A Path to Global Health Security
By: Amy Pope, Heather Higginbottom, Gayle Smith, and Thomas Frieden
This week, dozens of senior leaders from around the world — representing government, academia and the private sector — will converge in the Netherlands. Their charge? To advance the ambitious Global Health Security Agenda (GHSA) and ensure that it is sustained.
The world is more connected than in any time in human history. Distance no longer affords protection from disease, viruses, even epidemics. Pick two major cities anywhere in the world and there’s a near certainty there’s at least one commercial flight each day linking them. Los Angeles to Singapore. New York to Mumbai. Manila to Toronto. Washington, D.C. to Johannesburg.
Disease requires only the smallest opening to take root and spread. In today’s tightly connected world, disease can be transported from an isolated, rural village to any major city in as little as 36 hours. In addition, there is also the potential for bad actors to gain access to and disseminate dangerous pathogens. Our connectedness provides opportunity for people all over the world, but it also poses serious challenges with implications for our health security and for the stability and security of our populations.
That is precisely the world for which the GHSA was created.
When the GHSA was launched in 2014, the World Health Organization reported that more than 70 percent of countries were not properly prepared to address epidemic threats. There was no common set of standards or targets for preparedness countries could use. There was no precise or transparent way to gauge whether a country had strong and reliable laboratories or enough trained public health workers, including “disease detectives,” or an effective way to quickly and clearly gather and share information.
At the same time, Ebola, which spread across West Africa undetected for months, provided the world a sense of urgency. Working with our international partners, the United States led the effort that beat back the threat of Ebola and is strengthening health systems in West Africa, but we’ve got more work to do.
The GHSA is where that work happens and it is critical to our public health and security.
As a result of the GHSA, there is now an open, transparent, independent process to assess and improve global protection against health threats: the Joint External Evaluation (JEE) process.
Developed by the World Health Organization (WHO), Finland, the United States and a collection of GHSA member countries, the JEE is a stress test that allows countries to clearly and unambiguously identify the most urgent needs within their public health system and establish national plans to address those needs using common metrics. It provides — often for the first time — a clear roadmap any country can follow to strengthen its ability to address biological threats, whether naturally occurring, deliberate, or accidental. The JEE includes targets agreed to in 2015 by GHSA member countries as well as a mandate to transparently share results to better ensure accountability.
To date, 17 countries have completed and published results of their stress tests — including the United States — with another 32 planning to conduct the tests in the near future. The WHO’s goal is for more than 50 nations to complete their initial assessments by May 2017. We hope and anticipate that within another 1–2 years, more than 100 countries will have gone through the process.
But the JEE is just the beginning. As gaps are identified, they must be addressed. And to do that, as a community we must continue to recognize that global health security is our national security — that implementation of the international health regulations is a multi-sectoral problem that needs an all-inclusive approach. That health ministers must work with agricultural and security ministers. And that the private sector and other non-governmental organizations are crucial to our success.
Today, as we confront the spread of Zika virus — with the memory of SARS and avian influenza still fresh and recovery efforts from Ebola still ongoing — GHSA has never been more relevant. And it’s the reason the third annual High-Level meeting of the GHSA in the Netherlands — and continued international commitment to advance this unified agenda — is so important and so urgent.
GHSA is a high priority for the United States. Since 2014, the U.S. has made a commitment to assist 31 countries and the Caribbean Community to achieve the GHSA targets and is providing $1 billion in assistance to help 17 Phase One Countries become prepared. Our G-7 partners have recently stepped up with a collective commitment to assist 76 countries and regions, and many G-20, Nordic, and other partners are also participating.
Just last month, while speaking at the United Nations, the President underscored the importance of the GHSA: “We can’t combat a disease like Zika that recognizes no borders — mosquitos don’t respect walls — unless we make permanent the same urgency that we brought to bear against Ebola by strengthening our own systems of public health, by investing in cures and rolling back the root causes of disease, and helping poorer countries develop a public health infrastructure.”
President Obama doesn’t come new to this realization. Over 10 years ago, in 2005, then Sen. Barack Obama wrote an op-ed in the New York Times with then Sen. Richard Lugar argued that ensuring better and more robust protection from disease outbreaks was a top tier national security issue.
“We recommend that (the Bush) administration work with Congress, public health officials, the pharmaceutical industry, foreign governments and international organizations to create a permanent framework for curtailing the spread of future infectious diseases,” the two senators wrote, adding that special emphasis should be directed to “Increasing international disease surveillance, response capacity and public education and coordination, especially in Southeast Asia.”
The necessity of working together on global health has never been clearer.
New diseases are emerging, drug resistance is rising, and more laboratories are processing dangerous microbes. This reality is the driving force for what we all want and what GHSA promises — a tighter, more sophisticated, collaborative and standardized global effort to advance both accountability and assistance and use the best science and tools to detect and defeat disease at the earliest possible moment.
No one nation can ensure global health security. But our commitment to work with international partners to prevent, detect, and respond to infectious disease threats must remain unwavering.
About the Authors:
Amy Pope is the Deputy Homeland Security Advisor and Deputy Assistant to the President at the National Security Council;
Heather Anne Higginbottom is the Deputy Secretary of State for Management and Resources;
Gayle Smith is the Administrator of the United States Agency for International Development;
and Dr. Tom Frieden is the Director of Centers for Disease Control and Prevention.