The concept of global health security has incorporated itself rapidly into the vernacular of public health and national security circles. From journal articles to conferences, public sector initiatives to academic programs, the linking of health and security is becoming commonplace. The Ebola epidemic in West Africa accelerated the general understanding of the interdependencies of public health, emerging infectious disease, and national security. The launch of the Global Health Security Agenda (GHSA) has cemented the commingling of the worlds of health and security in the intergovernmental arena. As the GHSA develops in earnest, it is important reflect on the role the non-governmental sector can play in the GHSA in particular and global health security more broadly.
What is the GHSA?
The Global Health Security Agenda was launched in 2014 to facilitate cooperation among international partners to develop multisectoral solutions to the threats posed by infectious disease: for “all countries to come together to prevent, detect, and respond to infectious disease threats, whether naturally occurring, accidental or deliberately spread.” The objectives of the GHSA are grouped under three principal areas (Table 1): “Prevent,” “Detect,” and “Respond.” Specific “Action Packages” (Table 2) describe activities recommended to support those objectives.
Table 1: GHSA Objectives
1. Prevent the emergence and spread of antimicrobial drug resistant organisms and emerging zoonotic diseases, and strengthen international regulatory frameworks governing food safety.
2. Promote national biosafety and biosecurity systems.
3. Reduce the number and magnitude of infectious disease outbreaks.
1. Launch, strengthen and link global networks for real-time biosurveillance.
2. Strengthen the global norm of rapid, transparent reporting and sample sharing.
3. Develop an interconnected global network of Emergency Operations Centers and multi-sectoral response to biological incidents.
4. Develop and deploy novel diagnostics and strengthen laboratory systems.
5. Train and deploy an effective biosurveillance workforce.
1. Develop an interconnected global network of Emergency Operations Centers and multi-sectoral response to biological incidents.
2. Improve global access to medical and non-medical countermeasures during health emergencies.
Table 2: GHSA Action Packages
Prevent 1: Antimicrobial Resistance
Prevent 2: Zoonotic Disease
Prevent 3: Biosafety and Biosecurity
Prevent 4: Immunization
Detect 1: National Laboratory System
Detect 2 & 3: Real-Time Surveillance
Detect 4: GHSA Reporting
Detect 5: Workforce Development
Respond 1: Emergency Operations Centers
Respond 2: Linking Public Health with Law and Multisectoral Rapid Response
Respond 3: Medical Countermeasures and Personnel Deployment Action Package
The GHSA emphasizes the importance of taking a comprehensive approach to biological threats by addressing infectious disease risks broadly and with the support of the international community, including the international NGO community. Ownership of the GHSA is intended to be global, with over 40 member-states, a Steering Committee consisting of ten countries, and rotating Steering Committee leadership. Additionally, the GHSA seeks to strengthen existing international public health and surveillance initiatives through the full implementation of the World Health Organization (WHO)International Health Regulations (IHR) and the World Organization of Animal Health’s (OIE) Performance of Veterinary Services Pathway.
What are the Challenges and Opportunities for NGOs Involved the GHSA?
There are several important challenges in understanding and defining the role of the NGO community within the GHSA. First, delineating what is and what is not “health security” can be difficult. One can argue that the phrase is intentionally vague in order to emphasize the broad and diverse interconnections between public health and national security. The flexible definition of the concept, however, has the potential to dilute its meaning: is prevention of lymphatic filariasis “health security”? What about the prevention of a chronic condition such as diabetes in order to prevent excessive health expenditures that might cripple a nation and potentially destabilize it? Establishing common definitions, goals, and yardsticks by which to measure success is vital in this space. The GHSA, which focuses on communicable disease threats, offers fairly detailed goals for each action package (Table 2). These goals can help clarify and operationalize what is meant by health security within the context of the GHSA. Through the GHSA, the international NGO sector and its local partners can begin to speak the same “language” of health security, at least as it relates to infectious disease threats.
It is the role of the NGO sector to determine which goals and activities are relevant and useful for its stakeholders. NGOs have the opportunity, particularly at these early stages of the GHSA, to offer insight into what poses a health security risk in the communities within which they operate. NGOs are uniquely positioned to inform policy-makers on what might constitute a significant health security threat, whether that be Ebola Virus Disease or the overburdening of national health systems with costs associated with more common maladies.
While the GHSA may help to advance discussions by establishing common goals and promoting common language in the realm of health security, it is clear that many regional “dialects” still exist. While the linking of “health” and “security” has many positive impacts, including the elevation of public health issues to the level of national security concerns and an increase in information and resource sharing between public health and security entities, some communities may be uneasy with the commingling of these sectors. There are a variety reasons for this unease. Which sector receives more funding in a particular state or country? Which is viewed as more trustworthy by the public? What historical events have taken place that may cause the public to become weary of one or both sectors? The word “security” itself may have negative connotations in certain languages. There is the also the potential that some communities may view “health security” as a concept being imposed upon them by foreign interests.
The NGO community can play an important role in dispelling misconceptions about the GHSA and health security in general. NGOs, both local or international, understand the communities they work in. NGOs can adapt the language and message of the GHSA to the history, culture, and needs of the region within which they operate. The NGO sector has the established relationships with local private and public sector institutions that government agencies may not have. They are therefore able to cultivate trust and implement activities that support GHSA priorities more effectively, with the buy-in of local stakeholders. The NGO sector can help to inform policy makers what language and activities are most appropriate and useful for a given setting. In this way, they can be the true drivers of the GHSA.
Another challenge faced by the NGO community in relation to the GHSA is ensuring participation of the global NGO sector. The US-based NGO sector involved in the health security space has made steps to organize itself. A Global Health Security Agenda NGO steering committee has been developed to help elucidate the role the NGO sector can play within the Agenda. This work has been supported through the efforts of the US State Department, Government of Finland, and many others. The NGO sector has also established an online communications platform, with the support of the American Association for the Advancement of Science (AAAS). These efforts culminated in a event in July of 2015 at GW University in Washington, DC, which brought the NGO community working in health security together with other private and public sector GHSA stakeholders. The Global Health Council is also establishing a Global Health Security Roundtable to promote collaboration and discussion among NGOs involved in this space.
The next step must now be to expand this working group to include NGO stakeholders based outside of the US and Europe, particularly in developing countries, in order to ensure global participation. The NGO community can utilize international conferences such as the recent World Organization for Animal Health (OIE) Global Conference on Biological Threat Reduction, to promote international involvement in the NGO steering committee and other collaboration platforms. The development of regional committees consisting of NGOs supporting GHSA-relevant activities and the active recruitment of NGOs based in low and middle income countries on virtual collaboration platforms can facilitate increased global participation and representation. Dialogue with for-profit entities, such as pharmaceutical companies, medical device manufacturers, and private foundations is also crucial.
NGOs in the GHSA: Beyond Implementation
The NGO community can play an indispensable role in the realization of the GHSA objectives. In addition to being the implementers, the NGO sector now has the rare opportunity to mold and define its own role within the GHSA. The public sector has welcomed the voice of NGO stakeholders in this process. Outside of program implementation, key roles of the NGO community involved in the GHSA moving forward include:
- Defining and Clarifying Health Security: NGOs can help policy makers to understand how the communities they work in view health security issues and help those community members to understand what the GHSA is and how it can impact their communities.
- Advocacy: NGOs can advocate for issues relevant to the communities they operate in, such as the promotion of activities in support of women and girls, within the GHSA.
- Building a Global NGO Community: NGOs can launch activities to increase the participation of NGOs, particularly those in developing countries, in discussions on policy and activities related to the GHSA
- Resource Sharing: NGOs can promote the sharing of information and resources related to the goals of the GHSA, including best practices
- Involving Non-Traditional Private Sector Actors: NGOs can conduct outreach activities to promote the involvement of private sector entities, including for-profit companies and foundations, in the GHSA