November 29, 2021 at 5:00 am ET
The concept of global health security is not new. The idea that investments by wealthy nations in the health of low- and middle-income countries are an investment in their own safety and security has been around for quite some time. The COVID-19 pandemic has, however, elevated this idea once again. Now back in the spotlight, the global health security narrative has become so loud it seems to be drowning out other critically important reasons for investing in global health — chief among them human rights, equity, dignity and thriving development.
As a global health community striving towards health for all, our singular message should not be that we will protect others from disease only to protect ourselves. My organization, Global Health Council, just published a report, “From Security to Solidarity” calling for a new, more holistic definition of global health security — one that shifts the emphasis from national security to human security.
Benefits and risks of the global health security narrative
The global health security narrative has benefits. It aids in establishing champions in Congress by helping their constituents understand the need for U.S. leadership and investment in global health. It helps people understand that these actions are not only helpful to other countries, but also protective of, and advantageous to, their own security.
One of the first and most recognizable shifts toward health as a security issue was in the 1990s with HIV/AIDS. Though initially viewed as a more traditional security threat — the potential for high HIV prevalence among the military — high-income countries saw the impact that the disease had on private industries, the supply chain and more. It was soon viewed as a broader risk. Other outbreaks, namely SARS and Ebola, reinforced the idea that the national security of a country can be threatened by the spread of a new disease. COVID-19 has had a similar effect, bringing security back to the forefront of global health conversations.
But when national self-protection becomes the main justification for global health investment in LMICs, people are seen as little more than vectors of disease that threaten high-income countries. This feeds the incorrect perception that individuals living in disease-prevalent areas are dangerous and leads to policies and practices based on bias rather than evidence. It was in the early 2000s, for example, that Haitians were required to undergo tests before entering the United States, denied housing and dismissed from jobs because of stigma that associated their country with HIV.
Global health security should not be our only justification for investments. Experience shows that investing in health requires thinking beyond any single disease. In the past two years, we have seen a seismic shift in resources and attention toward COVID-19. As a result, progress against other diseases is not only slowing, but in some cases, it’s going backward. In its most recent results report, Global Fund data highlighted the devastating impact COVID-19 has had on the fight against HIV, tuberculosis and malaria, including a dramatic drop in the number of people on treatment and declines in testing and prevention programs.
This type of backsliding is likely to continue if we are not proactive. A recent analysis from the Centers for Disease Control and Prevention indicates that over 22 million infants missed their first dose of measles vaccine due to the pandemic, further indication that delivery of routine health care is suffering from the weight of COVID-19.
As we move to a more equitable vaccine response and ramp up COVID-19 vaccine distribution in LMICs, we must ensure that we are not further depleting existing health systems and resources to meet the current emergency. We must be vigilant in maintaining progress in other areas, such as diabetes screenings, nutrition screening for malnourished children, family planning and maternal health.
Redefining global health security
We need to think beyond the traditional approaches of global health security that have dominated the policy landscape over the past several decades. Health does not exist in a vacuum. It is tied directly to economies, human rights, gender dynamics and so much more. The current global health security narrative leaves such concerns out of the discourse entirely.
An expanded definition of global health security is needed. We have yet to have a dialogue, let alone reach a consensus, on what that means. That is heart of the Global Health Landscape Symposium, taking place Dec. 9-10. At this convening, key stakeholders will gather to discuss global health security and, importantly, how health equity is embedded within it.
Addressing health threats through a human security lens provides a sustainable path to resilience, not only of health systems, but also of individuals and communities. True health security means stopping outbreaks before they happen. It means taking a systemic approach to investments and strengthening cross-cutting infrastructure so that communities are more resilient. And it means investing in people — ensuring that health workers on the front lines have what they need, and that those who are marginalized are able to access care. History shows us that when we do this, when we invest in global health holistically, the collective benefit is far greater.
Elisha Dunn-Georgiou, president and chief executive of Global Health Council, is a lifelong advocate with over 20 years of experience working to advance political will, create systemic change, and increase resources for policies and programs to improve the health of women, youth, and communities.
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