“...The CDC [U.S. Centers for Disease Control and Prevention] recently established the National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), however, which addresses the human-animal health link. Nonetheless, effective linkages between animal and human health remain elusive []. An approach that is gaining attention for addressing the animal, human, and environmental nexus is One Health, which seeks to bring together multidisciplinary expertise in animal and human health and the associated environmental ecosystems. The goal of One Health in this context is to fully address biological threats—whether natural or man-made— in a transdisciplinary manner by integrating research, knowledge, and other defense mechanisms, including all aspects that can impact human health. In order for this program to become effective, a One Health approach needs to be institutionalized and recognized at the federal level across departments/agencies, particularly HHS, USDA, USAID, DHS, Department of Interior, and even DOD. Today, USAID is ahead of other agencies, applying One Health approaches through its emergency pandemic threats program in the Bureau of Global Health. Similarly, One Health needs to be applied locally by NGOs and universities toward the prevention of zoonotic infectious diseases at their source. ...” 2. Increased disease surveillance at the animal-human and wildlife-domestic animal interface is urgently needed.  Increased surveillance is particularly important in highrisk areas. Examples include the Zoonotic Disease Unit in Kenya, which is developing capabilities for rapid detection, response, and control of zoonotic diseases using a One Health approach, and increased risk-based infectious disease surveillance and monitoring along the borders of Kruger National Park in South Africa to check for tick-borne disease transfer between wildlife and domestic cattle populations. ... 4. Institutionalize One Health and apply One Health approaches to pandemic prevention. This was a recommendation made by the Blue Ribbon Study Panel for Biodefense. One Health is intended to promote multidisciplinary collaboration between researchers and other nongovernmental officials. The concept of integrating the knowledge and study of animal, plant, and human health is vital for protecting the United States from naturally occurring and man-made diseases. This integration should become more formalized across the federal interagency and implemented by NGOs, particularly in global high-risk regions where epidemics and pandemics are more likely to emerge. ...” The Growing Threat of Pandemics: Enhancing Domestic and International Biosecurity March 2017 The threat posed by pandemics grows alongside increased globalization and technological innovation. Distant cultures can now be connected in a day’s time, and international trade links global health and economic prosperity. In this report, the Scowcroft Institute of International Affairs at The Bush School of Government and Public Service at Texas A&M University details nine priority areas and accompanying action items that will help to address current pandemic response problems. 1.     Leadership: Strong leadership in biodefense and pandemic preparedness and response is the first area identified as needing improvement. Following the recommendations made by the Blue Ribbon Panel on Biodefense (2015), we recommend that United States leadership in biodefense be centralized in the White House, specifically within the Vice President’s office. Also in line with recommendations made by the Biodefense Panel, we recommend that a Biodefense Council, overseen by the Vice President, be established. Additional action items include the establishment of a new and overarching National Biodefense and Pandemic Preparedness Strategy. Beyond the panel’s findings, we recommend a detailed implementation plan, tied to a unified and integrated budget, with built-in accountability to ensure decentralized action. We also call for the re-prioritization of national and international pandemic preparedness and response exercises. 2.     International Response: We should re-evaluate pandemic response plans – in particular, the need to adopt the World Health Organization’s (WHO) reforms: WHO established an advisory group in 2015 to determine ways to improve their response to disease outbreaks and emergencies following an ineffective response to the Ebola outbreak in 2014. We endorse the recommendations for reform provided by the advisory group and urge priority action for reform implementation. We also recommend that WHO Regional Office Directors no longer be independent from WHO Headquarters, but report directly to the Director-General. Independence of the regional offices makes it difficult for unified WHO response and can impede efficient communication and organization during pandemic response. 3.     The Anti-Vaccine Movement: The increasing influence of the anti-vaccine movement in the United States is another growing threat. Leaders of the movement spread misinformation to parents with questions or anxiety over the safety of vaccines. Many within the anti-vaccine movement incorrectly believe that vaccines cause autism and the number of individuals seeking nonmedical exemptions to the vaccination requirements of schools is on the rise. In some states, like Washington and Texas, this puts public school populations dangerously close to falling below the threshold for “herd immunity”—which refers to the percentage of a population that needs to be vaccinated in order to provide protection to those who are unvaccinated. Dropping below herd immunity puts individuals who cannot get vaccinated – those that are either too young or immunocompromised -- at great risk. We recommend that public health authorities initiate education campaigns to communicate the risk that vaccine-preventable disease pose to unvaccinated individuals. Additionally, we strongly recommend that states re-evaluate their acceptance of personal belief or philosophical exemptions. These should be removed as exemption options. 4.     Animal – Human Health: Next we address the need to bridge the gap between animal and human health. The majority of emerging diseases are zoonotic. Whether due to living in close proximity with animals, destruction and encroachment of habitats, or lack of vaccinations, diseases originating in animals are increasingly making the jump into the human population. Some of our recommendations for bridging the gaps in this area include: expanded animal vaccination programs, institutionalization of One Health—which is a program that creates collaboration between human and animal health care professionals and researchers with the goal of developing an interdisciplinary strategy for animal, human, and environmental health—, increased disease surveillance along wildlife/livestock boundaries, and education and training for individuals who live or work in high risk areas. 5.     Uniform Health Screening: There should be uniform health screenings for individuals seeking permanent or extended temporary residence in the United States. Currently, there are discrepancies between the vaccination requirements for immigrants and the vaccination requirements for refugees. Immigrants are required to have all their vaccinations before entering the country, whereas refugees are only strongly recommended to do so. There are also limited health screening requirements for individuals who are not seeking permanent residence in the United States. It may not always be possible for refugees to receive their vaccinations overseas, so we suggest requiring immunizations upon entry and requiring health screenings for anyone staying in the U.S. more than 3 months. We also recommend implementing more risk-based infectious disease screenings that reflect the individual’s country-of-origin. 6.     Public Health and Health Care Infrastructure: In many developing countries, there is often insufficient infrastructure, expertise, and supplies to adequately provide for even basic day-to-day health care – let alone to detect, report, and respond to infectious disease outbreaks and other threats as required by WHOs International Health Regulations (IHR). Even the U.S., which has greater expertise and higher investment in healthcare, struggles with adequate surge capacity in the case of a high-impact infectious disease outbreak or other emergencies. In this section, we recommend investment in host country institutions, and restructuring hiring systems for health care professionals in developing countries. In addition, enhanced diplomacy and commitment to the Global Health Security Agenda will help support implementation of the International Health Regulations. We also recommend enhanced foreign aid investments in global health, specifically for pandemic prevention and preparedness, as they are essential to international security and U.S. national security. 7.     Effective Outbreak Response: The U.S. is often caught unprepared when an outbreak with pandemic potential strikes. Valuable time is wasted in the existing, cumbersome process of identifying the disease, predicting risk, and acquiring emergency appropriations to respond. To help create a more effective response, we recommend that Congress make funding for diagnostics and biosurveillance a high-priority budget item. In addition, the United States should use USAID/Office of Foreign Disaster Assistance’s (OFDA) financial authorities and resources, which are not earmarked, as an international pandemic emergency response fund to reduce the need for supplemental emergency appropriations. We further recommend that the new national biodefense and pandemic preparedness strategy affirm OFDA’s role as the lead coordinator of the United States’ international response for pandemic emergencies, similar to its lead role for all other international disaster responses. 8.     Cultural Competency: Ebola demonstrated that disease control protocols and cultural rituals can collide with devastating results. In this report, we suggest that cultural anthropologists and crisis communicators are consulted and included in U.S. public health missions to other countries. 9.     Academic Collaborations: Academic institutions situated in developing countries have pre-established relationships with the affected people in their local communities and regions, and will be around long after the acute response phase has ended. There are also growing global academic and scientific university-based collaborations between faculty and students in developed and underdeveloped countries. We suggest building university-based public health extension programs designed to work within local communities, communicate disease research to a non-academic audience, and incorporate host country universities and their established, global academic collaborations into the overall disease response. View The Growing Threat of Pandemics: Enhancing Domestic and International Biosecurity White Paper here.