The Intersection of National Security and Public Health
National security and public health have for decades been in a discordant relationship. Not long ago, efforts to link national security and public health would have perhaps resulted in disapproval and/or condescending sympathy from experts in both fields. The functional disconnection between the two is grounded on the inherent culture and interest/priority of the two. While public health conventionally focused on the efforts of the society in assuring best conditions to keep people healthy, national security primarily focused on the evaluation and investigation of external threats to the nation’s survival, interests, and security (Price-Smith, 2001). Arguments attempting to link national security and public health, have however intensified in the last three decades and climaxed in 2020 in the advent of the novel COVID-19 pandemic.
The link between security and disease took a back seat compared to politics, ideological conflicts, and wars of the twentieth century. Public health issues, particularly related to infectious diseases, have in the past dominated diplomatic activity amongst nations as early as the mid-nineteenth century (Fidler, 2003). Thus, the control and prevention of infectious diseases have existed as a foreign policy problem for nations for decades (Bernard, 2013; Fidler, 2003). Nevertheless, public health considered as a foreign policy concern is not equitable to public health amounting to a problem of national security. For most countries, national security has been one of the most crucial foreign policy concern.
Studies related to national security paid little or no focus on public health, likewise, the public health field has in the past had little interest in analyzing any domain link to debates on national security. Surpassing major USA’s national security disasters like the 9/11 and Pearl Habor attacks, the COVID-19 pandemic induced the near or total collapse of multiple sectors and the global economy and impacted national interests in the multilateral, globalized, and interdependent world. Therefore, there is a need to assess how recent events, particularly the COVID-19 pandemic, informs us of the intersection between national security and public health. This paper seeks to identify how best associations between national security including major players such as clandestine agencies (like the CIA), public health efforts, and other stakeholders’ collaborative initiatives could be leveraged to fight similar disasters in the future.
The Emergence of Public health – National Security Relationship
Though the imminent threat posed by biological weapons have indicated a link between public health and national security since the 1925 ban on the use of biological weapons, the mutual neglect between the two sectors had devoted little attention to the existence of such links until the 90s. During the Cold War, national security had mainly focused on all resources and efforts on the U.S and Soviet conventional and nuclear weaponry. However, in the 60s, America unilaterally declared a renunciation on the use of bioweapons. This move led to the scrutiny of biological weapons within the scope of national security. From the perspective of global health, concerns regarding the Soviet’s bioweapons triggered substantial global and public health preparedness initiatives after World War II (Elbe, 2010). However, these efforts significantly faded from the agendas of public health until the 90s when the influence of public health in policymaking related to biological weapons became visible.
In the late 90s, governmental, academic, NGOs, and intergovernmental studies, policies, and statements began to identify and recognize intersections between security and health. The emergence of links between national security and health in the 90s emanated from multiple factors, including the catastrophic levels of the HIV/AIDS pandemic within developing nations; the heightened interest and worries on biological weapons by nations; the escalated worries pertained to the occurrence of bio-terrorism attacks; and the acknowledgement of global issues related to novel and re-emerging infectious diseases (Bernard, 2013; Fidler, 2003). A significant factor was the catastrophic scale of the HIV/AIDS pandemic within developing nations. The most renowned intersection arguments between the two fields arose during the President Clinton’s administration which stated that re-emerging and new infectious diseases, particularly HIV/AIDS represented challenges to the American foreign policy as well as a threat to national security (Bernard, 2013; Elbe, 2010; Fidler, 2003).
The connection between national security and health was materialized through a report by the CIA’s National Intelligence Council in 2000 known as “The global infectious disease threat and its implications for the United States” (Fidler, 2003, p. 793). The report recognized infectious diseases as threats to national security. Debates from a superpower claiming infectious diseases are a threat to national security escalated the status of infectious diseases within the country and across the globe (Fidler, 2003). The new development was unprecedented within debates of national security. A second unmatched event also happened in January 2000 when the UN security council discussed for the first time the security challenges caused by a microbial enemy, namely HIV/AIDS (Feldbaum, et al., 2006). The UN had previously fought HIV/AIDS through the initiatives of the WHO’s 1986 Global AIDS Program and UNAIDS (established in 1996). The prioritization of the HIV/AIDS crisis as a matter of concern for global security and peace at the UN’s Security Council level was notably a new intergovernmental approach to infectious disease issues (Feldbaum, et al., 2006; Elbe, 2010). WHO also began bolstering its focus on infectious diseases as a ‘global health security’ issue, which appropriated the notion of security to enhance global efforts aimed at controlling infectious diseases (Feldbaum, et al., 2006).
Additionally, calls for the USA among other developed nations to perceive infectious diseases as threats to national security also emanated from academics, NGOs, and journalists. Moreover, the 2001 anthrax attacks in the US greatly transformed the nature of the debates pertained to the intersection between national security and health in ways that are felt to date. Debates on the dangers presented by bioweapons to the USA as well as the global security had been existent prior to the anthrax attacks, but the majority in global health and national security communities failed to believe that terrorists were capable of utilizing bioweapons. This belief changed barely a month after the 9/11 terrorist attacks when bioterrorism became clear to the US and the world through the anthrax terrorists’ attacks.
In the last few decades, the growth of academic literature and policies scrutinizing the connection between national security and health has generated the concept of ‘public health security’ within the national security and health communities (Feldbaum, et al., 2006; Elbe, 2010). Public health pertains to policy areas within which health and security policies and/or issues intersect/overlap as depicted in Figure 1.
Figure 1: The concept of public health security. Source: Fidler, (2003).
Infectious Diseases of the Contemporary World
The past is replete with accounts of epidemic infections that seem to adhere to a cyclic pattern as they induce immunity within survivors and have to wait for new non-immune host generations to infect. On the other hand, the microbes spreading the infections migrate to different locations within a nation and globally infecting immunologically susceptible people, resulting in an international outbreak or pandemic. Influenza, plague, and smallpox among other diseases decimated global populations until the beginning of the 20th century. Most developed nations then assumed that technological advancement had eradicated the spread of infectious diseases, with second-generation diseases/illnesses of affluence, inclusive of cancer, cardiovascular diseases, and diabetes replacing infectious diseases (Peterson, 2017). However, infectious diseases have prevailed as increasing threats with their third wave marked by the emergence of HIV/AIDS alongside re-emerging diseases such as Tuberculosis, Cholera, Plague, and influenzas.
The results of outbreaks have always been devastating with significant global impacts. In the past nearly 60 million people were killed by infectious influenzas, including the 1889 to 1890 Russian Flu, the 1918 to 1919 Spanish Flu (which solely killed approximately 50M people globally), the 1957 to 1958 Asian Flu, the 1968 to 1970 Hong Kong Flu, and the 2009 to 2010 Swine Flu (Elbe, 2010; Oshewolo & Nwozor, 2020). On the other hand, according to the UNAIDS global HIV/AIDS 2020 fact sheet, over 75.7M individuals have been infected with HIV since 1981, when the disease emerged, while over 32.7M have died from AIDS-related diseases since then by the end of 2019 (UNAIDS, 2020).
Such pandemics are not restricted to the 19th, 20th, and 21st century. Biblical accounts including plagues claimed the lives of many during such times. The Bible even provides instructions of medically sound quarantine guidelines that have been utilized for years. Such directions include avoiding contact with sick animals, people, or sick people’s items capable of transmitting pathogens (Leviticus 13: 47-59). To avoid the spread of disease-causing pathogens, the Bible recommended burning or washing contaminated items, quarantining or demolishing houses with fungal or mold growth, and plastering cracks that harbored disease-bearing insects. (Leviticus 14:33-48).
Other major outbreaks in the recent past included the dreaded Severe Acute Respiratory Syndrome (SARS) that killed over 700 individuals in over 24 nations and infected about 8,100 individuals. The 2014 to 2016 Western-Africa Ebola epidemic spread to over 10 nations killing approximately 10,000 individuals (Elbe, 2010; Oshewolo & Nwozor, 2020). SARS and Ebola greatly disrupted global trade and travel increasing the world’s awareness of the need for collaborative efforts to prevent the emergence of such diseases or define strategic plans that would prove effective in the event of such pandemics and outbreaks in the future. However, none of these seems to have prepared the world for the aftermath of the novel COVID-19 pandemic than began in Wuhan, China in November 2019, with about 190 nations reporting infection cases. Over 68M cases of infection with COVID-19 and over 1.57M deaths have been confirmed to date per the statistics by WHO international and the John Hopkins University’s Coronavirus Resource Centre (John Hopkins University, 2020).
The impacts of the COVID-19 which has so far resulted in disruption and/or destabilization of social norms, economic impairment, and political agitation across the globe qualify as national and global security issues. Possibly one of the most detrimental national security dimensions of any pandemic would be destabilizing the capacity of the military. A perfect reminder of the devastating impacts of pandemics on national security is the case of the aircraft carrier – USS Theodore Roosevelt that had to halt operations and seek emergency intervention after over 100 crew members were attacked by the coronavirus while patrolling in the pacific. Similarly, the novel coronavirus has also disrupted security and military operations for other nations. Though the emergence of a pandemic has always been possible creating a necessity for pandemic preparedness, the reality has been long neglected by policymakers including governments, intergovernmental organizations, and other stakeholders as intervention measures have been mainly reactionary.
The Role of National Security Players in Public Health
The Department of Defense’s (DOD’s) functions and the military’s operations and preparedness could be crippled if a huge number of its personnel are absent or become sick due to a pandemic. Acknowledging such a possibility, the DOD created plans and guidelines that would assist in supporting civil authorities particularly the Homeland Security (DHS) and the Department of Health and Human Services (DHHS) during a pandemic or domestic outbreak (Kirschbaum, 2017). For instance, the DOD’s Global Campaign Plan for Pandemic Influenza and Infectious Diseases 3551-13 guides the department as well as the military in preparing and planning for disease outbreaks or pandemics (Kirschbaum, 2017). Moreover, the Department of Defense’s Strategy for Homeland Defense and Support to Civil Authorities details the responsibility of the DOD in supporting federal agencies in also preparing, detecting, and responding to non-pandemic viruses such as the Zika virus (Kirschbaum, 2017).
Additionally, other initiatives by the DOD, including the Guidance for the Employment of the Force guides and leads the preparation of the U.S Pacific Command and the U.S. Northern Command to avail civil defense support (Kirschbaum, 2017). The DOD’s Global Campaign plan named the U.S. Northern Command as the worldwide synchronizer for infectious disease and influenza pandemic strategies. The US Northern Command is thus accountable for availing support during the DOD’s strategic planning initiatives in preparation for and responding to pandemics and infectious diseases (Kirschbaum, 2017). Such support leads military services and geographic and/or regional commands in defining infectious and influenza diseases and pandemic strategies and assists with synchronizing and coordinating the established strategies in compliance with the Global Campaign Plan, especially in aspects of disease monitoring, bio-surveillance and promoting best practice.
The US Northern Command’s responses to influenzas and pandemics, including during the COVID-19 pandemic, is guided by the USNORTHCOM CONPLAN 3591-09 in determining the forces and capabilities required to sustain homeland defense while limiting/reducing the long-term adverse impacts of pandemics on the nation’s safety, security, and health. The plan stipulates how the USNORTHCOM ought to respond during pandemics by defining capabilities, including PPEs (personal protective equipment) alongside medical measures to avert human-human transmissions (Kirschbaum, 2017). This role has been much evident during the current COVID-19 pandemic. The USNORTHCOM CONPLAN 3591-09 also calls for harmonizing and coordinating planning efforts within the DOD with other bodies, including economic, intelligence, diplomatic, and military as significant contributors of national power in supporting the federal government’s goals and plans contained in the National Strategy for Pandemic Influenza.
Another aspect of the connection between health and national security entails the role played by intelligence/information gathering elements in the FBI as well as the State, War, and Navy Departments. Multiple intelligence sources are utilized in detecting; monitoring threats, events, and developments that could endanger the state’s existence; and preventing ‘surprise’ pandemics and spread of infectious diseases (Birnbaum & Hopmeier, 2013). Such include reports and information collated and compiled by intelligence agencies including clandestine organizations such as the (CIA), global health groups, and ally countries. Commonly used intelligence tools for such purpose include the Open-Source Intelligence (OSINT) and Signal Intelligence (SIGINT) (Bernard, et al., 2018). The DOD defines OSINT as intelligence gathered from publicly available data/information. OSINT tools executed for health surveillance have assisted in automating the collection of data, facilitating the analysis of large data amounts through algorithms to prepare accurate reports (Bernard, et al., 2018). SIGINT is more sensitive in nature as it entails gathering communication data by intercepting emails, surveying location and Internet metadata, and telephone calls. It is hence, mainly utilized by law enforcement and national intelligence agencies targeting specific persons or analyzing big sets of data. On the other hand, the Digital Disease Detection (DDD) is one of the most extensively used intelligence sources in epidemiology. It has proved essential in studying the periods before a pandemic/outbreak, evaluating public viewpoints about their perceived impacts of a pandemic/outbreak, and in deciding the proportionality of health service or government’s response.
The way Forward
As evidenced by the past experiences, particularly by the current COVID-19 pandemic control efforts, effective mitigation, prevention, and protection policies and initiatives are not only limited to the government and the health sector as depicted in Figure 2. Rather, cooperation among the public; research and academic institutions (such as the John Hopkins University); the private sector; government officials (global, regional, local, and state); intergovernmental organizations; and different agencies are required to fulfill public health and national security responsibilities. Moreover, the ability of intelligence agencies, public health, and national security to share information and plan suitably should be leveraged. Moreover, shared technological advancements in intersectoral communication, science, surveillance, and leadership are key drivers for progress in the fight against the current COVID-19 pandemic and future outbreaks.
Building the resilience required to face and eradicate the COVID-19 pandemic and similar threats to national security and public health is challenging, yet easily undervalued. As illustrated by the Biblical parable of the house on the rock and the house built on sand, weak foundations are always exposed during storms and most nations that have been heavily and adversely impacted by the COVID-19 pandemic can relate (Mathew 7: 24-27).