Offline: Global health security—smart strategy or naive tactics?

Abstract

“Let's get real about this.” David Heymann, who leads the Chatham House Centre on Global Health Security, was understandably frustrated. He was facing two speakers who believed that making global health an issue of global security was a fatal error. The occasion for this sharp divide was last week's Global Health Lab, hosted by the London School of Hygiene & Tropical Medicine and The Lancet. Andre Heller Perache is head of Programmes for Médecins Sans Frontières UK. He posed a question that invited a straightforward choice. Is global health intended to improve population health or is it meant to be a diplomatic tool for countries to exert their “soft power”? He quoted the mission of USAID. While the USA's foremost government agency leading work to end extreme poverty has clear humanitarian goals, it seeks to do so principally in order to advance US security and prosperity. Security is about self-interest. It is not about a selfless commitment to improving human health. He reflected on the recent Munich Security Conference, the world's most important forum for discussing international security policy. The meeting has now embraced global health as a critical dimension of its work. It was attended this year by Paul Kagame, the President of Rwanda, and Bill Gates. Both spoke about the security importance of health, likening the threat of disease to the dangers of war. For Perache, their securitisation of global health was little more than “fear mongering”. Global health has evolved from a Cold War concern with human security to a post-9/11 emphasis on the securitisation of humanity. Applying a security perspective to global health justifies government violations of human rights in the name of health. Instead, the strategy global health should be pursuing is one guided by medical need, not by the exigencies of domestic security or foreign policy. “The security framing of health”, he argued, “risks distorting priorities and moving resources and attention away from other more pressing health needs”. Sudeepa Abeysinghe lectures on global health policy at the University of Edinburgh. Global health has now been adopted as a tool for soft power, she suggested. The US Government in particular has used global health as a means to renegotiate the way the USA is seen around the world. PEPFAR was a prime example. A global health security lens transforms health from low to high politics. Global health becomes just another instrument to assert the power of the nation state. People become a secondary concern. The agenda of global health is rewritten. Global health becomes oriented towards infectious diseases and health crises. Concerns about non-communicable disease, the social determinants of health, and the part played by corporate actors are marginalised. David Heymann took a radically different view. Smallpox eradication? This programme attracted multilateral funding because it was in the interest of donor countries for economic and political reasons. The eradication of smallpox was indeed a tool of foreign policy. It increased access to a life-saving vaccine. It facilitated the mobilisation of financial and technical resources. And it rid the world of an infection that caused over 2 million deaths annually. The Expanded Programme on Immunization and the Global Alliance on Vaccines and Immunisation? These initiatives attracted multilateral funding because they offered proven cost-effective interventions. They were clearly tools of foreign policy. They increased access to vaccines. And they saved countless lives. The Global Fund to Fight AIDS, Tuberculosis and Malaria? The Global Fund attracted multilateral and bilateral funding because G7 countries agreed that good health was required for rapid economic development. The Fund was manifestly a tool of foreign policy that increased access to essential medicines. The facts show that investments in global health security attract funding because they offer a means of protecting populations in donor countries against the spread of infectious diseases. Global health security is a tool of foreign policy and we should be glad of that. Global health security strengthens public health. It mobilises financial and technical resources. And it saves lives in all countries by preventing epidemic disease. The unfortunate reality is that humanitarian arguments alone often fail to win the support of politicians. Security arguments change the terms of the political debate. If global health advocates want to deliver on their admirable aspirations, they need to “get real”.