National Security and Public Health—Why the Controversy?

Defending the nation?

This post is contributed by Harvey Rubin, a member of the steering group of the OECD Future Global Shocks project and Director of the Univerity of Pennsylvania Institute for Strategic Threat Analysis and Response, and Nicholas Saidel, a Research Specialist at ISTAR. 

Thinking about certain aspects of public health and infectious diseases as “existential threats” to human security arguably began as early as December 10, 1948, when the General Assembly of the United Nations adopted and proclaimed the Universal Declaration of Human Rights, in which Article 3 states: “Everyone has the right to life, liberty and security of person.” This was reaffirmed in the United Nations Development Programme (UNDP) of 1994 and again in the 2003 UN Commission on Human Security. These efforts conceptualize security as human-centric rather than the traditional state-centric and include protection from the shocks that affect human safety and welfare – such as disease, hunger, unemployment, crime, social conflict, political repression and environmental hazards.  In this formulation, the nature of an existential threat depends in part on the particular threatened sector.

The traditional national security threat is understood to be the threat to the survival of the sovereignty, territory and physical condition of the nation. To the medical community in general, and especially to the public health and infectious diseases sectors, survival clearly refers to taking every action to minimize morbidity and mortality as well as to minimize the effect of disease on the economic, social and political stability of communities, nations and transnational organizations.  HIV/AIDS is frequently discussed in the context of securitizing public health issues.  This discussion originated with the UN Security Council Resolution 1308 (2000), which placed HIV/AIDS squarely in the cross-hairs of the security debate by stating: “Stressing that the HIV/AIDS pandemic, if unchecked, may pose a risk to stability and security.”  More recently, obesity has been identified as a national security issue by retired generals and admirals in the report Too Fat to Fight, concluding:  “If we don’t take steps now to build a strong, healthy foundation for our young people, then it won’t just be our military that pays the price – our nation as a whole will suffer also.”   Even Michelle Obama identified obesity as a national security issue in the announcement of her ‘Let’s Move’ campaign.

Where will the securitizaton of medicine and the medicalization of security lead with regard to the future of public health, and conversely, with regard to the future of national security?   These issues are generally addressed in the literature of the political scientists.  For example, Stefan Elbe’s new book, “Security and Public Health,” analyzes the framing of health problems as security concerns and whether this framing helps or hinders controlling these problems in national and international political, social and economic venues.  Elbe convincingly uses HIV/AIDS, SARS, and H5N1 influenza and bioterrorism as case studies of the effect of medicalizing security. Much like traditional security issues formulated in military language, a responsible reaction to threats is the development of countermeasures.  Widening the security gambit to include an “inflated list of possible medical threats to security (Elbe)” can lead to a corresponding extension in funding for medical countermeasures – new vaccines and therapeutics.   From our point of view—why is this bad? 

The controversy over sovereignty rights concerning epidemiological data and, more specifically, on influenza sequence data that continues to engage the international community, is fascinating.  This issue crystallizes many of the concerns of the national security community, including potentially weakening the traditional military agenda by widening the spectrum of security threats, removing the discussion of policy issues from the biomedical and public health practitioners and placing it in the hands of the diplomats, the military and possibly even the intelligence community, and focusing attention on the needs of the economically and militarily stronger countries and not on global health.

Understanding and dealing with the interdependencies of public health and national security spans widely divergent disciplines of clinical medicine, public health, basic biomedical science, economics, political science and international relations and deserves a deep and broad analysis by the interested parties. In this respect, Dr. Lincoln Chen’s comments in his address to the Helsinki Process Track on Human Security are instructive.

Given the perpetual tension between the demands of national security and the need to protect civil liberties, a balance must be struck whereby states can deal with national emergencies efficiently but without an unreasonable erosion of citizens’ privacy rights.  Moreover, an international system that fosters, rather than inhibits, cooperation between states in terms of data sharing and bio-surveillance is required.  For these reasons, we propose the implementation of a Global Compact for Infectious Diseases.

Useful links

OECD work on health

OECD Forum on Neglected and Emerging Diseases

OECD Working Paper on tackling obesity

OECD Observer article on democracy and sovereignty

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  1. Funding for new medical counter-measures is certainly not a bad thing! But – I would argue – there is also a danger that too much attention is focused on medical responses to infectious diseases. As we now know from the recent experience with pandemic H1N1 there can also be drawbacks associated with a predominantly medical approach to protecting citizens against pandemic threats. Such medical counter-measures are often not as effective as widely believed, as can be seen in the many who mistaken believe that anti-virals like Tamiflu or Relenza are cures for influenza. In the past such medical responses to infectious diseases have also proved to be temporary in light of rapidly emerging resistance, and have also prompted medical side effects that were not spotted in the initial trials.

    Then there are also a host of controverisal international political issues surrounding access to such medical counter-measures that need to be sorted. When it comes to vaccines in particular there is insufficient international production capacity for the world’s population, which has prompted intense debates between developed and developing countries about existing forms of international health co-operations, such as international arrangements for virus sharing.

    Does all of this speak against having a Global Compact for Infectious Diseases? Certainly not. If anything, it makes such a compact all the more important as the world remain more vulnerable to influenza viruses than is widely believed. Yet it also leads to the call for a more rounded and balanced approach between medical and wider responses.