Saturday, August 1, 2015

Global Health Security in an Era of Terrorism and Conflict

"Herington has argued that the “great potential of constructing health as a security issue is that it promises the appropriation of  vast resources and institutional attention”. More important, it better reflects the long-term effects of a major public health crisis to all parts of society and human life. Not least, the “Health in all Policies” doctrine could be understood that way." (/see: http://www.coemed.org/images/stories/2014-09-24-ebola%20outbreak%20west%20africa%20risk%20assessment.pdf)

"There is an inevitable linkage between public health security and bioterrorism, but foreign policy is also concerned with broader dimensions of cross-border health risks including, for example, the transmission of anti-microbial resistant organisms, as well as health risks associated with non-communicable diseases, environmental degradation and conflict."(http://www.coemed.org/images/stories/2014-09-24-ebola%20outbreak%20west%20africa%20risk%20assessment.pdf) 

Framing public health as a national security issue, be this via deliberate or natural disease outbreak, has been considered within most NATO Member States a policy priority particularly since the US anthrax attack's which called attention to the potential for 'bio-terrorism.' One of the lessons of Amerithrax, as its often termed is our increased interest in emerging, re-emerging, deliberate and natural disease outbreaks and a greater understanding in the face of transmissible and highly infectious diseases of 'global' public health threats versus the perception of endemic disease as a single state threat. Since the US anthrax attacks, SARS CoV, Avian Influenza, MERS, AMR, Polio, Malaria, Dengue and Ebola (just to name a few) have served to demonstrate how reliant nations are on creating and sustaining global public health infrastructures.

Conflict and disease often go hand in hand and in nations which have experienced conflict its often the case that their public health infrastructures are fragile which may lead to difficulties containing diseases which Western nations would not consider an issue. In terms of public health security we'e only as strong as our weakest link. Conflict and war which require much greater investment in public health and which often times slides under the radar unless it directly effects a western nation or economy is still a neglected sector of investment. Generally this sector is left to NGO's and UN agencies who work on extremely tight budgets just to maintain the minimum required.

Containing trans-boundary disease is not technically unfeasible, rather it is the lack of resources allocated in many instances, which inhibits swift containment as well as war and conflict which dramatically increase disease and simultaneously inhibits effective treatment of patients. Failed states and failing states struggle not only with endemic disease but groups of diseases be it tropical (Dengue, Malaria) or hemorrhagic (VHF's) which their public health infrastructures simply can not manage. Its critical that we understand the dynamics of war and terrorism and the often consequence of increased disease burden  and not only to the state or states directly involved but the international community as a whole.

When Ebola emerged in West Africa the economies and public health infrastructures of the states involved were recovering from civil war, war and other crisis. The World Health Organization which has been raked over the coals for what is perceived as a latent response has run for years on a budget the size of a hospital. Moreover announcing a public health emergency can have devastating effects on the nations involved far beyond disease transmission outside the boarders and can serve to increase mortality rates not decrease this. WHO's reluctance to declare such an emergency is understandable within the context and history of these states. Not only had there never been an Ebola outbreak in these nations, West Africa was recovering from several civil wars and crisis, the impact of then declaring a health emergency would have likely had very detrimental effects.

Preparing for future outbreaks of Ebola and the deliberate use of disease as a weapon, will require a change in mindset, particularly from those nations who are in a position economically to support investment in failed and failing states public health sectors. WHO and Medecines sans Frontieres simply can not do this alone and nor should they be criticized for the efforts undertaken given the outstanding issues involved. Public health is a security issue and prevention, preparedness and response to emergencies which don't acknowledge national borders mean our approach to public health security must be a global one, not a national one. Nations who take this approach are far more likely to protect their own citizens as well as the global community than those that are focused purely on their own national defence.

Although its likely that an act of mass casualty biological terrorism with state backing (not non-state supported bio-terrorism) will present a magnitude of difference on global scales which in my view have not been adequately assessed or prepared for by most states. This will require we work together to assess and contain any such outbreak of deliberate disease. Excluding partners will be to everyone's detriment. Disease is not political it effects everyone indiscriminately and it is a national security issue for all states. 

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