Institute of Medicine Committee on Transforming the Case for American Commitment to Global Health

Overview

Thank you for the opportunity to provide opening remarks today on an issue that is very important to the Department of State and to the Bureau of International Security and Nonproliferation. ISN is happy to serve as a co-sponsor of the study being undertaken by the Institute of Medicine as a sequel to the 1997 study on “America’s Vital Interest in Global Health,” alongside other State Department bureaus, health and security agencies, and private foundations and companies.

In my remarks I will touch briefly on the ISN Bureau’s particular reasons for being interested in the study, outline how our activities are related to global health, and indicate priority areas for the Committee’s consideration. I want to make clear at the very outset that I believe it is in the U.S. interest for countries to develop the capacity to deal with their health problems, including infectious diseases, above and beyond those that pose direct threats to the U.S.

In contrast to many of the other speakers today, I come from the security community, not the public health sector. But it is increasingly apparent to us that global health and global security, including economic and political stability, are interrelated and have a significant influence on each other. In order to maximize success in global health and security, we need to carefully plan and work to ensure the most efficient and effective employment of U.S. resources.

Global Security and Global Health

Clearly, new and re-emerging infectious diseases pose a rising global health threat that can influence the stability, economic, and humanitarian conditions within a country, across a region, or even globally. The outbreaks of Severe Acute Respiratory Syndrome (SARS) and the threat of pandemic influenza make clear that global security is intertwined with global health. The toll HIV/AIDS is taking on many military and UN peacekeeping forces is another example. HIV-related deaths have reduced the size of Malawi's armed forces by 40%. From a security standpoint, such developments alone are sufficient reason to be interested in improving public health globally.

The rapid advances in biotechnology, and in the life sciences more generally, while critical to protecting against the infectious disease threat, also have important implications for security in other ways. This new knowledge, and the rapid dissemination of materials, expertise and equipment around the globe, create new risks of potential misuse, as studies by the National Research Council have pointed out. In the past, our concern about biological weapons focused on the threat from nation states; now we must, in addition, be concerned about potential bioterrorists. Such a threat can come from international or domestic sources.

The Persian Gulf War heightened awareness of chemical and biological agents to military deployment. The 1995 release of nerve gas in the Tokyo subway system, the discovery that the Aum Shinrikyo cult in Japan had tried to use biological agents, and the anthrax attacks following 9/11, all transformed this risk from abstraction to reality.

We recognize that, in comparison with naturally occurring disease outbreaks, the likelihood of a bioterrorism attack is low. But any mass casualties resulting from the spread of infectious diseases, whether naturally occurring or deliberately released, could have a very high impact not only on health, but also on economic and political stability. And the psychological impact of a deliberate bioterror event, even if not successful in creating mass casualties, could be equally devastating.

ISN Programs

In pursuing their assigned missions, U.S. Government departments and agencies carry out a great variety of activities abroad that are related directly or indirectly to preventing epidemics of infectious disease and responding to outbreaks that do occur. While many are implemented purely for public health purposes, some programs also have been initiated to meet defense, biodefense, or non-proliferation goals.

To deal with the biological weapons threat, the security community has used tools such as negotiated limitations, export controls, dismantling BW infrastructure, and redirecting former bioweapons scientists into peaceful civilian activities. We have also invested heavily in medical protective measures, such as vaccines. More recently, there has been increased interest in Congress and within the Administration in preventing terrorists from acquiring dangerous pathogens, which has led to efforts to strengthen laboratory security.

The ISN Bureau’s biological threat-reduction activities are designed to strengthen international security through collaborative and sustainable assistance on prevention and protection, collaborative engagement with biological scientists in the former Soviet Union and elsewhere, and through the implementation of the requirements of the Biological Weapons Convention. Most recently, ISN has established its Biosecurity Engagement Program to develop cooperative international activities that promote the safe, secure, and responsible use of biological materials that pose significant risk from accidental release or intentional misuse.

To ensure effective implementation of its programs, the ISN Bureau relies upon diverse expertise in the security, health, and science communities. We collaborate with and fund experts from many different U.S. Government departments and agencies, international health organizations, universities, companies, and non-governmental organizations.

Issues for Consideration

There has come a growing realization in the security community that strengthening the public health capacity of a country’s institutions to deal with naturally occurring infectious disease also strengthens the ability to deal with disease outbreaks caused by accidental releases of pathogens or a bioterrorist attack. For example, the capacity needed to identify and respond rapidly and effectively to naturally occurring disease outbreaks is very nearly the same as the capacity required to respond to a deliberately caused epidemic. The development and widespread use of more effective vaccines is another example.

One issue that it would be useful for the study committee to examine would be the linkages between strengthening public health and medical capacity for addressing naturally occurring outbreaks and analogous efforts to protect against deliberately introduced disease.

As is often the case in government, many activities and programs related to protection against infectious disease are underway through numerous agencies and departments. Broadly speaking, all have a common goal of protecting public health. The programs underway involve many distinct sectors within the government and outside it – communities that have quite different cultures – for example, the public health, science and security communities. These communities have traditionally worked in relative isolation from one another.

In today’s world, I believe that the many different communities need to learn to work more closely together to promote and improve global health and security. Each contributes to overlapping goals. Engendering a more cooperative approach, however, will not be easy. Each has concerns that must be addressed.

In this connection, another issue that would be useful for the study committee to examine would be how the many different communities currently interact and how their efforts could be better coordinated and integrated into more efficient and collaborative efforts.

Finally, there is the question of resources and authorities. It would be useful for the study committee to examine roles and responsibilities, and how U.S. funding can best be applied when security and public health goals clearly overlap. Recommendations in this regard that would help ensure the most effective U.S. approach to promoting global health are welcome as we continue to explore this nexus.

The ISN Bureau at the Department of State looks forward to the IOM report and its recommendations. This report will provide further insights into areas where the health, science, and security communities can more effectively work together towards a common goal to create safe, secure, and effective capacity which can enhance the health and prosperity of the global community.