Pandemics and National Security: What’s the Role of Government in Managing Global Health?

At first, the deaths were a little more than the normal; then, the mortality rose still higher, and afterwards the toll of dead reached five thousand each day, and, again, it even came to ten thousand and still more than that.
 

This eyewitness account of a pandemic sounds all too contemporary; but, it was written in the sixth century by Procopius, a resident of Constantinople, about the Plague of Justinian. Subsequent pandemics have transformed the world:

• The Black Death ravaged Asia and Europe from 1346 to 1353 and is estimated to have killed more than half the population of Europe. The resulting labor shortage led to higher pay for workers and the end of serfdom. It also improved people’s diets and led to technological innovations.
• The American Plague of the 16th century began when smallpox and other Eurasian diseases were brought to the Americas by European explorers. It’s estimated that as many as 90% of the indigenous population of the Western Hemisphere was killed. The plague contributed to the collapse of the Inca and Aztec empires.
• The flu pandemic of 1889-1890 was the first infectious disease to use modern transportation to spread around the globe in just 3 months, ultimately causing the death of 1 million people.
• The Spanish Flu of 1918-1920 sickened an estimated 500 million people, which was about one-third of the world’s population at the time. The disease killed about 20% of infected people and was particularly deadly to many indigenous populations, nearly wiping them out. Soldiers kept in close quarters and poor nutrition during World War I contributed to the disease’s spread and high mortality rate.

The COVID-19 pandemic has demonstrated how devastating such events can be to the health and well-being of populations around the world. Pandemics cause socioeconomic disruptions that threaten national security, in part, by putting massive strains on health systems across the globe. National security strategies play a key role in the prevention, preparation, response, and mitigation of the devastation that pandemics can wreak on communities, countries, and populations around the world.

Why Is Global Health Important?

In the book Global Health and the Future Role of the United States, the National Academies of Sciences, Engineering, and Medicine (NASEM) describes successful public health systems as suffering from an “out of sight, out of mind” problem. Their success in preventing disease goes unnoticed, which results in complacency and leads to funding cuts that result in the return of infectious diseases once under control.

Many government leaders fail to grasp why global health is so important because of the success of past public health efforts. However, the dire consequences of a failed public health system are evident in the health emergencies and mass migrations of Syria, Yemen, and other war-torn areas of the Middle East. The same perilous situations exist in countries on the verge of economic collapses, such as Venezuela and the Congo.

The 2019 Worldwide Threat Assessment of the U.S. Intelligence Community from the U.S. Office of the Director of National Intelligence (ODNI) stated that “the United States and the world will remain vulnerable to the next flu pandemic or large-scale outbreak of a contagious disease that could lead to massive rates of death and disability [and] severely affect the world economy.”

The assessment warned that political upheaval, health crises, and increasingly radical militant groups will keep global displacement near record highs, further straining governments and economies throughout the world. NASEM cites studies that estimate the economic cost of a pandemic such as COVID-19 at $570 billion per year based on the intrinsic value of lives lost early and illnesses suffered, and $2 trillion in direct costs, worker absenteeism, and business disruptions.

To protect national security and the global economy, governments must increase their investment in public health systems to identify and control the spread of potentially threatening diseases. Doing so will help sustain domestic and international commerce. This goal is achievable only if countries work together through international diplomacy to help minimize the threat of a pathogen transforming into a pandemic threat.

The Movement of Pandemics: How Pandemics Spread Throughout the World

The World Health Organization (WHO) defines a pandemic as “the worldwide spread of a new disease.” An influenza pandemic occurs when a new influenza virus to which most people have no immunity spreads around the world. The book Disease Control Priorities: Improving Health and Reducing Poverty by Nita Madhav et al. explains that increased global travel and integration, urbanization, land-use changes, and heightened exploitation of the environment make pandemics more likely.

However, these trends don’t explain how pandemics spread so quickly to countries across the globe. Most pandemics originate from the zoonotic transmission of pathogens from animals to humans. Pandemics have two risk factors:

Spark Risk

Spark risk measures the likelihood of a pathogen crossing the natural species barrier from a domesticated or wild animal to humans. The risk increases in areas of dense livestock production and markets where live animals are sold. Potential sources are bushmeat hunting (consuming wild animals), use of animal parts in traditional medicine, natural resource extraction, and human encroachment on wildlife habitats.

Spread Risk

Spread risk is determined by the pathogen’s ability to adapt genetically and its mode of transmission, human population density, and human susceptibility to the pathogen. The risk is influenced by travel, trade, and migration, as well as the effectiveness of public health surveillance and response.

Several socio-economic conditions contribute to the spread of the pathogen to pandemic proportions.

• Overcrowded urban centers, particularly those in which people are housed in informal settlements.
• Environments of social inequality and poverty, which significantly increase the population’s susceptibility to infection.
• People whose immune systems are compromised by other health conditions, poor diets, or malnutrition.
• People who lack access to clean water and sanitation, which amplifies transmission rates and increases morbidity and mortality.

A country’s ability to prevent and contain a pandemic is expressed through a preparedness index that calculates the readiness of institutions to detect and respond to a large-scale outbreak of an infectious disease.

• The public health infrastructure’s ability to identify, trace, contain, and treat people infected by the pathogen.
• The ability of the physical and communications infrastructure to deliver critical resources and information in a timely manner.
• The capacities of public agencies and bureaucracies.
• The financial resources are available for mobilization to fight the disease and minimize its impact on the economy.
• The effectiveness of efforts to communicate the risk presented by the pathogen.

Relationship Between Pandemics and National Security

As the primary threat of a pandemic is to human life, the priority in combating the disease is helping people who are stricken to recover and preventing infections in everyone else. However, pandemics pose critical threats to the economic, political, and social systems on which the world relies to stay safe and healthy.

The connection between pandemics and national security is evident in the 2017 update of the U.S. Department of Health and Human Services Pandemic Influenza Plan. The strategy integrates seven domains that encompass intelligence, science, manufacturing, public health, and political partnerships.

Surveillance, Epidemiology, and Laboratory Activities

Quickly identifying and responding to infectious diseases with the potential to cause a pandemic requires widespread surveillance and reporting systems able to detect and monitor new influenza viruses. It’s just as important to develop, test, and deploy candidate vaccines fast enough to prevent widespread infections. Big data analytics and more accurate forecasting will help achieve these goals.

Community Mitigation Efforts

It takes much longer to react nationally and globally to a potential pandemic than to take action on a local level. The response of communities and individuals can have a profound impact on slowing and stopping the progression of an infectious disease. Local action is particularly important in the early stages of an outbreak of a novel infectious disease such as COVID-19 until the development of a vaccine.

Medical Countermeasures

Diagnostic equipment, respiratory devices, therapeutics, and vaccines effective in battling previous pathogens serve as the foundation on building new approaches and countermeasures. Health care providers must receive training in the use of new countermeasures, have ready access to the innovations, and understand how the approaches complement their mitigation and response efforts.

Health Care System Preparedness and Response

Recent years have seen fundamental changes in health care delivery, health care provider reimbursement, and the sharing of health information. To prevent being overwhelmed by a surge in cases during a pandemic, health services must prepare new models to accommodate steep increases in demand for critical health care resources.

Communications and Public Outreach

The public must receive accurate, consistent, timely, and actionable messages about a pandemic, with communications delivered in plain English and formats readily accessible by everyone. Ensuring effective communications goals requires testing messages, selecting appropriate communication channels, and choosing suitable spokespersons.

Scientific Infrastructure and Preparedness

Developing new vaccines and therapeutic treatments requires a state-of-the-art scientific infrastructure that extends from laboratories to testing facilities and health care settings. Rigorous scientific methods developed for information collection during the COVID-19 pandemic response can be applied to future mitigation and response efforts.

Domestic and International Response Policy, Incident Management, and Global Partnerships

Coordinating global efforts to prevent and respond to outbreaks of new infectious diseases requires clearly-defined communication channels that accommodate the timely exchange of massive amounts of information. Reagents and other resources also must be shared quickly and accurately between diverse parties located around the globe who are using a range of formats and equipment.

How Does a Pandemic Threaten National Security?

The 2019 Worldwide Threat Assessment of the U.S. Intelligence Community states that a pandemic or large-scale outbreak of an infectious disease would cause “massive rates of death and disability” that threaten the economy and international resources. The world is looking to the U.S. to lead the global response to the COVID-19 pandemic.

National security depends on the ability to protect public health in the face of tremendous levels of human displacement and threats to human rights and liberties. However, the Rand Corporation estimates that the budget for the U.S. Department of Defense could decline by between $350 billion and $600 billion over the next 10 years as a result of a COVID-19 recession. In addition, the pandemic may lead to the reprioritization of resources away from the DOD, as explained in the War on the Rocks blog. At the same time, many military facilities and assets will be deployed to assist in the country's response to COVID-19.

The U.S. intelligence community continues to shift its focus away from paradigms and strategies that are rooted in the Cold War era that followed World War II. The new models of national security emphasize threats posed by catastrophic climate change and what a Washington Post columnist refers to as “biothreats” such as highly infectious diseases and other pathogens.

National security policy in the 21st century will remain centered on maintaining U.S. leadership in technological innovation and manufacturing by ensuring a vital economy in the face of pandemics; climate disasters; and the resulting social, political, and economic disruption. A key component of this policy is guaranteeing ready access to the products and technologies essential to the health and security of U.S. residents.

Examining how a pandemic threatens national security extends beyond protecting people’s health and security. As nonessential businesses shut down to prevent the spread of COVID-19, jobs are cut, stock prices drop, international travel is disrupted, and supply chains slow down. The economic and social shock of such events increases the nation’s vulnerability to threats that aren’t directly related to the pandemic.

Much of the work that goes into preparing an effective pandemic response focuses on organization, leadership, and fact-based policy. On the Lawfare blog, Lisa Monaco, federal prosecutor and former Homeland Security and Counterterrorism Advisor to President Barack Obama, states that to improve the response to pandemic disease, three areas of government must improve:

• Leadership and organization in the executive branch
• U.S. leadership in the global strategy to combat the pandemic
• Policymaking based on scientific fact rather than alarmism

National Strategies for Influenza Pandemics

Efforts are underway to mitigate the damage inflicted by COVID-19 to social, economic, and political systems around the world. Governments working together can minimize the causes of infectious disease outbreaks, which include rapid unplanned urbanization, protracted humanitarian crises, increases in international travel and trade, loss of wildlands, and the impact of climate change.

However, the U.S. has no single national strategy for pandemics such as COVID-19. Instead, various federal agencies devised plans that address various aspects of a pandemic response.

The U.S. Department of Homeland Security (DHS) published its Pandemic Influenza: Preparedness, Response, and Recovery guide in September 2006. The guide outlines the roles, responsibilities, and authority of federal, state, and local government agencies, as well as private businesses, in planning and implementing contingency plans in the event of a pandemic. The goal is to protect critical infrastructure and key resources, 85% of which reside in the private sector.

The DHS guide states that its primary purpose is to “stimulate the U.S. private sector business community to act now” by expanding its  “traditional notions of continuity of operations.” It warns that a pandemic will “test the limits of their current contingency plans.”

By comparison, the U.S. Homeland Security Council’s Implementation Plan for the National Strategy for Pandemic Influenza, which was published in May 2006, assigns specific duties to federal government agencies and departments. However, the strategy states that the “center of gravity of the pandemic response ... will be in communities.” It will be up to local communities to “address the medical and non-medical effects of the pandemic with available resources.”

The federal government’s role is to coordinate the national and international response to the pandemic by working with WHO and the International Partnership on Avian and Pandemic Influenza. The federal response has three primary goals:

• Stop, slow, or otherwise limit the spread of a pandemic to the U.S.
• Limit the domestic spread of a pandemic, and mitigate disease, suffering, and death.
• Protect infrastructure and minimize the impact of the pandemic on the economy and functioning of society.

Much of the federal government’s response to a pandemic is governed by the National Response Framework and the National Health Security Strategy Implementation Plan. This is distinguished from the authority of state governments in coordinating their communities' response to COVID-19 at the county and local level.

The National Response Framework “describes specific authorities and best practices for managing incidents that range from the serious but purely local to large-scale terrorist attacks or catastrophic natural disasters.” The framework outlines roles in the government’s response to numerous federal agencies, as well as for private sector enterprises and non-governmental organizations.

The National Health Security Strategy Implementation Plan emphasizes “collaboration and leadership among all stakeholders” in protecting against, responding to, and recovering from all health threats in the U.S. It takes a whole-of-government approach that focuses on “public-private partners, non-governmental organizations, academia, professional associations, communities, families, and individuals.” The plan’s goal is to expand capabilities, mobilize resources quickly, and prevent incidents that result in serious health consequences.

Making the Country and the World a Safer Place

History has shown that no amount of prevention and preparation will eliminate the serious threats to people’s health and well-being posed by widespread outbreaks of infectious diseases such as COVID-19. Just as massive investments in U.S. defense capabilities are made with the intention of never having to use those capabilities, the U.S. must adopt a national security policy that invests in detection, prevention, and immediate coordinated response to deter future pandemics.

Leadership drives successful national security strategies, whether the threat originates from a hostile nation or organization, or from nature. Training tomorrow’s leaders is the goal of Norwich University’s online Master of Arts in International Relations program. In particular, the program’s National Security concentration offers courses such as World Politics - International Relations, National Security, and Intelligence and National Security Policy.

Learn more about how the Norwich University online Master of Arts in International Relations can prepare students to serve as global leaders in the battle to prevent pandemics.

Recommended Readings

6 Time Management Tips for Earning an Online Degree
The Biggest Threats to Cybersecurity Today and How Cybersecurity Specialists Can Help
Talking Leadership with General Richard I. Neal

Sources:

The Plague of Justinian May Not Have Been that Devastating, Researchers Suggest, Medievalists.net
20 of the Worst Epidemics and Pandemics in History, Live Science
Global Health and the Future Role of the United States, National Center for Biotechnology Information
Worldwide Threat Assessment of the U.S. Intelligence Community, U.S. Office of the Director of National Security
What Is a Pandemic?, World Health Organization
Disease Control Priorities: Improving Health and Reducing Poverty, National Center for Biotechnology Information
Pandemic Influenza Plan: 2017 Update, U.S. Centers for Disease Control and Prevention
Defense Budget Implications of the COVID-19 Pandemic, RAND Corporation
After the Pandemic: America and National Security in a Changed World, War on the Rocks
After This Pandemic Passes, America Needs a Reckoning with Its National Security, The Washington Post
The Coronavirus Shows Why the U.S. Must Make Pandemic Disease a National Security Priority, Lawfare
Pandemic Influenza: Preparedness, Response, and Recovery, U.S. Department of Homeland Security
National Strategy for Pandemic Influenza, U.S. Homeland Security Council
The National Response Framework, U.S. General Services Administration
National Health Security Strategy Implementation Plan 2019-2022, U.S. Office of the Assistant Secretary for Preparedness and Response
Pandemic Disease Is a Threat to National Security, Foreign Affairs
Spanish Flu: The Deadliest Pandemic in History, Live Science
Microbial Evolution and Co-Adaptation, National Center for Biotechnology Information
The Justinianic Plague: An Inconsequential Pandemic?, Proceedings of the National Academy of Sciences
The World Changed Its Approach to Health After the 1918 Flu. Will It After the COVID-19 Outbreak?, Time
National Security and Pandemics, United Nations
About Global Health Security, U.S. Centers for Disease Control and Prevention
Global Health Security Agenda, U.S. Centers for Disease Control and Prevention
National Action Plan for Health Security (NAPHS), U.S. Centers for Disease Control and Prevention
National Pandemic Strategy, U.S. Centers for Disease Control and Prevention
1918 Spanish Flu (H1N1 Virus), U.S. Centers for Disease Control and Prevention
Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—Social Distancing Measures, U.S. Centers for Disease Control and Prevention
Global Health, U.S. Office of Disease Prevention and Health Promotion
Pandemics, WebMD