By guest contributors Rashi Jhunjhunwala, MD MA; Arturo Cervantes Trejo MD MPH DrPH; Pablo Tarcisio Uribe-Leitz MD MPH; John Lindsay-Poland, Keith Martin…
By guest contributor Aida Hassan
Since the mark of COVID-19, the concept of ‘global health security’ has become a buzzword in academic and public discourse, as global health experts come together to discuss various ways to prevent the next pandemic. This agenda primarily aims to identify and prevent health threats that pose a burden on populations, societies, and the global economy in an increasingly interconnected world. By framing certain diseases as security threats, from novel or existing infectious diseases to the weaponization of biological agents, we can prevent the next pandemic from showing up on our doorsteps.
Despite the lack of clarity on how global health security can be maintained or achieved, the larger concern is the geopolitics at work here. For example, whose security are we promoting? While protecting ourselves from diseases that pose serious threats to our health is crucial, the global health security sector is rooted in westcentrism. This is partly because the framework of international security often reflects the needs and interests of North America and Europe, given their post-9/11 foreign policies on migration and counterterrorism. Yet it also speaks to the true nature of global health, namely the imbalance of power shown in the North-South relations and how global health is governed.
The wielding hegemony of the Global North is visible in almost every aspect of global health, and global health security is no exception – in fact, symptomatic of this very problem. There is a distinct lack of representation from low and middle-income countries on this agenda, instead dominated by the political leadership of privileged White men from high income countries. Even though this agenda requires global collaboration to succeed, it is primarily dictated by supranational entities such as the G7 and the European Union, arguably to safeguard their own economic and political capital. Global health security is not global in essence, and serves to protect the interests and security of those in positions of power.
In 2019, the Global Health Security Index ranked the United States, United Kingdom, and the Netherlands as the countries best prepared for an epidemic, while many African countries were ranked as the least prepared. However, given the public health failures demonstrated by both the UK and US governments during COVID-19, the validity of this metric has since been called into question. Given the diverse social, political, and economic realities of each country, it is difficult to capture the extent to which they are prepared for a future pandemic in just a few variables, much less draw for comparison. When it comes to health security, there is no one-size-fits-all framework for all countries, but these standards were created to align the priorities of the rich at its centre.
The goal of managing and combating ‘cross-border’ health threats is also underpinned by the problematic framing that disease burden lies with low-income countries in the Global South, and where novel diseases supposedly emerge. Even the global response to the Ebola crisis in West Africa focused on preventing this disease from being imported internationally rather than supporting the affected communities, while simultaneously portraying them as a barrier to WHO’s technical assistance for defending their social and cultural norms.
Throughout history, European colonial powers have portrayed the Global South as a reservoir for disease and illness, using health securitisation as a tool to help protect their political and economic expansion. However, even after the era of tropical medicine, this colonial narrative has remained a driving force in global health and its ensuing areas of work, including global health security. To protect wealthier countries in the Global North, much of the global health security agenda focuses on managing diseases from low and middle-income countries in the Global South, even if it means restricting migration and travel.
One example is the current implementation of health screening for migrants arriving in the UK or EU nations, due to the primary concern that migration may exacerbate the spread of communicable diseases, such as “importing” tuberculosis (TB) from high-incidence countries to low-incidence countries. But the validity of this association has yet to be established. Rather, migrants and refugees are vulnerable to these communicable threats as a result of destitution and poverty while travelling or after arriving in their host country, particularly in nations with poor socioeconomic conditions that impede their integration. The idea about migrants spreading diseases from their home countries stems from a moral panic that migration can introduce new and unknown threats to western society, which is primarily founded in racism and encourages anti-immigrant sentiments.
As COVID-19 demonstrates, achieving health security in this way can be counterproductive in the long run. Following the omicron variant, a number of Global North states, including the UK, US, Canada, and Germany, implemented travel bans against various African nations in December 2021. The travel bans were met with outrage by the global health community, including criticism from WHO, but also revealed the irony of these ostensible “health security” measures. If policymakers and world leaders were concerned about the emergence of new variants, the most crucial step would be to enhance access to COVID-19 vaccines in low-income countries and provide waivers on intellectual property rights, by which we might even begin to see an end to this pandemic.
Global health security, like many other aspects of global health, was designed with the socio-political interests of the Global North in mind. However, failing to include leadership from LMICs in this agenda renders this a short-sighted and ineffective goal in the long run. It’s crucial to remember that diseases do not recognise nor respect borders. While globalisation inevitably plays a role here, the next pandemic disease can easily come from a rich country in Europe than from a low-income country in Africa or Asia. By allowing this Western paradigm of ‘health security’ to persist and prioritise whom we protect, we become vulnerable to the very threats we seek to avoid. The only way to guarantee protection for everyone, and envision a world safe from infectious disease threats, is to ensure that global health security reflects the global majority and challenge the power asymmetries that hold us back.
About the author:
Aida Hassan is a PhD student at Wolfson Institute of Population Health Sciences, Queen Mary University of London. She is currently researching the conceptual challenges of global health governance in the context of conflict and political violence, with a focus on MENA states.