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\"Provides an overview of outbreak activities alongside compelling case studies and visualizations to guide readers through the complexity involved in outbreak preparedness, response, and recovery\"-- Provided by publisher.

Context: The International Health Regulations (IHR) have been the governing framework for global health security for the past decade and are a nearly universally recognized World Health Organization (WHO) treaty, with 196 States Parties. In the wake of the Ebola epidemic, major global commissions have cast doubt on the future effectiveness of the IHR and the leadership of the WHO. Methods: We conducted a review of the historical origins of the IHR and their performance over the past 10 years and analyzed all of the ongoing reform panel efforts to provide a series of politically feasible recommendations for fundamental reform. Findings: We propose a series of recommendations with realistic pathways for change. These recommendations focus on the development and strengthening of IHR core capacities; independently assessed metrics; new financing mechanisms; harmonization with the Global Health Security Agenda, Performance of Veterinary Services (PVS) Pathways, the Pandemic Influenza Preparedness Framework, and One Health strategies; public health and clinical workforce development; Emergency Committee transparency and governance; tiered public health emergency of international concern (PHEIC) processes; enhanced compliance mechanisms; and an enhanced role for civil society. Conclusions: Empowering the WHO and realizing the IHR's potential will shore up global health security—a vital investment in human and animal health—while reducing the vast economic consequences of the next global health emergency.

Policy epidemiology utilizes human subject-matter experts (SMEs) to systematically surface, analyze, and categorize legally-enforceable policies. The Analysis and Mapping of Policies for Emerging Infectious Diseases project systematically collects and assesses health-related policies from all United Nations Member States. The recent proliferation of generative artificial intelligence (GAI) tools powered by large language models have led to suggestions that such technologies be incorporated into our project and similar research efforts to decrease the human resources required. To test the accuracy and precision of GAI in identifying and interpreting health policies, we designed a study to systematically assess the responses produced by a GAI tool versus those produced by a SME. We used two validated policy datasets, on emergency and childhood vaccination policy and quarantine and isolation policy in each United Nations Member State. We found that the SME and GAI tool were concordant 78.09% and 67.01% of the time respectively. It also significantly hastened the data collection processes. However, our analysis of non-concordant results revealed systematic inaccuracies and imprecision across different World Health Organization regions. Regarding vaccination, over 50% of countries in the African, Southeast Asian, and Eastern Mediterranean regions were inaccurately represented in GAI responses. This trend was similar for quarantine and isolation, with the African and Eastern Mediterranean regions least concordant. Furthermore, GAI responses only provided laws or information missed by the SME 2.14% and 2.48% of the time for the vaccination dataset and for the quarantine and isolation dataset, respectively. Notably, the GAI was least concordant with the SME when tasked with policy interpretation. These results suggest that GAI tools require further development to accurately identify policies across diverse global regions and interpret context-specific information. However, we found that GAI is a useful tool for quality assurance and quality control processes in health policy identification.

The COVID-19 pandemic has raised concerns about the global capacity for timely outbreak reporting. However, gaps remain in our understanding of barriers and enablers to outbreak reporting, particularly at the local level. Field epidemiology training program (FETP) fellows often participate in the outbreak reporting process as part of both their training and the public health roles they assume after graduating; they therefore represent a potentially valuable source of information for better understanding these barriers and enablers. This study will investigate the barriers and enablers to outbreak reporting through a mixed methods approach that will encompass a review of the existing literature as well as surveying and interviewing FETP trainees and graduates from the Asia-Pacific region. This study will begin with a scoping review of the literature to identify existing evidence of barriers and enablers to outbreak reporting. Based on our findings from the scoping review, we will administer a survey to FETP trainees and graduates from the World Health Organization Western Pacific and South-East Asian Regions and conduct interviews with a subset of survey respondents to investigate the survey findings in more detail. We will summarise and compare the survey results according to various country-level economic and political indicators, and we will employ thematic analysis to evaluate the interview responses. Based on the findings from the scoping review, survey, and interviews, we will construct a model to comprehensively describe the various barriers and enablers to outbreak reporting. This study will contribute to our understanding of the determinants of outbreak reporting across several geographic, political, and economic contexts by eliciting the viewpoints and experiences of persons involved with outbreak reporting, particularly at the local level. This information will help improve the outbreak reporting process, allowing for more timely reporting and helping prevent future outbreaks from becoming pandemics.

Global health advocates often turn to medicine and science for solutions to enduring health risks, but law is also a powerful tool. No state acting alone can ward off health threats that span borders, requiring international solutions. A trilogy of global health law—the Framework Convention on Tobacco Control, International Health Regulations (2005), and Pandemic Influenza Preparedness Framework—strives for a safer, healthier, and fairer world. Yet, these international agreements are not well understood, and contain gaps in scope and enforceability. Moreover, major health concerns remain largely unregulated at the international level, such as non-communicable diseases, mental health, and injuries. Here, we offer reforms for this global health law trilogy.

Protecting public health depends on the effective communication of health-related information to the public, especially during public health emergencies. Health communication campaigns traditionally relied on mass media outlets but increasingly incorporate social media platforms. This paper presents a content analysis of original communications posted to X (formerly Twitter) by the Chicago Department of Public Health (CDPH) from May 1, 2022, to April 30, 2023, a time characterized by the concurrent COVID-19 pandemic and mpox epidemic public health emergencies. This paper aims to investigate: (1) what information was being discussed by CDPH, (2) how information was presented, (3) the nature of communications, and (4) the impact of communication attributes on engagement. Secondary objectives included investigating the correlation between mpox cases and mpox-related communications and using a bioethical risk communication framework to characterize the intent of mpox-related communications. Original communications posted by the CDPH from May 1, 2022, to April 30, 2023, were collected. Communication attributes including the date and time of posting, the communication text, accompanying media, text in image-based accompanying media, and the language of the text were extracted at the time of collection. A total of 2 researchers independently reviewed the communications using a coding schema that was developed to codify the health topics and the bioethical framework to codify the intent of mpox-related communications. Percent agreement and Cohen kappa were used to establish intercoder reliability. Negative binomial regressions were used to investigate the impact of attributes on public engagement. Spearman rank correlation coefficients were used to measure the strength and direction of the correlation between the weekly number of mpox cases and the number of weekly mpox-related communications. A total of 1105 original communications were posted, a majority of which discussed communicable diseases (n=539, 51.8%), were posted in English (n=801, 72.5%), during the standard workday (n=1003, 90.8%), and with additional media (n=839, 75.9%). All communications were proactive in nature, and none directly responded to other accounts. Regression analysis suggested that communications posted during the workday (event rate ratio [ERR]=1.25) and those with images (ERR=2.59) or videos (ERR=2.40) received significantly higher levels of engagement, as did those discussing maternal and child health (ERR=2.35), mental health (ERR=1.48), and substance use (ERR=1.61). Communications discussing communicable diseases were not among the health topics with higher levels of engagement. Communications posted exclusively in Spanish received significantly lower levels of engagement (ERR=0.67). In addition, mpox-related communications were positively correlated with reported mpox cases at a significant level, and most mpox-related communications sought to inform the public (n=60, 60.6%), as opposed to influence behavior (n=39, 39.4%). Social media platforms can represent valuable tools for risk communication during public health emergencies but should supplement other dissemination vehicles that may be more appropriate for communicating nuanced information, achieving behavior change, and reaching certain demographic groups.

In the light of the urgency raised by the COVID-19 pandemic, global investment in wildlife virology is likely to increase, and new surveillance programmes will identify hundreds of novel viruses that might someday pose a threat to humans. To support the extensive task of laboratory characterization, scientists may increasingly rely on data-driven rubrics or machine learning models that learn from known zoonoses to identify which animal pathogens could someday pose a threat to global health. We synthesize the findings of an interdisciplinary workshop on zoonotic risk technologies to answer the following questions. What are the prerequisites, in terms of open data, equity and interdisciplinary collaboration, to the development and application of those tools? What effect could the technology have on global health? Who would control that technology, who would have access to it and who would benefit from it? Would it improve pandemic prevention? Could it create new challenges? This article is part of the theme issue 'Infectious disease macroecology: parasite diversity and dynamics across the globe'.

Many nations, however, lack the capacity to prevent, detect and respond to public health emergencies, although such core capacities are obligated under the 2005 International Health Regulations (IHR), and the importance of prioritizing this capacity building has been reinforced through multilateral initiatives such as the Global Health Security Agenda (GHSA). Since entry into force of the International Health Regulations in 2007, most of the focus of global health capacity building has been at the national level. [...]the World Bank’s Regional Disease Surveillance Systems Enhancement (REDISSE) project leverages the Economic Community of West African States (ECOWAS) and specifically its public health arm, the West African Health Organization (WAHO), to build surveillance, laboratory, workforce, and emergency response capacity across the region [5]. The challenges with building effective global health security capacity have been well documented. Since the revised IHR entered into force in 2007, countries have called on WHO and the broader international community to provide continued technical and financial assistance for implementation, while also rightly demanding that capacity building solutions are nonetheless tailored to local needs and systems.

Background/Objectives: In a context characterized by persistent vaccine hesitancy, shifting mandates, and stagnating immunization coverage rates, novel policy tools may be required to bolster immunization coverage in the United States. We conducted a national survey to characterize public support for a new tax policy that would require parents to prove that their children are age-appropriately immunized against polio to be eligible for the federal child tax credit. Methods: The survey was conducted in November 2025. Respondents were asked to provide demographic information and use a Likert-scale to indicate their support for the proposed policy. Chi-squared tests and ordinal logistic regression models were used to compare support for the proposed policy across subpopulations. Results: 980 individuals were included in the analysis. 55.8% of respondents supported adding age-appropriate polio immunization to the child tax credit eligibility criteria. 20.9% of respondents opposed the policy proposal. Relative levels of support for the policy differed according to respondent gender, age, 2024 presidential election behavior, and geographic region. However, support did not differ significantly according to race, ethnicity, educational attainment, income, or partisanship. Conclusions: Results show that most survey respondents would support a policy that would add polio immunization status to the eligibility criteria for the federal child tax credit. Further, support did not differ across key demographic and political subgroups. Larger surveys should validate these findings and investigate support for adding additional vaccines to the eligibility criteria.

BackgroundUnsafe water, sanitation and hygiene (WASH) contributes to a high burden of disease and exacerbates factors that promote the development of antimicrobial resistance (AMR). Enforceable policies are foundational to curbing inappropriate use of antimicrobials and providing safe WASH. While many countries have established National Action Plans for AMR that include provisions for WASH, few have codified these plans into legally enforceable policy. Here, we provide a comprehensive map and describe the current regulatory environment for WASH.MethodsWe conducted a comprehensive analysis of the WASH-related policies in 193 countries. Policies were identified, collated, and categorised into a publicly available repository.ResultsA total of 672 policies met the criteria for inclusion in the dataset. No category of WASH-related policies had been adopted by all countries included in the study. Policy categories that were potentially more difficult to enforce in light of economic and governance limitations tended to be more prevalent and diverse, whereas policies in categories that were highly resource intensive and specific were less universal. Countries with gaps in policy categories also tended to be regionally clustered. While countries in the South Asian and European WHO regions had nearly universal policy coverage across all countries, the presence of policies was inconsistent across countries in the African and Eastern Mediterranean regions.ConclusionWhile decision-makers should rely on knowing which policies work best to mitigate the burden of WASH-related disease and AMR development, they must first have a comprehensive understanding of the current regulatory environment. Researchers and decision-makers need to know which policies work best and under what circumstances. The global mapping of WASH policies, which may have implications for AMR development, serves as a foundation for future policy analysis for AMR.