Identifying features of sustainability in global health security assessment tools – A document analysis of the IHR JEE and the WOAH PVS

This study evaluates the incorporation of sustainability as a concept within global health security capacity assessment tools from a One Health perspective. Focusing on the International Health Regulations Joint External Evaluation and the World Organization for Animal Health Performance of Veterinary Services—the most widely used and standardized health security capacity assessment tools worldwide—we conducted a study to identify and categorize explicit and implicit references to sustainability. Using the principles of a content analysis approach, we identified and characterized references to sustainability in the International Health Regulations Joint External Evaluation and the World Organization for Animal Health Performance of Veterinary Services tools. The READ ( r eady materials, i.e. document selection and identifying data, e xtracting data, a nalyzing data, d istilling findings) approach for document analysis was used to provide a framework and guiding questions to systematically extract relevant text, analyze data, and draw conclusions from the two documents. Our findings indicate that sustainability is inconsistently defined and applied across technical and core competency areas. Most references to sustainability are related to organizational capacity, notably, in biosafety, biosecurity, and laboratory systems, and lack comprehensive measures for wildlife and ecosystem/environment health, community engagement, and multisectoral partnerships. This study underscores the necessity for a standardized, holistic integration of sustainability as a concept within health security assessment frameworks, adhering to One Health principles, to enhance the long-term effectiveness and resilience of health systems and foster intersectoral collaboration for improved global health security. • An evaluation of sustainability in global health security tools through One Health. • Our findings show that sustainability is inconsistently defined and applied across tools. • References to sustainability are related mostly to organizational capacity. • Measures for ecosystem health, community engagement, and multisectoralism are lacking. • There is a need for a holistic integration of sustainability into health security assessment.