Background Public health measures to prevent, detect, and respond to events are essential to control public health risks, including infectious disease outbreaks, as highlighted in the International Health Regulations (IHR). In light of the outbreak of 2019 novel coronavirus disease (COVID-19), we aimed to review existing health security capacities against public health risks and events. MethodsWe used 18 indicators from the IHR State Party Annual Reporting (SPAR) tool and associated data from national SPAR reports to develop five indices: (1) prevent, (2) detect, (3) respond, (4) enabling function, and (5) operational readiness. We used SPAR 2018 data for all of the indicators and categorised countries into five levels across the indices, in which level 1 indicated the lowest level of national capacity and level 5 the highest. We also analysed data at the regional level (using the six geographical WHO regions).Findings Of 182 countries, 52 (28%) had prevent capacities at levels 1 or 2, and 60 (33%) had response capacities at levels 1 or 2. 81 (45%) countries had prevent capacities and 78 (43%) had response capacities at levels 4 or 5, indicating that these countries were operationally ready. (76%) countries scored more highly in the detect index than in the other indices. 44 (24%) countries did not have an effective enabling function for public health risks and events, including infectious disease outbreaks (7 [4%] at level 1 and 37 [20%] at level 2). 102 (56%) countries had level 4 or level 5 enabling function capacities in place. 32 (18%) countries had low readiness (2 [1%] at level 1 and 30 [17%] at level 2), and 104 (57%) countries were operationally ready to prevent, detect, and control an outbreak of a novel infectious disease (66 [36%] at level 4 and 38 [21%] at level 5).Interpretation Countries vary widely in terms of their capacity to prevent, detect, and respond to outbreaks. Half of all countries analysed have strong operational readiness capacities in place, which suggests that an effective response to potential health emergencies could be enabled, including to COVID-19. Findings from local risk assessments are needed to fully understand national readiness capacities in relation to COVID-19. Capacity building and collaboration between countries are needed to strengthen global readiness for outbreak control.

Background Under the International Health Regulations (2005) [IHR (2005)] Monitoring and Evaluation Framework, after action reviews (AAR) and simulation exercises (SimEx) are two critical components which measure the functionality of a country’s health emergency preparedness and response under a “real-life” event or simulated situation. The objective of this study was to describe the AAR and SimEx supported by the World Health Organization (WHO) globally in 2016–2019. Methods In 2016–2019, WHO supported 63 AAR and 117 SimEx, of which 42 (66.7%) AAR reports and 56 (47.9%) SimEx reports were available. We extracted key information from these reports and created two central databases for AAR and SimEx, respectively. We conducted descriptive analysis and linked the findings according to the 13 IHR (2005) core capacities. Results Among the 42 AAR and 56 SimEx available reports, AAR and SimEx were most commonly conducted in the WHO African Region (AAR: n = 32, 76.2%; SimEx: n = 32, 52.5%). The most common public health events reviewed or tested in AAR and SimEx, respectively, were epidemics and pandemics (AAR: n = 38, 90.5%; SimEx: n = 46, 82.1%). For AAR, 10 (76.9%) of the 13 IHR core capacities were reviewed at least once, with no AAR conducted for food safety, chemical events, and radiation emergencies, among the reports available. For SimEx, all 13 (100.0%) IHR capacities were tested at least once. For AAR, the most commonly reviewed IHR core capacities were health services provision (n = 41, 97.6%), risk communication (n = 39, 92.9%), national health emergency framework (n = 39, 92.9%), surveillance (n = 37, 88.1%) and laboratory (n = 35, 83.3%). For SimEx, the most commonly tested IHR core capacity were national health emergency framework (n = 56, 91.1%), followed by risk communication (n = 48, 85.7%), IHR coordination and national IHR focal point functions (n = 45, 80.4%), surveillance (n = 31, 55.4%), and health service provision (n = 29, 51.8%). For AAR, the median timeframe between the end of the event and AAR was 125 days (range = 25–399 days). Conclusions WHO has recently published guidance for the planning, execution, and follow-up of AAR and SimEx. Through the guidance and the simplified reporting format provided, we hope to see more countries conduct AAR and SimEx and standardization in their methodology, practice, reporting and follow-up.

As the Ebola outbreak in West Africa has demonstrated, outbreaks of infectious diseases pose a significant threat to the extractive industry. Extractive companies often operate in emerging infectious disease (EID) ‘hotspots’. The nature of extractive projects in these hotspots causes greater interaction between animals and humans which in turn, is thought to create a greater risk of infectious outbreaks. The Infectious Disease Risk Assessment and Management (IDRAM) initiative supports the extractive industry to better understand, assess and mitigate this risk through fostering partnerships between the industry, public health systems and other relevant stakeholders. During 2014 and 2015, IDRAM field tested planning and audit tools among four leading mining companies in the Katanga province, Democratic Republic of Congo; produced a qualitative study to better understand the industry's perception of EID-related risks; and conducted three desktop outbreak simulation exercises involving industry and other stakeholders. An ongoing economic evaluation study will quantify the economic impact of the Ebola outbreak at the company level. This study will focus on a single large mining company that has continued to operate throughout the epidemic. A literature review exploring past and current collaborative efforts between extractive industries and national health systems related to health emergencies is also being carried out. This will provide strong evidence-based best practice for effective partnership. These activities have highlighted that although the industry recognizes a need for collaborative approaches to managing EID risks, its response remains focused "inside the fence" with an emphasis on limiting contact between humans, wildlife and domestic animals and maintaining hygiene standards. As a result, companies are still vulnerable to disease outbreaks, due to a lack of coordination and engagement with stakeholders "outside the fence". In public health crises such as the recent Ebola outbreak, no single organization has the capacity to deal with global outbreaks on its own. Through future activities, IDRAM will facilitate oil and gas sector's contribution to national preparedness and response capabilities for EIDs and pandemics, thereby contributing to health system strengthening and improving the sustainability and coordination of disease control efforts in countries where the sector is active.

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