ghsa_prevent_detect_respondCDC GHSA Graphic

By Rebecca Holliman and Allee Torres



With our backgrounds in Biomedical Science Policy and Emerging Infectious Disease, here at AREA Health Design, the Global Health Security Agenda (GHSA) is a natural guiding force for the projects that we select. We wanted to write a post about our views of the GHSA and how we fit into the picture, because it is a natural lead into the story of why we founded AREA Health Design.


Background on the GHSA

The GHSA is an international document that is designed to create a framework to address global threats to biosecurity by coordinating global response to disease outbreaks and increasing global surveillance and response (1). It is a codified recognition that germs do not respect borders and that only coordinated international efforts can be effective in combating emerging disease threats.  The impetus for the GHSA is the understanding that we live in an increasingly global economy and this increases the likelihood of emerging diseases spreading rapidly across the globe, crippling work forces and slowing global trade. The 2003 SARS outbreak and the 2009 H1N1 outbreaks taught the world this lesson in a dramatic way–SARS cost the global economy an estimated $30 billion in only a few months and H1N1 caused an estimated $2.2 billion disruption to Mexico’s economy alone (2). The GHSA hopes to better equip the global community to identify and respond to emerging global disease threats quickly and effectively in order to help minimize these global economic impacts and minimize death and suffering.

48 countries have committed to the GHSA, along with the World Health Organization (WHO), the Food and Agriculture Organization (FAO) of the United Nations, and the World Organization for Animal Health (OIE) (1). The GHSA is managed by a Steering Group that consists of 10 countries with a rotating Chairmanship. When a country commits to the GHSA, they are committing to participating in the Steering Committee and to play various leadership roles on the Action Packages outlined in the GHSA, based on the country’s resources, expertise, and experience (1). These Action Packages are designed to provide focused goals and measures for countries to prevent, detect, and respond to emerging threats.

The specific Action Packages are:

  • Prevent: Antimicrobial Resistance, Zoonotic Diseases, Biosafety/Biosecurity, and Immunization
  • Detect: National Laboratory System, Real-time Surveillance, Reporting, and Workforce Development
  • Respond: Emerging Operations Centers, Linking Public Health with Law and Rapid Response, and Medical Countermeasures and Personal Development (1).


Combating Antimicrobial Resistance: A case study in GHSA funding channels

In his remarks at the Global Health Security Agenda Summit, President Obama said: “We now have a national strategy to combat antibiotic-resistant bacteria, to better protect our children and grandchildren from the reemergence of diseases and infections that the world conquered decades ago.” The Obama administration has made combating the spread of antibiotic resistance a priority, but unlike other action items (like vaccination campaigns) this GHSA action item is under-addressed within US borders. This makes it an ideal case study for three reasons: 1) it gives us an interesting look into the domestic funding channels for the GHSA, 2) it demonstrates how the GHSA is designed to coordinate Global Health Security efforts, not just with foreign aid programs, but by identifying and strengthening the weaknesses in each country’s ability to respond to emerging health threats within their own borders, and 3) it offers us opportunities to launch initiatives that impact the GHSA within domestic markets.

President Obama began his campaign to address antimicrobial resistance (AMR) by utilizing his authority to push an issue without the aid of Congress. In 2014, he released the “Executive Order launching Federal efforts to combat the rise in antibiotic-resistant bacteria.” This was shortly followed by the PCAST “Report to the President on Combating Antibiotic Resistance” and the “National Action Plan for Combatting Antibiotic Resistance.” (6)

In 2016, the president has been able to write in specific funding requests for AMR initiatives into the budget request. He has requested 1.2 billion dollars to combat AMR for FY 2016. This includes:

  • $650 million to the NIH and the Biomedical Advanced Research and Development Authority (BARDA) “to develop diagnostics and characterize AMR resistance”
  • $280 million to the CDC to “support antibiotic stewardship, outbreak surveillance, antibiotic use and resistance monitoring, and research and development related to combating antibiotic resistance”
  • $47 million to the FDA to “support evaluation of new antibacterial drugs for patient treatments and antibiotic stewardship in animal agriculture”
  • $77 million to USDA (Dep. of Agriculture) for antibiotic research and surveillance
  • $85 million to the VA and $75 million to the DoD to “address issues related to antibiotic resistance in healthcare settings” (6)

It is important to note that these are all primarily domestic agencies, meant to promote our domestic work to combat AMR. The point of the global health security agenda is to increase the initiatives of local governments to combat global health threats. It is in line with the GHSA to spend our resources combating the threat of AMR within our own borders, and to help other countries do the same thing across the world.

A Global Network

The CDC and GHSA recognize that global health challenges cannot be addressed by government entities alone. With this in mind, the GHSA works to actively involve key stakeholders in the non-governmental sector who are currently involved in international health initiatives and who wish to assist the federal government in GHSA efforts.  This partnership is the foundation of the GHSA Leadership Consortium.

The consortium is currently led, in part, by Jim Welch.  As the Executive Director of the Elizabeth R. Griffin Research Foundation, Mr. Welch and colleagues are heavily involved in global health efforts and work with the federal government and with each other to not only track current global health activities but to pursue future goals.  The federal liaison for the consortium is Ambassador Bonnie Jenkins,  housed within the U.S. Department of State. Ambassador Jenkins and the GHSA Leadership Consortium are currently focused on holding regular meetings in order to inform all interested parties about the current involvements of key, non-governmental organizations (7).


In the case of antimicrobial resistance, the CDC has compiled a list of over 150 organizations, entitled Leaders Committed to Antibiotic Stewardship, that have publicly declared their intent to work towards improving the issue (9). Similarly to the GHSA Leadership Consortium, many of these organizations have grant funding available under their charitable wing or foundation.  Among these organizations are: Anthem, Walgreens, The American Medical Association, AstraZeneca, and Kaiser Permanente, among others.  Available grants hold the familiar requirement of the applicant organization being a 501c3 non-profit.


AREA’s Piece of the Puzzle

So where does that leave our team at AREA Health Design? The point of this post is not just to show that large organizations around the world are united in combating AMR, but to illustrate (through tracing this web of funding and initiatives) the community that is woven together around a common goal of combating a looming global health threat. It is a problem that we at AREA care deeply about as well.

However, we believe that there is a piece of this puzzle that is missing. These big organization with large goals are also slow moving and have large budgets that emphasize initiatives that will make sweeping changes or will revolutionize global health. They are looking for the next big health campaign or the next medical breakthrough. This means that there are very few organizations that are attacking the big public health challenges of our time in small, targeted ways that utilize existing structures to create incremental change, and by implementing these changes one region at a time. That way, the small organizations are able to adapt quickly and make changes to meet the unique needs of each individual area.

We founded AREA Health Design because, after working closely with the huge government initiatives and massive budgets, we saw a need for a small, low cost, nimble organization that can “tie up the loose ends.” Please don’t think that we are discounting the critical importance of game changing technologies or of massive upgrades to infrastructure. Those are critical. However, they need to be paired with organizations that look at the small details of every day life, and address the barriers to healthy decisions that show up in day-to-day decisions: like the need to get back to work, or the cost of an item, or cultural influences. These things cannot be effectively addressed at the level of large corporations and governments, because these organizations are limited by their massive scope to implementing solutions that work across broad populations.

We founded AREA because we saw a need, in the fight against AMR, but also across the entire field of public health, for organizations with a narrow scope that can focus on changing individual decisions, or addressing barriers in individual communities, with solutions that build off of existing technologies and infrastructure. We base all of our work on the belief that change at this level cannot be forced or require indefinite funding, but must be something that individuals and communities want to adopt, and that can sustain itself through market demand. We want to work in collaboration with the big organizations that have the resources to make huge changes, to help them reach our mutual goal. We want to help them by greasing the wheels of public health, by removing the pressures working on individuals that make it difficult for them to adopt the big changes.


*This blog post was adapted from a paper that Rebecca Holliman and Allee Torres wrote for the Georgetown University Department of Microbiology and Immunology in December 2015, titled “Who Pays for the Global Health Security Agenda?”


  1. Global Health Security Agenda: Frequently Asked Questions. (2015, November 18). Retrieved November 23, 2015, from
  2. A Health Threat Anywhere Impacts Business Everywhere. (n.d.). Retrieved November 23, 2015, from
  3. Policy Basics: Introduction to the Federal Budget Process. (n.d.). Retrieved November 23, 2015, from
  4. The U.S. Global Health Budget: Analysis of the Fiscal Year 2016 Budget Request. (n.d.). Retrieved November 23, 2015, from
  5. The U.S. Global Health Budget: Analysis of the Fiscal Year 2016 Budget Request. (n.d.). Retrieved November 23, 2015, from
  6. FACT SHEET: President’s 2016 Budget Proposes Historic Investment to Combat Antibiotic-Resistant Bacteria to Protect Public Health. (n.d.). Retrieved December 13, 2015, from
  7. ERGF AND THE GLOBAL HEALTH SECURITY AGENDA. (n.d.). Retrieved November 21, 2015, from
  8. Robert Wood Johnson Foundation Funding Opportunities. (n.d.). Retrieved November 21, 2015, from
  9. Leaders Committed to Antibiotic Stewardship. (2015, November 13). Retrieved October 21, 2015, from

It would not be appropriate not to end include in this post one of the CDC’s infographics. This is the infographic that the CDC made to explain the GHSA.

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Global Health Security Agenda and Where AREA Health Design Fits

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