The Western African Ebola virus epidemic (2013-2016) was the most widespread outbreak of this disease in history and one of the most recent examples of the inefficiencies of global, collective action in an increasingly prominent threat to international and national security. The Ebola virus disease had more than 28,000 cases and over 11,000 deaths over the duration of the epidemic. Naturally occurring, deliberate, and accidental infectious disease threats are a global health concern that require concerted and coordinated efforts on a multilateral and multi-sectoral level among nations, private companies, international institutions, and humanitarian organizations. Transatlantic relations have a unique role in this context, given the shared ideals, private sector resources, and diplomatic commitments.
The United States and Europe share several ideals and values that underscore the joint responsibility of global health security. President Obama and Chancellor Merkel emphasized the importance values of freedom, justice, and democracy in a recent op-ed published by the German Daily “Wirtschaftswoche” on November 17, 2016. They mentioned the importance of collaborating on tackling global health security, among other global challenges, in their vision for the future of transatlantic relations. Confronting global health security concerns involves developing bilateral and multilateral diplomatic relations with both developing and developed countries to strengthen state capacities in countries that are the most vulnerable to infectious disease outbreaks. Freedom in a country depends on one’s ability to fulfill the role of an active citizen, which in turn depends on being able to develop as a healthy, informed member of the public. With an emphasis on healthy, this requires developed health systems that can maintain a healthy citizenship and also respond to public health emergencies as and when needed. Further, efforts to establish and strengthen democracies are built into US, EU member-state, and transatlantic development efforts that include creating stable education and health systems.
One of the main shortcomings of the emergency preparedness policies in place to mitigate global health security threats in West Africa was the lack of coordination and resulting slow response to the outbreak – and even to the WHO’s declaration of the Ebola crisis as Public Health Emergency of International Concern (PHEIC). The EU and transatlantic community overall did not have clearly defined responsibilities in the case of a global health emergency. In the case of the EU, while it established the European External Action Service (EEAS) in January 2011 and commissioned the Crisis Response and Operational Coordination Department (CROC) to coordinate responses to such a crisis, it seems to lack sufficient coordination between the different EU bodies involved. The role of military when public health systems are overwhelmed in the context of a health security threat is also not clearly defined. Thus, while the US deployed thousands of soldiers to West Africa in a short time, Europe was more fragmented. France and the UK sent military forces to Guinea and Sierra Leone, and other EU member-states helped with logistics and supplies on the ground, but it was also a delayed and fragmented effort.
Further, the transatlantic community has a unique role to play in global health security issues given its pharmaceutical and medical resources. The concern over pharmaceutical monopoly power has already been debated in the context of several global health concerns, namely AIDS. While it is unideal that big pharma and the most up-to-date medical technologies are usually located in and focused on the markets in the Global North, a transatlantic partnership focusing drug development of diseases more common in the Global South could effect positive change. In the case of Ebola, a vaccine may have already been developed if investing in the issue were more attractive to companies. As such, there needs to be more advocacy for drug development and initiatives established in the EU and North America to make this happen.
In addition, given the number of medical and scientific experts that are trained in North America and Europe’s medical institutions, having access to a pool of transatlantic response teams with expertise in public health, epidemiology, clinical medicine, microbiology, and other relevant fields could further strengthen a response to a global health security threat. This area of development in transatlantic relations is particularly useful given the often low density of medical personnel in countries where natural outbreaks of infectious diseases occur. For example, the density of physicians per 1000 population in Guinea, Sierra Leone, and Liberia were 0.1, 0.022, and 0.014, respectively. Comparing this to 2.9 doctors per 1000 population in Belgium indicates just how much of a contrast there often is.
Finally, health humanitarian interventions such as the ones undertaken during the Ebola epidemic are crucial but often short-sighted, leaving room for the development of more medium- and long-term development strategies. Countries often come to the aid of a country or countries in crisis, especially if there is a potential for a security threat to expand into their borders. However, containing a short-term crisis is one thing, and committing to developing a country’s state capacity by mitigating poverty, increasing livelihoods, and establishing or strengthening institutions is another. The latter brings us back to those ideals of freedom, justice, and democracy, and they also require more strategic health diplomacy. Strategic health diplomacy is an interdisciplinary field encompassing public health, international affairs, management, law and economics. Historically health has been viewed as predominantly a humanitarian issue, but the advent of globalization, climate change and recent political events – especially since the fall of the Berlin Wall – has given this field a new meaning. Today it is a field in the making, with applications for major economic and security interests as well.
As such, global health security provides an avenue for the broadening of transatlantic cooperation. The rise of global health concerns related to infectious disease threats has been bolstered by developments in globalization, climate change, and transnational terrorism, and it will only become an increasingly important area of security policy to address. The transatlantic community is particularly well positioned to lead in strategic health diplomacy efforts given their shared ideals, access to private sector resources, and preexisting diplomatic connections.