Global Health Is National Security

by Joia Mukherjee

September 30, 2020


The COVID-19 pandemic has demonstrated that the national security of the U.S. depends on the country reckoning with its outdated health-care architecture. The pervasive damage to the global system of commerce, profit, and labor wrought by the coronavirus has proven that we are, indeed, an interdependent world.

The U.S. stands out as exceptionally ill-prepared for this threat. For too long, many have believed that outsized military might would guarantee U.S. national security. But COVID-19 demonstrates that national security — the security of everyday men, women, and children, of small business, of schools, of the food supply, of livelihoods – relies on health. And health in the U.S. is inextricably linked to the health of everyone around the world.

The risks Americans face on account of pandemics, fires, floods, and migration are all accelerated by climate change. Enjoying security in this century requires reimagining it, and taking bold action to secure a healthy planet and a healthy global population. No wall can protect against these threats. Most importantly, these 21st century threats simply do not have military solutions. If they did, the U.S.’ world-leading defense spending — more than the next 10 highest countries combined — would have prevented its world-leading COVID-19 death toll. For the U.S. to promote security at this important moment in history, it must move from investing in war to investing in health, at home and abroad.

As an infectious-disease doctor, I have seen first-hand the decades-long, successful U.S. leadership in efforts to improve global health. From pandemics like HIV to more focal crises like the West African Ebola epidemic, U.S. investments in global health have enjoyed uniquely bipartisan support.

Three key elements made global health bipartisan. First, whether Democrat or Republican, leaders and their constituents have been motivated by compassion for the sick. Second, both parties understood that a healthier world is more prosperous and peaceful for everyone. Third, all understood that in this era of globalization, uncontrolled disease outbreaks elsewhere threaten health at home.

Partners in Health (PIH), where I serve as chief medical officer, was on the front lines of responding to the 2014 West African Ebola outbreak. We saw how the Obama Administration’s rapid and generous response helped contain the disease and prevent transmission to the United States. We fought AIDS both before and after George W. Bush launched his President’s Emergency Plan for AIDS Relief (PEPFAR), so we know the human stories behind the more than 22 million lives saved by the initiative. We gratefully collaborate worldwide with the World Health Organization (WHO), whose largest funder has been the United States, from its founding in New York in 1946 through the present (thankfully the Trump administration’s July notice that it would withdraw from the WHO requires a year to take effect). These efforts made by both Republican and Democratic presidents with bipartisan congressional support and budgetary authorization not only saved lives but were critical elements of U.S. diplomacy.

Abdicating Global Health Security

Sadly, at the very moment that such global and domestic leadership in health is needed, the Trump administration has abdicated this tradition. Instead of supporting the bipartisan consensus for global health efforts, President Donald Trump and other Republican leaders have politicized science and even common sense. The abandonment of reason has weakened institutions like the Centers for Disease Control and Prevention and the World Health Organization that have advanced global health — and U.S. health — for decades.

These political tactics have facilitated COVID-19’s advance in the U.S. and worldwide. They are directly responsible for the loss of more than 200,000 American lives – 60 times more than U.S. lives lost in the 9/11 attacks, and more than were killed in battle during the U.S. wars in Afghanistan, Iraq, Vietnam, Korea, and World War I, combined. The economic fallout, also unprecedented, will force the United States to put money towards recovery that could have been invested in health care and pandemic prevention.

The lack of U.S. leadership on COVID-19 and the failed strategy at home mean the United States is nowhere near the end of this crisis. However, that means there is still an opportunity to change course, to change the trajectory of the pandemic in the United States and to collaborate to fight this pandemic around the world.

Past investments in global health are already benefitting the U.S. coronavirus response. Partners in Health is using what we learned fighting epidemics overseas to support successful government contact-tracing efforts in Massachusetts and other U.S. cities and states. Tools developed for diseases like tuberculosis are now being used to fight COVID-19. And collaborative international efforts in vaccine development multiply the chances that we will succeed in finding a vaccine sooner.

But U.S. investments in domestic and global health must be commensurate with the scale of this pandemic. Billions of dollars are needed now to save countless lives and to right the sinking global and domestic economy. And these billions of dollars should go to the proven strategies of fighting pandemics—prevention, testing, care, and treatment.

Record Defense-Budget Increase Dwarfs U.S. Global Health Spending

But instead of investing in the domestic and global health strategies that have proven effective against pandemics as deaths surged in July, the president proposed — and a bipartisan majority in both the House and Senate approved — a record $740 billion defense budget. The budget increase for this year alone — $18 billion — dwarfs the U.S. government’s entire annual global health spending — about $12 billion.

But even Congress’ massive mis-investment of resources in the wrong solutions was not enough for the Defense Department. The Washington Post reported on Sept. 22 that the Pentagon diverted hundreds of millions from money that Congress had appropriated for medical supplies to combat COVID-19 to defense contractors making body armor, jet engines, and army dress uniforms.

Six months after the president signed the CARES Act, Congress has yet to approve a second fiscal response to the pandemic, explain how it will prevent defense officials from making dress uniforms with COVID-19 prevention money, or fight the lack of accountability that a 2018 audit blamed for billions in improper payments. In the meantime, hospitals lack basic supplies like masks, and the failure of the national response kills hundreds of Americans every single day.

Vice President Joe Biden has promised to renew American leadership to mobilize transnational cooperation on global threats. This is a good start, but he should commit to detailed plans to enhance U.S. security by supporting the ability of poor countries to contain pandemics. He should endorse the People’s Pandemic Prevention Plan, a proposal developed by major progressive organizations and experts to develop diagnostics, treatments, and vaccines that would be available for all. Biden must fully fund PEPFAR and the Global Fund to Fight AIDS, TB and malaria, and re–join and fully support the WHO. Biden should explain how he will pay for this work, and promise to fund global health with savings from defense spending if necessary.

Rebalancing U.S. spending to increase support for global health is not just the right and practical thing to do; it is also good politics. Voters understand that the main security threats to the U.S. are largely non-military. They support a 10 percent cut in defense spending, and prefer the money go to health care and to coronavirus response.

If a Biden administration is to stop the ravages of COVID-19 and fulfill the promise of a return to effective U.S. leadership, both the administration and Congress would be wise to heed experts and voters rather than defense industry lobbyists, and to direct more taxpayer resources to countering the security threats that those taxpayers actually face.
IMAGE: A healthcare worker talks to a patient in the ER at Oakbend Medical Center in Richmond, Texas, on July 15, 2020. (Photo by MARK FELIX/AFP /AFP via Getty Images)