There's a Global Shift Towards Health Securitisation: What's the Way Forward?

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On 1 August 2023, the US State Department announced the launch of a new bureau to help strengthen the global health security architecture.

Headed by a leading virologist, Dr John Nkengasong – with over 30 years of experience in public health, the Bureau of Global Health Security and Diplomacy would be directly under US Secretary of State Antony Blinken, indicating new found importance towards health security.

Are other states also similarly approaching health security?

And how will this securitisation impact regional groupings like the Quad?

Global trust was at an all-time low when COVID-19 hit the world. However, it also highlighted the importance of global health diplomacy. It paved the way for vaccine diplomacy wherein states that were lagging or unable to vaccinate their populations were given a chance to do so.

Vaccines were provided by many countries, including India, to those most in need due to inequity in access to vaccines.

In what was seen as an unprecedented diplomatic victory, the COVID-19 vaccine was almost declared a 'Global Public Good' when World Trade Organisation (WTO) members agreed to partially waive intellectual property protections with a narrow exception to an export restriction on COVID-19 vaccines for five years.

But good intentions, if not formalised, are unable to last.

While countries were prepared to push their populace to get vaccines, multiple roadblocks made the process more challenging such as supply chain disruptions of essential medical countermeasures, including vaccines, therapeutics, diagnostics as personal protective equipment (PPE) kits, and active pharmaceutical ingredients (APIs).

Quadrilateral Security Dialogue 

Changing geo-political considerations and rising mistrust forced countries to engage in health securitisation to protect their people.

The one grouping where this shift from diplomacy to securitization has been evident is the Quad or the Quadrilateral Security Dialogue.

In their search to ensure a resilient and secure Indo-Pacific region, the Quad members began engaging in health diplomacy early on.

The Quad Vaccine Partnership, announced in March 2021, was yet another multilateral effort to help address the problem of vaccine inequity that became stark due to the aftereffects of  COVID-19.

In 2021 and 2022, Quad partners helped meet the region’s most pressing need and helped provide over 400 million safe and effective COVID-19 vaccine doses to Indo-Pacific countries and almost 800 million doses globally, bilaterally and in partnership with COVAX.

The 2023 Quad Leaders’ Summit announced a move from Quad Vaccine Partnership into a more comprehensive Quad Health Security Partnership, with committed funding to support field epidemiology, outbreak responder training, boost disease surveillance, improve data systems, and strengthen public health laboratories.

These go beyond the Quad agenda of a strategic alliance that already includes climate change, maritime domain awareness, humanitarian assistance and disaster relief, cybersecurity, space, and infrastructure.

Hence, today the Quad aims to strengthen their partnership to better coordinate and collaborate on health security in the Indo-Pacific.

The World and Health Security Partnership: Engagement of State Actors 

Most recently, South Africa’s initiative to strengthen cooperation in the field of Integrated Early Warning systems and Russia’s initiative for BRICS Collaboration in Nuclear Medicine, which comes at the behest of India’s commitment to the BRICS TB Research Network Initiative, are signs of movement from health cooperation towards the need for health securitization.

The Group of Twenty (G20), a premier forum for international economic cooperation, has also recognised the importance of health and its impact on economies with G20 leaders underscoring the need for deeper collaboration and cooperation on aspects related to health with each passing year

Securitisation of Global Health 

Securitisation of global health may have begun with the pandemic, but a clear demarcation of what comes under the purview of existential health threats still needs to be made more evident.

This development comes at the behest of a new turn of events in public health, whose purview also includes social and cultural factors.

Instability and insecurity from destabilising economic and social changes endangers whole communities and exacerbates their pre-existing social conditions such as poverty, mortality, and morbidity.

While states debate on the contours of health security, it is vital that state actors, in their need to safeguard security interests, do not forget the larger goal of ensuring the benefits of cooperation for public health where the disease be considered the threat and not the person carrying it.

As the shift towards securitization of global health is taking place and different multilateral groupings work together to address public health concerns, governments need to be equally mindful of ensuring equitable access to healthcare within national health systems.

The journey from being considered a global public good to a security concern may be unavoidable.

However, if countries keep themselves conscious of their larger responsibilities, securitization may be able to go hand in hand with responsible behavior in building a resilient global health architecture.

With several prominent disease outbreaks apart from COVID-19, such as Ebola, Zika, and Nipah, global health security is again high on the international agenda. Thus, multilateral groupings and subsequent health security partnerships are a much needed preventive step in the right direction

India and Health Security Partnership: Harnessing Our Strengths 

As a country, India has much to provide in terms of strengthening health security, especially for other members of the Global South.

New Delhi’s strength lies in numbers, and this was made amply evident during the pandemic when India launched the world’s largest vaccination drive in January 2021 using the indigenously developed digital platform CoWIN. It entailed:

• Capacity building along with communication and coordination among the community health workers

• Tailored vaccine distribution based on real-time monitoring of demand & supply

• Developed and improved manufacturing capacities of PPE kits

• And, supplied vaccines to over 150 countries under Vaccine Maitri.

As a member of the three major groupings discussing health security- Quad, BRICS and G20- India is well positioned to further assist other Global South countries.

During its G20 Presidency, India focused on-

• Discussing health emergencies prevention, preparedness and response (PPR).

• Strengthening cooperation in the pharmaceutical sector with a focus on availability and access to safe, effective, quality, and affordable medical countermeasures.

• Use of Digital Health solutions for achieving Universal Health Coverage (UHC) and improving healthcare service delivery.

• In addition, G20 health ministers, this year, also recognized critical issues such as the climate-health nexus.

Harnessing our collective strengths and resources and promoting both international and regional collaborative activities on common policy issues that require cooperation and engagement within and beyond the Indo-Pacific region will help maintain and strengthen a free and open international order, bringing the benefits of public health collaboration for all.

A few instances of this could be:

• Fostering regional One Health collaboration in capacity-building and exchange of knowledge and technical know-how

• Helping regions improve their health workforce capacities especially for health emergencies

• Strengthening partnerships for timely exchange of trusted data;

• Harmonising regulatory standards and much more.  

The contours of BRICS may change with new members or the G20 Presidency may move from one member to another, but the writing on the wall is clear; there is a thin line between health cooperation and securitization and global health securitization is definitely here to stay.

WHO DG, Dr. Tedros has stated, "No one is safe unless we are all safe" multiple times. But this should not be seen merely as a slogan, as dismissing or ignoring it may limit our lifestyles and futures.

(Dr Kanica Rakhra is an Assistant Professor at Kautilya School of Public Policy where she teaches global affairs in public health. Dr Smritima Diksha Lama is a Consultant primarily engaged with the Health Working Group, G20 Secretariat, Ministry of External Affairs. This is an opinion piece and the views expressed are the author’s own. The Quint neither endorses nor is responsible for them.)