To understand the potential human health effects of exposure to hazardous substances among first responders from the East Palestine train derailment, an electronic self-administered Assessment of Chemical Exposures (ACE) survey was created and available to first responders between February-March 2023. Among the 339 completed responder surveys analyzed, most reported working at least 1 day during the incident between February 3-8, 2023. Most (79%) reported inhaling, touching, or swallowing potentially harmful substances and did not report using a face mask or respirator while working (75%). Nearly half reported at least 1 new or worsening physical symptom after incident response. These findings support several recommendations to mitigate exposure to hazardous substances among first responders during future incidents, including using a hierarchy of controls framework to reduce exposure to hazards, timely communication of possible hazardous substances involved in the event, and using the Emergency Responder Health Monitoring Surveillance (ERHMS) framework.

By 2014, only 33% of countries had self-reported compliance with the International Health Regulations (2005), including 8 countries from the Eastern Mediterranean Region (EMR). During the Ebola epidemic, the discovery of a gap between objective assessment and self-reports for certain IHR capacities prompted the World Health Organization (WHO) to review and update the IHR monitoring and evaluation framework to include a voluntary objective review process, called Joint External Evaluation (JEE), that did not exist before. The regional committee for the EMR approved the JEE and encouraged its 21 member states to volunteer for reviews. Standardized processes and procedures were developed for conducting JEEs. Of the 52 JEEs completed to date globally, 14 (27%) are from the EMR. Three (21%) of 14 member states completing the JEE in the EMR have also worked on a post-JEE national action plan for health security (NAPHS). A survey conducted about the JEE experience from focal points in EMR member states underlined the strengths of the JEE process: its multisectoral and open discussion approach; standardization of the JEE process; WHO's critical role in supporting JEE preparation and conduct; and the need for guidance development for a costed NAPHS. The success of JEEs depends not only on proper preparations and completion of the JEE but also on the development of a country-led, owned, and costed NAPHS and its implementation, including financial commitments along with donor and partners' engagement and coordination.

Background: Joint External Evaluation (JEE) was developed as a new model of peer-to-peer expert external evaluations of IHR capacities using standardized approaches. Aims: This study aimed to consolidate findings of these assessments in the Eastern Mediterranean Region and assess their significance. Methods: Analysis of the data were conducted for 14 countries completing JEE in the Region. Mean JEE score for each of the 19 technical areas and for the overall technical areas were calculated. Bivariate and multivariate analyses were done to assess correlations with key health, socio-economic and health system indicators. Results: Mean JEE scores varied substantially across technical areas. The cumulative mean JEE (mean of indicator scores related to that technical area) was 3 (range: 1-4). Antimicrobial resistance, Biosecurity and Biosafety indicators obtained the lowest scores. Medical countermeasures, personnel deployment and linking public health with security capacities had the highest cumulative mean score of 4 (range: 2-5). JEE scores correlated with most of the key indicators examined. Countries with better health financing system, health service coverage and health status generally had higher JEE scores. Adolescent fertility rate, neonatal mortality ratio and net primary school enrollment ratio were primary factors within a country's overall JEE score. Conclusions: An integrated multisectoral approach, including well-planned cross-cutting health financing system and coverage, are critical to address the key gaps identified by JEEs in order to ensure regional and global health security.