During the COVID-19 pandemic, the traditional global health emergency effort of prevention, detection, and response – collectively known as ‘global health security’ (GHS) – swung into action. Some actions were “successes”, such as the accelerated development of vaccines and therapies. Others were met with a wide-range of critiques from unequitable distribution of vaccines to inaccurate diagnostics and policies that prioritised national protectionism over community health.
Now, GHS is in a period of recalibration, with resources aligned to leverage the innovations that came out of the recent pandemic to inform a more resilient response to the next emerging threats.
For instance, Ministries of Health worldwide have endorsed a global effort called the Global Health Security Agenda, which is now extended to 2028. The World Bank has launched the Pandemic Fund, and global architecture reforms are underway through revisions to the International Health Regulations and negotiations for a pandemic treaty. Governments around the world are intensifying efforts to prioritise One Health, which connects human, animal, and environmental health domains. USAID is expanding its focus on key countries identified in the Global Health Security Agenda, while the UK’s FCDO is prioritising global health security in its Global Development Delivery Framework.
“These developments hold great promise but will only be successful if a delicate balance can be achieved to break the historic cycles of crisis and complacency that have plagued global health security,” says Palladium Head of Global Health Security, Clint Cavanaugh. On one end, prioritisation of pandemic-specific activities and structures may be too narrow – too specific to one disease or issue and isolated from broader systems – to achieve sustainable gains. On the other end, driving global health security through broad systems strengthening and universal health coverage may be too diffuse – not specific enough to result in measurable gains and suffering from the reality that, when everything is a priority, nothing is a priority.
“Our experts leading our health security efforts see a new approach that best addresses the comprehensive set of issues, which we're calling ‘Integrated Health Security’,” Cavanaugh announces. “This is a unique approach to rise to this challenge and strike the fine balance required to move beyond traditional GHS and look towards a new paradigm of pandemic preparedness, prevention, detection, response, and recovery.”
The Scope of Integrated Health Security
Integrated Health Security (IHS) is the next step in the evolution of global health security. It’s informed by the current landscape, including the reality of competing demands (from the ongoing response to HIV to the COVID-19 pandemic), along with emerging and overlapping initiatives aimed at systems strengthening (from health workforce strengthening to the renewed focus on primary health care).
“It’s not enough to look just at health outcomes in a pandemic; we need to integrate other issues, including economic harms and livelihoods.”
“To understand modern health security opportunities, shortcomings, and controversies, it’s helpful to note that international collaboration evolved over centuries,” explains Cavanaugh. “The driving forces were about preserving trade routes and the interests of powerful nations – not the public health issues facing populations outside their borders.”
This trajectory eventually led to the International Sanitary Regulations endorsed by the World Health Organization in 1951, which were re-named the International Health Regulations (IHR) in 1969. Even through a revision in 2005, the benefits and risks continue to be imbalanced between more and less powerful countries.
The IHR, if adopted in full, would certainly benefit communities in any nation. “But in practice, the funded elements are often focused on preventing cross-border spread, with limited benefit to local communities,” notes Cavanaugh. “As we saw in COVID-19, countries with strong detection and reporting functions were punished with sanctions in a generally futile attempt to protect high income countries.”
Palladium’s Integrated Health Security builds on this background to create a new approach.
Integrated Health Security
IHS encompasses One Health principles and emphasises that important outcomes cannot be measured through health indicators alone; economic, agricultural, and other elements of community well-being and resilience must be incorporated.
So, what does integration mean for health security? According to Cavanaugh, it’s a departure from vertical, isolated attention to issues that only come up when a pandemic threatens – issues that are traditionally seen as the business of national governments and global donors.
Integration for health security means aligning efforts all the way down to the local level; it means true engagement of sectors beyond health and government alone, with the private sector making meaningful contributions in the One Health context; and it means using an integrated approach to outcomes.
“It’s not enough to look just at health outcomes in a pandemic; we need to integrate other issues, including economic harms and livelihoods,” Cavanaugh says. “IHS aligns the approach to health security with foundational elements of how health development is best conducted, including localisation and gender equity. IHS facilitates a better understanding and coordinated implementation with related initiatives, including partnerships to accelerate primary health care, immunisation across the life span, and the One Health Joint Plan of Action.
“At this critical juncture, there is reason to hope for a new trajectory in health security,” Cavanaugh concludes. The IHS paradigm can help support an improved health security architecture and fidelity in implementation aligned to the nuanced needs of different country contexts.
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