Global health is an imperative component of foreign policy. Yet the Trumpian “America First” policy is not paying enough attention to the health security environment. This flies in the face of America’s responsibilities and obligations in the world.
According to the inaugural Global Health Security Index (GHS), released on October 24, 2019, the United States ranks first of 195 countries assessed for global health capabilities. But, and it’s a big but, the U.S. also ranks 19th in overall risk environment and country vulnerability to biological threats, behind Lichtenstein (1st in this category), Norway (2nd) and Switzerland (3rd) and right behind Australia (18th). In other words, the U.S.A is not fully prepared to respond to either a deliberate or accidental health threat with potential to wipe out humanity.
Why should you care?
The ability of our government to prevent an epidemic or pandemic from spilling across our borders depends on the capabilities it has to identify and mitigate the risks associated with accidental or deliberate release of biological agents. With scientific advances outpacing the ability of national governments to provide effective oversight, today it’s possible for a broader array of actors to engineer biological agents and synthesize them from scratch in a laboratory. So identifying and mitigating risk is critical to ensure systems are in place so our country is safe, healthy and more secure.
Health security begins at home. But just how important is it really to America’s leadership, in the present environment of uncivil politics and shortcuts to political victory through disloyal opposition (in reference to Daniel Krauthammer’s October 25, 2019 Friday Opinion piece in The Washington Post)? It is doubtful that in the hyper-partisan Washington DC political playground, our decision makers are more interested in winning the pottymouthed debate than in planning for hypothetical high-consequence biological events. The thing is, that if left unchecked, they can lead to enormous suffering and loss of life.
A case in point is the Ebola outbreak that began on August 1, 2018 in the Democratic Republic of Congo, the second-largest outbreak in history. It has so far infected over 3,200 people and killed over 2,100 in the Democratic Republic of Congo and the surrounding area, with cases confirmed in Rwanda, Uganda and South Sudan. Yet, compared to the leading role played by the U.S. in mobilizing funding and personnel during the Ebola outbreak in West Africa in 2014-2015, under the Trump administration, the U.S. has chosen to play a more limited role.
Citing improvements in the global capacity to respond to Ebola and ongoing security challenges, among other factors, the current administration has restricted U.S personnel from working in the outbreak zone. It is true that the United States, through the US Agency for International Development (USAID), as of September 2019 has dedicated a total humanitarian and aid package of $158 million, directed at the eastern Democratic Republic of the Congo (DRC). Apart from the fact that you can’t finance or buy your way out of a potential health risk, the question that is not being asked is whether, given the lack of progress in interrupting Ebola transmission to date, the U.S. government going forward is also dedicating resources at home to prevent any possible spread of Ebola to the United States and mitigate the consequences of such a risk materializing.
Distance is no buffer to health pandemics
The fact that Democratic Republic of Congo (DRC) is one of the s***hole countries referred to by Trump and is 7884 miles away is no reason not to plan forward. The 2014 Ebola outbreak mainly affected Liberia, Guinea Conakry and Sierra Leon, but small outbreaks were reported in Nigeria in Mali and isolated cases in Senegal, United Kingdom, Italy, Spain and the United States. Eleven cases were reported in the U.S., including four laboratory-confirmed cases and seven cases medically evacuated from other countries.
Past experience shows that the present Ebola outbreak in DRC could conceivably become what the GHS Index calls a “high-consequence biological event” affecting citizens within our borders. Although highly unlikely, it is nevertheless a risk that needs to be considered. That is precisely why the GHS Index prioritizes national capacity to reduce the risk of biological events that have the potential to cause catastrophic damage on a global scale and lasting, population-wide harm. But the U.S. is not fully prepared for a health pandemic, nor is the Trump administration focusing much attention on closing the preparedness gap.
Low health care access is a huge risk
Not only is the U.S. weak in risk prevention and mitigation. It also ranks extremely low in health care access: a 25.3 score. In other words, according to the GHS, “the United States scores in the bottom tier of countries for the access to healthcare subindicator owing to lack of governmentally guaranteed access to healthcare plus high out-of-pocket expenditures per capita.” This compounds the lack of risk mitigation preparedness, as public health vulnerabilities “affect the ability of a country to prevent, detect, or respond to an epidemic or pandemic and increase the likelihood that disease outbreaks will spill across national borders”.
Universal health care is not just a liberal or conservative debate issue. It’s paramount to our country’s health security. An individual’s ability to access healthcare is of prime importance for disease surveillance and detection, and to seek evaluation and treatment during an outbreak.
Given the broken trust in the U.S. healthcare system, universal access to routine health services is not ensured. This means that in the event of a biological pandemic - for example, an outbreak of a novel strain of influenza (which, by the way, is a veritable looming threat) - people without access to healthcare will more likely not seek care during an outbreak.
It is very important to support efforts to promote the adoption of Universal Health Coverage (UHC). Coupled with training in healthcare capacities for delivering core health services, availability of public health practitioners, including veterinarians, and access to infection prevention and control measures, universal health care can “help increase health security by improving access and reducing barriers to healthcare and ensuring that there is sustainable financial support for health systems.”
Global health is no tweeting matter
Global health is a critical element of the government’s responsibilities. Those who live in America are lucky enough to live in a relatively stable, open and prosperous democratic country. But We the People are called upon to ensure that our government protects us in all possible dimensions. Assaulting the character of opposing candidates who argue for universal health care or, worse yet, pottymouthing them or characterizing them as enemies of the state, in no way makes for better protection or risk mitigation.
Global health is also part of America’s sovereign obligation as a nation. Despite Trump’s laissez moi faire attitude, based on an underlying l’état c’est moi thinking, America has rights and obligations vis-à-vis other governments and countries (Richard Haas, A World in Disarray, 2017). Beyond his responsibility to protect Us the American People, President Donald Trump and Congress have an obligation to other governments and through them to their citizens.
As Haas points out, the challenge is to make sure that government has the capacity to meet disease outbreaks. This requires strong ethical and normative frameworks that can complement existing legal and regulatory health security measures, as well as reinforcing and developing collaboration across all levels of the public health system.
Opting-out of consultation or conversation that takes into account the views of others is not a choice. The U.S. cannot act unilaterally on matters of global health. Nor can our government make relevant policy by impulse or tweet (Dan Balz, The Take, The Washington Post, October 16, 2019). In health as in war, the damage from destructive actions cannot be mitigated. Failure to honor our sovereign obligation not only puts our country’s health at risk. It puts our very nation’s legitimacy at risk.