The Health-Climate-Security Triad

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A Need for Fresh Thinking

Imperiled health is the human face of climate change. Indeed, the climate crisis is increasingly recognized to be a health crisis. It is a crisis marked by higher mortality, costly illnesses, and increased risks of new biological pathogens that together threaten U.S. national security interests.

The most visible climate-related factors endangering health are dangerous forms of heat, along with wildfires and smoke, as well as ferocious storms and floods. It is the exceptionally fluid, dynamic interaction among these extreme events when mixed with changing land use patterns and rising sea levels, that wreaks havoc upon health systems, supply chains, and the delivery of health care in the United States and around the world. Deaths, illnesses, and mass displacement rise in their wake.

At the same time, this toxic brew is giving rise to formidable—and difficult to predict—biological threats that spill over from the animal world to affect human health. It is influencing the seasonal transmission of vector-borne diseases, such as dengue, and shifting the geographic range in which malaria is reported, as well. It is increasingly suspected to play a hand in the proliferation of threats of pandemic potential, with 75 percent of emerging infectious diseases believed to be zoonotic in origin.

As climate shocks with grave, enduring health impacts become more common, at home and abroad, they underscore the imperative for not just better domestic policies. They call for fresh thinking on how U.S. foreign policy is to address the climate-health-security triad. Such a new U.S. foreign policy approach will ultimately require action by both the executive branch and Congress. Important work can begin at many places outside the federal government. It requires patience and a long-term view, as the second Trump administration commences.

The National Security Argument

There is a credible and compelling national security argument for forging a more coherent U.S. foreign policy that addresses the health-climate-security triad. The case rests on four propositions.

First, the evolving climate crises are generating new pandemic threats to Americans. To guard against those threats, the United States needs a strategy of engagement outside its borders to strengthen partnerships that will enable rapid threat detection and containment.

The cascading, dynamic, and complex changes underway in our climate are leading to new modes of contact between humans and wildlife, shifting vector habitats and land use patterns, and changing animal migration patterns, which in turn are associated with the emergence of dangerous new pathogens that have the potential to directly threaten the health of Americans. We see strong hints of this shift in the advent of the far more dangerous Mpox clade 1b outbreak, concentrated in central Africa; the Marburg outbreak in Rwanda, where the virus had not been previously reported or expected to appear; and the reemergence of highly pathogenic avian influenza (H5N1) in the United States and elsewhere in a widening array of animals, including dairy cattle and swine.

Second, the negative impacts of climate change on health threaten two decades of U.S. global health programs. For both national security and humanitarian reasons, the United States has in recent decades invested billions of dollars in building low- and middle-income countries’ capabilities to deliver health services and detect and respond to dangerous outbreaks, through both bilateral and multilateral programs. Most substantial is the more than $120 billion invested through the President’s Emergency Plan for AIDS Relief (PEPFAR), launched in 2003 by President George W. Bush. PEPFAR’s achievements include saving an estimated 26 million lives and today sustaining the lives of more than 20 million people on antiretroviral therapy. These accomplishments are now under threat, whenever health workers cannot report to their posts or deliver services when extreme weather washes out roads, imposes heat and smoke that are simply too dangerous, and communities become unviable. Substantial U.S. investments over the past two decades in Gavi, the Vaccine Alliance, and the Global Fund to Fight AIDS, Tuberculosis and Malaria are now also increasingly imperiled.

Third, mass dislocations associated with climate change outside the U.S. borders should be a visible U.S. national security concern. Experts forecast that by 2050, more than 1.2 billion people will be living in 31 countries ill-prepared to withstand weather-related and ecological events, making this population vulnerable to mass displacement. The health status of the newly displaced, which includes men, women, and children, both those with their families and those who are unaccompanied, is often already quite precarious. At the same time, urgent health needs inevitably escalate as people at high risk of illness experience stress, poor access to food and water, or exposure to infections while on the move. Sudden mass movement, in turn, places new, acute demands upon health systems both in transit communities and at migrants’ final destinations. 

It is in the U.S. national interest to focus strategically on these climate-induced demographic shifts, to better understand, anticipate, and help partners deal with the rapid changes that are reconfiguring the global map. Investing in improved forecasting and tracking tools can ensure a more accurate calculation of the degree to which climate is inducing movement and driving deleterious health outcomes. It requires concrete strategies of investment in adaptation and resilience in vulnerable, key ally partner countries that will lessen the destabilizing impacts of sudden outmigration and bring about a more effective and sustainable health response.

Fourth, the challenges posed by the health-climate-security triad are part of the larger U.S. strategic competition with China and Russia. Neither China nor Russia is, at present, offering much in the way of solutions. Indeed, China’s Belt and Road Initiative, which should logically be the forum for partnerships that address adaptation, has so saddled its low- and middle-income countries with excess debt that it has lost its credibility and nimbleness. But in the meantime, the United States has no countervailing diplomatic strategy twinned with programmatic initiatives. Allies are coming to the United States’ door increasingly with requests for support in adaptation and resilience, for which the United States at present has no ready answers.

How to Move Forward?

There are stark barriers to near- and medium-term action on the climate-health-security triad. Most obvious is the advent of the second Trump administration, which in short order has withdrawn from the Paris Climate Agreement and annual COP negotiations; declared a national energy emergency, and rescinded clean energy policy and programs, replacing by “drill, baby drill” policies; withdrawn membership from the World Health Organization (WHO); and suspended foreign aid, with a few exceptions, for a 90-day review. In its first week, the Trump White House made clear its intent to use the purported threat of migrants carrying unnamed infectious diseases into the United States as the basis for denying entry and asylum. Any independent effort to put a focus on the climate-health-security triad will have to navigate carefully this tricky political terrain.

Well before the January 20, 2025, inauguration, the national climate in the United States was not very favorable. The topic of climate and global health was already highly charged politically and polarized along partisan lines. The language itself surrounding climate change can be highly triggering, blocking informed, civil discourse. It is a subject that suffers from a considerable gap in perception between experts and non-experts and is beset by pervasive mis- and disinformation. This divide appears to leave very little space or motivation for bipartisan policymaking at the state or federal level.

Still, there is reason to be modestly hopeful.

The consciousness of Americans has changed. Remote health threats cannot be ignored in the false belief that they will remain “over there.” In ever-warmer Florida and Texas, malaria outbreaks have taken root, fueled by the introduction of cases from Central and South America. H5N1, which surfaced decades ago among birds in East Asia, has unexpectedly infected over 950 dairy cattle herds, 147 million wild and commercial birds, and 67 people in the past year, killing one individual. While the risk to Americans remains low, and there has not been human-to-human transmission, changes in transmission patterns and the virus’ genetic makeup have raised the risk of a pandemic.

The health threat of climate change has become an ever-larger part of Americans’ lived experience and consciousness. At home, the extreme heat that sends thousands of people to hospitals each year is linked with worsening outcomes for cardiovascular diseases, respiratory conditions, kidney disease, and mental health. In the last two years, wildfires propelled by high-velocity winds have swept through Hawaii and Los Angeles, endangering the health of thousands and exposing gaps in resilience and preparedness while disrupting power and medical services, along with national medical supply chains.

Realistically, moving forward on a bipartisan basis—an essential element for any sustainable U.S. foreign policy on health, climate, and security—is going to be arduous and require patience and a long-term view. The Trump administration is likely to remain hostile to this strategy, but over time, as it settles, it may entertain the national security argument and promising concrete ideas for moving forward.

In the meantime, important work can begin in Congress, state and local government, and, outside of government, among experts, nongovernmental organizations, think tanks, the private sector, development banks, and regional partners. Focused commissions and dedicated convenings have great potential to shape discourse and map strategies for the future. Idea generation does not need to stall. Indeed, it can and should accelerate.

Work can begin in advocating for the incorporation of the strategic argument into evolving national security doctrine.

Work can accelerate in building better forecasting models that integrate health into research on climate impacts. That should include engaging the military and intelligence communities which have for several years actively explored the intersection of climate, security, and health.

Work can begin in developing plans to elevate adaptation and resilience systematically into U.S. bilateral and multilateral investments. One guiding priority should be creating a private sector marketplace and strengthening local capabilities in vulnerable partner countries. That can emerge through innovative finance and public-private partnerships that drive technological innovations in data and forecasting, in finance and risk insurance, and in building localized capabilities to manage the health impacts of extreme heat.

While technological innovations have driven the advance of renewable energy sources and have attracted massive private sector engagement in a new marketplace to reduce dependence on fossil fuels, no comparable marketplace exists today to drive innovation and investment in adaptation to climate and health impacts and the promotion of resilience. It is critical now to develop a credible vision for return on investment that can resonate widely. Many promising efforts are underway, including the National Commission on Climate and Workforce Health, as well as efforts by the International Finance Corporation to support the strengthening of climate-resilient health systems. But, data to guide decisionmaking is often incomplete, and incentives for private-sector engagement have remained weak. These problems can be solved step-by-step if there is a focused, coordinated effort.

A strategic argument on the health-climate-security triad is an essential starting point if the United States is to eventually compete effectively with its adversaries, meet the legitimate needs of its vulnerable allies, protect U.S. national security interests, and build bipartisan consensus. As we have argued here, progress is possible, and important work can commence, even in the face of multiple obstacles.

Stephen Morrison is senior vice president and director of the Global Health Policy Center at the Center for Strategic and International Studies in Washington, D.C. Katherine E. Bliss is a senior fellow and director of Immunizations and Health Systems Resilience with the Global Health Policy Center at CSIS.

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Katherine E. Bliss
Senior Fellow and Director, Immunizations and Health Systems Resilience, Global Health Policy Center