The World Health Summit (WHS) reflects the complex, interdisciplinary nature of global health practice. As medical innovation and technology offers a myriad of life-saving treatment options, all of mankind must benefit, and the right of health and access to health needs to be expanded to reach the most vulnerable populations. Expanded access of health care for the world’s population directly contributes to the ongoing trend of eliminating poverty. Global morbidity and mortality may be shifting from infectious to noncommunicable diseases (NCDs), but many NCDs are either caused or exacerbated by infectious disease and in some countries NCD and infectious diseases compete in both incidence and prevalence, the so-called “double burden.” However, climate change and environmental degradation, social and political instability, asymmetric and hybrid war, complex emergencies, economic crisis, and mass migration have securitized many of these health transitions and burdens, all key topics at the WHS. These new threats require new therapeutic ecosystems rooted with interdisciplinary approaches to inform policy and practice. 1
There are over 90 panels and hundreds of speakers at the WHS each year, most are from key policy and decision-making positions, core research institutes and universities, ministries of health, as well as scientists from multiple disciplines and others who attend and participate. The WHS brings together the leading researchers, physicians, government officials, and representatives from industry, nongovernmental organizations (NGOs), and health-care systems worldwide. The core focus is not only on the common health future of humanity, but more practically, the sustainable development goals, universal health coverage (OneHealth agenda), and policy considerations to maintain global health security.
Although global health security definitions differ, the assumed and very simple definition for this rapid report is the combination of unexpected, nonroutine, or novel health threats, risks, and security, particularly those health threats that cross national boundaries. For the sake of a common understanding among the humanitarian, development, health, and security communities, Global Health Security Alliance (GloHSA) defines Global Health Security as:
“The collective ability to mitigate health threats that have the potential to destabilize societies, states and regions. The goal of Global Health Security is to establish resilient health systems in order to promote peace and security for all.” 2
GloHSA links the many stakeholders and decision-makers into the process or prevention of threats and rapid deployment when regional and global public health crises arise. The GloHSA axiom assumes that, regardless of the international relations conceptions of governments either focusing on war, wealth, peace, and/or power doctrines (namely, realism/neo-realism vs idealism/neo-idealism), those doctrines will, in the future, face the reality principle of global health status of the territories that such government administer either directly or indirectly. Said simply, disease knows no boundaries.
THE BIRTH OF GLoHSA
So, what better venue to grow a global health security alliance than at the WHS? The seeds were planted in October 2017 during 1 workshop at the Command and Staff College of the Bundeswehr with international experts working at the nexus of global health and security. This unique council of interdisciplinary experts in global health, military medicine, and global health and security policy discussed 3 core questions:
1. What should the next generation of global health security efforts emphasize?
2. What should the role of nonhealth sectors, particularly the security sector, be in promoting global health security?
3. How should goals be defined and a global health security enterprise, with its plurality of stakeholders and actors be governed?”
As a direct result of this workshop, GloHSA delivered a first concept paper on the future of global health security 2 incorporating recommendations to address these core questions above. Future global health security efforts should focus on developing and monitoring indicators of threats and disruptions to national health systems. Moreover, ethical and legal frameworks need to be developed to support decision-making related to strengthen health systems in fragile and failed states and ungoverned spaces. Bringing together critical interdisciplinary actors to mitigate diverse impacts of health system collapse and to foster health system resilience must be a focus in promoting global health security.
GloHSA is dedicated to empower decision-makers in the complex field of Health and Security by constantly studying the various dimensions of global health security engagement across health security themes by articulating areas for investment of security resources in capacity building and resilience strengthening and by offering multi-sectoral international training. At the WHS 2017, the young GloHSA network organized a WHS session on “Health in Conflict Settings”, participated at the Munich Security Conference (MSC), Roundtable at the WHS, and chaired 2 MSC side events at the MSC in February 2018. 3 GloHSA was able to promote the described multidisciplinary approaches to key policy and decision-makers.
At the WHS 2018, GloHSA, in support with the German Institute for Defence and Strategic Studies, hosted a session on “Disease X”; a workshop where panelists considered the challenge of detection, warning, preparedness, and response for red teaming an unknown disease originated by unknown pathogens previously unknown to science. This session highlighted the complex, interdisciplinary nature of health security issues by including the input of international experts from the policy world, academics, security and private sectors. and was driven. In the Red Teaming process, the combination of clinical and veterinary medicine, health and security policy experts and economics were able to highlight novel solutions in overcoming complex challenges with an unknown disease agent; and what the global community can do to prepare, quickly respond, and combat such a disease threat. The objective of this event was to foster universal interconnection and collaboration between diverse stakeholders dedicated to solving global health security challenges through engagement, particularly by protecting and strengthening health systems as a core part of society and increasing health security.
DEFINED PURPOSE
The GloHSA mission is to bridge global health and security communities by supporting the creation of national and transnational strategies, developing multi-sectoral educational and training programs, conducting live crisis policy assessments and intelligence analysis with clear policy output, fueling the international dialogue for global health security issues and engagement, and by the coordination and relationship-building among both the global health and security communities to combat the growing dynamic global challenges. GloHSA is dedicated to helping safeguard the universal humanitarian values and international humanitarian law, and acknowledge that every sovereign nation-state has the need to protect its own population as a core principle of governance, and that a responsibility to protect (R2P) may also play a role in policy-making throughout the international community. Despite the controversial nature and charged terms, R2P is expanded to include fragile and failed states, ungoverned spaces and occupied regions.
GloHSA offers key decision-makers’ advice regarding whether an issue is related to global health security and engagement and provides confidential situational analysis to help build a process to maximize strategic outcomes. Methodologies include early warning systems analysis, alternative analysis / Red Team events, policy papers, remote and onsite health assessments, expert briefings, among many other threat specific analysis. This may be in the form of a policy paper to address a new and emerging pandemic threat, flu or pathogen, a deployed advance team to assess a health systems and infrastructure preconflict need, or and it may be a complex meta-analysis of antimicrobial resistance in a potential theater of conflict before a crisis erupts or becomes recalcitrant. In addition, other products may include rapid decision support across agencies to maximize interoperability between the humanitarian, disaster response and military operations during crisis with multi-state networks and multi-domain response preparedness.
THE POLICY–PRACTICE INTERFACE
Health security encompasses not only pandemics and infectious disease threats, but also the many aspects of health and state fragility, especially in ungoverned ecosystems. The requirement of nations to work multilaterally to maintain their own health security, in addition to supporting regional and global efforts is resource dependent. Policy Think Tanks write policy papers. GloHSA is a departure from the standard humanitarian paradigm and serves to fill the gaps in the current policy-operations sector across domains, disciplines, and intergovernmental agency. Complex emergencies and disaster practitioners react to crisis when it strikes, which is often more costly than prevention or early response; GloHSA fills this gap through a policy of prevention.
The multisectorial partnership required to maximize outcomes in the global health security space is complex, resource intensive, crisis-specific, and requires rapid decision-making and process mastery across bureaucratic-heavy institutions. This often falls short of expectations for the populations most at risk and affected, and may increase exposure of preventable disaster. This is the focused problem in global health security policy and operational space that GloHSA has focused its efforts. Institutions and individuals using the GloHSA services are governments, NGOs, private industry, and other transnational institutions in support of health security engagement and best practices.
SUMMARY
The Global Health Security Alliance (GloHSA) was created as a byproduct of the intellectual and academic promotion from the WHS. GloHSA plans to address many of the growing threats and risks to global health security. The subject matter expertise, focus on interdisciplinary methodology, and streamlined process will provide policy-makers and decision-makers interdisciplinary solutions to complex threats. GloHSA’s focus on the intersection between policy and operations provides novel approaches and targeted methodology that will maximize outcomes and streamline global health success.
Ethics Approval and Consent to Participate
No human subjects participated in this report.
Availability of Data and Material
All material and data related to GloHSA are available at the website.
Conflicts of Interest
John Quinn is active Editorial Board Member at Globalization and Health. All authors of this report are co-founders of GloHSA.
Funding
The German Institute for Defence and Strategic Studies (GIDS) supported the registration fees for the World Health Summit in Berlin in 2018 for all founding members and co-authors in this conference report. The authors have no further funding sources to disclose.
Authors’ Contribution
J.Q. Provided the main drafting of this short report; C.H. is the founder of GloHSA and contributed to the drafting process; A.O., J.W., T.M., S.J., M.B., R.S., and J.C.H. are co-founders of GloHSA, contributed to the drafting process and approve of the final submission.
Acknowledgments
GloHSA has no official affiliation with any entity of the World Health Summit. With this, the authors thank the World Health Summit for its tireless efforts in bringing experts together and promoting best global health practices for over a decade and for encouraging academic and intellectual debate across disciplines.
