Introduction: The Global Fund to Fight AIDS, TB, and Malaria (the Global Fund) pivoted investments to support countries in their response to the COVID-19 pandemic. Recently, the Global Fund's Board approved global pandemic preparedness and response as part of their new six-year strategy from 2023-2028. Methods: Prior research estimated that US$124 billion is required, globally, to build sufficient country-level capacity for health security, with US$76 billion needed over an initial three-year period. Action-based cost estimates generated from that research were coded as directly, indirectly, or unrelated to systems strengthening efforts applicable to HIV, TB, and/or malaria. Results: Of approximately US$76 billion needed for country level capacity-building over the next three-year allocation period, we estimate that US$66 billion is needed in Global Fund-eligible countries, and over one-third relates directly or indirectly (US$6 billion and US$21 billion, respectively) to health systems strengthening efforts applicable to HIV, TB, and/or malaria disease programs currently supported by the Global Fund. Among these investments, cost drivers include financing for surveillance and laboratory systems, to combat antimicrobial resistance, and for training, capacity-building, and ongoing support for the healthcare and public health workforce. Conclusion: This work highlights a potential strategic role for the Global Fund to contribute to health security while remaining aligned with its core mission. It demonstrates the value of action-based costing estimates to inform strategic investment planning in pandemic preparedness.

The COVID-19 pandemic has highlighted critical gaps in global capacity to prevent, detect, and respond to infectious diseases. To effectively allocate investments that address these gaps, it is first necessary to quantify the extent of the need, evaluate the types of resources and activities that require additional support, and engage the global community in ongoing assessment, planning, and implementation. Which investments are needed, where, to strengthen health security? This work aims to estimate costs to strengthen country-level health security, globally and identify associated cost drivers. The cost of building public health capacity is estimated based on investments needed, per country, to progress towards the benchmarks identified by the World Health Organization’s Joint External Evaluation (JEE). For each country, costs are estimated to progress to a score of “demonstrated capacity” (4) across indicators. Over five years, an estimated US$124 billion is needed to reach “demonstrated capacity” on each indicator of the JEE for each of the 196 States Parties to the International Health Regulations (IHR). Personnel costs, including skilled health, public health, and animal health workers, are the single most influential cost driver, comprising 66% of total costs. These findings, and the data generated by this effort, provide cost estimates to inform ongoing health security financing discussions at the global level. The results highlight the significant need for sustainable financing mechanisms for both workforce development and ongoing support for the health and public health workforce.

Law and policy differences help explain why, as HIV-related science has advanced swiftly, some countries have realised remarkable progress on AIDS while others see expanding epidemics. We describe the structure and findings of a new dataset and research platform, the HIV Policy Lab, which fills an important knowledge gap by measuring the HIV-related policy environment across 33 indicators and 194 countries over time, with online access and visualisation. Cross-national indicators can be critical tools in international governance-building social power to monitor state behaviour with the potential to change policy and improve domestic accountability. This new and evolving effort collects data about policy through review of legal documents, official government reports and systematic review of secondary sources. Alignment between national policy environments and global norms is demonstrated through comparison with international public health guidance and agreements. We demonstrate substantial variation in the content of law and policies between countries, regions and policy areas. Given progress in basic and implementation science, it would be tempting to believe most countries have adopted policies aligned with global norms, with a few outliers. Data show this is not the case. Globally, alignment is higher on clinical and treatment policies than on prevention, testing and structural policies. Policy-makers, researchers, civil society, finance agencies and others can use these data to better understand the policy environment within and across countries and support reform. Longitudinal analysis enables evaluation of the impact of laws and policies on HIV outcomes and research about the political drivers of policy choice.

Multiple costing tools have been developed to understand the resources required to build and sustain implementation of the International Health Regulations (IHR), including a detailed costing tool developed by WHO ("WHO Costing Tool") and 2 action-based costing tools, Georgetown University's IHR Costing Tool and CDC's Priority Actions Costing Tool (PACT). The relative performance of these tools is unknown. Nigeria costed its National Action Plan for Health Security (NAPHS) using the WHO Costing Tool. We conducted a desktop review, using the other tools to compare the cost estimates generated using different costing approaches. Technical working groups developed activity plans and estimated component costs using the WHO Costing Tool during a weeklong workshop with approximately 60 participants from various ministries, departments, and federal agencies. We retrospectively applied the IHR Costing Tool and PACT to generate rapid cost estimates required to achieve a Joint External Evaluation (JEE) score of "demonstrated capacity" (level 4). The tools generated similar activities for implementation. Cost estimates varied based on the anticipated procurement and human resources requirements and by the level of implementation (eg, health facility-level versus local government area-level procurement). The desktop IHR Costing Tool and PACT tools required approximately 2 and 8 person-hours to complete, respectively. A strategic costing approach, wherein governments select from a menu of recommended and costed actions following the JEE to develop a NAPHS, could accelerate implementation of plans. Major cost drivers, including procurement and human resources, should be prioritized based on anticipated resource availability and countries' priorities.

This Viewpoint proposes creation of algorithmic stewardship programs at health systems, tasked similar to antibiotic stewardship committees with oversight of artificial intelligence and machine learning technologies to ensure they are used safely, effectively, fairly, and to the benefit of diverse patient populations.

Countries, philanthropies, and private sector organizations have been actively investing in global health security around the world. However, despite the coordinated approach to funding within the Global Health Security Agenda, there is currently no well-established method to track the commitment and disbursal of funds for global health security from funders to recipients or to identify the activities supported by existing funding initiatives. To address this need, we developed the Global Health Security Tracking Dashboard. This interactive, publicly available, Web-based dashboard maps the flow of funds from funder to recipient and categorizes the target efforts of those funds, allowing users to identify patterns of influence and success in health security funding implementation. The dashboard provides an evidence-based approach for defining targets for future funding by identifying the areas in which funds have not yet been effectively allocated, showcasing successes, and providing a source of information to promote mutual accountability.

Background: Recent infectious disease outbreaks have brought increased attention to the need to strengthen global capacity to prevent, detect, and respond to natural biological threats. However, deliberate biological events also represent a significant global threat, but have received relatively little attention. While the Biological Weapons Convention provides a foundation for the response to deliberate biological events, the political mechanisms to respond to and recover from such an event are poorly defined. Methods: We performed an analysis of the epidemiological timeline, the international policies triggered as a notional deliberate biological event unfolds, and the corresponding stakeholders and mandates assigned by each policy. Findings: The results of this analysis identify a significant gap in both policy and stakeholder mandates: there is no single policy nor stakeholder mandate for leading and coordinating response activities associated with a deliberate biological event. These results were visualized using an open source web-based tool published at https://dbe.talusanalytics.com. Interpretation: While there are organizations and stakeholders responsible for leading security or public health response, these roles are non-overlapping and are led by organizations not with limited interaction outside such events. The lack of mandates highlights a gap in the mechanisms available to coordinate response and a gap in guidance for managing the response. The results of the analysis corroborate anecdotal evidence from stakeholder meetings and highlight a critical need and gap in deliberate biological response policy.

Member States of the WHO working to build capacity under the International Health Regulations (IHR) are advised to develop prioritised, costed plans to implement improvements based on the results of voluntary external assessments. Defining the costs associated with capacity building under the IHR, however, has challenged nations, funders and supporting organisations. Most current efforts to develop costed national action plans involve long-term engagements that may take weeks or months to complete. While these efforts have value in and of themselves, there is an urgent need for a rapid-use tool to provide cost estimates regardless of the level of expertise of the personnel assigned to the task. In this paper, we describe a tool that can—in a matter of hours—provide country-level cost estimates for capacity building under the IHR. This paper also describes how the tool can be used in countries, as well as the challenges inherent in any costing process.

Background: Few studies have evaluated patient perspectives on neuromyelitis optica (NMO) and NMO spectrum disorder (NMOSD). Objective: Describe patient-reported clinical and treatment experience in NMOSD and compare disease characteristics of NMOSD with those of multiple sclerosis (MS). Methods: This retrospective, observational study included 522 members with NMO or NMOSD (hereafter collectively referred to as NMOSD) from PatientsLikeMe (PLM), an online patient community. Data describing member demographics, symptoms, and treatments were collected, analysed descriptively, and compared with data from PLM members with MS. Results: Fatigue, pain, and stiffness/spasticity were each rated as moderate to severe by more than half of NMOSD members, and 59% reported that their health limited the type of work or other activities they could perform all or most of the time. Overall, symptom severity and disability levels were comparable between NMOSD and MS members; however, NMOSD members were more likely than MS members to attribute disability to vision-related symptoms and were less likely to report moderate to severe cognitive and emotional symptoms, including brain fog, depressed or anxious mood, and emotional lability. Conclusion: This analysis underscores the challenges of living with fatigue, pain, stiffness/spasticity, and visual difficulties, prevalent NMOSD symptoms among members of the PLM community.

Background: As their mobility deteriorates, people with ALS (PALS) increasingly rely on mobility aids and devices to maintain their independence. As their needs increase, power wheelchairs are increasingly becoming platforms for other assistive technology such as communication devices, ventilators, or environmental control mechanisms. Innovations such as GPS, integration of cellular services, and Bluetooth offer possible enhancements but also raise privacy concerns. Objective: To describe the experience of PALS on PatientsLikeMe using power wheelchairs, the benefits and challenges experienced, ways they use their wheelchairs to promote their health, and their desires for future upgrades. Methods: Analysis of existing quantitative ALSFRS-R and symptom data from PatientsLikeMe profiles, as well as qualitative analysis of open-text discussions in social forums, and a prospective survey (N=100) of experiences with power wheelchairs across patients with ALS, MS, and spinal cord injury. Results: Treatment evaluations show that >80% of patients reported moderate or major efficacy of power wheelchairs to address their fatigue, lack of mobility, and balance problems, noting that wheelchairs help them to regain independence and minimize the risk of injury. Patients still face challenges, however, such as repairs when devices break down, or trying to engineer their own solutions for making chairs compatible with other devices, underlining the potential importance of modular mounting and power systems. Patients appear enthusiastic about the potential for newer forms of "connected wheelchairs" but want transparency and control over how their data is shared. Engaging online with patients in product R&D may be an efficient way of developing better products and services to meet patient needs. Discussion: Our findings may support future development directions for wheelchair manufacturers and underline that in the modern era, power wheelchairs support patients living their best lives, not just getting from A to B.

While medication labels are considered the authoritative resource for medication information, emerging research suggests that patient-generated health data (PGHD) are a valuable tool to understand the ways in which patients experience medications in real world settings. However, the relationship between these two data sources has not been closely examined.