The pandemic proves “health security” should no longer drive global health policy. Article by Celia Almeida, Senior Researcher and Professor at the Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil. Published at Think Global Health, an Council on Foreign Relations intitiative.

The concept of “health security”: has long been prominent and controversial in global efforts to protect health. Paradoxically, the COVID-19 pandemic has provided evidence of this concept’s failure and reignited interest in it for the post-pandemic world. The past shortcomings and present interest highlight the continued failure to address political and economic structural problems that generate inequities and produce neither health nor security for most of the world’s population. Thinking beyond the pandemic, policymakers should reject health security and center policy on promoting human solidarity and protecting the human right to life.

Policymakers should reject health security and center policy on promoting human solidarity and protecting the human right to life

A Brief History of Health Security

As a concept, health security arose after the Cold War. Many factors contributed to this development, but the public health community played a prominent role in the process by intending to mobilize political attention and economic resources for global health. In a new confluence of ideas, foreign policy and security communities began to “securitize”  transnational health events, such as pandemics. The security framing provided a way to understand complex challenges, produced a narrative about how to address them, and set priorities for national and international action. However, the focus on security broke with strategies prominent during the 1970s that had emphasized universal access to primary health care based on the right to health, such as the Global Strategy for Health for All by the Year 2000.

In the 1990s, Western-dominated multilateralism facilitated an upsurge in the global health involvement of international economic and financial institutions, which challenged the traditional primacy of the World Health Organization (WHO) and supported the “securitization” of strategies to address health threats. The foreign policy and national security interests of high-income states, especially the United States, helped stimulate significant growth in voluntary contributions to the WHO’s budget and a proliferation of public-private partnerships on global health issues. These developments eroded the WHO’s leadership role and gave high-income countries more control over resources supposedly allocated for advancing global health, as well as more influence over the resulting initiatives.

In addition, the growing financial, political, and ideological presence of the World Bank and International Monetary Fund affected the health sector through, among other things, structural adjustment and austerity programs. These imposed conditions on social spending, which particularly constrained publicly financed health systems. Creation of the World Trade Organization (WTO) in 1995 increased the power of multinational corporations based in high-income countries by opening markets and protecting intellectual property rights. In these ways, powerful countries and companies harnessed health security to their own interests. 

Health security also influenced policymakers’ justifications for increased political and financial commitments on epidemic and pandemic diseases. For example, the approach to HIV/AIDS transitioned from the human rights strategy of the 1980s to treating the pandemic as a security threat in the 1990s. This change sparked a controversy over equitable access to antiretroviral drugs, largely resolved by foreign aid and special programs from high-income countries—such as the U.S. President’s Emergency Plan for AIDS Relief—which increased access without compromising intellectual property rights. 

In addition, the growing financial, political, and ideological presence of the World Bank and International Monetary Fund affected the health sector through, among other things, structural adjustment and austerity programs. These imposed conditions on social spending, which particularly constrained publicly financed health systems. Creation of the World Trade Organization (WTO) in 1995 increased the power of multinational corporations based in high-income countries by opening markets and protecting intellectual property rights. In these ways, powerful countries and companies harnessed health security to their own interests. 

Health security also influenced policymakers’ justifications for increased political and financial commitments on epidemic and pandemic diseases. For example, the approach to HIV/AIDS transitioned from the human rights strategy of the 1980s to treating the pandemic as a security threat in the 1990s. This change sparked a controversy over equitable access to antiretroviral drugs, largely resolved by foreign aid and special programs from high-income countries—such as the U.S. President’s Emergency Plan for AIDS Relief—which increased access without compromising intellectual property rights.