In 1967, US Surgeon General William Stewart famously said, “the time has come to close the book on infectious diseases. We have basically wiped out infection in the United States.” This statement is regarded by public health practitioners as a grave miscalculation. By “closing the book”, public health practitioners in the 1960s allowed for infectious diseases to lay under the radar and continue to wreak havoc. In fact, since Dr. Stewart made his fateful statement, the number of emerging infectious diseases (essentially, infectious diseases newly appearing in humans) has increased. Despite the eradication of smallpox, dozens of emerging infectious diseases such as Ebola Virus Disease and Nipah have garnered international attention.
By this point, it has become clear that global health security is a crucial part of national security. In response, over the last few years the United States and other nations have ramped up their respective biosecurity protection programs. In the wake of the 2001 anthrax attacks, the US Congress passed the Pandemic and All-Hazards Preparedness Act (PAHPA), which expanded the Public Health Service Act to establish the Assistant Secretary for Preparedness and Response within the Department of Health and Human Services (HHS). PAHPA also established a quadrennial National Health Security Strategy, and provided further grant funding. In 2011, it was re-authorized as the Pandemic and All-Hazards Preparedness and Reauthorization Act (PAHPRA) and expanded to include programs such as the Hospital Preparedness Program, the Project BioShield Act, and increased the power of the U.S. Food and Drug Administration in order to respond to public health emergencies.
Meanwhile, two major documents have dominated the international health security scene. The first is the International Health Regulations (2005), a legally binding instrument used to promote health security worldwide by constructing and maintaining strong national health surveillance systems. One of the key points of this document is that which mandates that wealthier nations financially support the health surveillance system establishment efforts of less-wealthy nations. The IHR (2005) also established new outbreak reporting guidelines and mechanisms, which include a broader pool for reportable outbreaks. The second crucial document is the Global Health Security Agenda (GHSA), which sets goals for achieving global health security. One of the specific benefits of the GHSA is that states can request a Joint External Evaluation (JEE) to evaluate their national health security capacity. Like the IHR (2005), the GHSA also encourages wealthier nations to support less wealthy nations in the development of their health systems. For the US, the idea behind both the IHR (2005) and the GHSA is that we are only as strong as our weakest link, and that a threat to health security in one nation is a threat to health security worldwide.
In the last few decades, the world has made strides against health security threats. But are we prepared to battle these microscopic foes?
The answer is, simply, no.
The United States is on the cusp of backpedaling in its efforts to achieve global health security. Since the 2001 anthrax attacks, funding for public health preparedness programs has steadily declined. While the 2014 West African Ebola epidemic produced a surge in global health security funding from the U.S. government- including the appropriation of $1 billion to “build capacity to prevent, detect, and respond to future infectious disease outbreaks” in 17 key nations - those $5.4 billion in total funds have dried up and are not currently set to be replaced. Therefore, out of the 49 international surveillance programs established by the U.S. Centers for Disease Control and Prevention (CDC), 39 will be shutting down over the next few months. These programs set up labs and other types of surveillance mechanisms, and work with local professionals to increase infectious disease emergency preparedness. Without these 39 CDC programs in place, we face the risk of a world uninformed and unprepared to deal with infectious disease threats. If that wasn’t enough, President Trump announced budget cuts on February 12th that would starve the CDC of $1 billion. As more and more information slowly seeps out about this monstrous slash, the fate of health security becomes continues to sink into the fog.
Additionally, The Pandemic and All-Hazards Preparedness Act is on the table yet again, after years of steady funding cuts. In testimony before U.S. Congress in late January, Dr. Tom Inglesby, Director of the Johns Hopkins Center for Health Security, noted that “in larger scale infectious diseases emergencies, most US health care systems would not do well. It was quite evident how difficult it was to care for even one hospitalized Ebola patient, let alone to consider how a hospital would handle a larger scale infectious disease emergency.” Dr. Inglesby’s testimony along with others by medical professionals and biosecurity experts was profound and articulate, but it may not be enough to secure a second re-authorization of PAHPA, without which we will see global health surveillance wither.
Health security isn’t normally at the top of a congressional candidates’ priority list. Decades, and arguably, centuries, of excellent American health have blinded citizens to the devastating effects of poor health. While lower income populations are much more familiar with this than the average American, the majority of the U.S. population does not deal with the effects of crumbling health systems or debilitating infectious diseases particularly well. In the past, diseases like yellow fever and cholera debilitated Washington’s political functioning and crashed local economies. While these diseases have been effectively eliminated from the U.S. today, antimicrobial resistance, anti-vaxxers, and emerging infectious diseases all pose new risks. Without the protection provided by organizations like the CDC and domestic and international laws and agreements like PAHPA, the GHSA, and the IHR (2005), the future of health and national security becomes uncertain.
In order to make certain that global health security efforts remain intact, it is important for us to remain informed about the development of these issues and to elect representatives that reflect our concerns for the health security of our nation and our world. With midterm elections quickly approaching, I encourage everyone to thoroughly investigate candidates’ stances on more than just traditional security threats; biological, chemical, and radiological security matter just as much as nuclear security, and in the 21st century, may even matter more. The current U.S. administration’s efforts at isolating the United States will only further endanger us when it comes to global health security. While withdrawing from global politics may be able to remove us from international conflict, microbes do not recognize borders. In the words of former CDC Director Tom Frieden, “We can’t be safe if the world isn’t safe. You can’t pull up the drawbridge and expect viruses not to travel.”
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