EL-CSID European Policy Brief: Coordinating Global Health Responses

1 / 2016
Annamarie Bindenagel Šehović

The end of the Cold War gave the (western) world an apparent reprieve from weapons of mass destruction. Then came HIV and AIDS. Since then, a host of human insecurities and pandemic threats have converged to upend that semblance of order.

The ‘grand decade of global health’ (2000-2010) posited a litany of responses. These were meant to (re)establish order. They were overwhelmingly characterized by vertical (top-down) solutions to individual health threats: HIV, tuberculosis, and malaria being the three diseases which received the most attention. Being infectious diseases, this focus left non-communicable diseases (NCDs), maternal health, mental health, and even (re)emerging (infectious) diseases largely in the lurch. It also neglected horizontal responses based on local networks and knowledge: the successful response of some communities to the 2014-2015 Ebola outbreak in West Africa showcases alternative solutions.[1] Yet with the grand decade over, the a priori importance once attached to health has disappeared from the international agenda.

Indeed, health has only regained a fraction of its policy prioritization through the ascendance onto the international agenda of potential epidemic/pandemic threats such as Ebola and Zika. Here, however, the risk of non-intervention almost pales in comparison with the risk of intervention: “Epidemics appear not only as a threat, but as a challenge, a chance for the interventionist state that wants to prove its ability to act against infectious disease.”[2] Compounding the direct challenges posed by epidemics and pandemics themselves are the indirect complications such as “panic, social unrest and economic consequences”[3] which up the ante for response – with unknown consequences:[4] A number of regions of Brazil “proactively declared a public health emergency with regard to Zika in November 2015.”[5] If and when the expanded political, and military, powers granted under the emergency are not revoked, these could lead to serious infringement of biological and civil liberties.

The current context is one defined by varying degrees of disorder. This is the state of affairs in the realms of geopolitics to market (dis)regulation, of climate (dis)agreement to (il)legal migration status. Each of these has a bearing on global as well as local health. In fact, health is of particular importance as its causes and consequences, alongside its associated vulnerabilities and threats, crosses borders.

As such, mounting a coordinated effort to respond to global health issues is an imperative. The question is, how to do it?

[1] Villagers in a number of the affected countries identified transmission chains and implemented isolation of the sick to interrupt the spread of disease.

[2] Author’s translation. Original: “Epidemien erschienen nun nicht nur als Bedrohung, sondern ebenso als Herausforderung, ja als Chance für den Interventionsstaat, der seine Handlungsfähigkeit in der Seuchenbekämpfung unter Beweis stellte,” in Thießen, Malte (2015). ‘Infizierte Gesellschaften: Sozial- und Kulturgeschichte von Seuchen,’ in Aus Politik und Zeitgeschichte (ApuZ), 65. Jahrgang, 20-21/2015, S. 16.

[3] Author’s translation. Original: “Panik, soziale Unruhen und wirtschaftiche Folgen”  in Ehlkes, Lutz und Jürgen May (2015). ‘Seuchen – gestern, heute, morgen.’ in Aus Politik und Zeitgeschichte (ApuZ), 65. Jahrgang, 20-21/2015, p. 9.

[4] ibid.

[5] Gostin, Lawrence O. and Daniel Lucey (2016). “The Emerging Zika Pandemic: Enhancing Preparedness,” JAMA (Online), (27 January).