The Global Health Security Agenda: A Snowy Promising Start
February 19, 2014
J. Stephen Morrison, Senior Vice President;
Director, Global Health Policy Center
Center for Strategic and International Studies
On February 13, while official Washington, D.C. was otherwise shuttered by the winter’s largest snow storm, the Obama administration launched the Global Health Security Agenda. Its principal aim is to accelerate the strengthening of capacities among low- and middle-income countries to prevent, detect and respond to outbreaks of infectious diseases, epidemics and bioterrorism. A U.S.-led diplomatic collaboration, the effort brought together representatives of 26 countries, along with remote links to the World Health Organization (its Director General Margaret Chan live from Geneva), and the Food and Agriculture Organization and World Organization for Animal Health.
Secretary of Health and Human Services Kathleen Sebelius, host to the gathering, explained that germs “do not recognize or stop at national borders…A threat anywhere is indeed a threat everywhere.” In a companion editorial posted on CNN, Secretary of State John Kerry, Secretary Sebelius, and senior White House official Lisa Monaco proclaimed: “This is not just a health challenge; it’s a security challenge as well…80% of the world’s nations are not prepared to deal with new pandemics, and more can and must be done across the health, agriculture and security sectors to elevate this issue and steer resources to it.”
The United States is committed to work in partnership with ten countries to create high tech laboratories and cadres of skilled experts, financed by $40 million in Defense Department and Centers for Disease Control and Prevention (CDC) resources this year, while seeking an additional $45 million in new funds in FY2015. These emergency operations centers, modeled after those already up and running in Uganda and Vietnam, are to be established in India, Kenya, Ethiopia, and Tanzania, among other partner countries.
Later in 2014, Washington intends to host a follow-on high-level meeting to review evolving commitments and concrete progress. The GHS Agenda resembles the Nuclear Security Summit, first launched in Washington, D.C. in 2010, in mobilizing a subset of engaged countries and international bodies around a long-term agenda to strengthen international collaboration, confidence and capacities in meeting shared threats.
Why this effort now?
Interestingly, there appears to be no single predominant outbreak or threat that animates the GHS Agenda. Rather, it is an accumulation of factors.
There is mounting unease about anti-microbial resistance, at home and abroad; indeed, recent uncontrolled outbreaks on the National Institutes of Health campus brought that reality powerfully into focus. The West Nile virus has become familiar in parts of the United States, while the mosquito-borne chikungunya virus has spread nearby in the Caribbean.
There is the still live memory of how, outside U.S. borders, the SARS outbreak 11 years ago killed almost 800 and imposed $30 billion in economic damage, and the H1N1 swine flu that killed more than a quarter million people in 2009 and is still in circulation. At present, there are the persistent threats posed by H7N9 bird flu virus, the SARS-like Middle East respiratory syndrome, drug resistant forms of tuberculosis and malaria, and the vast chaotic marketplace of fake and substandard drugs.
It builds on multiple prior health security efforts, e.g. the CDC’s Laboratory Response Network (launched in 1999), the Global Health Security Initiative (2001) and the G-8 Global Partnership Against the Spread of Weapons and Materials of Mass Destruction (2002).
In retrospect, the decision by the White House in 2012-2013 to make global health security a subject of intensified interagency deliberations was pivotal to setting the stage for the GHS agenda. That decision moved global health security out of the strictly technocratic realm and into the domain of high politics, and charged senior officials from across diverse U.S. government agencies with defining how health, security and science were indeed to be integrated. It helped reduce the neuralgia health experts often have about associating their work with security considerations. Perhaps most important, it empowered CDC Director Dr. Thomas Frieden to translate the normally gray, technically complex International Health Regulations that bind nearly 200 countries into clear actionable priorities that made sense to diplomats as well as security officials. He was able to streamline them into the three compact goals of prevent, detect and respond; delineate nine key operational areas; prove the viability of the Uganda and Vietnam pilot emergency operation centers; and devise concrete measures of progress.
As for the future of the GHS Agenda, there are a few outstanding questions.
It will be incumbent upon the organizers and their partners to define realistic, concrete next steps that can be tracked systematically. Sustaining interest will require convincing proof in the near to medium term that the GHS Agenda is generating results, and that it is indeed a valuable new additional tool not duplicative of existing G8, G20 and other initiatives.
Second, more ample multi-year resources will be essential to build U.S. credibility.
Thus far, the careful, phased approach in creating the pilot schemes in Uganda and Vietnam, and now an additional ten countries, has been smart, given the budgetary constraints at play in the current era of austerity. Yet that cannot be the permanent strategy. If the United States is to make a convincing case that global health security truly does matter to U.S. national interests, it will need to match that proposition with far higher levels than $85 million over two years. That will communicate seriousness of purpose to Congress, partner governments, security strategists, and the scientific research, biosecurity and global health constituencies outside government which will be important partners in advancing implementation of the GHA Agenda over the long-term.
Third, thus far it appears the private sector has not been an active partner in these deliberations, owing to sensitivities around conflict of interest, intellectual property, and confidentiality. That gap will somehow need to be bridged, sooner rather than later, if the private sector’s logistics expertise, distribution networks, and role in the development, manufacture and marketing of vaccines and therapies are to be leveraged.
Fourth, while the GHS Agenda presumes relative normality and stability that are permissive to capacity-building efforts, there is nonetheless a need to tackle the really tough security challenges. In northern Nigeria, three areas of Pakistan, eastern Syria, and south/central Somalia, there are large populations cut off from polio and other vaccination campaigns; active fighting; overt bans from armed movements against immunization; deliberate, violent targeting of health workers; and the risk of spillover into neighboring populations. Solutions will not come easily or soon, but will only be achieved through intensified high-level political engagement. The United States, which finds itself in the awkward position of having relied on an immunization effort in the hunt for Osama Bin Laden in Abottabad in 2011, must do more to segregate its efforts to prevent, detect and respond to future outbreaks from counter-terror approaches.
The GHS Agenda marks an important and promising turning point in U.S. policy. It is timely, coherent, compelling and concrete. It raises the bar for using U.S. diplomacy to advance health security; getting Margaret Chan, the Chinese, Russians, Saudis and Indians initially on board was no small achievement. Importantly, the GHS Agenda visibly presses diverse U.S. agencies to operate in concert. In fairly rapidly order, it can building emergency operations centers in a dozen partner countries. And it can enlist the active involvement of the non-governmental scientific, biosecurity and health communities – and the private sector. Whether it is successful over the medium to long term will rest on the results achieved, whether the United States and partners continue to see value in staying engaged diplomatically, whether there are ample resources to build capacity, and whether those powers joined in the GHS Agenda conversations are willing to confront systematically how the world’s broken places threaten health security.
↩ Countries that participated: Argentina, Australia, Canada, Chile, China, Ethiopia, France, Georgia, Germany, India, Indonesia, Italy, Japan, Kazakhstan, Mexico, Netherlands, Norway, Republic of Korea, Russian federation, Saudi Arabia, South Africa, Turkey, Uganda, United Kingdom, and Vietnam.
↩ For more information, see: Global Health Security - Vision and Overarching Target, http://www.globalhealth.gov/global-health-topics/global-health-security/Overarching%20Target.pdf