**Abstract**

Maintaining international health security requires proactive and reactive activities and actions to minimise the negative impact of any health event that threatens public health. Blood transfusion services are a critical part of healthcare services, and blood and blood products can neither be synthesized nor stored for a long period. So, proper management of blood supply and blood demand is mandatory to preserve adequate safe blood. A failure to manage blood inventory and the resulting blood shortage are considered national and international health security threats because maintaining an adequate supply of safe blood is lifesaving for many patients. Blood shortages lead to the failure of blood transfusion services that ends with the collapse of the health system and health insecurity if health authorities do not take immediate corrective action. An imbalance between blood supply and blood demand is not only a threat to health security, but also poses some of the greatest threats to the national and international economy and security. The perception of health issues as an international health security threat is associated with benefits through attracting political and decision-makers' attention and support. The global health policies and international health regulations concerning the management of blood supply and blood demand should be implemented and updated regularly. The information provided by this chapter addresses the management of blood supply and blood demand as an international health security issue and provides guidance in planning for proper management of blood inventory to avoid a sudden blood shortage and its catastrophic consequences.

**Keywords:** international health security, management of blood supply, blood demand, adequate safe blood, blood inventory, blood shortage, blood transfusion services failure, health insecurity

#### **1. Introduction**

International (global) health security is defined by the World Health Organization (WHO) as the proactive and reactive activities and actions required to minimise the danger and impact of any health event that threatens people's health nationally and internationally. Management of blood supply and blood demand means close monitoring of blood supply and blood demand and appropriate responses to avoid sudden blood shortages, particularly for blood components with a short shelf life, such as platelets. Health problems and the collapse of health systems not only cost lives, but also pose some of the greatest threats to the global economy and security.

Many health issues have affected global health security and necessitated the United Nations Security Council announcing a risk to international security and stability [1–4]. Recently the coronavirus disease-2019 (COVID-19) pandemic has been considered a threat to the global economy, health and security. Maintaining blood supply is important for international health security since blood transfusions are lifesaving in many conditions. A failure to manage blood supply and blood demand and resulting blood shortages are threats that affect national and international health security. This is because maintaining an adequate supply of safe blood is lifesaving for many patients, such as those with blood diseases, cancer, trauma, and those who need emergency surgeries [5]. Blood shortages negatively affect blood transfusion services (BTS) and health services, and can end with the collapse of the health system and health insecurity. The latter starts nationally, but if national and international health authorities and organisations do not work together and manage national health insecurity, it will appear in other countries and become international in time. Furthermore, health insecurity can lead to societal insecurity, political insecurity, and ultimately national and international insecurity. This chapter discusses the management of blood supply and blood demand from the perspective of international health security and why and how it is an international health security threat.
