Documentation

Health Security Net is one of a suite of free resources from the Georgetown University Center for Global Health Science and Security that makes data and information about pandemic planning and oversight centralized and publicly accessible. Built on an integrated data architecture to support cross-platform analysis, this global health security library is a searchable and filterable database designed to enable ready access to warnings, evaluations, oversight efforts, strategies, and other documents concerning pandemic risk and related issues, including documents from governmental, international, and non-governmental organizations. The library is a work in progress and continues to be updated as additional resources are identified. Please contact us with any questions or additions at healthsecuritynet@georgetown.edu.

As of its launch in January 2021, the library includes documents from global and national-level sources dated from 1995-2019. Global sources are the Food and Agriculture Organization, United Nations General Assembly, United Nations Security Council, World Organisation for Animal Health, and World Health Organization (including the World Health Assembly). National sources as of January 2021 are drawn from the United States. Academic journal literature as it relates to coronaviruses as a global infectious disease threat is also represented. This is an ongoing research project and the library may be updated to reflect pre-1995 or post-2019 sources, additional countries, and other elements.

The site includes:

  1. A searchable, filterable database of all documents in the dataset. The complete dataset can be downloaded in an Excel file format directly from the site.
  2. A written analysis from the Georgetown University Center for Global Health Science and Security reflecting key observations about the dataset.

This work and underlying dataset is available for use under the Creative Commons Attribution 4.0 International Public License (https://creativecommons.org/licenses/by/4.0/), with appropriate reference and acknowledgement of the original research teams, as listed on this site.

This documentation includes:

  1. The Library and the methodology used to populate it
  2. The data coding process
  3. The glossary of terms as applied to the Library

Library

Data collection

The modern biothreat can be viewed as a tripartite construct that consists of intentional acts, emerging infectious diseases (EID) from nature, and accidents. Preparedness for that threat may be specific to one of those elements, to individual pathogens of concern, or may be approached generally as “all-hazards.” This library is designed to primarily capture documents relating to federal/national and global officials’ awareness of the EID or naturally-occurring pandemic threat and the risk from that threat. The researchers did not specifically seek information related to intentional acts and biological accidents, but did not exclude such documents where they were relevant to pandemic preparedness in general. All-hazards items captured by the search were included only if they also directly addressed the nexus between all-hazards preparedness and infectious disease. The library includes items published from January 1, 1995 – December 31, 2019.

Global

The research team collected documents online from multiple global sources and excluded those meeting any of the following criteria: 

  • Items published outside of January 1, 1995 – December 31, 2019.
  • Items strictly about bioterrorism and/or biosafety/biological accidents.
  • Items solely focused on endemic diseases or those typically addressed by the global health (as opposed to global health security) community, e.g., HIV, TB, malaria, and noncommunicable diseases.
  • Items focused on a single country (e.g., country-level Joint External Evaluation mission reports; reports published by a World Health Organization regional office).
  • Fact sheets on diseases.
  • Items not in English.

Global sources were reviewed for relevant documents. The search strategy varied among them, for instance depending on the sophistication of their websites’ search functionality, or whether the site provided its own relevant terms for grouping. Global sources currently included in Health Security Net include:

  1. Food and Agriculture Organization of the United Nations (FAO): FAO holds biennial conferences to discuss and review programs and provide guidance for Member States on health-related activities. Resolutions and decisions from each conference are published in the conference report at http://www.fao.org/unfao/govbodies/gsbhome/conference/conference-reports/en/. Because resolutions and decisions are not published separately from the full conference report and the search function is not sufficiently advanced to search only for terms within the resolutions and decisions, the research team was unable to employ the comprehensive list of search terms used for other entities (e.g., see United States hearing section). The research team therefore reviewed the table of contents of each report from 1995-2019 for the titles of the resolutions and decisions to determine their relevance to pandemics. If the title included the search terms, it was captured; if it contained terms that may otherwise be relevant to infectious disease in the judgement of the researcher, the contents were reviewed to determine inclusion or exclusion. 
  2. United Nations General Assembly (UNGA): The United Nations Digital Library (https://digitallibrary.un.org/?ln=en&as=1) was searched in the primary search field for “pandemic” using All of the words and any field. Full text search was by default not toggled on, resulting in 142 hits for UNGA; despite this, the search appeared to capture documents with the search term in the body of the document, not just the title. This search methodology as applied to the Digital Library was not perfectly sensitive; in some cases, upon reading the captured resolutions, the researchers found references to additional resolutions about pandemics, and these were searched for directly and added to the database if relevant. (In some cases, the captured record did not have the word “pandemic” at all.) Once the dataset was ready, exclusion criteria were applied.
  3. United Nations Security Council (UNSC): Based on the experience and judgement of Center faculty, the following UNSC resolutions were deemed relevant to global health security within the years 1995–2019: 1308, 1983, 2177, and 2439. Each of these was logged into the database. The text of each was also reviewed for mentions of other resolutions, exclusion criteria were applied, and any that remained were captured into the database. (All such entries met exclusion criteria and thus are not represented in the database.)
  4. World Organisation for Animal Health (OIE): OIE holds annual conferences to discuss and review programs and provide guidance for Member States on health-related activities. Resolutions and decisions from each conference are published at https://www.oie.int/about-us/key-texts/resolutions-and-recommendations/resolutions-adopted-by-the-world-assembly-of-delegates-of-the-oie/. Because resolutions and decisions are not published separately from the full conference report and the search function is not sufficiently advanced to search only for terms within the resolutions and decisions, the research team was unable to employ the comprehensive list of search terms used for other entities (e.g., see United States hearing section). The research team therefore reviewed the table of contents of each report from 1995-2019 for the titles of the resolutions and decisions to determine their relevance to pandemics. If the title included the search terms, it was captured; if it contained terms that may otherwise be relevant to infectious disease in the judgement of the researcher, the contents were reviewed to determine inclusion or exclusion. 
  5. World Health Assembly (WHA): WHA holds annual conferences to discuss and review programs and provide guidance for Member States on health-related activities. Resolutions and decisions from each conference are published at https://apps.who.int/gb/index.html. Because resolutions and decisions are not published separately from the full conference report and the search function is not sufficiently advanced to search only for terms within the resolutions and decisions, the research team was unable to employ the comprehensive list of search terms used for other entities (e.g., see United States hearing section). The research team therefore reviewed the table of contents of each report from 1995-2019 for the titles of the resolutions and decisions to determine their relevance to pandemics. If the title explicitly included the search terms, it was captured; if it contained terms that may otherwise be relevant to infectious disease in the judgement of the researcher, it was reviewed to determine inclusion or exclusion.
  6. World Health Organization (WHO): WHO documents located in the Institutional Repository for Information Sharing (IRIS) database were searched (https://apps.who.int/iris/). Because many of our desired search terms (see United State—Hearings section below) returned thousands of results, and IRIS can only export 500 at a time, the research team instead used the “MeSH” subject categories that IRIS uses to organize its topics. In the IRIS database, we manually searched the “MeSH subjects” category and chose relevant subjects (number of records in parentheses): Coronavirus Infections (133); Ebola Vaccines (24); Ebolavirus (430); Epidemics (138); Epidemiological Monitoring (1284)—in English, 519; Infectious Disease; Medicine (2); Infectious Disease Transmission, Patient-to-Professional (16); Infectious Disease Transmission, Professional-to-Patient (6); Infectious Disease Transmission, Vertical (280);Infectious hazards (1); infectious hazards (1); Infectious mononucleosis (1); Influenza (3); Influenza A virus (60); Influenza A Virus, H1N1 Subtype (183); Influenza A Virus, H1N2 Subtype (6); Influenza A Virus, H3N2 Subtype (4); Influenza A Virus, H5N1 Subtype (5); Influenza A Virus, H5N2 Subtype (3); Influenza A Virus, H7N9 Subtype (5); Influenza B virus (36); Influenza Vaccines (455); Influenza, Human (971); Influenza, Human A virus (1); Influenza, Human vaccine (1); Influenza Humanvirus B (1); Influenzavirus A (12); Influenzavirus B (10); Medical Waste (31); Medical Waste Disposal (43); Middle East Respiratory Syndrome Coronavirus (41); Public Health Surveillance (488); and SARS Virus (35).

    The following terms from the team’s broad list of terms (see United States section) appeared as MeSH terms (number of records in parentheses): biosurveillance (1); coronavirus (10); influenza (1); pandemics (760); Severe Acute Respiratory Syndrome (103). In addition to these MeSH search terms, we also searched for these specific situation reports: 2001 anthrax attacks (Amerithrax); 2003 SARS; 2005 H5N1; 2009 H1N1; 2013 MERS; 2014-2016 Ebola (i.e., West Africa); 2016 Zika; 2018-2020 Ebola (i.e., Democratic Republic of the Congo). We entered these terms into the IRIS search bar within quotations. “All of IRIS” was selected in the search bar. The following filters were added: Subject MeSH—Contains—“term”; Language—Equals English; Date issued—Not equals—2020. We repeated these steps for each MeSH term.

    “Weekly Update” reports and country-specific items were excluded from the captured sources; regionally-oriented WHO reports were included. Others that in the researchers’ expert judgement were irrelevant to health security were also excluded.

National (United States)

The research team compiled United States documentation in the form of congressional hearings, government reports and other documents, and third party reports and other documents. In most cases, a list of 25 search terms were deployed to capture a broad array of hits relevant to pandemics (see details below). The team excluded documents meeting any of the following criteria:

  • Items outside of January 1, 1995 – December 31, 2019.
  • Items strictly about bioterrorism and/or biosafety/biological accidents.
  • Items solely focused on endemic diseases or those typically addressed by the global health (as opposed to global health security) community, e.g., HIV, TB, malaria.
  • Fact sheets on diseases.

The research term sought information from the following sources:

  1. Hearings: The website www.congress.gov was used as a primary source of information on congressional activity by way of the Congressional Record (CR). The CR captures committee activity in the form of committee hearings, briefings, and business meetings. Records were sought using the following keyword searches:

    biodefense; biological threat; biopreparedness; biosurveillance; biothreat; CBRN; chemical, biological, radiological, and nuclear; coronavirus; Ebola; emerging infectious disease; global infectious disease; health security; infectious disease epidemic; influenza; MCM; medical countermeasure; medical preparedness; medical readiness; medical supply chain security; MERS; middle east respiratory syndrome; pandemic; public health response; SARS; severe acute respiratory syndrome

    Hits were reviewed for the two types of records that contain information on committee activity, the Daily Digest and Senate Committee Meetings. Each record was reviewed and the activity it represented categorized as a hearing, briefing, or business meeting. Hearings were the primary unit of interest, as they represent one of the most public forms of congressional oversight and information-gathering. Briefings, of which only a small minority are noticed in the CR, and business meetings, which almost always represent markups of legislation, were excluded. Exclusion criteria were applied after all hearings consistent with the search terms were identified. Some hearings used the topic of bioterrorism to discuss broader preparedness efforts also relevant to pandemics, and these were included. Some hearings identified from early in the timeframe parameters related to Department of Defense (DoD) budgets use terms like “health security” in a way different from the contemporary usage, or cover the topic of “health readiness” more broadly than this library is meant to capture; these were excluded. When the search occasionally resulted in an announcement for a hearing but no actual notice confirming that the hearing took place, additional research through www.congress.gov, www.gpo.gov, or committee websites was undertaken to find a notice confirming that the hearing was held. Rarely no such notice can be found, and these hearings were excluded on the presumption that they were cancelled. On occasion when the research team was aware of relevant hearings not captured by any of the keywords, these were included for comprehensiveness. All hearing titles were copied from the relevant hearing report.

    In addition to their inclusion in the library, the list of included hearings has also been made available as a supplemental file containing additional metadata. In this document, witness names and affiliations for each hearing were noted from the CR and other sources, including official committee reports available at www.govinfo.gov and committee websites. Witness names were manually standardized to resolve spelling or other discrepancies. Each hearing was tagged as having occurred during either Democrat or Republican control of a given chamber.12 Some committee names changed across the data capture period; these were grouped with their current names to permit proper committee-level analysis of activity.3 Two hearings were held jointly by multiple committees; for analysis purposes, these were treated as though they were held by separate, unique committees.

  2. Government reports. The research team sought reports from sources to which decision-makers in the Executive and/or Legislative branches could or should reliably be exposed. Three primary groups were considered: independent advisory bodies such as federal advisory committees; departments and agencies with significant operational jurisdiction over and spending on EID-relevant activity;45 and government bodies whose specific role is to advise decision-makers.

    Rosters of federal advisory committees for the Department of Health and Human Services (HHS) (specifically for the Centers for Disease Control and Prevention, National Institutes of Health, and Office of the Assistant Secretary for Preparedness and Response), the Department of Homeland Security (DHS), and DoD were reviewed; those with some responsibility for biodefense were further researched for all published reports, and those consistent with the same parameters used for hearing adjudication were retained. Reports issued by the President’s Council of Advisors on Science and Technology were included in the same manner. Because the body of work issued by each of these entities is relatively small and not contained in searchable databases, we did not apply the hearing search terms but rather examined the available report titles, and content where necessary, to judge whether reports were relevant.

    All Worldwide Threat Assessments issued by the Director of National Intelligence (and their precursors by a different name) were identified; those that reported an infectious disease threat or risk were included. Reports from Inspectors General (IG) of DHS, DoD, HHS, U.S. Agency for International Development (USAID), and Department of Veterans Affairs (VA) were sought on their respective websites; the search terms (same as those used for hearings) were input into the search bar for DHS, DoD, HHS, and VA. The HHS IG additionally provides a pre-populated category of “emerging infectious disease preparedness and response” reports and these reports were also captured.6 USAID presents its reports by category; from the “Global Health” page we manually reviewed all entries to extract relevant reports. The HHS Public Health Emergency Medical Countermeasures Enterprise (PHEMCE) collates and makes a variety of reports available on its website, and from these we pulled the organization’s multi-year budgets. For all of these searches, the standing exclusion criteria were applied; those deemed topically irrelevant or focused on areas like expenditure audits were also omitted.

    While these and other departments and agencies have issued many other EID-relevant reports throughout the timeframe of interest, these reports are often one-offs and are not available in any systematized fashion to the authors’ knowledge. The research team captured some of these by the methods outlined in United States Step 3.

    Two legislative branch agencies that provide analyses to Congress were also included: the Congressional Research Service (CRS) and the Government Accountability Office (GAO). The same search terms and date parameters used for hearings were applied. For CRS, the primary search bar in the public database (crsreports.congress.gov) was employed, and for GAO, the primary search bar on its website (www.gao.gov) was used. CRS reports are sometimes updated and re-released at a later date; in these cases, we documented the most recent date and uploaded the most recent report.

    We also sought to identify relevant federal strategies and implementation plans. We aimed to keep these related as narrowly as possible to biothreats, excluding broader works like national defense or national security strategies. We used the following sources for this information: the HHS Public Health Emergency website,7 which compiles several relevant strategies and plans, and two published collations of key strategies, executive orders, and related documents.89

    In a small number of cases, the researchers became aware of reports that were not captured by the search strategy, for instance, when a captured GAO testimony is based on a series of prior GAO reports, some of which may not themselves have been captured; these were then included for comprehensiveness.

  3. Third-party reports. This category includes non-governmental organization, academic, and private sector reports. Researchers consulted the University of Pennsylvania TTSCP Global Think Tank Index, published annually, to compile a list of all institutions that have appeared among the top ten in the “Top Think Tanks in the United States” category in any year from 2008 through 2019.10 From this list, we excluded the Pew Research Center, the National Bureau of Economic Research, and the Peterson Institute for International Economics due to their specialized research focuses on other topics. The final list consisted of the following organizations: the American Enterprise Institute, the Atlantic Council, the Brookings Institution, the Carnegie Endowment for International Peace, the Cato Institute, the Center for American Progress, the Council on Foreign Relations, the Center for Strategic and International Studies (CSIS), the Heritage Foundation, the Hoover Institution, the Hudson Institute, Human Rights Watch, RAND Corporation, the Urban Institute, and the Wilson Center. The team consulted the website of each think tank to view its published reports. In addition to the standing exclusion criteria, we excluded commentaries, blog posts, and other informal products (as opposed to formal reports). For each site, we searched for “pandemic” and manually reviewed titles of resulting reports, as well as texts when needed, to determine relevancy.

    The RAND Corporation and Council on Foreign Relations sites categorize reports by topic and have particularly relevant categories for global health security (e.g., “Public Health Threats and Pandemics”). We manually reviewed all reports in these relevant categories in lieu of using a site search. We also manually reviewed all reports in relevant categories from the CSIS and Hudson Institute sites, but due to concerns about the comprehensiveness of these sites’ categories, the search term “pandemic” was also applied to these two sites.

    Conducting these searches and manual reviews and applying exclusion criteria led to document inclusion from the following institutions: the American Enterprise Institute, Brookings Institution, the Center for American Progress, the Council on Foreign Relations, CSIS, the Heritage Foundation, the Hoover Institution, the Hudson Institute, and RAND Corporation.

    For the National Academies of Sciences, Engineering, and Medicine (NASEM), the National Academies Press reports (www.nap.edu) were searched within the topics “Biology and Life Sciences” and “Heath and Medicine,” dated from 1995-2019; the same search terms and date parameters used for hearings were applied. The researchers were aware from experience about the existence of one relevant NASEM report not captured by any of the keywords and included it for comprehensiveness. All reports from NASEM (including Institute of Medicine or other such sub-NASEM publishers) were titled as “National Academies of Sciences, Engineering, and Medicine” as the publishing organization.

    In some cases, the publishers of third party reports do not provide permission for posting the report on other websites; in these cases, information about the report was still provided for comprehensiveness, along with a hyperlink for accessing it elsewhere.
  4. Other methods. To capture additional relevant documents that were not already captured by other methods, documents referenced by GAO reports already included in the Library (see U.S. Step 3) were reviewed. We used document titles and, if needed, document contents to assess relevancy. In addition to the standing exclusion criteria, articles in academic journals, situation reports, laws (including treaties), entries in the Federal Register, and items that could not be located online using an internet search were excluded. In some cases, GAO reports included in the Library by the methodology specified in U.S. Step 3 referenced another GAO report that we deemed relevant; in these cases, we included the referenced GAO report, but did not in turn consider the second report’s references for inclusion.

After all documents were captured, duplicates and those that based on the researchers’ expert judgement were irrelevant to health security and/or pandemics were excluded.

Other

  1. Academic journal literature. Journal literature was searched using Ovid Medline (https://ovidsp.ovid.com/). The following Boolean search was performed using the Advanced Search tool: (exp Coronavirus Infections/ or exp Coronavirus) AND (exp Risk Assessment) as limited to articles in English published between January 1, 1995 and December 31, 2019. The research team reviewed each article to exclude any that met the following exclusion criteria (in addition to the standing exclusion criteria) regarding article focus: clinical management; non-human species; bioterrorism; or biowarfare. Articles behind paywalls were not posted; open access articles were posted if the research team received permission to do so. When the paper was unavailable or behind a paywall, the research team reviewed the piece and summarized the item to reflect the comprehensive search results. On occasion, journal articles were also captured through other means—specifically, as a result of the search of the WHO IRIS database (see Global Step 6), or when a journal record was an editorial that flagged one or more relevant papers on coronavirus within that issue.
  2. Simulations and exercises. Databases and other sources that might have records of simulations or exercises were initially identified by a Google search of the keywords “infectious,” “disease,” “tabletop,” “exercise,” “report,” and “readout” in various combinations. The research team looked for records that described a national or international simulation or exercise that was conducted, and ideally provided a report-out. Through this method, key databases were identified, such as the Homeland Security Digital Library (https://www.hsdl.org/c/) and the National Institute of Health Emergency and Disaster Response Training Exercises (https://dr2.nlm.nih.gov/training-exercises). The same keyword searches were performed in these databases and the hits reviewed for relevance. To review for any potentially missed records, the Department of Homeland Security website (https://www.dhs.gov/) was examined via a parallel search in its primary search bar. The exercise summaries for those exercises mentioned in Maxmen and Tollefson 202011 were also sought.

Data coding

The team developed a custom data taxonomy and data dictionary to define key metadata and organize the dataset. The data were populated into Airtable and transferred via API into a database on Amazon Web Services. The complete dataset including definitions and a glossary of terms can be downloaded here. The Glossary below provides the guidance that researchers used to code the data.

Glossary

This glossary is designed to provide the user with key information to understand the way items were coded and the meaning ascribed to them by the research team. Other explanations are available throughout the above methodological discussion, and through the tooltips available throughout the website.

Event

A select list of outbreak events to which an item may directly relate. This list is not comprehensive; it is a narrow usage that applies to records directly related to a specific, select outbreak. It does not address records that may be about the same infectious disease, or about other outbreaks that pathogen caused.

Funder

The entity that provided the financial support for the item. Where a document specifies the funder of the work (or in some cases, the funder of the group that produced the work), the entity or entities are listed. Where the document specifies that funding received was “None,” this is indicated as such. Where no funder is offered, this is indicated as "Funder not specified.”

Organization has governance authority

Captures whether the Publishing Organization has governance authority over the topic, recommendations, or other content of the item in the sense of whether it can act on the information contained in the record. Intergovernmental organizations may have governance authority depending on the context and topic of the product.

Publishing organization

The group that published the work or led the effort (such as a tabletop exercise).

Publishing sub-organization

When applicable, a more granular level of detail for the Publishing Organization. This field is generally populated only when the sub-organization is deemed particularly relevant to understanding the importance of the report—for instance, the subcommittee of a full congressional committee, or the Inspector General of a federal department. The indication can be found beneath the Publishing Organization on the View Details page of the record.

Publishing organization type

Reflects the category of publishing organization that issued the work:
  • Academic: An institution of higher learning.
  • Academic journal: A scientific journal or other scholarly publication.
  • Intergovernmental organization: An entity typically created by treaty, involving two or more nations, to work on issues of common interest.
  • National/federal government: A governing body within a country, operating at the national or federal level.
  • Local government: A subnational governing body within a country.
  • Non-governmental organization (NGO): An organization independent of government and distinct from industry or academia; NGOs are usually non-profit or not-for-profit entities.
  • Private: A private sector company, usually for-profit.

Title

The title of the work as listed on the document. In a small number of cases, the title reflects that in the database from which the work came, not the title on the document itself. In a small number of cases, a document has no title, for instance, a report provided in the form of a letter. In these cases the researchers used titles as listed elsewhere (e.g., the National Biodefense Science Board letters are given "titles" by the Department of Health and Human Services on its website).

Type of record

Reflects a high-level categorization of the form of the record; viewed above the report title in the detailed view of a record:
  • Report: An item presented as a reporting of findings; may include written documentation of studies, meetings, investigations, etc. Guidance and technical guidelines are also included in this category.
  • Government action: An item that reflects a decisive oversight, strategic, or other action taken on the part of a national government or an intergovernmental body; may include hearings, strategies, plans, resolutions, decisions, etc.
  • Simulation or Exercise: An item about simulations or exercises held, where simulations and exercises can be table-top or operationalized training activities.
  • Journal paper: An item published in a professional journal; may reflect original research, literature reviews, commentaries, editorials, letters, and news items; may or may not be peer-reviewed.

Topic area

Reflects the major topic the report addresses, chosen from a set of six selected by the research team; some reports may cover multiple topical areas, but only one topic is chosen:
  • Threat/risk awareness: An item primarily about intelligence, identification of threats, identification of risks, threat and/or risk assessments (where risk includes threats, vulnerabilities, and/or consequences), etc.
  • Surveillance/detection: An item primarily describing the detection and identification of infectious diseases (and relevant systems, technologies, challenges, etc.).
  • Medical preparedness/emergency response: An item primarily addressing medical readiness, which is wide-ranging and may include: medical countermeasures, non-pharmaceutical interventions, medical training and workforce, state or local infectious disease preparedness, hospital preparedness, clinical responses, etc.; or items concerning the response to a public health emergency (emergency services capacity, biohazard training, hospital surge capacity, etc.). Response to agricultural disease outbreaks is generally not included in this category.
  • International aid/collaboration: An item primarily about bilateral or multilateral international aid (fiscal, personnel, etc.) or about bilateral or multilateral collaborations (information sharing, sample sharing, capacity building, etc).
  • Strategic planning: A strategic plan or an implementation plan; also, items primarily about planning, the need for plans, recommendations for exercises, recommendations for strategic frameworks, etc. May include items addressing need for policy reforms.
  • Other: Any topic that does not fall into the defined key topics; may include reports on a variety of important topics, such as laboratory research, research and development, critical infrastructure protection, or economic impacts of pandemics. Such reports may address key topics, but in a minor or tangential way.

Welcome to Health Security Net, a publicly accessible, centralized library housing decades of documents related to pandemics.

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