Category Archives: Global Health Security

Global Health Security, Human Rights, Inequality, World Politics

Health, Peace, and the Summit of the Future: A Wake-Up Call

The Summit of the Future laid bare the stark reality of our global predicament. As young voices echoed through the halls, pleading for a better world, the disconnect between rhetoric and action was palpable. With a mere 16% of SDG targets on track for 2030, the clock is ticking, and the world is falling behind.

Leaders paraded their support for renewed efforts, yet their messages blurred into a cacophony of sameness. The elephant in the room remained unaddressed: If we can’t collaborate here, where can we? Who will step up to forge the future we desperately need?

This was nowhere more apparent than in the connections between Sustainable Development Goal 3 (Good Health and Well-being) and SDG 16 (Peace, Justice and Strong Institutions).  While there is a stronger recent focus on the link between health and economic or climate goals, the mutually reinforcing goals of health and peace are sometimes overlooked.  The ‘siloes’ of politics and strategy operate separately from those of health professions, public health experts, and socioeconomics.  Despite the overlaps, there is little discussion between the two communities.   

In 1981, the World Health Assembly acknowledged that the role of physicians and other health workers in the preservation and promotion of peace is “the most important factor for attainment of health for all.”  Similar initiatives include the World Health Organization’s Peace Through Health plan, begun in the 1990s; and the Health as a Bridge for Peace (HBP) framework, was formally accepted by the 51st World Health Assembly in 1998.

But the onus should not only be on the health sector: diplomats, security experts and foreign policy analysts should note the importance of the connection between health and peace. Similarly to the women, peace and security agenda, the health and peace agenda enables ‘multi-solving’ by addressing the root causes of violence and conflict.  Protecting health security  inoculates against violence in its many forms.  Attention to health security during post-conflict reconstruction reduces the potential for violence to feed into vicious cycles of retribution.

The pandemic exposed the critical need for global health diplomacy. Instead of uniting against a common threat, leaders retreated into nationalist health security postures, squandering chances for conflict resolution through health diplomacy.

Dr. Jeffrey Sachs speaks at the Pre-Summit of the Future at Columbia University, September 2024

Dr. Jeffrey Sachs speaks at the Pre-Summit of the Future at Columbia University, September 2024

Amidst the gloom, glimmers of progress shine through:

On September 21st 2024, the International Day of Peace, as part of the UN General Assembly Action Days, I was struck by the comments of Juan Manuel Santos, Former President of Colombia and 2016 Nobel Peace Prize recipient. He noted the strong connection between health and peace when he observed the way in which the civil war conflict in Colombia changed over time.  As he said, “when soldiers were taken to hospital instead of being killed, it changed the dynamic: when one could trust that the other side would respect their humanity, the level of trust rose on all sides.  The ‘enemy’ became human.”

Similarly, in 1859 when Swiss businessman Henri Dunant heard the cries of the wounded on the plains following the Battle of Solferino and called for a halt in the fighting to organize aid, a shift took place that changed the world forever.  Dunant’s proposal to create national relief societies to provide neutral and impartial care during conflicts led to the formation of the International Committee of the Red Cross in 1863 and the adoption of the first Geneva Convention in 1864.  Ever since, heeding the needs for health has been a powerful lever for upsetting the vicious cycle of violence.  In September, fighting was paused in Gaza to enable the vaccination of 640,000 children from the scourge of polio. This effort was not an outlier:  the World Health Organization has assisted with vaccine drives during humanitarian crises in many other parts of the world, including the Congo in 1999, where the immunization-related days of tranquility enabled the vaccination of 80% of 10 million children younger than 5 years.

To break the cycle of violence and create a healthier, more peaceful world, we must:

1. Deploy dedicated health diplomats to navigate the geopolitical minefield

2. Revitalize human rights and the Geneva Conventions, prioritizing protection for healthcare workers in conflict zones

3. Boost Official Development Assistance (ODA) for health systems (currently a paltry 0.37% of OECD GNI)

4. Educate relentlessly on the health-peace connection

The Pact for the Future offers a chance to recognize that investing in health creates a powerful multiplier effect on peace. It’s time to move beyond lofty declarations and take decisive action. The future we promised to safeguard is now, and it’s slipping through our fingers.

Global Health Security, Sustainable Development

Working Towards a Definition that Works: Planetary Health

The concept of planetary health has recently joined a plethora of new vocabulary that sparks new meanings and imaginaries about what constitutes health, what parts of the planet we value, and what the aspirations are for the human and the non-human family. As a social imaginary, planetary health is concerned with issues and problems that are related, but simultaneously embedded with systems of social, economic, political, and environmental architectures of order and change. This video uses the metaphor of planetary health to improve understanding of planetary health as a state of well-being, optimal functioning and system thriving.

Video presentation for “Exploring “Planetary Health” in the Context of Earth System Governance” Innovative Session for Earth System Governance Annual Conference, Radboud the Netherlands with Prof Kathryn Bowen, The University of Melbourne, Dr Belle Workman, The University of Melbourne – accepted Innovative Session proposal to the 2023 Radboud Conference on Earth System Governance (online), October 2023

Disasters, Global Health Security, Sustainable Development, World Politics

Ethical Governance of Global Health Security in an Age of Polycrisis

Dr. W. Andy Knight and Dr. Rosalind Warner

The COVID-19 pandemic has exposed critical gaps in the effort to improve global health security and highlighted the need for ethical frameworks to guide preparedness and response efforts. This study examines the ethical challenges in governing global health security amidst intersecting crises. The objective is to identify and analyze key ethical dilemmas and propose principles for equitable, accountable, and effective global health security governance.

Poster prepared for Canadian Association for Global Health Conference October 23-25, 2024

Vancouver, BC Canada

Ethical Governance of Global Health Security in an Age of Polycrisis Dr. W. Andy Knight and Dr. Rosalind Warner (1)Download

Selected References

Equity and Fairness

Balabanova, D., McKee, M., Mills, A., Walt, G., & Haines, A. (2010). What can global health institutions do to help strengthen health systems in low income countries. Health Policy Research and Systems, 8, 1–11. https://doi.org/10.1186/1478-4505-8-22

Connolly, K. (n.d.). Freedom and Fairness: Covid Vaccine Passport Plans Cause Global Unease. The Guardian. Guardian News and Media. https://www.theguardian.com/world/2021/feb/07/freedom-and-fairness-covid-vaccine-passport-plans-cause-global-unease.

Deivanayagam, T. A., English, S., Hickel, J., Bonifacio, J., Guinto, R. R., Hill, K. X., Huq, M., Issa, R., Mulindwa, H., Nagginda, H. P., de Morais Sato, P., Selvarajah, S., Sharma, C., & Devakumar, D. (2023). Envisioning environmental equity: Climate change, health, and racial justice. The Lancet, 402(10395), 64–78. https://doi.org/10.1016/S0140-6736(23)00919-4

Dewan, A. (n.d.). A Fight between the EU and UK Reveals the Ugly Truth about Vaccine Nationalism. CNN. Cable News Network. https://www.cnn.com/2021/01/30/europe/uk-eu-astrazeneca-vaccine-nationalism-gbr-intl/index.html.

Elbe, S. (2010). A Global Pharmacy for the poor? Endemics and Other Human Insecurities. In Security and Global Health (p. 220). Polity Press.

Loh, M. (n.d.). Who Chief: It’s ‘Seriously Disappointing’ That Rich Countries Are Ordering Booster Shots While Other Nations Need Vaccines. Insider. Insider. https://www.insider.com/who-admonishes-rich-countries-buying-booster-shots-others-need-vaccines-2021-7.

O’Neill Institute For National & Global Health Law Georgetown Law & Center for Transformational Health Law. (2022, April). Equitable Access Review of CEPI’s COVID-19 Vaccine Development Agreements. https://oneill.law.georgetown.edu/publications/equitable-access-review-of-cepis-covid-19-vaccine-development-agreements/

Smith, R., Beaglehole, R., Woodward, D., Drager, N., & Smith, R. (2003). Global public goods for health: Health economic and public health perspectives. Oxford University Press.

Van De Pas, R., Widdowson, M. A., Ravinetto, R., N Srinivas, P., Ochoa, T. J., Fofana, T. O., & Van Damme, W. (2022). COVID-19 vaccine equity: A health systems and policy perspective. Expert Review of Vaccines, 21(1), 25–36. https://doi.org/10.1080/14760584.2022.2004125

Beneficence and Non-Maleficence

McDougall, L. (2016). Discourse, ideas and power in global health policy networks: Political attention for maternal and child health in the millennium development goal era. Globalization and Health, 12(1), 309. https://doi.org/10.1186/s12992-016-0157-9

Pike, J., Bogich, T., Elwood, S., Finnoff, D. C., & Daszak, P. (2014). Economic optimization of a global strategy to address the pandemic threat. Proceedings of the National Academy of Sciences of the United States of America, 111(52), 18519–18523. https://doi.org/10.1073/PNAS.1412661112

Autonomy and Privacy

Dror, A. A., Eisenbach, N., Taiber, S., Morozov, N. G., Mizrachi, M., Zigron, A., Srouji, S., & Sela, E. (2020). Vaccine hesitancy: The next challenge in the fight against COVID-19. European Journal of Epidemiology, 35(8), 775–779. https://doi.org/10.1007/S10654-020-00671-Y/FIGURES/3

Packard, R. M. (2016). A History of Global Health: Interventions Into the Lives of Other People.

Sallam, M. (2021). Covid-19 vaccine hesitancy worldwide: A concise systematic review of vaccine acceptance rates. Vaccines, 9(2), 1–15. https://doi.org/10.3390/VACCINES9020160

Salmon, D. A., Haber, M., Gangarosa, E. J., Phillips, L., Smith, N. J., & Chen, R. T. (1999). Health consequences of religious and philosophical exemptions from immunization laws: Individual and societal risk of measles. Journal of the American Medical Association, 282(1), 47–53. https://doi.org/10.1001/jama.282.1.47

Turnbull, S. (n.d.). Here’s What Canada’s Privacy Commissioners Say Must Be Considered for Vaccine Passports. Coronavirus. CTV News. https://www.ctvnews.ca/health/coronavirus/here-s-what-canada-s-privacy-commissioners-say-must-be-considered-for-vaccine-passports-1.5434967?fbclid=IwAR1Qu_olw-hmvgTkxJpDJCIYhCQ2mwKUKoEb1b3BchNJrjX7LU6YFAYdk7A.

Global Solidarity

Acharya, A. (n.d.). A ‘Third Way’ for World Order after Covid-19: Think Global Health. Council on Foreign Relations. https://www.thinkglobalhealth.org/article/third-way-world-order-after-covid-19.

Duff, J. H., Liu, A., Saavedra, J., Batycki, J., Morancy, K., Stocking, B., O Gostin, L., Galea, S., Bertozzi, S., Zuniga, J. M., Alberto-Banatin, C., Dansua, A. S., del Rio, C., Kulzhanov, M., Lee, K., Scaglia, G., Shahpar, C., Ullmann, A. J., Hoffman, S. J., … Szapocznik, J. (2021). A global public health convention for the 21st century. Lancet Public Health, 6(6), 428–433.

Eaton, L., & Humphreys, G. (2020). The need for a coordinated international pandemic response. Bulletin of the World Health Organization, 98(6), 378–379. https://doi.org/10.2471/BLT.20.020620

Gostin, L. O., & Friedman, E. A. (2014). Ebola: A crisis in global health leadership. The Lancet, 384(9951), 1323. https://doi.org/10.1016/s0140-6736(14)61791-8

Gupta, N., Singh, B., Kaur, J., Singh, S., & Chattu, V. K. (2021). Covid-19 pandemic and reimagination of multilateralism through global health diplomacy. Sustainability (Switzerland), 13(20). https://doi.org/10.3390/SU132011551

Heymann, D. (2006). SARS and emerging infectious diseases: A challenge to place global solidarity above national sovereignty. Annals Academy Of Medicine Singapore, 35(5), 350.

Jamison, D. T., Summers, L. H., Alleyne, G., Arrow, K. J., Berkley, S., Binagwaho, A., Bustreo, F., Evans, D., Feachem, R. G. A., Frenk, J., Ghosh, G., Goldie, S. J., Guo, Y., Gupta, S., Horton, R., Kruk, M. E., Mahmoud, A., Mohohlo, L. K., Ncube, M., … Yamey, G. (2015). Global health 2035: A world converging within a generation. The Lancet, 382(9908), 1898–1955. https://doi.org/10.1016/s0140-6736(13)62105-4

Taghizade, S., Chattu, V. K., Jaafaripooyan, E., & Kevany, S. (2021). COVID-19 Pandemic as an Excellent Opportunity for Global Health Diplomacy. Frontiers in Public Health, 9. https://doi.org/10.3389/FPUBH.2021.655021

Tong, S., Samet, J. M., Steffen, W., Kinney, P. L., & Frumkin, H. (2023). Solidarity for the Anthropocene. Environmental Research, 235, 116716. https://doi.org/10.1016/j.envres.2023.116716

Individual vs Collective Rights

Global Health Governance: Health Security Vs. Human Rights? (n.d.). Australian Institute of International Affairs. Retrieved 23 September 2023, from https://www.internationalaffairs.org.au/australianoutlook/global-health-governance-health-security-vs-human-rights/

HAYDEN, P. (2012). The human right to health and the struggle for recognition. Review of International Studies, 38(3), 569–588. https://doi.org/10.1017/S0260210511000556

Hollingsworth, T. D., Ferguson, N. M., & Anderson, R. M. (2007). Frequent travelers and rate of spread of epidemics. Emerging Infectious Diseases, 13(9), 1288–1294. https://doi.org/10.3201/EID1309.070081

Hostmaelingen, N., & Bentzen, H. B. (2020). How to operationalise human rights for COVID-19 measures. BMJ Global Health, 5(7), 1–4. https://doi.org/10.1136/bmjgh-2020-003048

Kata, A. (2012). Anti-vaccine activists, Web 2.0, and the postmodern paradigm—An overview of tactics and tropes used online by the anti-vaccination movement. Vaccine, 30(25), 3778–3789. https://doi.org/10.1016/J.VACCINE.2011.11.112

UNGA (United Nations General Assembly). (2022, July 28). UN General Assembly declares access to clean and healthy environment a universal human right | UN News. https://news.un.org/en/story/2022/07/1123482

Proactive vs Reactive

Ayala, A., Brush, A., Chai, S., Fernandez, J., Ginsbach, K., Gottschalk, K., Halabi, S., Hosangadi, D., Mapatano, D., Monahan, J., Moretti, C., Pillinger, M., Ramirez, G. S., & Rosenfeld, E. (2022). Advancing Legal Preparedness through the Global Health Security Agenda. Journal of Law, Medicine & Ethics, 50(1), 200–203. https://doi.org/10.1017/JME.2022.26

Cáceres, S. B. (n.d.). Global Health Security in an Era of Global Health Threats—Volume 17, Number 10—October 2011—Emerging Infectious Diseases journal—CDC. https://doi.org/10.3201/eid1710.101656

de Guttry, A. (2020). Is the International Community Ready for the Next Pandemic Wave? A Legal Analysis of the Preparedness Rules Codified in Universal Instruments and of their Impact in the Light of the COVID-19 Experience. Global Jurist, 20(3), 1–41.

Fukuda-Parr, S. (2022). When indicators fail: SPAR, the invisible measure of pandemic preparedness. Policy and Society. https://doi.org/10.1093/polsoc/puac024

Gostin, L. O., & Ayala, A. S. (2017). Global Health Security in an Era of Explosive Pandemic Potential. Journal of National Security Law & Policy, 9, 53.

Knight, W. A., & Reddy, K. S. (2020). Caribbean response to COVID-19: A regional approach to pandemic preparedness and resilience. The Round Table, 109(4), 464–465. https://doi.org/10.1080/00358533.2020.1790759

Lal, A., Abdalla, S. M., Chattu, V. K., Erondu, N. A., Lee, T., Singh, S., Abou-taleb, H., Morales, J. V., & Phelan, A. (2022). Health Policy Pandemic preparedness and response: Exploring the role of universal health coverage within the global health security architecture. 22, 1–9.

Manika, S. (2021). Fostering preparedness for COVID-19 in cities: How cities can support the healthcare system by efficiently managing emergency funding. TPR: Town Planning Review, 92(3), 293–299.

Nelson, C., Lurie, N., Wasserman, J., & Zakowski, S. (2007). Conceptualizing and Defining Public Health Emergency Preparedness. American Journal of Public Health, 97, S9–S11. https://doi.org/10.2105/ajph.2007.114496

The Petrie-Flom Center Staff. (2022, October 24). Using Legal Preparedness to Minimize Liability Barriers to Accessing Pandemic Vaccine and Medical Countermeasures. Bill of Health. https://blog.petrieflom.law.harvard.edu/2022/10/24/using-legal-preparedness-to-minimize-liability-barriers-to-accessing-pandemic-vaccine-and-medical-countermeasures/

Virtual Blockbuster Bird Flu and the Pandemic of Preparedness Planning. (2018). In Stefan Elbe, Pandemics, Pills, and Politics: Governing Global Health Security (p. 106). Johns Hopkins University Press

Proportionality and Necessity

Dace, H., Miller, B., Ramli, R., Sleat, D., Thorne, E., & Wain, R. (n.d.). The New Necessary: How We Future-Proof for the Next Pandemic. Tony Blair Institute for Global Change. Retrieved 8 July 2021, from https://institute.global/policy/new-necessary-how-

Dzau, V. J., & Rodin, J. (2015). Creating a global health risk framework. New England Journal of Medicine, 373(11), 991–993. https://doi.org/10.1056/nejmp1509136

Knight, W. A., & Oriola, T. B. (2022). Vaccine nationalism, violent extremist problematique and state management of combat-related deaths. Https://Doi.Org/10.1080/19392206.2022.2059923, 15(1), 1–3. https://doi.org/10.1080/19392206.2022.2059923

Lal, A., Abdalla, S. M., Chattu, V. K., Erondu, N. A., Lee, T., Singh, S., Abou-taleb, H., Morales, J. V., & Phelan, A. (2022). Health Policy Pandemic preparedness and response: Exploring the role of universal health coverage within the global health security architecture. 22, 1–9.

Samaan, G., Patel, M., Spencer, J., & Roberts, L. (2004). Border screening for SARS in Australia: What has been learnt? Medical Journal of Australia, 180(5), 220–224. https://doi.org/10.5694/J.1326-5377.2004.TB05889.X

The Lancet: New report details “massive global failures” of COVID-19 response, calls for improved multilateral cooperation to end pandemic and effectively manage future global health threats. (2022). SDSN Newsletter. https://www.unsdsn.org/the-lancet-new-report-details-massive-global-failures-of-covid-19response-calls-for-improved-multilateral-cooperation-to-end-pandemic-andeffectively-manage-future-global-health-threats

Transparency and Accountability

Lindmeier, C. (2021). WHO, Germany launch new global hub for pandemic and epidemic intelligence. World Health Organization. https://www.who.int/news/item/05-05-2021-who-germany-launch-new-global-hub-for-pandemic-and-epidemic-intelligence

MacIntyre, C. R., & Aginam, O. (2022, June 22). At what point is a disease deemed to be a global threat? Here’s the answer. The Conversation. http://theconversation.com/at-what-point-is-a-disease-deemed-to-be-a-global-threat-heres-the-answer-185547

Ozawa, S., Paina, L., & Qiu, M. (2016). Exploring pathways for building trust in vaccination and strengthening health system resilience. BMC Health Services Research, 16, 131–141. https://doi.org/10.1186/S12913-016-1867-7

Sturmberg, J. P. (2020). Approaching complexity—Start with awareness. Journal of Evaluation in Clinical Practice, 26(3), 1030–1033. https://doi.org/10.1111/JEP.13355