A Devex special report
The state of global health security
“Global health security” had been a rising priority on the international agenda even before the latest pandemic saw it bursting into mainstream awareness.
Although it has a long history — quarantines were first used in the 14th century in a bid to control the spread of the bubonic plague — the massive growth in international trade and travel has made it increasingly urgent.
By 2014, governments around the world had come together to launch the Global Health Security Agenda — an effort to strengthen the world’s ability to prevent, detect, and respond to infectious disease threats.
But despite the growing attention to global health security, COVID-19 revealed major weaknesses.
What is the state of global health security today, and where does it go from here? Over the past year and a half, the Devex newsroom has been asking these questions. Read on for a look at what we found.
Jessica Abrahams
Editor, Devex Pro
How to build a global health security movement
Global leaders knew the world wasn’t prepared for another pandemic. Health and development experts had long raised alarm bells about the “cycle of crisis and complacency” that characterized pandemic preparedness and response.
Could COVID-19 be different? Will lessons learned from this pandemic finally spark a long-term, sustainable plan for preparedness?
During last year’s World Health Assembly, Michael Igoe took a look at the history of efforts to achieve this, and what needs to happen to make it a reality.
Follow the money
As always, funding is a key issue. Leaders have been talking about the need for more investment in global health security for years — so who has been stepping up, and who hasn’t?
Lisa Cornish digs into data from Devex’s funding platform in an attempt to find an answer. Devex Pro subscribers can explore the data with our interactive visualization, covering more than $60 billion of funding announcements for health security between October 2002 and March 2021.
One limitation of the data is that what is labeled as global health security funding isn’t always consistent: The area can cover a huge range of issues and each donor approaches it differently.
To dissect how donors think about health security, Lisa also looks in-depth at billions of dollars of health security spending from the United States, the biggest donor historically, and how its approach to health security has evolved over the years.
Explore the data: Leading health security donors — and those that have dropped the ball 
The limits of health security
Donor spending brings us to another issue raised by experts as the pandemic played out. While global health security efforts are typically focused on specific activities, such as disease surveillance, this overlooks the fact that infectious disease control can’t be separated from health systems more broadly.
As Arush Lal, a civil society representative at the ACT-Accelerator, writes for Devex, “health systems worldwide are chronically underfunded, disjointed, and inequitable … [and] global health security efforts — while essential — will fall short unless concretely tied to broader health systems strengthening initiatives.”
Many experts believe the limits of health security don’t stop there, either. In October, more than 250 organizations signed the “São Paulo Declaration on Planetary Health” emphasizing the need for a “fundamental shift” to act on the links between human health and the natural environment.
Opinion: Global health security must be tied to health systems
The US cannot afford to treat global health investments as business as usual. The Biden administration/Congress muet not repeat previous mistakes by over-relying on GHS while sidelining fundamental investments needed to keep health systems functioning.https://t.co/p6gJS2Bphe
— Arush Lal (@Arush_Lal) June 17, 2021
The future of WHO
As it attempted to coordinate one of the largest global responses to a disease outbreak in history, the World Health Organization found itself battered by criticisms and caught up in geopolitical disputes.
COVID-19 exposed weaknesses within the organization and put into question the international instruments that govern its response to global health emergencies, with discussions about potential reforms ongoing.
Funding also emerged as a key issue for WHO. The current system restricts where it can allocate resources and also leaves it vulnerable to political shocks — such as when former U.S. President Donald Trump attempted to withdraw funding last year.
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Jenny Lei Ravelo has been following the agency’s attempts to secure more predictable and flexible funding.
The German official leading the talks on reform tells her there’s growing support among countries to raise their membership fees, but that “not everybody is convinced yet.”
Watch: How to strengthen WHO
Read: Last chance for WHO funding reform, lead diplomat warns
Agendas, agreements, and treaties
The 2014 Global Health Security Agenda was supposed to strengthen the implementation of the International Health Regulations, which govern how countries prevent, control, and respond to the international spread of disease.
To some, failures in the COVID-19 response suggest that neither instrument is working. They want the World Health Assembly to adopt a new pandemic treaty — which it has just agreed to start negotiations on — to tackle accountability issues, as well as the sharing of data and technologies. Meanwhile, with vaccine equity emerging as one of the key challenges of the pandemic, negotiations over a possible intellectual property, or "TRIPS," waiver at the World Trade Organization are rumbling on.
But can a new treaty succeed where its predecessors have failed? Jenny Lei Ravelo maps out the Global Health Security Agenda’s successes and failures, and what it needs to do to stay relevant now.
Read: The future of the Global Health Security Agenda
Go deeper: Where are we on COVID-19 after a year of TRIPS waiver negotiations?
Who’s in charge?
Beyond new agreements, some wondered if a new agency might be needed to govern and coordinate future preparedness and response efforts — especially given the massive remit and challenges facing WHO.
Numerous new bodies have already opened — including WHO’s pandemic preparedness hub in Berlin and the Pandemic Institute in Liverpool, United Kingdom.
The European Commission also launched its Health Emergency Preparedness and Response Authority, or HERA. Although the EU says its mission is global, experts say the test will be whether it helps to provide “medical countermeasures” — such as medicines, vaccines, and diagnostics — internationally, or rather takes a “Europe first” approach.
But the global health security architecture — the network of institutions and authorities that help to support and govern pandemic preparedness and response — was already immensely complex before the pandemic.
Some wonder whether instead of new bodies, what is really needed is more clout for those that already exist.
Read: Can the new WHO hub in Berlin build trust for data sharing?
Stay updated: What HERA could mean for global health security
How to fix pandemic preparedness measures
The global health community has two main measures for pandemic preparedness. Neither of them successfully predicted how countries would fare during the COVID-19 outbreak.
Countries that were thought to be well prepared, such as the U.S., have in reality been badly affected, while others exceeded expectations.
“We want to believe that ... what we’re measuring is valuable in preparing for a pandemic,” says Joseph Dieleman, an associate professor at the Institute for Health Metrics and Evaluation. COVID-19 “has shown [that] maybe that’s not the case.”
Laura López González asks how pandemic preparedness measures got it so wrong, and what it teaches us about how to be better prepared next time.
Building on regional successes
One of the regions that fared better than expected — at least during the first part of the pandemic — was the African continent.
Various factors may have affected this, but several experts tell Sara Jerving that Africa Centres for Disease Control and Prevention’s leadership played a key role.
For some, its success provides a persuasive argument for creating equivalent bodies for other regions of the world.
Thank you for reading.
The State of Global Health Security is the latest in Devex’s range of special reports on issues at the heart of the global development sector.
Written by: Jessica Abrahams
Images and videos by: Kilian Figueras Torras/Pexels
Produced by: Mariane Samson and Jessica Abrahams
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