When Secretary of State Antony J. Blinken laid out the U.S. administration’s diplomatic plans on March 3, the first item was to “stop COVID-19 and strengthen global health security.” Experts have long warned about pandemics, but countries often failed to make them a top priority. While COVID-19 may change that, there needs to be an understanding that global health security is a bigger issue than any one pandemic and that too narrow a focus could lead to failure.
Leaders may want to consider three additional items as they develop their strategies to prepare for such health threats: other diseases, social determinants of health, and logistics.
Other diseases — infectious and chronic
Only a comprehensive approach can avoid unnecessary strains on health systems. Dealing with COVID-19, for example, must account for other infectious diseases and chronic noncommunicable diseases. Of course, it’s no wonder new infectious diseases such as COVID-19, Ebola, and Zika get attention; they’re terrifying. But under the radar, HIV-related causes still killed 690,000 people in 2019, while malaria took 409,000 lives.
The World Health Organization and U.S. President's Malaria Initiative wanted malaria interventions to continue during the pandemic so that avoidable hospitalizations wouldn’t burden facilities taxed by COVID-19. Abt Associates leads PMI’s VectorLink Project, which sprays insecticide in homes and distributes insecticide-treated bed nets in 24 countries. We managed to complete our campaigns, despite all of the work being in person. Such interventions cut the incidence of malaria mortality by 67% from 2000 to 2019.
It’s vital that malaria control remains a health priority — not only to avoid competing with COVID-19 for hospital beds, but also because the disease is associated with lower rates of economic growth.
Chronic noncommunicable diseases are even bigger killers. They account for 71% of global deaths and present comorbidities that make COVID-19 more lethal. For example, a World Obesity Federation study revealed COVID-19 mortality rates are over 10 times higher in countries where overweight prevalence exceeds 50% of adults, compared with countries that have a prevalence below 50%.
There needs to be an understanding that global health security is a bigger issue than any one pandemic and that too narrow a focus could lead to failure.—
Of course, we can’t forget pandemics, as COVID-19 won’t be the last one. Preplanning is critical. At a meeting of 26 Caribbean countries in 2016, the U.S. Agency for International Development’s Health Finance and Governance Project helped develop the first regional self-assessment of the capacity to address infectious diseases — an ongoing issue with the potential to overwhelm small health systems.
After the meeting, HFG developed a Caribbean Region Global Health Security Agenda Roadmap. Health leaders have since followed the road map and improved communications, coordination, and cooperation. Among other things, the countries track passenger movements on cruise liners and flights and share vaccine donations and testing capacity. And the countries took a whole-of-society approach, including not just government and the private sector but also universities, communities, and civil society organizations.
This innovative regional, multisectoral, and collaborative process is one that other regions should consider and adapt, since pathogens don’t need passports.
Social determinants of health
Focusing on just diseases to improve health security won’t work either. Emerging threats have greater impact on communities whose health is already compromised by toxic pollutants, nonpotable water, a lack of income to pay for health care, and poor education that can’t lead to decent jobs. It’s critical to address these issues holistically to make progress.
In Uganda, for example, the Integrated Community Agriculture and Nutrition project in its first two years improved the resilience of more than 100,000 people. According to data that’s yet to be published, it linked more than 1,400 community groups to markets, equipped more than 1,600 out-of-school girls with livelihood skills, and worked with 750 cultural leaders. ICAN improved school enrollment, nutrition, livelihoods, resource management, and hygiene. COVID-19 offers an opportunity to make multisectoral approaches to improving health outcomes the norm.
Systems and logistics
Both systems and logistics are critical in military combat and in health care battles.
On March 8, national security adviser Jake Sullivan noted that the United States would follow spending on COVID-19 vaccinations with outlays for “strengthening the capacity of health systems.” This can be done through a combination of approaches that move a country toward sustainable universal health coverage.
Activities can include institutionalizing transparent national priority-setting processes for health, strengthening financial management of health systems, obtaining accurate and reliable data on pharmaceutical expenditures, and improving health care quality.
Jake Sullivan, national security adviser for President Joe Biden, says that the administration wants to streamline global health institutions and help build stronger health systems.
A good model is the Abt-led USAID Local Health System Sustainability Project, which currently operates in Asia, Latin America, and Africa and is expected to work in dozens of countries. While LHSS is assisting countries with COVID-19 responses, its broader mission is to help nations improve coverage for those in need, deliver quality services, and make care more affordable.
To improve health outcomes, clinics and patients must be able to get the products and services they need. That requires a reliable supply chain. Its absence was clear when personal protective equipment, ventilators, and testing kits were chronically in short supply. But there are solutions.
In the Democratic Republic of Congo, USAID Integrated Health Program data — which is yet to be published — shows it has contributed to reducing stockouts of vital commodities in target provinces from an average of over 70% two years ago to 45.7% in late 2020. The program empowers providers to manage stock — particularly at the “last mile.”
The private sector also has a role in ensuring global health security, as it is the first stop for priority health care for many vulnerable people. Projects such as Sustaining Health Outcomes through the Private Sector Plus help develop public-private partnerships that improve distribution of services and products. In one year, SHOPS Plus partnered with the private sector to treat nearly 96 million liters of drinking water with chlorine water treatment solution.
The private sector’s innovations help produce better health outcomes as well. Entrepreneur Nneka Mobisson co-founded Nigeria’s mDoc, a social enterprise supported by LHSS that harnesses technology, behavioral science, quality improvement, and data to enhance health care for people living with chronic diseases. It connects people to multidisciplinary care teams, provides a directory of health facilities, and trains health care providers to ensure high-quality care.
COVID-19 presents a chance for a reset. We should focus foreign assistance on strengthening social infrastructures by tying together all parts of society with water and sanitation, workforce development, education, the environment, and food security in community contexts. And we must ensure the resilience of health systems and supply chains.
It won’t be cheap. But it’s hard to imagine a better return on investment for national stability, family well-being, and, above all, lives saved and potential reached.