1.5. Closing Panel: Global Health Security
The concept of health security is not new. More than 100 year ago the Spanish flu took a heavy toll during WWI and affected the dynamics of the war. Historically, the health sector used the term “security” interchangeably with “public health” and it was not until 1994 that the UNDP’s Human Development Report referenced health security as an emerging concern for human security. Outbreaks of the viral respiratory illness SARS in 2003, the identification of the H1N1 swine flu virus in 2009, and the more recent MERS outbreak demonstrated how adverse effects could rapidly spread across borders. The 2014 Ebola outbreak in West Africa further magnified the importance of health security. Today with more and more frequent and serious epidemics, health has clear national and international security implications. The panel examined the impact of global health issues on society as well as outlined policy responses to manage international health crises – ranging from the potential role of the security sector to the contributions of specific initiatives such as the Global Health Security Agenda.
What is the significance of health security in the hierarchy of transnational threats to global security?
We live in a complex world where security threats are multifaceted and interlinked and where health crises are major security threats. Ebola is an excellent case study which demonstrates that health is both an issue of individual security understood as access to health services and maintaining a healthy, productive society and a collective security going beyond boarders of an individual country. Ebola is interesting for another reason: people tend to forget health crises relatively quickly moving to other issues on the security agenda. This has changed with the 2014 Ebola crisis. Health is still high on the agenda and there is an increased understanding that pandemic preparedness and response is not uniquely a health issue. The G7 Summit in Japan, which recognized the link between health security and human security and the 2016 UN General Assembly agenda which included the AMR threat, are examples of this increased awareness.
At the same time the 2016 World Humanitarian Summit (WHS) failed to sufficiently recognize the link between health threats and humanitarian challenges. This is becoming increasingly an issue considering the effect hybrid warfare can have on health systems. MSF pulled out from the WHS in protest of the increasing number of attacks on health institutions.
World leaders still need to recognize the inherent dependence of traditional security and health security. This will have to be addressed in the context of other challenges such as climate change, urban security, planetary health (including animal health, ecology) as part of a “one health” concept.
Where and under what circumstance are future health risks likely to require a global security policy response?
A global security policy response means reaching out to security providers both locally and internationally to address health crises as illustrated by the Ebola outbreak. In particular, in situations where domestic, civilian actors cannot adequately manage the challenges security actors have to step in. Their involvement increases dramatically the speed and quality of early warning, tracking systems, field responses, resilience, and global health governance in the long run.
Interestingly, the role of the military role in addressing health crises is not purely logistical. It has a role in intelligence gathering, treatment, and as shown during the Ebola crisis in R&D with development of a vaccine by the US defence laboratories. There are also other security sector actors such as police, boarder guards, intelligence services, judicial system, private security actors and occasionally non-state actors who are indispensable in dealing with health security threats.
At the same time security actors are feared and there is a lack of trust which can be counterproductive especially in fragile contexts. Hence, trust and good security sector good governance is key.
How does the existing global health security architecture need to change in order to respond to future health crises?
The global health security architecture has so far been governed by the International Health Regulations (IHRs) - an international treaty of all the WHO member states. In spite of good intentions, the Ebola crisis showed that the IHRs need to be better implemented in order to develop core capacities to enable early detection and response.
The WHO is at the centre of preparedness and response and has made attempts to reform health security architecture by improving its internal mechanisms. There is, however, a need for other actors to be more active in addressing health security challenges. First, the UN system needs to be involved. The initial attempts are related to an improved coordination mechanism between the DG of the WHO and UNSG and attempt to create a UNSC sub-committee on health. Second, the role of the security sector in health security needs to be better defined and operationalized in addition to raising awareness of the links between health threats and traditional security threats in both communities. Third, nations need to take greater responsibility and commit to better implement the IHRs by investing in public health systems and focusing on prevention.
One crucial challenge to the global health security architecture is the financial gap. It costs us 3 to 4b per year to prevent a pandemic and 60b per year to address it. The world is still under-investing in prevention and new finance mechanisms are necessary. There needs to be a paradigm shift in the development aid model including on health security financing. Global funds are seen as paternalistic and countries need to be able to address their own health security challenges. One solution would be to allocate a part of funding set aside for institutions in national defence budgets to public health ensuring greater health security.
Ensuring health security is a question about how seriously heads of state take the health of their citizens. Health, as a global public good, must be recognized at the highest level of governments.
There is still a great deal of distrust between the developing world and developed world when thinking about health security, as exemplified by the late action on the Ebola outbreak. Trust in governments and national security forces, is instrumental to guarantee global and national security and solidarity. Global health security is ultimately about stabilising demography, assuring economic development, and good governance which contribute to international security across systems.