Bio-Preparedness in a Global Context: Multi-Site International Study Investigating Global Health Security Challenges in Egypt, Oman, and the United States

The COVID-19 pandemic exposed myriad vulnerabilities globally within public health systems, from inadequate bio-risk management in laboratories to overwhelming utilization of hospital resources and disparities in vaccine access and uptake. The Global Health Security Index (GHSI), which critically evaluates health security domains including health systems and risk environments, reports serious weaknesses in global health security. This dissertation aims to investigate critical aspects of global health security domains by examining factors impacting biosafety and biosecurity capacities in laboratories in Egypt, healthcare resource utilization in hospitals in Oman relating to acute respiratory infections (ARI), and COVID-19 vaccine uptake in the United States. In the first study, results show that laboratory characteristics, specialization, and employee training are significant predictors of biosafety and biosecurity knowledge and practices. Emphasizing a multidisciplinary approach to biosafety and biosecurity training that incorporates both technical and administrative perspectives leads to improvement in biosafety and biosecurity knowledge and practices. In the second study, results show that oxygen therapy, geographic location and institutional policies are significant predictors of healthcare resource utilization beyond that attributable to disease severity. The development and standardization of policies, resource allocation, and healthcare strategies to manage patients more effectively leads to improvement in health outcomes and reduced burden on healthcare systems. In the third study, results show a novel finding that immigrant populations had higher vaccine uptake than native-born Americans, particularly in the Midwest region. This suggests that further studies of the immigrant population – a supposedly vulnerable population for health care access – are necessary to identify risk environment factors associated with vaccine uptake. To promote vaccination equity, public health interventions will have to go beyond traditional models to utilize novel mechanisms to improve vaccine uptake among vulnerable populations. By developing a more thorough understanding of biosafety and biosecurity knowledge and practices in laboratories in a lower-middle income country, hospital resource utilization and disease severity in a higher-income country, and COVID-19 vaccine uptake among vulnerable populations in a higher-income country, this multi-site international study contributes to the global health security knowledge base that informs more effective public health policies and interventions.