Commission aims to create roadmap for US role in global health security

The U.S. needs to be able to participate in responses to outbreaks, such as the Ebola outbreak in the Democratic Republic of the Congo. Photo by: REUTERS / Zohra Bensemra

WASHINGTON — A commission including global health and national security leaders, and members of Congress has released a set of recommendations it believes can serve as a blueprint for improved U.S. action on global health security.

“We began the Commission’s work with a simple, powerful proposition: health security is national security, in a world that is increasingly dangerous and interdependent,” Dr. Julie L. Gerberding, the co-chair of the Center for Strategic and International Studies Commission on Strengthening America’s Health Security, said in her written testimony for a Senate Committee on Armed Services Subcommittee hearing Wednesday. 

“We need to adjust our thinking to account for this fundamental new reality. We need new approaches to operate effectively, on-the-ground, in difficult, insecure places,” she said in the testimony. “The Commission also arrived at a stark, companion conclusion: U.S. health security policy is caught in a cycle of crisis and complacency, which leaves Americans very vulnerable.”

Members of the commission included four members of the U.S. House of Representatives, two senators and 12 leaders from the global health, development, and national security fields. The commission’s final report, which was released this week, makes seven recommendations of actions that the administration and Congress can take to improve global health security and bolster the U.S. role in addressing critical issues facing the world.

“I was pleased and surprised to be able to get an agreement on that package of recommendations without having to soften them up in order to reach a compromise,” said Stephen Morrison, senior vice president and director of the Global Health Policy Center, who helped organize the commission. “We need to think in bigger terms about what we’re trying to do here.”

Among the recommendations for the administration is to bring back health security leadership to the White House National Security Council — the NSC’s global health security team was disbanded in 2018 by John Bolton, who was national security adviser at the time. The report also calls on the administration to commit to multiyear funding for the global health security agenda, to help build capacity and preparedness in low- and middle-income countries.

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Another one of the proposals in the report is to create a pandemic preparedness challenge at the World Bank to incentivize countries to invest more in preparedness. The report suggests that Congress should push for U.S. leadership in the initiative.

The report also calls on Congress to increase contingency funds for the U.S. Centers for Disease Control and Prevention and the U.S. Agency for International Development to ensure that there is rapid access to resources when health emergencies occur.

Increasingly in global health emergencies, U.S. personnel are unable to access outbreak zones due to insecurity, an issue that has been particularly apparent in the U.S. response to the current Ebola outbreak in the Democratic Republic of the Congo. While caution is understandable, the U.S. needs to be able to participate in responses to such outbreaks and there must be a way for experts to access outbreak zones despite security risks, Morrison told Devex.

The U.S. cannot accept being confined to the sidelines and must alter its thinking about acceptable levels of insecurity, he said. To that end, the commission recommends establishing a U.S. global health crisis response corps — small teams of experienced U.S. civilian public health and humanitarian experts working alongside local partners, an effort that would build upon the rapid response abilities of CDC and USAID today.

The idea is to take USAID and CDC capacities and train teams in a number of factors, working with a Department of Defense adviser, to prepare them to work in less stable environments, building partnerships with local actors and improving services, Morrison said.

The commission also sought to enlarge the definition of health security beyond preparing for outbreaks, he said. That is why one of its recommendations focuses on the delivery of health care services to vulnerable populations, particularly women and girls, in conflict or fragile states and in humanitarian crises. In those unstable areas, the U.S. should focus and invest more in vaccine programs and addressing gender-based violence, according to the report.

It urged Congress to authorize $30 million in funding annually for five years to ensure that issues of maternal health, reproductive health, family planning, and gender-based violence prevention, and response “are moved from the sidelines to the heart of crisis response.”

Women and girls often bear the brunt of the effects of global health security challenges, according to experts at an event organized by CSIS on the topic last month.

There needs to be a mindset shift and a change in the level of ambition as people think about gender-based violence or women’s programs, Lisa Carty, the director at UNAIDS’ U.S. liaison office, said at the CSIS event. They need to be seen as “core lifesaving programs, not additional,” she said.

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The final recommendation by the commission was for an increase in investment in vaccine programs and the development of new vaccines, including funding for the Coalition for Epidemic Preparedness Innovations. It also called on the U.S. government to work to better understand the rise of anti-vaccination advocates and find ways to communicate accurate information.

Members of the committee will be working to push forward the proposals in the report, through events, briefings on Capitol Hill, and meetings with congressional staff about potential legislation.

“We’re hoping that we can stir some discussion,” Morrison said.

The proposals are not designed to break the bank and should cost less than $1 billion a year, which is a sweet spot in terms of funding level, and a range that Congress has been comfortable supporting in the past, he said.  Morrison emphasized that the recommendations are asking Congress and the administration to allocate news funds, not drain other accounts.

The U.S. needs to be more proactive in its approach to global health security and needs to acknowledge and adapt to a more dangerous world, he said. The recommendations illustrate that there are affordable and sensible actions that the U.S. can take to do so, and the composition of the commission indicates that they should be able to get bipartisan support, Morrison added. At the event on women and girls’ health security Rep. Susan Brooks, a Republican from Indiana, echoed his sentiments.

“Yes, we are a very polarized country and divided on many things, but that does not mean we cannot work together, particularly on health security,” she said.

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    Adva Saldinger

    Adva Saldinger is an Associate Editor at Devex, where she covers the intersection of business and international development, as well as U.S. foreign aid policy. From partnerships to trade and social entrepreneurship to impact investing, Adva explores the role the private sector and private capital play in development. A journalist with more than 10 years of experience, she has worked at several newspapers in the U.S. and lived in both Ghana and South Africa.