Foreword

It is with great honor that I have had the privilege of traveling and lecturing with many of the editors of this novel Volume 1 of Contemporary Developments and Perspectives in International Health Security. As I have traveled the world and visited every continent, it is striking to see the lives of ordinary citizens around the world and how different basic health and living standards (security) are based on where one lives.

I do remember one time in New Delhi, India, where a cab driver lamented at the conditions of the roads in India and told me of his dream of visiting America. He showed me a video of his relative in the United States, driving down a highway with clearly marked lanes, much more orderly than we were experiencing in our drive through this massive and beautiful Indian city. The paving of a dirt road not only expands the possibilities to travel more efficiently but also extends to health, culture, and community. The international experience highlights the interwoven aspects of everyday life that can impact a person's ability to live and survive based on the culture and components of a secure civilized society.

A threat to one can be a threat to all. Death, disease, famine, and pestilence. The reality of the coronavirus disease 2019 (COVID-19) created a ripple in our world that will impact humans for years, if not decades, to come. The broadened definition of International Health Security (IHS) is the right idea at the right time. The focus on HIS as that is based on individuals who participate in their community, as well as the security of physical, emotional and spiritual needs, is the link to foster dialogue and discovery well into the future.

In 2020 we find ourselves in the midst of one of the most information-dense times in human history. As medical knowledge doubles every few months, keeping up makes the organization of this information and best evidence a necessity across the world. The manifestation of Moore's Law, the metronome of digital advancements as a function of silica chips doubling the capacity and shrinking in size by half every 18–24 months, is our next generation smartphone universe and access to massive sets of information, right in the palm of one's hand. With the thought of Elon Musk's Starlink, the satellite connectivity of every continent and possibly every person will be the realization of a truly global human network. Gordon Moore, the founder of Intel Corporation, described the phenomenon that has seen computer processing progress to artificial intelligence and machine learning. The mathematics behind these amazing advancements and more in some economically resourced zip codes of the world is astonishing. As the world transitions from analog to the digital transformation of knowledge, power, and truth amidst societies, communities, and health systems, the next step is to codify the language used to describe our new world with the new challenges we encounter every day.

Each person is the first line in an onslaught of massive information and even more disinformation. What is the truth? What is logic? What is the spin? What does the evidence say? What would the scientist do? Now, what would the politicians do? The world and information availability is not the problem; it is the critical analysis of this information and separating the wheat from the chaff. When should I evacuate with this incoming storm? Am I at risk for this new infectious disease? Signal-to-noise ratios depend on the individual and cohort goals of you and your "family" social group to interpret information and balance it with one's experience and insight. In some cultures the fight is for equal opportunities. The future challenge is equalizing outcomes.

It is our health. Do we control our health information? Is it in a form that is portable, secure, and able to be updated as new information emerges? Can information help us meet and achieve our own hierarchy of needs? The future of HIS will be determined by how communities try to implement best practices for all. The equality of all with freedom, liberty, and justice in America is much different than that of the 194 other countries and sovereign nations.

IHS is the thread to this earthen security blanket. The idea of IHS is innovation. This book is a testament to the importance of seeing how the global security of the individual is transformed into IHS. We are more interconnected than we have ever been. The future is the understanding of this reality through further innovation and creativity. This is why this book is so important. The topics to focus on will be much different post COVID. Telemedicine was a great leap forward, while lockdowns were a significant step back. The future is the innovation of ideas such as IHS, and the path forward is feasible for the destiny of an evolved humanity.

The infrastructure of culture and access to health care, emergency care, and other necessary services is much different depending on where one lives. According to 2008 data from the World Bank, 80 percent of the world's population lives on less than \$10 dollars a day. There are billions of living in poverty. The wealthiest 20 percent are creating 75 percent of the world's income, while the less fortunate 40 percent are able to contribute only 5 percent of the world's income. Economic disparity, food "deserts," and energy insecurity stagnate the standards of living in some areas across generations, even in high-income nations. Health disparities exist in every country, yet in many nations, these are closely related to socioeconomic status, ethnicity, immigration status, and being a refugee.

A global pandemic resulted in the need to have thoughtful, evidence-based strategies in response to the many threats to human health. Living a healthy life that is productive and full should be an option for every human, but that is sadly not the case. Growing up in America is a much different experience than growing up in Delhi. Yet for whatever class, caste, or socioeconomic condition one finds themselves in, injuries and infections persist in everyday life, without exceptions. The coronavirus is the most recent threat to IHS. Secure patient data, artificial intelligence, and genetically modified organisms are just some of the many modern challenges faced by individuals worldwide. How does the global network of humanity respond to twenty-first century threats to IHS? How should we prioritize education and knowledge, scientific curiosity and skepticism, thoughtful deliberation and teamwork? IHS recognizes that each individual exists with humanity and free will, yet many persons do not have the socioeconomic environment conducive to learning, growing, and securing a humane life with basic elements of health security.

The world is more interconnected than ever before and when supply chains, essential minerals, and medical supplies were transported seamlessly pre COVID and distributed in an efficient way; with COVID, the world is a much different place. This is why the topic of IHS is more important than ever. The health of every

**V**

person has a connectedness of purpose and happenstance related to each other in multiple ways. Moving forward, the prioritization of IHS will be important for generations to come as modern humans survive and thrive in a world of social media, information overload, and cyber- and in-person threats to health. This volume and subsequent textbooks on IHS are resources to help solve the many challenges that confront humanity in our modern times. The old adage of Pandora's Box had the ills of the world being released onto humanity, yet at the bottom of that "box" was hope. This book stands out as a hope of collaboration between

Global participation in this knowledge economy will need entrepreneurs and innovators from across the world. To solve modern problems, we need modern solutions from a wide array of scientists and persons with experience and desire to help affect change. The authors of this book are dedicated to contributing to that change with much-needed attention to the importance of the current moment and the language needed to solve these problems around IHS. Historians will mark 2020 as a turning point, and this book is the first to conceptualize humanity as the

Respectfully,

Professor,

**David P. Bahner MD** Ultrasound Division Chief,

The Ohio State University, Columbus, Ohio, United States

Department of Emergency Medicine,

multiple experts to confront threats to health.

common denominator in IHS.

person has a connectedness of purpose and happenstance related to each other in multiple ways. Moving forward, the prioritization of IHS will be important for generations to come as modern humans survive and thrive in a world of social media, information overload, and cyber- and in-person threats to health. This volume and subsequent textbooks on IHS are resources to help solve the many challenges that confront humanity in our modern times. The old adage of Pandora's Box had the ills of the world being released onto humanity, yet at the bottom of that "box" was hope. This book stands out as a hope of collaboration between multiple experts to confront threats to health.

Global participation in this knowledge economy will need entrepreneurs and innovators from across the world. To solve modern problems, we need modern solutions from a wide array of scientists and persons with experience and desire to help affect change. The authors of this book are dedicated to contributing to that change with much-needed attention to the importance of the current moment and the language needed to solve these problems around IHS. Historians will mark 2020 as a turning point, and this book is the first to conceptualize humanity as the common denominator in IHS.

Respectfully,

**David P. Bahner MD** Ultrasound Division Chief, Professor, Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, United States

Preface

International health security (IHS) is a broad and highly heterogeneous area. Within this general context, IHS encompasses subdomains that potentially

definition of health security stems from the realization that topics such as EID; food, water, and pharmaceutical supply chain safety; medical and health information cybersecurity; and bioterrorism, although important within the overall realm of health security, are not only able to actively modulate the wellness and health of human populations, but also are likely do so in a synergistic fashion.

influence (and more specifically endanger) the well-being and wellness of humans. The general umbrella of IHS includes, but is not limited to, natural disasters, emerging infectious diseases (EID) and pandemics, social determinants of health, systemic racism and discrimination, rapid urbanization, population growth, environmental matters, civilian violence, warfare and terrorism, inappropriate use of antibiotics, and the abuse of social media (SM). The need for this expanded

The editors of this book believe that the broadly defined IHS inherently encompasses the plurality of concepts that include "public health," "global health security," and "planetary health." At the same time, it is important to ensure that the overall context of IHS implementation maintains compatibility with the modern concept of the world constituting a collection of independent countries and states that operate within a well-defined set of international conventions, organizations, and frameworks. This is the foundation and the starting point of our approach, upon which we expand and build our multi-pronged argument for the more broadly defined and understood IHS.

This inaugural tome of our multi-volume collection, Contemporary Developments and Perspectives in International Health Security, introduces many of the topics directly relevant to modern IHS theory and practice. Starting with a summative assessment by the IHS Working Group of the American College of Academic

International Medicine, the book then moves on to discuss a variety of contemporary topics such as refugee crises, cybersecurity, SM, big data analytics, scientist training, and point-of-care diagnostics. Unique contributions to Volume 1 include a compendium by Reis and Cipolla on the impact of organized systems of care on IHS, focusing on the tremendous value of such systems to our overall healthcare security landscape.

Of importance, a new set of insidious threats to health security emerged with the widespread adoption of the Internet and various SM platforms. These important topics are covered in two excellent chapters by Miller, et al., and Conti, et al. The first of the two chapters discusses an all-too-common phenomenon of ransomware that increasingly plagues our healthcare systems and contributes to significant risk of critical data loss. The second chapter discusses both the benefits and the dangers of modern SM technology, including some of the proposed approaches to mitigate the negative aspects. Of special concern is the emerging evidence regarding the very design of SM platforms, with the key element of the business model being the

ability to fractionate people into self-reinforcing, opinion-based camps.

The book then shifts focus to very important and emerging topics of the refugee crisis and refugee healthcare. Attributable to a confluence of multiple factors,
