Evolving responses
The modern era of global health security and coordinated international action dates back to the 1950s and the development of international sanitary regulations. These morphed into the International Health Regulations (IHR), published in 1969 and revised in 2005, and again in 2024 after the COVID-19 pandemic. In parallel, intense global discussions eventually led to the recent signing of the Pandemic Treaty (or, more correctly, the WHO Pandemic Accord, WHOPA).
These developments focused almost entirely on infectious disease. The WHO Global Health Security Agenda, for example, features three pillars – ‘prevent’, ‘detect’ and ‘respond’. WHO has carried out a pathogen prioritisation exercise, identifying key families of pathogens that could trigger pandemics, including the hypothetical ‘pathogen X’.
Yet, Dr Amuasi noted, there are many other current health emergencies, including an epidemic of non-communicable diseases (NCDs), responsible for an estimated 70% of global deaths. Infectious disease has greater impact in Africa but the balance is shifting, and the burden of infectious disease is concentrated in the lowest-income countries in the region. There are other challenges to public health, he added, including the rising tide of misinformation.
Dr Amuasi suggested that, although it may not have achieved everything that stakeholders in the Global South wanted, the Pandemic Treaty was a step forward. It incorporates equity in access, is framed around a One Health approach, and includes agreement on pathogen access and benefit sharing (PABS). Downsides include the absence of some signatories and the remaining need to thrash out details of PABS mechanisms.
Rethinking global health security
As well as urging for a more holistic One Health approach, he concluded by arguing for a revisiting of the ethical foundations of global health security. Transparency was key, he suggested, but the way that global health security is framed also needs to be considered. “We need to revisit the foundations for a new model for global health security, focusing on the inclusivity, the equity, the accountability, the solidarity.”
An isolationist approach, he suggested, would not work: “We have the scientific knowhow. We have painfully learned the lessons of past failures, and now we need the will to act differently. Global health security will be measured not by the walls we build to keep the threats out, but by the bricks we build to ensure that no one is left behind.”
“It’s about securing health through foresight, ethics and empathy, rather than the fear that seems to rule the world and is informing many decisions globally these days.”
This will require sustained investment and international collaborations around shared objectives – the principles at the heart of EDCTP’s work. “Health security cannot be achieved without international commitment to sustain investment and collaboration in scientific research and development. And I think EDCTP and its outputs are a shining example of this.”