Logistics

Amir Khorram-Manesh, Eric Carlström, Attila J. Hertelendy, Krzysztof Goniewicz, Carter B. Casady, and Frederick M. Burkle Jr. 8/2020. “Does the Prosperity of a Country Play a Role in COVID-19 Outcomes?” Disaster Medicine and Public Health Preparedness.Abstract

Objective: This study aims to clarify the association between prosperity and novel coronavirus disease 2019 outcomes and its impact on the future management of pandemics.

Methods: This study is an observational study using information from two online registries. The numbers of infected individuals and deaths and the prosperity rank of each country were obtained from worldometer.info and the Legatum Institute’s Prosperity Index, respectively.

Results: There is a combination of countries with high and low prosperity on the list of coronavirus disease 2019 infected countries. The risk of the virus pandemic seems to be more extensive in countries with high prosperity. A Spearman’s rho test confirmed a significant correlation between prosperity, the number of coronavirus disease 2019 cases, and the number of deaths at the 99% level.

Conclusion: New emerging pandemics affect all nations. In order to increase the likelihood of successfully managing future events, it is important to consider pre-existing health security, valid population-based management approaches, medical decision-making, communication, continuous assessment, triage, treatment, early and complete physical distancing strategies, and logistics. These elements cannot be taught on-site and on occasion. There is a need for innovative and regular educational activities for all stakeholders committed to safeguarding our future defense systems concerning diagnostic, protection, treatment, and rehabilitation in pandemics as well as other emergencies.

Alan Parnell, Krzysztof Goniewicz, Amir Khorram-Manesh, Frederick M. Burkle Jr., Ahmed Al-Wathinani, and Attila J. Hertelendy. 8/2020. “COVID-19 a health reform catalyst? -Analyzing single-payer options in the U.S.: Considering economic values, recent proposals, and existing models from abroad.” Journal of Hospital Administration.Abstract

The United States has continued to face severe health coverage and spending challenges that have been attributed to a fragmented multi-payer and fee-for-service delivery system which has become even more exposed by the COVID-19 pandemic. Legislators and healthcare professionals have tried to answer the challenges faced by the U.S. health system through the introduction of several state and federal proposals for a "Medicare-for-all" like system, which have failed to be adopted likely due to the lack of consideration for free-market economic values. Looking to existing models abroad can provide the U.S. with different ways to understand how to achieve the benefits of single-payer models with universal coverage while maintaining the integrity of free-market values. The health systems in wealthy, industrialized countries are closely referenced in this article because of the variation of methods in which each achieves a single-payer/universal coverage model as well as the contrast in their health outcomes compared to that of the U.S. The biggest considerations for any reform effort to achieve an efficient single-payer system with universal coverage is the maintenance of private health insurers and the degree to which expanded government influence would be accepted. The future state of health care remains uncertain and unstable as a result of the COVID-19 pandemic, therefore a window of opportunity exists now for leveraging this uncertainty to achieve reform.

Frederick M. Burkle Jr. 7/2020. Robert Fox Interview with Frederick M. Burkle on Population-based Triage Management.Abstract
Interview: At first sight, Population-based Triage, PBT for short, isn't the most enticing social formula-but it may be the key to how the UK manages the next stages of the current Corona quagmire-and prepare for the next one, when and not if it happens. It could, and probably should, become standard operating procedure in public health population-based management decisions in the outbreak of widespread pestilence and disease. We need that new Public Health Strategy now. Under the PBT plan the population as a whole is treated to the triage technique familiar in accident and emergency, and battlefield medicine. Medical and rescue teams concentrate on treating the salvageable in preference to those most likely to die. "Traditional health care systems care systems care for patients individually, while public health is caring for an entire population," says Professor Frederick Burkle, Senior Scholar and Scientist of Public Health at Harvard. He published his plan for a population-based approach to pandemic in 2006. It was used in the major desk-top exercise by Public Health England for tackling a major influenza pandemic, Operation Cygnus, in 2016. The report partly adopted the professor's clear-eyed approach to running a major pandemic operation, but left many questions open. If they had been addressed in the present Covid crisis, thousands of lives might have bene saved. Much the same goes for Exercise Isis carried out by National Health Scotland in 2018, focused on a major outbreak of MERS (Middle East Respiratory Syndrome). The lessons of both exercises have been taken aboard, according to Matt Hancock, but as they say in Scots law, it looks like a case of not proven. Both the Cygnus and Isis reports of 2017 and 2018 cannot conceal the serious shortcomings in preparation against a major public health emergency. The Cygnus exercise, for instance concentrates on the role of the Local Resilience Forums in coordinating emergency services-yet the representatives of the eight LRFs were explicit about their lack of resources. The LRFs have proved vital since March, but they have no statutory powers and no funding. More ominously the Isis report for the Scottish Health flags up the lack of availability of protective equipment-PPE-for a nationwide viral outbreak. The problem of managing a workable Public Health Emergency strategy for this coronavirus crisis is brilliantly illustrated BBC1's drama documentary, The Salisbury Poisonings. It tells the real events of the attack by the nerve agent Novichok on the Skripals in Salisbury two years ago. The heroine is the Wiltshire Public Health Officer Tracy.
Krzysztof Goniewicz, Beata Osiak, Witold Pawłowski, Robert Czerski, Frederick M. Burkle Jr., Dorota Lasota, and Mariusz Goniewicz. 7/2020. “Bioterrorism Preparedness and Response in Poland: Prevention, Surveillance, and Mitigation Planning.” Disaster Medicine and Public Health Preparedness.Abstract

Objectives: Biological weapons are one of the oldest weapons of mass destruction used by man. Their use has not only determined the outcome of battles, but also influenced the fate of entire civilizations. Although the use of biological weapons agents in a terrorist attack is currently unlikely, all services responsible for the surveillance and removal of epidemiological threats must have clear guidelines and emergency response plans.

Methods: In the face of the numerous threats appearing in the world, it has become necessary to put the main emphasis on modernizing, securing, and maintaining structures in the field of medicine which are prepared for unforeseen crises and situations related to the use of biological agents.

Results: This article presents Poland’s current preparation to take action in the event of a bioterrorist threat. The study presents both the military aspect and procedures for dealing with contamination.

Conclusions: In Poland, as in other European Union countries fighting terrorism, preparations should be made to defend against biological attacks, improve the flow of information on the European security system, strengthen research centers, train staff, create observation units and vaccination centers, as well as prepare hospitals for the hospitalization of patients—potential victims of bioterrorist attacks.

Eric Weinstein, Luca Ragazzoni, Frederick M. Burkle Jr., Mea Allen, David Hogan, and Francesco Della Corte. 5/2020. “Delayed Primary and Specialty Care: The Coronavirus Disease-2019 Pandemic Second Wave.” Disaster Medicine and Public Health Preparedness.Abstract

Time is of the essence to continue the pandemic disaster cycle with a comprehensive post-COVID-19 health care delivery system RECOVERY analysis, plan and operation at the local, regional and state level. The second wave of COVID-19 pandemic response are not the ripples of acute COVID-19 patient clusters that will persist until a vaccine strategy is designed and implemented to effect herd immunity. The COVID-19 second wave are the patients that have had their primary and specialty care delayed. This exponential wave of patients requires prompt health care delivery system planning and response.

Frederick M. Burkle Jr. and Asha V. Devereaux. 5/2020. “50 States or 50 Countries: What Did We Miss and What Do We Do Now?” Prehospital and Disaster Medicine.Abstract

There have been multiple inconsistencies in the manner the COVID-19 pandemic has been investigated and managed by countries. Population-based management (PBM) has been inconsistent, yet serves as a necessary first step in managing public health crises. Unfortunately, these have dominated the landscape within the United States and continue as of this writing. Political and economic influences have greatly influenced major public health management and control decisions. Responsibility for global public health crises and modeling for management are the responsibility of the World Health Organization (WHO) and the International Health Regulations Treaty (IHR). This review calls upon both to reassess their roles and responsibilities that must be markedly improved and better replicated world-wide in order to optimize the global public health protections and its PBM. 

Amir Khorram-Manesh, Phatthranit Phattharapornjaroen, Luc J Mortelmans, and Frederick M. Burkle Jr. 2/2021. “Current Perspectives and Concerns Facing Hospital Evacuation: The Results of a Pilot Study and Literature Review.” Disaster Medicine and Public Health Preparedness. Read PublicationAbstract

Objective: To analyze the evacuation preparedness of hospitals within the European Union (EU).

Method: This study consisted of 2 steps. In the first step, a systematic review of the subject matter, according to the PRISMA flow diagram, was performed. Using Scopus (Elsevier, Amsterdam, Netherlands), PubMed (National Library of Medicine, Bethesda, MD), and Gothenburg University´s search engine, 11 questions were extracted from the review and were sent to representatives from 15 European Union (EU)- and non-EU countries.

Results: The findings indicate that there is neither a full preparedness nor a standard guideline for evacuation within the EU or other non-EU countries in this study. A major shortcoming revealed by this study is the lack of awareness of the untoward consequences of medical decision-making during an evacuation. Some countries did not respond to the questions due to the lack of relevant guidelines, instructions, or time.

Conclusion: Hospitals are exposed to internal and external incidents and require an adequate evacuation plan. Despite many publications, reports, and conclusions on successful and unsuccessful evacuation, there is still no common guide for evacuation, and many hospitals lack the proper preparedness. There is a need for a multinational collaboration, specifically within the EU, to establish such an evacuation planning or guideline to be used mutually within the union and the international community.

6/2018. “An Innovative Global Diplomacy Public Health Student Program – Lessons from the Field in a Post-Conflict Medellin, Colombia”.Abstract

For over fifty years, Colombia has been embroiled in conflict, displacing nearly seven million people, second only to Syria for the highest number of internally displaced persons (IDPs) in the world. Most are displaced to urban environments into dense informal settlements with inadequate water, sanitation, shelter and power infrastructure. The city of Medellín, has become home to over 200,000 IDPs in informal agglomerations. Medellín’s transformation to a city of progress and innovation through the promotion of “social urbanism” is an example of how collaboration between city institutions and government sectors can address issues of poverty, violence, equality, engagement, and reintegration of displaced populations in Colombia.

The Post-Conflict Colombia Public Health Project is a collaborative academic exchange program aimed at bringing together public health students from the United States and Colombia for the purpose of understanding between the people of both countries. The project aims to educate students while also providing direct service and fostering long-term cross-cultural relationships and sustainable projects. Seminars, skill building workshops, cultural experiences, and community engagement are used to build professional competencies and inform policy recommendations for future projects. Despite the limited research on the educational impact of short-term global emersion programs, small scale evaluations point to an increase in learners’ cross-cultural adaptability. The believed benefit to students’ professional and personal development must be balanced with ethical considerations including preparedness of students, health and safety risks, cultural sensitivity, and issues of sustainability. In order to address these concerns, programs should be developed collaboratively through bi-directional participatory relationships, incorporating both education and direct service components, and promoting local capacity building and long-term sustainability.

Our course pairs 16 carefully selected graduate-level public health and medical students from Harvard and Universidad de Antioquia, who will serve as both student and citizen ambassadors, to come together and share about their culture, values, and experiences through the lens of diplomacy and dialogue to make a meaningful impact in the people and country of Colombia. The course examines the social development model of Medellín and its impact on advances in peace, social equity, and health. Beyond the theoretical concepts, students will learn to apply them to the Granizal community in order to create practical solutions that are sustainable, scalable, innovative, and measurable.

As other disciplines move away from curricula limited to rote learning and fact-based content, public health and policy education will also benefit from incorporating experiential and competency-based learning with an emphasis on skill building in leadership, management, policy-making, and research.5 The Institute of Medicine’s 2003 report, Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21st Century, recommends eight content areas as essential to graduate level public health education programs: informatics, genomics, communication, cultural competence, community-based participatory research, global health, policy and law, and public health ethics.6 The report further acknowledges the importance of developing international relationships between academic institutions, community organizations, and health agencies for collaboration in interdisciplinary and community-based research, learning, and service. Health disparities, issues of social justice, and public health threats from infectious disease are less and less confined by political and geographic boundaries. The future generation of leaders in public health and policy must be able to bridge nations and cultures through diplomacy and be equipped to develop innovative strategies and partnerships across professional disciplines and on a global scale.

While several public health approaches have been documented in the literature, we describe a model for a multi-institutional and cross-cultural collaboration based on The Post-Conflict Colombia Public Health Project, a three-week intensive course developed in partnership between the Harvard Humanitarian Initiative, the Open Hands Initiative, and the University of Antioquia. While this model is a public health course focusing on Colombia, the concepts and educational strategies can be applied across academic disciplines and to other countries and communities.

 

HPCR. 6/2003. The Future of the Afghan Legal System: Perspectives from the Young Generation - Roundtable Report.Abstract

The purpose of this report is to present the results of a youth roundtable on constitutional and legal reform, hosted February 5-6, 2003, by the Harvard Program on Humanitarian Policy and Conflict Research (HPCR) and co-organized by the Afghanistan Youth Center (AYC). This roundtable discussion, entitled “The Future of the Afghan Legal System: Perspectives from the Young Generation,” was held at the Khyber Hotel in Kabul, Afghanistan. The roundtable was organized as one of a series of activities aimed at enriching the information environment in which legal reform decisions are made in Afghanistan by the Afghanistan Transitional Administration (ATA), the Drafting Committee of the Constitutional Commission, the Judicial Reform Commission, the United Nations Assistance Mission in Afghanistan (UNAMA), and the international community of donor nations. The current publication reflects further research and observation in the months of February through June 2003. It is hoped that many of the views expressed by the participants will serve as an example of the types of frank and open conversations on sensitive issues that can and should take place in the critical months leading to the Constitutional Loya Jirga in October 2003.

Vincenzo Bollettino. 10/2006. Designing Security.Abstract

Humanitarian organizations operate in increasingly hostile environments. Although authoritative statistics are scarce, anecdotal evidence suggests that aid workers face life-threatening risks that are exacerbated by the growing number of humanitarian organizations operating in the field with varying mandates, without common professional security standards and with limited success with inter-agency security coordination. The ability of humanitarian organizations to fulfill their mandates in the future will depend in part on their individual success in improving internal security management practices and in finding ways to coordinate their efforts on building common security standards and security coordination across agencies. To meet this challenge, humanitarian organizations must implement improved security management methods and find ways to coordinate their security operations and planning. Despite broad acceptance of the need to develop better security management and coordination, many humanitarian organizations remain ambivalent about coordinating their security activities and few have instituted robust measures for improving their own security management practices. Further, efforts to improve security management practices are hampered by a critical lack of basic empirical knowledge about the field security environment. In discussions about humanitarian staff safety and security, the least common denominator continues to be cumulative anecdotal evidence provided by the many security personnel working for humanitarian organizations in the field. This policy brief reviews the literature on humanitarian organization security management, highlighting common misconceptions about the field security environment, reviews the main structural and procedural issues impeding more effective security management, and illustrates why current initiatives to improve security management practices will remain only partial successes if they do not include a serious effort to replace anecdotal reporting on the field security environment with systematic collection and analysis of field security data. It argues that staff security requires a common professional approach based on sound security expertise adapted to meet the operational needs of humanitarian organizations. A model is developed for creating a network of security professionals responsible for guiding the design and implementation of common security standards and security information sharing protocol.

Derek Jinks. 6/2004. The Temporal Scope of Application of International Humanitarian Law in Contemporary Conflicts.Abstract

When does the application of international humanitarian law properly begin and end in modern conflicts? Classical international law distinguished three types of armed conflict: (1) war; (2) civil war; and (3) armed hostilities short of war. The laws of war were applicable in time of war--from the declaration of war until the formal reestablishment of peace (for example, by the signing of a peace treaty). The laws of war were not applicable in civil wars--which were considered internal matters--unless a state formally recognized the insurgency as a belligerent. And, of course, the laws of war were not applicable as a formal matter in hostilities short of war. Prior to the drafting of the Geneva Conventions in 1949, the applicability of the “law of war” was, therefore, delimited by formal acts of state such as a formal declaration of war or a formal recognition of belligerency. The Geneva Conventions substantially revised this formalistic, de jure approach--making contemporary international humanitarian law applicable during armed hostilities that de facto constitute “armed conflicts.” In both international and non-international armed conflicts, the Geneva Conventions, in general, govern the conduct of hostilities for the duration of the “armed conflict.” This background note briefly outlines the regime established in the Geneva Conventions and summarizes several ambiguities in these rules. Because the scope of application regimes differ sharply between international and non-international armed conflict, these two types of conflict are analyzed separately. 

Claude Bruderlein. 2006. Towards a Common Security Framework: Securing Access and Managing Risks in Hazardous Missions.Abstract

International agencies are facing increasing levels of threats against their staff and activities in many of their operations. Since the end of the Cold War, these agencies, intergovernmental and non-governmental alike, have been called to work more intensely in conflict areas.1 These areas have become singularly more dangerous in recent years, exposing staff to greater risks. The threats of attack, as well as recurring levels of criminal violence, are now part of the daily life of international agencies’ workers in many of these situations, hindering their work and limiting their access to people in need. Although significant resources have been invested recently in building the security capabilities of international agencies, the escalation in security threats has not been matched with the development of corresponding institutional strategies to mitigate operational risks and reduce the exposure of international agencies. Despite serious flaws in existing security systems, international agencies have been inclined to expand their security capacity at a technical level rather than reviewing the relevance of their security strategies. As a response to the attacks against United Nations (UN) headquarters in Baghdad and other field missions, the United Nations is planning to expand significantly the capacity of the UN security system by creating a Directorate of Security, which will centralize all UN security systems, and by adding a number of staff and layers of technical responsibilities to an already bureaucratic and over-procedural security apparatus. While most operational managers agree that the security environment of UN agencies has evolved considerably over the recent years, this significant expansion in security capabilities is being considered without a clear and proper understanding of the types or sources of threats the UN will face in the coming decades.2 There are few discussions on global and local threats against UN operations or the role that agencies can play to mitigate exposure to risks. Similarly, other agencies, such as the International Committee of the Red Cross (ICRC) or Médecins Sans Frontières (MSF), are increasingly tying their security response to conservative interpretations of their mission — relying significantly, in the process, on the neutral character of their activities and the acceptance of the communities. Many organizations, however, fail to acknowledge the changing perceptions of international assistance in some areas of the world and the changing profile of the security threats that endanger not only their operators but the recipient communities as well. For these agencies, the current security developments represent a major challenge 

HPCR and Center Security Peace Studies Gadjah Mada for and University. 7/2002. Building Sustainable Peace and Fostering Development in Papua - E Conference Report.Abstract

From 20th June through the 5th of July 2002, the Conflict Prevention Initiative of the Harvard Program on Humanitarian Policy and Conflict Research (CPI HPCR) in cooperation with the Center for Peace and Security Studies at the University of Gadjah Mada (CSPS) carried out a series of activities under the theme: “Building sustainable peace and fostering development in Papua”. This event was an effort to gather ideas and support from those representing Papua in the fields of peacebuilding and development. Using the Internet to discuss policies in the field of conflict prevention, this CPI-CSPS event also aimed at providing a platform for spreading information and strengthening networks between participants and decision makers at the national and international levels. The event started with a roundtable discussion at the University of Gadjah Mada on 20-22 June 2002, with 8 people from Papua representing the academic world, NGOs, religious organizations, customary institutions, women’s groups and youth. The main ideas that emerged during this discussion then became entry points for the e-conference, an online virtual discussion online in Indonesian. The e-conference took place between 24 June and 25 July 2002, with the participation of 89 people from various backgrounds. Simultaneously, an e-forum was carried out in English, with the participation of 32 people.

ATHA. 1/2006. “ATHA: Security of Humanitarian Staff”.Abstract

Humanitarian organizations operate in increasingly hostile environments. Although authoritative statistics are scarce, anecdotal evidence suggests that aid workers face life-threatening risks that are exacerbated by the growing number of humanitarian organizations operating in the field with varying mandates, without common professional security standards and with limited success with inter-agency security coordination. The ability of humanitarian organizations to fulfill their mandates in the future, will be depend in part on their individual success in improving internal security management practices and in finding ways to coordinate their efforts on building common security standards and security coordination across agencies. To meet this challenge, humanitarian organizations must implement improved security management methods and finds ways to coordinate their security operations and planning. Despite broad acceptance of the need to develop better security management and coordination, many humanitarian organizations remain ambivalent about coordinating their security activities and few have instituted robust measures for improving their own security management practices. Further, efforts to improve security management practices are hampered by a critical lack of basic empirical knowledge about the field security environment. In discussions about humanitarian staff safety and security, the least common denominator continues to be cumulative anecdotal evidence provided by the many security personnel working for humanitarian organizations in the field. This policy brief reviews the literature on humanitarian organization security management, highlighting common misconceptions about the field security environment, reviews the main structural and procedural issues impeding more effective security management, and illustrates why current initiatives to improve security management practices will remain only partial successes if they do not include a serious effort to replace anecdotal reporting on the field security environment with systematic collection and analysis of field security data. It argues that staff security requires a common professional approach based on sound security expertise adapted to meet the operational needs of humanitarian organizations. A model is developed for creating a network of security professionals responsible for guiding the design and implementation of common security standards and security information sharing protocol. 

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