The 2014 West African Ebola epidemic exposed the harsh inadequacy of global public health systems. Health security stepped out from the shadows as a field determined to prevent future health-related disasters. Despite an abundance of modern-day technology and deep understanding of the requisite components of a robust health system, large disparities exist in the quality of health systems worldwide. Strengthening health systems has become a key goal of 21st-century public health officials, and encompasses everything from community engagement to health systems financing. However, one notable goal continues to be put on the back burner, perhaps because it remains a significant gap in the American health system: access to affordable medicine.
Part of the historical backlash against global health security has had to do with concerns over its purpose. Global health security has been placed in contrast with humanitarian biomedicine, which focuses on diseases that feed off of poverty, like tuberculosis, HIV/AIDS, and malaria. While humanitarian biomedicine is introduced as a truer form of public health for being concerned principally with injustice as a source of disease, global health security has been accused of being an extension of U.S. national defense policy. In reality, global health security serves as a form of national defense for all states, and while the extent to which it protects certain states is debatable, its intentions in securing the health of billions are not. Within the field of global health security, there is an understanding of the profound political and economic effects of disease on society. While public health as a whole has made strides in its quest to promote global health security, the gaps formed by issues of healthcare affordability undermine efforts to ensure medical, economic, and political stability. When states have well-functioning health systems that can manage crises, but medical care is too expensive to be accessible, those health systems do not serve their purpose. If the United States is going to lead the battle to achieve global health security, it must reckon with the fact that it has repeatedly faced challenges in having a health system and emergency response capacity that are accessible to all.
Mosquitos are abundant in areas generally associated with poverty, such as areas near swamps and marshes or neighborhoods with many sources of standing water such as empty tires. Therefore, many residents of mosquito-heavy neighborhoods would struggle to pay for a very expensive vaccine. The United States Department of Health and Human Services (HHS) gave French pharmaceutical giant Sanofi-Pasteur $43 million to co-develop a Zika vaccine with the United States Army. In summer 2017, rumors began circulating that the U.S. government would allow the Army to give Sanofi-Pasteur the exclusive license to the patents. The implications for this were enormous: with an exclusive license, Sanofi would be able to charge whatever prices it wanted for the vaccine. Therefore, a vaccine created to solve a problem faced in very particular communities would be unaffordable for those same communities.
Fortunately, in the summer of 2017, several members of the U.S. Congress and Florida Congress openly spoke out about the issue. Among them were Vermont Senator Bernie Sanders, Florida Senator Bill Nelson, and Florida Representative Ileana Ros-Lehtinen, the first member of the GOP to speak out against the proposed exclusive license. After many letters, social media posts, New York Times articles, and an appeal filed by Medicins Sans Frontieres, the plan began to collapse. Finally, in September 2017, HHS decided to gut the rest of the operation, due to the virus’ supposedly changing epidemiology. Sanofi-Pasteur withdrew from the project. Sadly, this was not a win- despite the pharmaceutical titan’s withdrawal, a Zika vaccine is yet to be developed at all.
Global health security efforts in the last two decades, such as the International Health Regulations (2005) and the Global Health Security Agenda, aim for the noble goals of creating self-sufficient systems of prevention, detection, and response to international health threats. If we admit that health security is involved with the well-being individuals, states, and their economies, we must also face the fact that access to affordable medicines and healthcare endangers the well-being of both, especially in the response stages of a health emergency. While it is crucial that the United States continues to lead the fight against international health threats by singing praises of existing global health security programs, it is equally important that we understand the fatal flaw in our own armor. Access to affordable healthcare and medicines makes healthy people, healthy markets, and a healthy workforce. This is especially true during crises. If American health systems and emergency response capacities cannot provide medical care to all Americans, regardless of economic status, then they are ultimately faulty. To be true leaders of global health security, we must lead by example.
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