Public Health as National Security

Accordingly, the US and UK governments, both erstwhile leaders in global health and biological preparedness, have committed to promoting health security as a framework for mitigating the threat of future pandemics. A health security approach, it has been argued, will increase attention, resources, and institutional capacity for dealing with health crises.

Yet the reflexive tendency to frame health risks in security terms has precluded serious examination of the assumptions and trade-offs underlying the health security paradigm. In this report, we contend that, while the security implications of pandemics are clear, the concept of health security distracts attention from the underlying determinants of health that exacerbate the effects of severe disease outbreaks and disproportionately affect the most vulnerable. Rather than adopting a securitised approach to infectious disease, COVID-19 should prompt world governments to focus on the wider determinants of health – such as universal health coverage and access to quality health care, among other health-related UN Sustainable Development Goals – as a way to ameliorate the impact of pandemics and other crises. The report challenges the following assumptions that undergird health security and proposes recommendations for an alternative approach.

Health Security: Assumptions and Policy Trade-offs
Assumption 1: Securitizing health generates resources for responding to severe disease outbreaks.

·  While framing health as a security issue is a useful tool for raising attention, awareness, and funding for pandemic preparedness, the focus on the external threats posed by infectious disease detracts from progress in the wider determinants of health, including access to quality health care, education, and clean water, which exacerbate health outcomes during biological events.

Assumption 2: Securitization fosters multilateral cooperation on public health problems.

·  Instead of promoting a collective approach to health challenges, the focus on health security has the potential to deepen the Global North-South divide, given the lack of consensus around the meaning of health security – with the North largely focused on preventing the cross-border spread of infectious diseases and the South emphasising action on the social determinants of health for non-communicable diseases.

Assumption 3: Synergy between national security and public health communities is necessary for rapid responses.

·  Deepening the cooperation between the national security and public health communities is an integral part of pandemic preparedness and response, but an increased reliance on the military in health initiatives will likely prove unsustainable, counterproductive, and potentially self-defeating in the long run.

Policy Recommendations
What might an alternative approach to health, grounded in multilateralism and respect for individual rights, look like in practice?

1. Move away from securitised responses to health in favour of a traditional public health approach that prioritises human health and well-being as a component of foreign policy.

·  Emphasise the need for global solidarity on health issues more broadly, including on infectious disease outbreaks and non-communicable diseases.

·  Increase resources for addressing the wider determinants of health that exacerbate the impact of disease outbreaks, such as access to quality health care, education, and clean water, as set out in the UN Sustainable Development Goals.

2. Maintain a separate focus on biodefense in the appropriate fora.

·  Decouple public health from bioterrorism, which requires a different institutional approach and risks diverting scarce resources away from improving health systems.

3. Strengthen existing global health institutions to facilitate multilateral cooperation.

·  Empower the World Health Organization to respond more effectively to future health crises by increasing and diversifying funding streams to include both communicable and noncommunicable diseases.

·  Encourage donors to provide unrestricted funding to international health institutions to prevent the politicisation of health.

·  Build public-private partnerships to improve the efficacy, sustainability, and durability of global health initiatives in the long term. These partnerships should build international capacity to proactively address underlying determinants of health that can prevent or mitigate the impact of infectious diseases.

4. Promote equitable vaccine distribution and long-term funding for vaccine and medical countermeasure development.

·  Support multilateral funding mechanisms, such as COVAX, as part of a more systematic approach to global health research and development.

·  Increase manufacturing capacity for diagnostics, treatments, and vaccines and share vaccine research, as well as any surplus supply.

5. Consider adopting a multilateral pandemic preparedness treaty or other legally-binding instrument to promote enforcement of obligations.

·  Adopt the proposed multilateral pandemic preparedness treaty, provided that its negotiations lead to legally-binding enforcement provisions, in order to improve trust, increase information sharing, and boost capacities in both developed and developing countries in response to emerging health challenges.