International Health Security In The Era of COVID-19

The COVID-19 pandemic has changed the world forever. Some of its consequences are already apparent, but many are yet to be truly appreciated. The changes we can readily "see" include widespread use of personal protective equipment (PPE), social distancing measures, and, sadly, decreased overall life expectancy. At the same time, major technological advances have been made across multiple areas of life, from messenger RNA vaccines to telemedicine, novel therapeutics, Internet- and blockchain-based applications, and a plethora of innovative public health tools.

But perhaps most important in the context of this book is the emergence of International Health Security (IHS) as an essential component of modern public health. Not only has the pandemic affected all of us directly via the harm inflicted by a merciless and impersonal pathogen, but it has also exposed numerous weaknesses and blind spots across various domains of our society's operating fabric, from critical supply chains to mass transportation, civil unrest, and healthcare system inefficiencies. Many of these "systemic symptoms" continue to persist well beyond the well-defined "waves" of the pandemic.

We must acknowledge that largely unprepared, humanity was collectively deeply humbled by the ongoing pandemic. As has been true in the past, we must all-toofrequently learn and re-learn the same lessons of overconfidence, passivity, and missed opportunities. Yet we must also emphasize the victory of human resolve and our ability to "rise to the occasion" when facing overwhelming odds. In addition, the COVID-19 pandemic reinforced the fact that we are all part of a true "global community." After all, what used to be an isolated problem for one region of the world can no longer be contained in the era of inexpensive, easy-to-access, universal mass transportation, even when the strictest of precautions are taken.

Within this general context, a thorough evaluation of the relationship between COVID-19 and IHS is warranted, including a detailed examination of all pertinent domains that directly or indirectly influence the wellbeing of human health and wellness. Using the expanded definition of "health security" as it evolved during this current pandemic is especially important and central to highlighting the impact of future emerging infectious diseases (EIDs) on multiple other spheres of human life, with medical and direct healthcare aspects constituting only a small proportion of factors that actively modulate wellness and health across the planet.

Moving forward, it appears that more comprehensive, inclusive, and multidimensional approaches to any future pandemic event may represent a much better way to reduce both human and economic costs of any such "once-in-a-century" global event. In the end, our ability to successfully navigate this complex crisis is a true reflection of human resolve and a testament to our collective accomplishments. After all, when we all work together as close partners, in a well-orchestrated manner, outcomes tend to be significantly better than when corresponding alternatives are concerned.

Pandemics are known to force our existing systems, established patterns, and the way we operate in general to rapidly evolve and change. While it is generally acknowledged that there is often an inherent "reluctance to change," especially if there is contentment with the status quo, major transformational events are defined as such because they mandate change, often in ways that are difficult to initially anticipate or accept. Although short-term change can be reactive, the longer-term response to the pandemic tends to be both more deliberate and constructive. The latter may include scientific research, development, and distribution of therapies, vaccines, and medical devices, as well as an in-depth reflection on various limitations and "lessons learned" that became evident in the process.

The early pandemic created a perfect environment for the accelerated maturation and implementation of various existing technologies. Two particular examples include telehealth and artificial intelligence. At the same time, the adoption process of novel technologies and approaches must also ensure that we carefully consider appropriate safety and ethical considerations, any potential limitations, well-defined staff responsibilities, evolution of team roles, as well as adherence to protocols. While such new technologies very quickly become a part of the modern medical lexicon, widespread acceptance was often challenged, not just by individual human reluctance or aversion but also by various other limitations that may not have been known until the corresponding implementation was complete.

Although the post–COVID-19 future is still difficult to conceptualize, we will eventually—and hopefully sooner rather than later—enter this new and eagerly awaited "state of the planet." It will hopefully be an environment where politics, interpersonal violence, acute and chronic disease, economic, racial and healthcare disparities, the viability of healthcare systems, delivery of care, mental health, homelessness, and aging are all thoroughly re-evaluated and properly addressed. Of importance, both skills and knowledge regarding pandemic preparedness fundamentals should become an established competency for those holding or running for key public office positions. After all, ignorance and complacency toward problems for which there are clear political, social, economic, and scientific solutions are simply not acceptable (and more so if there is clearly associated harm).

Within the expanded IHS framework, the response to the current pandemic has been a kind of "one-size-fits-all" public health policy without sufficient strategic assessment of the local and regional situation. The relatively diminished capacity of peripheric surveillance and control systems has forced local governments to "copy and paste" control strategies from abroad, often with suboptimal results. Consequently, we must always remember that "one size may not fit all." Finally, there is a tendency to extrapolate from previous scientific approaches to pandemic management. However, this way of managing the current crisis may not adequately consider variables such as the evolution of human social, political, medical, economic, and financial changes over time. Lessons of pandemic management in the 19th and 20th centuries, for example, need to factor in the reality that the 21stcentury IHS framework is vastly different and inherently more complex. Moreover, in the last few decades, there has been a dramatic disinvestment in the area of public health, a phenomenon that clearly needs to be reversed.

The expanded and redefined scope of IHS provides a unique opportunity for the public health community to embrace a more holistic approach to an area that was traditionally much more narrow in scope. Our current crisis reminds us, on a daily basis, how unprepared we continue to be for the current Public Health Emergency of International Concern (PHEIC). As we tackle one of the greatest challenges to IHS in recent decades, that of the COVID-19 pandemic, it becomes increasingly important to shift our focus to a more global yet significantly more granular and scientific perspective on IHS threats and emergencies. Such a perspective will help facilitate quicker, more effective, and more equitable responses for future PHEICs. We hope that this book will provide a solid springboard for an insightful and captivating discussion in this rapidly developing and important area of academic international medicine and public health.

### **Stanislaw P. Stawicki**

Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA

#### **Thomas J. Papadimos**

Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio, USA

#### **Sagar C. Galwankar**

Department of Emergency Medicine, Sarasota Memorial Hospital, Florida

State University College of Medicine Emergency Medicine Residency Program, Sarasota, Florida, USA

#### **Andrew C. Miller**

Department of Emergency Medicine, Nazareth Hospital, Philadelphia, Pennsylvania, USA

#### **Michael S. Firstenberg**

Department of Research and Special Projects, William Novick Global Cardiac Alliance, Aurora, Colorado, USA
