California, with response rates of 68%, 79%, 58%, and 53%, respectively. The median time from case assignment to first interview for EDIT interviews was less than or equal to 1 day. The completeness of all interviews was satisfactory. Enteric disease epidemiologists from host state health departments and students reported valuing the interstate work. Establishing interstate student interview team support requires coordination but is possible and can be effective in providing essential surge capacity for states without a student interview team. It also provides intangible benefits such as strengthening relationships between states and affiliated university programs and providing professional experiences and networking opportunities for students.