Publications

On October 4 and 6, 2022, the Johns Hopkins Center for Health Security, in collaboration with the Center for Health and Economic Resilience Research at Texas State University, convened a virtual symposium to consider how to operationalize the process of holistic recovery from the COVID-19 pandemic. The purpose of the event was to advise leaders in local and state government on what strategies they might adopt and/or support to facilitate recovery of the whole person from COVID-19, reverse the societal determinants of uneven impacts, and develop resilience to future public health emergencies.



Participant discussions produced a set of strategic actions that government authorities and partners can implement now and moving forward to effect necessary repair and change when the impulse to forget and move on is strong. Speakers represented a broad range of stakeholders, including local elected officials, recovery/resilience officers, planners, public health practitioners, disaster managers, financial investors, mental health professionals, healthcare administrators, religious leaders, housing advocates, community health providers, rural health experts, food security providers, social service administrators, academic researchers, restorative justice experts, equity strategists, artists, writers, and journalists.

The home healthcare worker is a unique, under-represented subgroup in healthcare research. Based on labor statistics, 87% are female and 39% lack affordable housing. Just over 50% receive some kind of public assistance and most do not have a college degree. Home healthcare workers are racially diverse and earn relatively low wages.¹ This population has high levels of vaccine hesitancy, yet close interaction with potentially at-risk individuals.^{2, 3}

A constellation of factors related to confidence, complacency, and convenience affect vaccine hesitancy.⁴ Innovative countermeasures that engage, educate, and empower diverse populations with varied beliefs, life circumstances, and means of engaging with media are needed.⁵ Personalized persuasion has proven to be effective means of motivating behavioral change,⁶ but requires a thorough understanding of sub-populations. Political discord and social divides heighten the need for highly tailored communications.⁷

We aimed to understand underlying motivations and/or behavioral inhibitions of the home healthcare population to support proactive public health outreach campaigns, and aid responses in future health crises. This study was conducted in accordance with Johns Hopkins University's Institutional Review Board.

The University of Maryland team has codified and communicated lessons learned from its successful track record of implementing hyperlocal approaches to community engagement and health promotion, epitomized by a network of barbers and hairstylists championing the health of their host neighborhoods. Community health champions from elsewhere are welcome to adapt/apply the Maryland team’s the practical guidance on fostering partnerships and communicating successes.

Based on their own experiences, the CommuniHealth San Diego State University team developed these training materials to support other community-oriented universities that wish to leverage their neutral brokering position and access to resources to strengthen academic-community partnerships that integrate community health workers/promotores.

In this report, the University of Alabama team recounts how they conducted a communitywide needs assessment of community health infrastructure in the state’s Black Belt counties as the first step in mobilizing a community health coalition well suited to serving rural populations, which are often overlooked. Other jurisdictions wanting to establish a baseline of their community health sector are invited to adapt and apply the CommuniHealth Alabama team’s tools and templates.

The CommuniHealth Playbook compiles field-tested strategies and tactics for advancing the community health sector locally. The Playbook’s practical guidance is the culminating product of CommuniHealth, the successor to the CommuniVax Coalition. With the support of a national working group, teams in Alabama, California, and Maryland used direct experience, trial and error, and ground-level truth to develop practical ways of mobilizing local forces for vibrant and sustainably resourced community health systems. This introductory text provides context for the project, shares the CommuniHealth “Principles for Partnership with Communities,” and serves as a centralized index to the guidance contained in the 3 local team reports.

Cyanide is a naturally occurring chemical, found in many plants, that has been used in conventional warfare and poisoning for 2 millennia. It is highly lethal, whether inhaled as a gas, ingested in solid form, or absorbed through topical exposure. Two notorious incidents in recent history—the Jonestown Massacre in 1978 and the Tylenol poisonings in 1982—highlight the lethality of this poison.

The Johns Hopkins Center for Health Security hosted a meeting, “National Strategy for Improving Indoor Air Quality,” in Washington, DC, on September 8, 2022. The meeting featured a keynote speaker and four expert panels focused on the importance of indoor air quality (IAQ), challenges to providing healthy indoor air across the United States, international perspectives and strategies for healthy air improvements, and catalyzing needed science and technology innovation in the IAQ field. Dr. Ashish Jha, White House COVID-19 Response Coordinator, opened the meeting by reiterating the importance of IAQ to the Biden-Harris Administration. 

A hallmark of the coronavirus disease 2019 (COVID-19) pandemic in its current stage is the ubiquity of home diagnostic testing for severe acute respiratory coronavirus virus 2 (SARS-CoV-2). These tests have been touted for their varied uses to facilitate navigating a world in which SARS-CoV-2 is an ever-present consideration. Apart from HIV at-home testing, COVID-19 is one of the only conditions that can be tested for at home with an almost immediate result. At-home infectious diseases testing has gained significant momentum during the COVID-19 pandemic given the myriad cascading positive benefits the technology offers. Currently, plans for home influenza and RSV tests are underway, as well as tests for sexually transmitted infections (STIs). These efforts began before the pandemic and have only accelerated as COVID-19 home tests have demonstrated their value. Here, I discuss how at-home infectious disease tests can be harnessed to optimize individual treatment outcomes and positively influence public health efforts. I have explored many of these themes in a prepandemic report,¹ and the ensuing years have concretized many of the theoretic benefits.

The Tianjin Biosecurity Guidelines for Codes of Conduct for Scientists are a set of ten principles designed to promote responsible science and strengthen biosecurity governance. They should be broadly adopted, including being endorsed by the Biological Weapons Convention at its 9th Review Conference in November 2022.

Despite projections of an oversupply of residency-trained emergency medicine physicians by 2030 and amidst intensifying national debate over Nurse Practitioner (NP) qualifications to practice independently and unsupervised, NPs are increasingly staffing Emergency Departments (EDs) as hospitals seek to contain costs while simultaneously expanding services. We sought to characterize NP practice in the ED by examining NP independent billing by level of severity of illness, and relationship to practice authority, State Medicaid expansion status, and rurality.

This report — a joint collaborative effort between the Infectious Diseases Society of America and the Johns Hopkins Center for Health Security — captures just how valuable infectious diseases professionals are to America’s health care system and society and sheds light on critical policies needed to ensure they are well positioned to help America for decades to come. We invite you to learn more.

The response by the biotech and pharmaceutical sectors to the COVID-19 pandemic has been historically unprecedented. Vaccines based in cutting-edge technologies, such as the mRNA platform, were invented, tested, and distributed to patients in less than a year. Yet politicians and activists argue that patents and other intellectual property (IP) have impeded the development and distribution of these vaccines. In explaining why this is profoundly mistaken, this essay first describes the medical and economic uncertainties inherent in the production of vaccines, especially those made in response to an emerging infectious disease like COVID-19. This makes clear the unprecedented achievement in the mass production and distribution of COVID-19 vaccines in less than 1 year after the start of the COVID-19 pandemic. It then describes the current manufacturing and licensing landscape, which was created on the basis of a market infrastructure built by reliable and effective patent rights. There is now a glut in the global supply of vaccine doses—and billions more doses are still being produced. The essay concludes by identifying the non-IP causes impeding global vaccine distribution, such as lack of infrastructure in the developing world, as well as regulatory restrictions and trade barriers. Those concerned with global vaccine equity should focus on policies to resolve these real-world problems.

The ability to diagnose and screen for infection is an important component of the US COVID-19 response and is facilitated by public health laboratories (PHLs). Anecdotal media reports and limited case studies have described some of the challenges faced by PHLs during the pandemic, particularly initial challenges related to developing and deploying tests to PHLs, but there has not been a systematic evaluation of the experience of PHLs during the pandemic.

The US nursing workforce crisis represents a danger to the quality and safety of patient care and an imminent threat to the nation's health security. The COVID-19 pandemic has exposed a range of perversities related to the nursing profession, including the inequitable financing and compensation of the nursing workforce, lack of workplace protections, and the perception that nursing is a subservient profession. It has also exacerbated workforce issues that predated the pandemic, leading to physical and mental exhaustion, lack of trust and perceptions of betrayal by hospital leaders, and moral injury and burnout. Nurses are critical to the sustainability of the US healthcare system, to the health of communities, and to the ability of the nation to respond to health security threats, including pandemics, natural disasters, and other large-scale emergencies. In the absence of an adequate labor supply of nurses, healthcare services are substantially degraded, hindering the country's ability to respond to emergencies and ultimately putting patients at risk.

Racial and ethnic minorities in the United States have been disproportionately affected by the COVID-19 pandemic, experiencing increased risk of infection, hospitalization, and death. In this study, we sought to examine race- and ethnicity-based differences in SARS-CoV-2 testing. We used publicly available US state dashboards to extract demographic data for COVID-19 cases and tests. Poisson regression models were used to model the effect of race and ethnicity on the number of SARS-CoV-2 tests performed per case. In total, just 8 states reported testing data by race and ethnicity. In regression models, race and ethnicity was a significant predictor of testing rate per case. In all states, Hispanic/Latino patients had a significantly lower testing rate than their non-Hispanic/Latino counterparts, with an incident rate ratio varying from 0.45 to 0.81, depending on the state and referent race category. These results suggest disparities in testing access among Hispanic/Latino individuals, who are already at a disproportionate risk for infection and severe outcomes.

This study examined the feasibility of creating a new nongovernmental health security research policy center in Asia, how such a center might benefit the advancement of policies promoting health security, and where such a center might be located. Health security policy encompasses numerous aspects of global health, including emerging infectious diseases, epidemics, medical and public health preparedness and response, deliberate and accidental biological threats, risk management related to advanced life science research and other biosecurity issues, and reduction of global catastrophic biological risks (GCBRs). GCBRs are those events in which biological agents—whether naturally emerging or reemerging, deliberately created and released, or laboratory engineered and escaped—could lead to sudden, extraordinary, widespread disaster beyond the collective capability of national and international governments and the private sector to control.¹ If unchecked, GCBRs could lead to great suffering, loss of life, and sustained damage to national governments, international relationships, economies, societal stability, or global security.

On April 8, 2022, the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health convened a virtual, not-for-attribution meeting to solicit expert input on the US Department of Defense’s (DoD) first Biodefense Posture Review (BPR). US Secretary of Defense Lloyd J. Austin III called for a comprehensive BPR in a November 2021 memo concerning the DoD’s biodefense vision. In the memo, Secretary Austin points out the critical roles DoD played in the COVID-19 response, both within the Department and as part of the broader whole-of-government response. After-action reviews of these vital contributions highlighted areas for improvement in DoD’s preparedness and response. Therefore, Secretary Austin directed a whole-of-department review to efficiently and robustly assess the DoD’s capabilities and modernize its strategies for biodefense.

A radiological emergency such as the detonation of a radiological dispersal device would have catastrophic health, environmental, and economic consequences. Community assessments can provide useful information about radiological and other emergency preparedness at the household level. Tools such as logic models can be applied to link data collected in a community assessment to planned activities and targeted outcomes. This study sought to answer how public health departments can use the results of a community assessment to improve preparedness for radiological and other types of emergencies and to present a sample logic model demonstrating how questions asked in a community assessment can be used to drive intended outcomes.

Few clinicians practicing in the United States have ever seen a case of monkeypox infection. However, a new, unusual, multinational outbreak of monkeypox that is unfolding rapidly makes it important to know what a case might look like. This is critical not only to permitting rapid and proper medical and public health interventions but also to helping to understand the extent and spread of the outbreak. The current outbreak—which includes confirmed or suspected cases in the United States, the United Kingdom, Spain, Portugal, Italy, Belgium, Sweden, France, Canada, Australia, Germany, and the Netherlands—appears to have a pattern of spread that does not mirror past outbreaks outside of Africa, almost all of which have been related to importation via flights from Africa or exposure to infected exotic pets (1). This unusual monkeypox outbreak should prompt all clinicians to be attuned to the possibility of this infectious disease. Clinicians who suspect they may have a patient with monkeypox should contact their state or local health department immediately.