Suchergebnisse

Abstract
In the absence of a treaty protocol or verification regime, the Biological and Toxin Weapons Convention (BWC) instituted confidence-building measures (CBMs) as a mechanism to increase confidence in compliance by enhancing transparency and mitigating ambiguities regarding states parties' biological activities. While a promising tool to support treaty compliance, low participation, concerns regarding the completeness and accuracy of CBM submissions, a dearth of analysis, and restricted access to many submissions have limited CBMs' value. Through interviews with 53 international experts—38 from BWC delegations and 15 independent experts—we identified concrete opportunities to increase CBMs' value while mitigating the burden on states parties. This study supports states parties' efforts in the BWC Working Group on the Strengthening of the Convention, as part of a series of research on BWC assurance that aims to characterize challenges around BWC verification and increase certainty in BWC compliance.

OBJECTIVE: This article describes implementation considerations for Ebola-related monitoring and movement restriction policies in the United States during the 2013–16 West Africa Ebola epidemic. METHODS: Semi-structured interviews were conducted between January and May 2017 with 30 individuals with direct knowledge of state-level Ebola policy development and implementation processes. Individuals represented 17 jurisdictions with variation in adherence to US Centers for Disease Control and Prevention (CDC) guidelines, census region, predominant state political affiliation, and public health governance structures as well as the CDC. RESULTS: Interviewees reported substantial resource commitments required to implement Ebola monitoring and movement restriction policies. Movement restriction policies, including for quarantine, varied from voluntary to mandatory programs, and occasionally quarantine enforcement procedures lacked clarity. CONCLUSIONS: Efforts to improve future monitoring and movement restriction policies may include addressing surge capacity to implement these programs, protocols for providing support to affected individuals, coordination with law enforcement, and guidance on varying approaches to movement restrictions.

OBJECTIVES. To gather lessons from the communities that responded to confirmed cases of Ebola Virus Disease (EVD) in the United States in order to inform recommendations to improve resilience to future High Consequence Infectious Disease (HCID) events. METHODS. Key informant interviews (n=73) were conducted between February and November 2016 with individuals who participated in EVD planning or response in Atlanta, Georgia; Dallas, Texas; New York, New York; or Omaha, Nebraska. Participants represented healthcare; local, state, and federal public health; law; local and state emergency management; academia; local and national media; and local and state government. Two focus groups were then conducted in New York and Dallas, and study results were vetted with an expert advisory group. Accounts from the domestic Ebola response and recommendations for future events were used to develop an evidence-informed checklist that outlines specific actions for public health authorities. RESULTS. Participants focused on a number of important areas to improve public health resilience to HCID events, including governance and leadership, communication and public trust, quarantine and the law, monitoring programs, environmental decontamination, and waste management. CONCLUSIONS. The direct experiences of select jurisdictions recently engaged in EVD response provided a rare opportunity for collective learning and the development of a concrete list of actions with which to strengthen of public health resilience to future HCID events.

BACKGROUND: The domestic response to the West Africa Ebola virus disease (EVD) epidemic from 2014–2016 provides a unique opportunity to distill lessons learned about health sector planning and operations from those individuals directly involved. This research project aimed to identify and integrate these lessons into an actionable checklist that can improve health sector resilience to future high-consequence infectious disease (HCID) events. METHODS: Interviews (N = 73) were completed with individuals involved in the domestic EVD response in 4 cities (Atlanta, Dallas, New York, and Omaha), and included individuals who worked in academia, emergency management, government, health care, law, media, and public health during the response. Interviews were transcribed and analyzed qualitatively. Two focus groups were then conducted to expand on themes identified in the interviews. Using these themes, an evidence-informed checklist was developed and vetted for completeness and feasibility by an expert advisory group. RESULTS: Salient themes identified included health care facility issues—specifically identifying assessment and treatment hospitals, isolation and treatment unit layout, waste management, community relations, patient identification, patient isolation, limitations on treatment, laboratories, and research considerations— and health care workforce issues—specifically psychosocial impact, unit staffing, staff training, and proper personal protective equipment. CONCLUSIONS: The experiences of those involved in the domestic Ebola response provide critical lessons that can help strengthen resilience of health care systems and improve future responses to HCID events.