This week, the Trump Administration unveiled its proposed budget, calling for cuts in a number of agencies. The proposal will need to be approved by Congress before it can be enacted. As lawmakers take this on, I found it necessary to re-publish an old post from November of last year, following the election, for its relevance.
The take-home message is that infectious diseases know no borders, that countries with weak health systems will be unable to contain viruses that could eventually reach the U.S., and that, for these reasons, the Trump Administration should hold global health security as one of its key priorities.
If behind the budget cuts are concerns over reducing the U.S. deficit, we should remember that recent epidemics have showed us that a reactionary approach to epidemics and a failure to strengthen health systems can have a tremendous toll on a country’s economy–and we are not immune to this risk. The Commission on a Global Health Risk Framework (CGHRF), which was created following the Ebola epidemic, estimated that pandemics can cost $60 billion per year. This means at least $6 trillion in the 21st century. (For more analysis on this topic, see Global Health Security in an Era of Explosive Pandemic Potential). Ignoring this reality can lead to a grave economic and public health crisis.
GLOBAL HEALTH SECURITY: WHAT COULD BE AN EASY WIN-WIN FOR THE TRUMP ADMINISTRATION
If there is anything that we have learned from the Ebola crisis and the Zika outbreak in the Americas is that public health surveillance and response systems are critical to ensuring health security at the national and global levels. Health systems that ensure strong surveillance and rapid response to disease threats are the key to minimizing the impact of epidemics. A country, and the world for that matter, can incur significant social and economic costs during an epidemic and its aftermath. The 2014 Ebola outbreak in West Africa decimated what were already fragile health systems, killing an estimated 11,000 people in the region—half of all those infected. This experience was what framed the Global Health Security Agenda (GHSA) as we know it today. For these reasons, the incoming administration under President-Elect Donald Trump would be well advised to think carefully as it decides whether to support global health security efforts, which include the implementation of the GHSA and other legal and policy frameworks for pandemic preparedness and response like the World Health Organization’s International Health Regulations (IHR) (2005) and the Pandemic Influenza Preparedness (PIP) Framework.
It all boils down to the fact that viruses do not obey borders or politics. Viruses will continue to emerge and re-emerge regardless of whether the new administration makes global health security a priority or not. The GHSA and other frameworks reflect the lessons learned. Granted, there is still a substantial need to invest further in fighting Zika and building preparedness in the U.S. and abroad, but we have made great strides in the last few years. Turning a blind eye or actively undermining efforts to ensure global health security can be catastrophic not only to U.S. national security but also to the new administration’s agenda. As the Commission on a Global Health Risk Framework (CGHRF) (one of four global commissions created following the Ebola epidemic) concluded in its report, a pandemic is costly. It estimated that losses from pandemics figure approximately $60 billion per year. It also emphasized that an annual incremental investment of $4.5 billion (or 65 cents per person) for increasing global preparedness could significantly reduce costs, both social and economic.
The countries in West Africa affected by the Ebola epidemic struggled from the start. They lacked the capabilities to prevent, detect, and respond to the virus on their own, which posed a serious threat to surrounding countries and those on the other side of the world. What is more, the world had moved away from investing in global preparedness since H1N1 and the response at the global level was also inadequate (see WHO Ebola Interim Assessment Panel report and MSF report). Once Ebola hit and the virus began to spread across populations, the virus soon reached the United States. The American people grew frantic. Government officials at the local, state, and federal levels were ready to take drastic measures, including involuntarily placing health workers (symptomatic or not) returning from West Africa under quarantine and banning flights coming in from affected countries.
In February 2015, the White House issued the National Security Strategy. It states:
“The spread of infectious diseases constitute a growing risk. The Ebola epidemic in West Africa high- lights the danger of a raging virus. The spread of new microbes or viruses, the rise and spread of drug resistance, and the deliberate release of pathogens all represent threats that are exacerbated by the globalization of travel, food production and supply, and medical products. Despite important scientific, technological, and organizational accomplishments, most countries have not yet achieved international core competencies for health security, and many lack sufficient capacity to prevent, detect, or respond to disease outbreaks.
America is the world leader in fighting pandemics, including HIV/AIDS, and in improving global health security. At home, we are strengthening our ability to prevent outbreaks and ensure sufficient capacity to respond rapidly and manage biological incidents. As an exemplar of a modern and responsive public health system, we will accelerate our work with partners through the Global Health Security Agenda in pursuit of a world that is safer and more secure from infectious disease. We will save lives by strengthening regulatory frameworks for food safety and developing a global system to prevent avoidable epidemics, detect and report disease outbreaks in real time, and respond more rapidly and effectively. Finally, we will continue to lead efforts to combat the rise of antibiotic resistant bacteria.”
Many promises were made along Trump’s presidential campaign, but if his administration were to neglect building and maintaining U.S. and other countries’ ability to combat infectious disease outbreaks, those promises can go to naught. Continuing to bolster our and other countries’ preparedness and response capabilities can only bring greater national security in the U.S. Failing to do so can have dire consequences that go beyond the health sector.