Health Security Notes

Definition

According to the World Health Organisation (WHO), health security encompasses activities required to minimize the danger and impact of acute public health events that endanger the collective health of populations living across geographical regions and international boundaries.

Why is Health Security Important in Security Studies?

• Issues affecting a critical mass of people in a society become a state security issue.

• If it has transboundary relevance, it can be considered an international security issue.

• The potential impact of health security cannot be relegated to a secondary position in Security Studies.

• The spread of infectious disease can be deadlier than even world wars.

  • Comparison:

    • World War I: 20 million military and civilian deaths.

    • 1918 Spanish flu: As many as 50 million deaths (Johnson and Mueller, 2002).

Role of International Cooperation and Coordination

• Highly systematized public health control efforts have been in place since the 1850s.

• The idea that infectious disease control should not only be a priority of national public health systems but also be coordinated through multilateral institutions is a 20th-century phenomenon (Fidler, 2005).

Birth of the WHO and IHR

• The WHO was founded in 1948 as an arm of the UN.

• The International Health Regulations (IHR) were adopted in 1951 and revamped in 1969 to coordinate efforts to battle the most dangerous infectious diseases of that time, namely, yellow fever, plague, and cholera.

• The IHR outlined the requirements that each member state report any disease outbreaks to the WHO and adopt sanitary and hygiene measures at points of entry into a country.

• The IHR offered nations the ability to enforce vaccination requirements and other countermeasures for travelers entering a country.

Rise of New Global Diseases and Changes to Scope of IHR

• The last few decades of the 20th century brought about a sea change in the way public health practitioners understood global health challenges.

  • This was chiefly owed to the outbreak of the HIV/AIDS epidemic that erupted in the 1980s, the effects of which were so severe that it became a watershed moment in the historical development of global health security.

• Besides other things, it shed light on the narrow focus of the IHR on a limited number of infectious diseases—yellow fever, plague, and cholera (Gostin, 2004).

Exposed limitations of WHO and IHR

• In 2003, the rapid spread of severe acute respiratory syndrome (SARS) highlighted the need not only to further extend the scope of the IHR but also to make it more future-proof.

  • This reframing encompassed themes of anticipation, constant vigilance, high alert, and the ability to act swiftly when crises occur by strengthening communication pathways to report public health emergencies more efficiently (Katz, 2009).

• With this revision, the IHR incorporated a much larger number of infectious diseases and extended beyond infectious diseases to address threats from other sources, including industrial accidents, natural disasters, and conflict.

GHSA (Global Health Security Agenda)

• Despite the great strides made in advancing the scope of the IHR, it still had considerable shortcomings that arguably impeded efforts to cope with global health crises.

• In 2014, the Group of Seven (G7) endorsed the Global Health Security Agenda, a partnership and plan of action among nearly 50 countries, nongovernmental agencies, and international organizations.

  • The GHSA, in conjunction with the IHR, requires countries to report certain disease outbreaks and public health events to the WHO.

  • The outbreak of the Ebola crisis in 2014—a narrowly missed global pandemic—helped to solidify support for the GHSA.

Assessing Case for Cooperation

What are the pros and cons of increasing international cooperation in global health security?

• Pros

  • Provides crucial guidance during health crises, which is essential for poorer states.

  • Supports knowledge and management strategies to deal with health risks.

  • Helps to contain the spread of diseases beyond their immediate geographical origin.

• Cons

  • Institutions such as the WHO can get it wrong with their guidance.

  • States prioritize national interests.

  • For instance, states realize that investment in health security comes at a cost to other areas of public and national life.

  • The regulations often lack enforcement provisions.

  • Peer pressure.

  • Poor handling of the H5N1 virus (Bird Flu) during the 2007 outbreak.

Declaring and Responding to Epidemic/Pandemic

• One of the chief roles of the WHO is to make determinations and declarations on whether a health crisis constitutes an epidemic/pandemic.

• Response stages:

  1. Detection

  2. Transmission

  3. Containment

  4. Prevention

  5. Treatment

  6. Cure

Top 20 contributors to the Programme budget 2018 (US$ thousands)

• The top contributors include the United States of America, the Bill & Melinda Gates Foundation, the United Kingdom, Germany, GAVI Alliance, United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA), Japan, National Philanthropic Trust (NPT), Rotary International, European Commission, Kuwait, Sweden, United Nations Central Emergency Response Fund (CERF), Australia, Norway, China, Canada, Republic of Korea, France, and the United Arab Emirates.

• Total revenue: 2160 (US$ million)

  • (or 79% of total revenue)

  • Assessed contributions

  • Core voluntary contributions accounts

  • Voluntary contributions - core

  • Voluntary contributions - specified

Case Study: COVID-19 Pandemic

• Covid-19 caused by the coronavirus strain, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2).

• The first cases were identified in Wuhan, Hubei province, China.

• It has been suggested that this type of coronavirus originated in bat species.

  • A theory is that this migrated to humans through a wet market, another theory indicates that this virus could have been a laboratory creation.

  • If the latter, there have been murmurs from some about whether this was an intentional release or an accidental one.

  • Some of the medical whistle-blowers from Wuhan that tried to raise the alarm, such as Dr. Li Wenliang, died shortly after and were accused by the Chinese police of spreading rumors.

• The WHO about the outbreak has also been criticized by some.

• China went into lockdown in Wuhan and other cities of Hubei province on January 23, 2020.

• The WHO then finally declared a pandemic on March 11, 2020.

  • By then, the virus had spread outside of China, with countries such as Italy (especially the Lombardy region) and Iran, at this initial stage, being the most severely affected.

• There was a delayed reaction to this virus globally, arguably lessons not learned from previous outbreaks such as H1N1 (Swine Flu).

• By late March/April 2020, most countries around the world had been affected and thus went into some form of lockdown—travel restrictions, closure of international flights, and stay-at-home curfews.

Impact of the COVID-19 Pandemic

• Many health services around the world were unable to cope with the large patient influxes.

• The elderly and those with underlying health problems have been most vulnerable to the severe effects of this disease.

• The Covid-19 virus, as of March 2024, has over 700 million recorded cases and over 7 million known deaths (although the true death toll is probably higher).

Other Effects

Economic

• The pandemic has also had considerable economic repercussions; many people have lost their jobs and livelihoods, and businesses have shut down permanently.

• The great reset envisioned by the World Economic Forum? New world order? Orchestrated by the elite? Were the negative economic consequences felt equally?

• Tech Giants Crush Profit Records in Q2

  • Net income of selected tech companies in the second calendar quarter of 2021 vs. 2020:

    • Alphabet: +93\%

    • Amazon: +47\%

    • Microsoft: +49\%

    • Facebook: +101\%

• How COVID-19 Vaccines Changed Pharma Company Profits:

  • Net income/profit of selected pharma companies for Q1-Q3 in 2020 and 2021 (in billion U.S. dollars):

    • Johnson & Johnson: +24\%

    • Pfizer: +124\%

    • AstraZeneca: -78\%

    • Moderna.

Education and Working Life

• The pandemic also impacted normal work, education, and life practices, with working and studying from home becoming more common (and even mandated), especially in technologically advanced countries, with platforms such as MS Teams and Zoom facilitating that transition.

• In the case of children, especially those at key ages, it was noted that the absence of physical peer-to-peer contact stunted their social development.

Physical Health

• It was noted that during the pandemic, when states were enforcing various forms of lockdown, there had been a widespread deterioration in the physical health of populations.

• In terms of those who contracted Covid-19, while most recovered within a matter of days without any long-term effects, some, especially those with pre-existing health problems, suffered from "long-Covid" – life-changing consequences.

• While the rollout of the Covid-19 vaccines has been credited with helping to contain the spread of the virus and minimizing its health consequences, it has also been noted that owing to the condensed period of trial testing, we are not fully aware of their long-term health consequences, and indeed, many of the mRNA vaccines have been linked to severe health complications, such as myocarditis and heart attack.

Mental Health

• The pandemic has also had huge psychological and other associated health implications, with rates of depression and suicide increasing during the period of the pandemic, increased alcohol consumption, increases in obesity, and other diseases associated with a sedentary lifestyle.

Civil Liberties

• Many have contended that the pandemic has threatened civil liberties.

  • The imposition of vaccine mandates has been a controversial move that certain states have adopted, together with rigorous media censorship of any so-called "misinformation".

State Response to Pandemic

• One thing that can be observed by the global response to the pandemic was the relative uniformity in the manner in which states around the world responded to it, with most of the world going into lockdown in March and April of 2020, and providing similar guidance and vaccination advice to their citizens.

• However, it can be noted that not all states were equally adept at handling this pandemic, as adjudged by the varying death rates from state to state.

What were the major factors that accounted for the success of the state response?

• Factors influencing the success of state response:

  • Level of submission to WHO directives.

  • Receptiveness to recommendations of the scientific community such as virologists and public health professionals such as Dr. Anthony Fauci in the United States.

  • Trust in scientific consultancy.

  • Receptiveness to public pressure.

  • Level of tracking (e.g., Apps/GPS as in South Korea).

  • Health service manpower and facilities (i.e., sufficient supply of beds and ventilators).

  • Demographic spread of the population.

  • Proportion.

  • Speed, spread, and severity of lockdown measures.

  • Level of compliance among the population to recommendations and orders from the government.

  • Access to vaccine and the efficacy of the vaccine (i.e., Pfizer vs. Sinopharm).

  • Miscellaneous factors, such as climatic differences (Kjellstrom et al., 2010), and relative genetic and lifestyle health conditions of the wider population.

Return to Normalcy

• While the global Covid-19 pandemic has not actually ended, most states and societies in the world have returned to a pre-Covid 19 level of normalcy:

  • Regular testing or quarantine not required, or quarantine not strictly enforced.

  • Vaccine requirements and mandates have dropped.

  • Travel and entry restrictions, namely vaccine passports or valid PCR tests, are no longer required.

  • International flights have recommenced, almost back to full passenger capacity on flights.

  • Face masks and other protective clothing either not enforced or not used to the same extent.

• What caused the return to normalcy?

  • Economic factors (cost-benefit analysis).

  • Societal pressure and protests.

  • Vaccine and natural immunity.