Director, D

Director, Executive

Head A I, Unit

Hersey, Sara

Namara, Geoffrey

National Public Health Agencies Governance Learning network

Officer, Country Support

Rasanathan, Kumanan

Shroff, Zubin Cyrus

LSHTM Research Online

Governance of national public health agencies: a crucial yet neglectedaspect of health emergency preparedness and responseKumanan Rasanathan, 1 Sara Hersey, 2 Zubin Cyrus Shroff, 1 Geoffrey Namara2, on behalf of the NationalPublic Health Agencies Governance Learning networkDespite innovations and some impressive nationalresponses, the covid-19pandemic revealed limitationsand gaps in efforts at national and global levels toprepare for and respond to health emergencies.1 2National public health agencies are “governmentagencies or closely networked groupof agencies thatprovide science-based leadership, expertise, andcoordination for a country’s public health activities.”3The impact of the governance of these agencies onthe provision of essential public health functions hasdrawn greater attention in the wake of the covid-19pandemic.4 5 Similar attention to the role andstructure of national public health agencies occurredafter previous infectious disease pandemics andoutbreaks such as the 1918 influenza pandemic, theSARS outbreak of 2003-2004, and the West AfricaEbola epidemic.6 -9Taking advantage of the window of opportunity10afforded by the high level of political attention tocovid-19, many countries are reforming,strengthening, and creating national health andemergency institutions including national publichealth agencies.11 For example, Australia, Singapore,and Japan are setting up new agencies. TheAustralian government is working to establish afederal Australian CDC, with an interim CDC set upwithin the Australian Government Department ofHealth and Aged Care as the first step. Similarly,Singapore has set up an interim CommunicableDiseases Agency linked to the Ministry of Health. TheJapanese government has established a new JapanInstitute for Health Security (JIHS) through newlegislation merging the National Institute ofInfectiousDiseases and theNational Center forGlobalHealthandMedicine, addingnew functions includingenhancing infectious disease intelligence,coordinating surge capacity during crises, andsupporting clinical development of medicalcountermeasures.Not all countries are creating new agencies or haveseparate national public health agencies. In SriLanka, governance of essential public healthfunctions related to emergency preparedness andresponse is overseen by the Ministry of Health, actingthrough its relevant departmental units. For example,the Quarantine Unit coordinates health security andimplementation of the International HealthRegulations (IHR) and theDisaster Preparedness andResponse Unit coordinates health sector emergencypreparedness and response. In Rwanda, the RwandaBiomedical Centre continues to act as the nationalpublic health agency for the country, managingessential public health functions for emergencypreparedness and response.In considering current country experiences with thegovernance of national public health agencies,several key conclusions can be drawn. First,governance of national public health agencies is acrucial yet neglected aspect of health emergencypreparedness and response. For countries involvedin the formation of new national public healthagencies, there is a paucity of available knowledgeon governance that presents an obstacle during theirestablishment.Second, there is no “one-size-fits-all” governancearrangement for national public health agencies orthe delivery of essential public health functions thatcan be recommended for adoption by all countries.Governance and structure of national public healthagencies vary according to the country context, thehistory of its health system, previous experiences ofhealth emergencies, and the agency’s relationshipwith the Ministry of Health or other parentgovernment bodies. Broad categories of structuralarrangements can be identified—for example, anautonomous institution, semi-autonomousinstitution, or distributed functions across multipleunitswithin theMinistry ofHealth—withnoone formidentified generically with greater success or failure.Third, regardless of the structure of national publichealth agencies, clear lines of authority and effectivecoordination are essential. Enabling governancefactors and conditions for success can be identified.Legal authority and mandates to delineate the roleof national public health agencies, including thenature of autonomy, and the capacity to navigatetheir relationship effectively with overseeingauthorities are necessary, but not sufficient foreffective functioning. The ability of national publichealth agencies to retain scientific and operationalindependence (including financial and hiringautonomy) is pivotal to their effectiveness in thegenerationof evidenceandprovisionof science-basedadvice. The capacity to partner effectively with otherparts of the health system (including internationalagencies) and with other sectors crucial forpreparedness and response are fundamental, butoften challenging for national public health agencies.This is an aspect where governance arrangementscan contribute more. Each health emergency eventprovides the opportunity to learn lessons and identifyjurisdictions that successfully apply these lessons inthe governance of national public health agencies.This learning can enable countries to reap significantrewards during future emergencies—underscoringthe importance of acting now on the lessons fromcovid-19.1the bmj | BMJ 2025;388:q2823 | doi: 10.1136/bmj.q2823OPINION1 Alliance for Health Policy andSystems Research, World HealthOrganization, Geneva, Switzerland2 Collaborative Intelligence, WorldHealth Organization, HealthEmergencies Programme, Berlin,GermanyCite this as: BMJ 2025;388:q2823http://doi.org/10.1136/bmj.q2823Published: 9 January 2025Protected by copyright, including for uses related to text and data mining, AI training, and similar technologies. .by guest on 16 July 2025 https://www.bmj.com/Downloaded from 9 January 2025. 10.1136/bmj.q2823 on BMJ: first published as Fourth, challenges faced by national public health agencies,including with respect to their governance, reflect broaderchallenges within health systems. These include financing flows,the ability to attract and retain human resources, data and researchcapacity, information flows, and thegovernanceof thehealth systemitself—including how it is able to work across different levels ofgovernment.The current political attention paid to health emergencies runs therisk of a singular focus on large-scale structural reform, withoutensuring improvements in function—and that by the time thestructural change is completed, the political window for changehas passed, and the opportunity for functional improvement,including greater resources, has been exhausted. The focus andpace of reform is therefore key. To respond to the increasing interestin countries and demands for guidance on the governance andorganisation of national public health agencies in the wake of thecovid-19 pandemic, the WHO Health Emergencies Programme andthe Alliance for Health Policy and Systems Research are conveningapeer learningnetworkofnational publichealth agencies to supportcountry-specific research and learning to inform ongoing efforts tostrengthen and improve the capacities of national public healthagencies in the management of health emergencies.Competing interests: We have read and understood BMJ policy on declaration of interests and haveno interests to declare.KR, SH, ZCS and GN are staff members of theWorld Health Organization. They are alone and themselvesresponsible for views expressed in this article which may not represent the views, decisions, or policiesof the World Health Organization.Acknowledgments Members of the National Public Health Agencies Governance Learning Network:S.Mahendra Arnold, Deputy Director General, Public Health Services, Ministry of Health, Colombo, SriLanka; Till Baernighausen, Director, Heidelberg Institute of Global Health, Heidelberg University,Heidelberg, Germany; Sara Bennett, Professor and Vice Chair, Department of International Health, JohnHopkins Bloomberg School of Public Health, Maryland, United States of America; Samuel T Boland,Technical Officer (Emergency Preparedness), World Health Organisation Regional Office for Africa,Brazzaville, Republic of the Congo; Shelly Bratton, National Public Health Institute Program Lead,Division of Global Health Protection, Centers for Disease Control and Prevention (US. CDC), Atlanta,Georgia, United States of America; Sarah Emami, Legal Director, Public Health Policy, Resolve to SaveLives, New York, United States of America; Daniel Faktaufon, Head of Health Protection, Fiji Centre forDisease Control, Suva, Fiji; Helen Grinbergs, First Assistant Secretary, Australian Centre for DiseaseControl Taskforce, Canberra, Australia; Lorena Guerrero-Torres, Technical Officer, Alliance for HealthPolicy and Systems Research, World Health Organisation, Geneva, Switzerland; Johanna Hanefeld, VicePresident, Robert Koch Institute (RKI), Berlin, Germany; Judith Mary Healy, Visiting Fellow, NationalCentre for Epidemiology and Population Health, Australian National University, Canberra, Australia;Sara Hersey, Director, Collaborative Intelligence, World Health Organisation, Health EmergenciesProgramme, Berlin, Germany; Marc Ho, Group Head (Policy and Systems), Interim CommunicableDiseases Agency (iCDA), Singapore; Natasha Howard, Associate Professor, National University ofSingapore Saw Swee Hock School of Public Health, Singapore; Iris Hunger, Deputy Head, Center forInternational Health Protection, Robert Koch Institute (RKI), Berlin, Germany; Anas Ismail, YoungProfessional, Alliance for Health Policy and Systems Research, World Health Organisation, Geneva,Switzerland; Paul Kelly, Chief Medical Officer and Head, Interim Australian Centre for Disease Control,Canberra, Australia;Wasiq Khan, TeamLead, Health Emergencies Programme,World Health OrganisationRegional Office for the Eastern Mediterranean, Amman, Jordan; Seon Kui Lee, Director of Planning andFinancing, Korea Disease Control and Prevention Agency (KDCA), Cheongju, South Korea; Vernon JLee, Executive Director, Interim Communicable Diseases Agency (iCDA), Singapore; Jong-Koo Lee, Chairof the COVID-19 Response Committee, National Academy of Medicine of Korea, Seoul, South Korea;Sadaf Lynes, Director of Collaborative Surveillance, Workforce and Health Emergencies, InternationalAssociation of National Public Health Institutes (IANPHI), Dubai, United Arab Emirates; BuddhikaMaheshPK, Public Health Specialist, Regional Directorate of Health Services, Colombo, Sri Lanka; TamanoMatsui, Programme AreaManager, Health Emergency Information and Risk Assessment, World HealthOrganisation Regional Office for the Western Pacific, Manila, Philippines; Jean Baptiste Mazarati, Headof Biomedical Services, Rwanda Biomedical Center, Kigali, Rwanda; Claude Mambo Muvunyi, DirectorGeneral, Rwanda Biomedical Center, Kigali, Rwanda; Geoffrey Namara, Country Support Officer,Collaborative Intelligence,World Health Organisation, Health Emergencies Programme, Berlin, Germany;Tania Maria Peixoto Fonseca, Coordinator of Surveillance and Reference Laboratories, Oswaldo CruzFoundation (FIOCRUZ), Rio de Janeiro, Brazil; Ihor Perehinets, Regional Emergency Director, WorldHealth Organisation Regional Office for Europe, Copenhagen, Denmark; Kumanan Rasanathan, ExecutiveDirector, Alliance for Health Policy and Systems Research, World Health Organisation, Geneva,Switzerland; Edison Rwagasore, Division Manager, Public health surveillance and emergencypreparedness and response, Rwanda Biomedical Center, Kigali, Rwanda; Tomoya Saito, Director, Centerfor Emergency Preparedness and Response, National Institute of Infectious Diseases, Tokyo, Japan;Haruka Sakamoto, Associate Professor, Department of International Affairs and Tropical Medicine,TokyoWomen’sMedical University, Tokyo, Japan; Muhammad Salman, Chief Executive Officer, NationalInstitutes of Health, Islamabad, Pakistan; Sileshi Demelash Sasie, Public Health Expert, Ethiopian PublicHealth Institute (EPHI), Addis Ababa, Ethiopia; Christophe Schmachtel, Partnership Officer, StrategicPlanning and Partnerships, WHOHealth Emergencies Programme, Geneva, Switzerland; Yesser Sebeh,Consultant, ATA Health Strategies Ltd, Washington, DC, United States of America; Babar TasneemShaikh, Health Services Academy, Ministry of National Health Services, Regulations and Coordination,Islamabad, Pakistan; Zubin Cyrus Shroff, Unit Head (a.i.), Alliance for Health Policy and Systems Research,World Health Organisation, Geneva, Switzerland; Niklas Sievers, Technical Officer, CollaborativeIntelligence, WHOHub for Pandemic and Epidemic Intelligence, Berlin, Germany; Haftom Taame Desta,Principal Program Lead for NPHI and Workforce, Africa Centres for Disease Control and Prevention(Africa-CDC), Addis Ababa, Ethiopia; Raji Tajudeen, Head, Division of Public Health Institutes andResearch, Africa Centres for Disease Control and Prevention (Africa-CDC), Addis Ababa, Ethiopia; TakajiWakita, Director-General, National Institute of Infectious Diseases, Tokyo, Japan; Gade Waqa, Head,C-POND Research Centre, Fiji National University, Suva, Fiji; Wen Qing Yeo, Head (Global Partnershipsand Engagement), Interim Communicable Diseases Agency (iCDA), Singapore; Kong Ching Ying, DeputyHead (Global Partnerships and Engagement), InterimCommunicable Diseases Agency (iCDA), Singapore;Neima Zeynu, Director, Preparedness and Capacity Building Directorate, Ethiopian Public Health Institute(EPHI), Addis Ababa, Ethiopia.1 Sirleaf EJ, Clark H. 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Health Policy Plan2023;38:-50. doi: 10.1093/heapol/czac102 pmid: 36610743the bmj | BMJ 2025;388:q2823 | doi: 10.1136/bmj.q28232OPINIONProtected by copyright, including for uses related to text and data mining, AI training, and similar technologies. .by guest on 16 July 2025 https://www.bmj.com/Downloaded from 9 January 2025. 10.1136/bmj.q2823 on BMJ: first published as 

Governance of national public health agencies: a crucial yet neglected aspect of health emergency preparedness and response.

https://researchonline.lshtm.ac.uk/id/eprint/4676681/1/Rasanathan-etal-2025-Governance-of-national-public-health.pdf

Governance of national public health agencies: a crucial yet neglected aspect of health emergency preparedness and response.

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