"Better Health Systems Strengthen Our Common Security"

"Health, security and stability are inextricably linked. As global instability and interconnectedness increase, so does the risk of a catastrophic outbreak," warnt Wolfgang Ischinger im Jahrbuch des World Health Summit.

Wolfgang Ischinger, Vorsitzender der Münchner Sicherheitskonferenz und Professor an der Hertie School of Governance (Photo: MSC / Kuhlmann).

"What keeps you up at night?" is a popular question directed at security leaders and decision-makers. Often, their responses refer to weapons of mass destruction (WMD), the use of which could kill people on a massive scale. Answers usually have an atomic component, ranging from the risk of nuclear terrorism to a catastrophic escalation of conflict between nuclear weapons powers. Bioterrorism, especially after the 2001 anthrax scare in the United States, is also near the top of the list – although it is not certain we are actually prepared for such an attack. But, many will admit, an epidemic stemming from natural causes has long not received the attention it deserves. Yet an epidemic could also bring about mass destruction – but there would be no enemy to blame but ourselves for not being prepared.


"Freedom is indivisible, and when one man is enslaved, all are not free," US President John F. Kennedy famously said in his "Ich bin ein Berliner" speech. Paraphrasing him, one might also say: When one human is sick, all of us may be threatened. Unfortunately, it did take a major outbreak of a deadly disease, the Ebola crisis, to highlight that danger again: The health systems in place in one country can have a great impact on global health as well as on international security and stability. Without a doubt, "the unprecedented extent of the Ebola outbreak in Africa constitute[d] a threat to international peace and security," as the UN Security Council found in September 2014.


One the one hand, none of this is new. Since the plague killed almost 1 in 3 Europeans in the 14th century, states have recognized that diseases can pose a disastrous danger and have tried to take necessary precautions. And in the 20th century, in particular, there have been important health success stories, including the advent of antibiotics and the eradication of small pox.


Key global trends increase the risk of pandemics 


On the other hand, key global trends and characteristics of today's international system create a higher risk of a catastrophic global pandemic.


First, the progression of globalization, urbanization and population growth keeps decreasing the time between the outbreak of a disease and its spread. These trends are not entirely new, but they are accelerating – and make it more difficult to get a pandemic under control again. In other words, the 2002-2003 severe acute respiratory syndrome (SARS) pandemic may only be a light blueprint of how a much deadlier global spread might occur. For example, Africa's population is projected to more than double by 2050, and most of that growth will be in cities. Population density in megacities can speed up the spread of diseases – and make widespread unrest and chaos more likely in case of an outbreak.


Second, the proliferation of state failure throughout key parts of Africa and the Middle East is also accelerating, which exacerbates health security challenges in those countries. After all, preventing or responding to disease outbreaks is extremely difficult in areas with limited governance or in areas of civil strife and war.


And consider this: We all know that if Ebola had been an airborne pathogen of a similar lethality, the outbreak could have caused millions of deaths. But, under different circumstances, Ebola could have been just as catastrophic: What would have happened if, for instance, populous Nigeria had been in complete turmoil in 2014 – or did not have relatively good health infrastructure in place from the fight against polio? If Ebola had spread to the megacity of Lagos under conditions of a civil war in Nigeria, the world would be very, very different today.


Moreover, the proliferation of state failure and civil conflict in today's world has also led to the biggest refugee crisis in history, leaving many millions of migrants vulnerable and without adequate healthcare. And these state failures, by the way, also increase the risk of terrorist groups having safe spaces to flourish and possibly even plot attacks with weapons of mass destruction, including biological weapons.


Conversely, of course, health security crises feed and foster instability as well; the Western African states most afflicted by Ebola will need years and years to fully recover. In some countries, HIV/AIDS has decimated entire generations. Beyond the millions of personal tragedies, the societal, economic and political consequences of such a massive health challenge can hardly be exaggerated.


Add to this challenge antimicrobial resistance, which experts say will skyrocket in the next decades and thus make treatment of common infections and bioterrorism more difficult, and you get a worrisome picture. These are a few critical issues at the intersection of health, security and stability – and I have not even mentioned the protection of healthcare workers in conflict zones or the role of militaries in fighting outbreaks yet.


These are also some of the key reasons why I have been committed to promoting discussions between health officials, NGOs, security strategists, the private sector and decision-makers at Munich Security Conference events in order to deepen the conversation between professionals from different sectors.


To be sure, none of this is to suggest that security officials should only care about health questions if and when they have an impact on security policy in the traditional sense. It is true that health policy and security policy are two different policy areas, with sometimes competing priorities. Mixing them all together and "securitizing" health as a matter of principle is not sensible. But it would also be negligent to downplay the critical intersection of the two. A comprehensive understanding of security today must include health security.


In addition, in terms of communication, it might be useful to frame global health emergency preparedness in security terms. This could help sharpen the awareness among publics around the world that this is not just a problem of and for certain regions, and certainly not just for less developed countries, but that this problem affects everyone. It could help find the funds necessary for research and development, for disease surveillance, and for health and response systems. The launch and first operation of the European Medical Corps in the Congo, for example, has been a good step.


Moreover, it would be useful to routinely and prominently include health in security strategies, risk assessments and early warning mechanisms. Health systems are, after all, a line of defense. They help prevent both health and security crises, and thus strengthen our common security.


Speaking at a panel discussion on the intersection of health and security policy at this year's Munich Security Conference, Ghana's Minister of Foreign Affairs and Regional Integration, Hanna Serwaah Tetteh, observed: "Even though the discussion [of health security] is now more prevalent within our region and within our continent, […] I'm really wondering whether the lessons have been learned as well globally as they have within the place where we suffered the crisis."


Global health and global security may well depend on learning those lessons without further delay.



Wolfgang Ischinger ist Vorsitzender der Münchner Sicherheitskonferenz und lehrt an der Hertie School of Governance in Berlin. Dieser Essay erschien in dem vom World Health Summit veröffentlichten "Yearbook 2016," das hier abrufbar ist.

30. Januar 2017, von Wolfgang Ischinger