Introduction

Global Health Security can be split into three main areas. The first can be defined as Personal Health Security, relating to the protection of the health of individuals. It looks at improving access to safe medicines, vaccines and health care in general. The second main area can be defined as Collective Health Security, and relates to the health of societies. It looks at reducing the collective vulnerability to global public health events such as influenza and SARS. The third main aspect relates to how health security can contribute to overall national stability and national security.

In all three areas, there are obstacles and political hurdles which can ultimately hinder efforts to making advances in ensuring the health of individuals and populations. It is these obstacles that need to be identified and solutions proposed in order to assist policy makers in making decisions that have favourable outcomes for all those involved.

Personal Health Security

Over the past century, great progress has been made in developed nations in ensuring personal health security. However, this advance has not taken place to the same extent in developing nations. Global funds have been established in recent years to readdress the balance and assist in providing the billions of dollars needed to deal with personal security issues, such as combating AIDS, tuberculosis and malaria, and providing access to safe medicines, vaccines and medical care. These funds have made a huge advance in assisting developing nations in ensuring the personal health security of their populations. But is this a long-term solution? Are these funds sustainable, especially in times of economic crisis when donor and development communities’ priorities might change? What effect could the cessation or lessening of these funds have on the personal health security of developing nations? Underlying the important issue of providing access to safe medicines is the serious problem of counterfeiting. In some cases relating to counterfeit medicines, it is an issue of quality, as poor medicines manufactured with the intent to deceive can severely increase the risk of individuals from certain diseases. In other cases the issue is not so much the quality, but intellectual property and the risk of infringing on copyrights, trademarks and patents. So what is the solution? One possibility is the high-volume, low-cost model which could allow for the access of high quality medicines, vaccines and health care to the periphery of all nations. To achieve this, it goes without saying that policy makers need to sit down with industry to figure out a solution that keeps all parties satisfied in the long term. Either way, a comprehensive analysis of these funding mechanisms would help provide a long term solution to the issue of providing access to safe medicines.

Collective Health Security

Collective health security relates to the health of societies, and looks at reducing the collective vulnerability to global public health events. A good place to start would be to look at the many international agreements in place that assist international coordination once health risks have been identified. They can range from setting of best practices, international regulations, treaties and conventions. These frameworks have been developed to help deal with public health emergencies and outbreaks of infectious diseases. However, they can sometimes be limited in their scope as the most appropriate existing agreements are often not used and the reasons why are poorly understood. Take for example the withdrawal of Indonesia from the influenza virus sample sharing network in 2007, stating that it would not share any more virus samples with the WHO, as they were not able to purchase the vaccines that were being made. The WHO had a framework - the International Health Regulations - which could have been used to negotiate and discuss a solution, but instead decided to use an intergovernmental process to resolve the problems. These mistakes need to be addressed in order to prevent similar failures in the future.

Societies also remain vulnerable to disease transmission at the human / animal interface. Infectious agents can cross the species barrier from animals to human as demonstrated by outbreaks of SARS, BSE and Avian Influenza (H5N1). However, health prevention efforts are hampered in this area, owing to the tensions between the human health and economic gain at the interface. What is needed is a full analysis of the situation to establish where these tensions lie and what is causing them in order to provide a satisfactory resolution that protects the interest of industry as well as the health security of populations.

Another aspect that can influence collective health security relates to the way in which public health risks are communicated to and by the public. Recent years have seen a huge change in the way public health risks are communicated, owing mainly to the advent of the internet and blogosphere. More traditional media outputs have been greatly affected by these newer media sources and have had to adapt the way in which they report these incidences accordingly. These changes can ultimately have a profound effect on health policies. As a result, a more comprehensive understanding of new sources of risk communication is needed to prevent medical evidence being overwhelmed whilst preparing and implementing policies.

Finally, another burgeoning area of collective health security relates to the potential of climate change to impact on human health. Whilst the effects of human interference on climate change remain disputed, what cannot be ignored is the affect that any potential climate change would have on the spread of disease and therefore human health. It is a difficult area for policy makers to tread owing to the complexity of the evidence base. Nonetheless it is an area which great attention needs to be paid, owing to the potential of climate change to undermine progress in attaining collective health security.

Health Security and Stabilisation

The final area of this presentation, relates to health security and its contribution to overall stability and national security. Although evidence in this area remains fairly limited, there is growing recognition that the reconstruction of health systems in post-conflict regions and after natural disasters can provide a major contribution to social stability, government legitimacy and favourable demographic developments which ultimately help aid stability and underlie national security. It is also equally important to pay attention to the maintenance of health systems in countries affected by regime change, civil disturbance and especially in those affected by natural disasters, as demonstrated by the devastation caused by the recent earthquake in Haiti. Examples of successful reconstruction of health systems in such complex environments have not been methodically examined and lessons learned have not been applied to other similar situations, resulting in the loss of opportunity to strengthen health security. Although there cannot be a one-size fits-all solution, previous failures and success can be used to provide a road-map of how things might be done in the future.

Conclusion

In summary, despite great advances having been made in the twentieth century protecting individuals against infectious diseases, there is still plenty of work to be done. A systematic review of processes is needed in order to ensure long-term sustainable access to safe medicines and vaccines, and the overall health security of individuals. There are many issues that need to be reviewed to ensure the health of populations too. Weaknesses in the implementation of health regulations have been exposed, and the way that risk is communicated to populations can also have a huge effect on how people perceive a health threat and how they take necessary precautions. Economic gain is sometimes given higher priority than ensuring public health and the potential for climate change to impact on advances made in collective health security need to be investigated further. Finally previous examples of the reconstruction of health systems in post conflict regions and areas affected by natural disasters need to be systematically examined to identify opportunities that possibly contributed to a stronger linkage between health provision and national security / stability, and propose how they could be utilized more effectively in the future.

references

1. Ministers of Foreign Affairs of Brazil, France, Indonesia, Norway, Senegal, South Africa and Thailand, 2007 ‘Oslo Ministerial Declaration - global health: a pressing foreign policy issue of our time.’ The Lancet, Vol 369 (9570): 1373-1378.
2. Heymann, D, 2009. Chatham House Centre on Global Health Security. Chatham House.
3. Heymann, D, 2009. Centre on Global Health Security: Inaugural Information Evening. Chatham House
4. Fiddler, D. P. 2008. Influenza Virus Samples, International Law, and Global Health Diplomacy. Emerging Infectious Diseases, 14, 88-94
5. Keusch, G., Pappaioanou, M., Gonzalez, M., Scott, K., Tsai, P., (eds) 2009. Sustaining Global Surveillance and Response to Emerging Zoonotic Diseases. National Academies Press. Washington D.C. Lancet and University College London Institute for Global Health Commission, 2009. Managing the health effects of climate change. The Lancet 373: 1693–733