Cause Area Introduction - Health Security

Written By High-Impact Medicine

Authors: Louisa Rasp, Holly Kristensen

Table of Contents:

What falls into the realm of health security?

Is health security a neglected area?

Is health security a tractable area?

Find out more

Get involved

Before 2020, very few of us spent much time worrying about pandemics. Now, we’ve all experienced the immediate and ongoing effects of a pandemic and how this impacts our daily lives. As of October 2022, COVID-19 has killed over 6 million people and destroyed tens of trillions of dollars of economic value. Yet it is possible future pandemics may be even more devastating. 

Beyond pandemics, there are several potential biological threats to human health and society that are not pandemics. These include weak health systems, antimicrobial resistance and the potential for malicious actors to release harmful biological agents. 

Health security is a term that describes the actions governments and other regulatory bodies take to reduce or eliminate threats to human health and society posed by biological agents. We think health security is a relatively neglected and potentially tractable cause area of high importance that doctors may be well placed to work on.

What falls into the realm of health security?

Given its broad nature, health security deals with several potential biological threats to human health and society. Some groups focus more on infectious agents however the term itself can capture several issues. We have listed some of the most common issues concerning health security below and expanded on a few of them. 

Infectious Threats

Infectious threats include: 

  • Pandemics 

    • Zoonotic or synthetically engineered novel pathogens, or mutation of existing pathogens 

    • The persisting threat of a global influenza pandemic

    • Emerging COVID-19 variants of concern

    • Potential for malicious intentional release of infectious pathogens or accidental release of pathogens from laboratories

  • Emerging multi-resistant organisms or ‘superbugs’ in the face of antimicrobial resistance (AMR)

    • Emerging multi-resistance organisms (MROs)

    • Waning efficacy of current antimicrobials 

    • Necessity for novel anti-microbial discovery

Pandemics have been and remain one of the greatest threats to human health and society. The 1918 Spanish Flu killed 3-6% of the entire world’s population. Other pathogens such as tuberculosis, Ebola, SARS and HIV have caused similarly significant public health impacts. The idea of a ‘once in 100-year pandemic’ is fondly held but a misconception, if we consider that there were 3 pandemics - 1957 H2N2, 1968 H3N2, 2009 H1N1 - prior to the arrival of COVID-19 some 100 years after the Spanish Flu. The likelihood of pandemics may be increasing due to the effects of climate change and our continual encroachment into wild places. As such, it is imperative that we continue to bolster our efforts towards pandemic preparedness.  

Of those described above, all have been linked to cross transmission of pathogens from animals to humans (zoonotic transmission), which can happen due to human contact with domestic, agricultural or wild animals, or water/soil infected by the same. Advances in biotechnology have created an increasingly sophisticated tool kit to synthesise biological agents. These discoveries could beget something dangerous despite the good intent behind their development, or could be used for nefarious activities by malicious actors. This is known as dual-use research of concern (DURC). Some believe engineered pathogens of these sorts could pose an extinction risk to humanity (known in the field as a global catastrophic biological risk). 

Non-infectious threats 

Non-infectious threats that are considered in the field of health security include: 

  • Anti-microbial resistance (AMR)

    • Emerging multi-resistance organisms (MROs)

    • Waning efficacy of current anti-microbials 

    • Necessity for novel anti-microbial discovery

  • Major natural disasters

  • Biological accidents / hazards / exposures

  • Health system regulation and policies

  • Vaccine hesitancy

  • Dual-use research of concern (DURC)

Although the likelihood of non-infectious threats may be lower than infectious threats, their impact can and may be equally damaging if not responded to well. For example, antimicrobial resistance (AMR) is in the top 10 public health threats (WHO, 2021) and causes 4.95 million deaths a year, and 192 million DALYs lost per year (Lancet, 2022), making it a significant cause of disability and death if it were counted on the Global Burden of Disease. A primary driver of AMR is misuse and overuse of antimicrobials, which in an of itself has complex causes, such as: weak or absent regulations around antimicrobial prescribing, poor infection control practices in health settings, poor sanitation, lack of awareness and lack of access to certain antimicrobials leading to inappropriate prescribing. At the same time, development of novel antimicrobials is both tricky and costly. Taken together, the impact of rising AMR is a significant threat to individual / public health and the economic/developmental health of society.  

Perhaps of similar or more importance is that of bolstering strong health systems globally, for without strong systems to regulate and implement good public health policies, all other issues in the lists above will be difficult to combat. Health system strengthening is the process of identifying and implementing policies and practices to improve a health system’s fundamental duties and to respond to challenges like pandemics and other biological threats (WHO). Ensuring adequate infrastructure, resources, personnel and surveillance methods within a health system is a foundational approach and key in preparing for all sorts of health security threats.

Is health security a neglected area?

Health security is a relatively neglected area. Although there is increased awareness of the need to prepare for emerging infectious diseases, the world is still dangerously unprepared to respond to future epidemic and pandemic threats. Furthermore, funding and infrastructure are still lacking across several key pillars in the process of preventing and responding to health security threats, as shown in the figure below. 

Figure 1: The pillars of health security, from the global Health security index, GHS, 2021, Nuclear Threat Initiative www.ghsindex.org

To take some specific examples:

  1. During COVID-19, we saw that initial and subsequent responses was immensely lacking, especially in terms of administration of supplies and vaccines. Acquisition of vaccines was especially hard for low and middle-income countries. This meant having additional costs of $9 trillion worldwide, according to the International Chamber of Commerce. The economic contraction pushed 95 million people to the brink of extreme poverty ($1.90/day) in 2020, with 80 million more people undernourished than before .

  2. In the realm of emerging threats from engineered pathogens, our ability to detect and respond to these potential pathogens is influenced by national and international health governance, access to and mastery of biotechnology and the intent behind the use or research around these pathogens. High regulation and seamless detection systems are needed to prevent disastrous effects. Although billions are spent in the field, the guesstimated quality adjustment (additional money spent to have sufficient preparedness) would yield ~ $1 billion per year.

In considering both examples, we begin to see that the issues examined within the field of health security cannot be done so discretely. There are complex systems at play and as such, tightening our responses to emerging infectious diseases calls also for strengthening our health systems and vice versa. Interventions and research in this are somewhat neglected, so taken together with the potential impact they might have, we think health security is an important field requiring more work to be done. 

Is health security a tractable area?

We think health security is a tractable area to work on inasmuch as there are several issues within the domain that still need work. Furthermore, we think doctors are potentially well-placed to work on these problems given their knowledge of clinical medicine and infectious diseases, their position, and capital in society to advocate for change and their understanding of public health strategies and systems. 

There is a wide portfolio of roles that help reduce threats to health security including (in whole or in part) public health, clinical infectious diseases, health system strengthening, benchside research on vaccines and therapeutics, laboratory safety regulation, social science, bioethics and bioengineering. Doctors may have a reasonable foundation for these combination careers, given medical education usually suggests competence with both biological sciences and an appreciation of health-system level thinking. Some avenues we think are particularly promising are:

  • Research - Desk or lab based research exploring a particular facet of health security, biosecurity, biosurveillance, vaccine technology, AMR or novel anti-microbials

  • Policy - Scientifically competent policy-makers are valuable at domestic and international levels in developing policies to improve our preparedness for and response to health security threats

  • Entrepreneurship - Either starting or working at non-profit or for-profit companies working on health security issues might be useful. A number of organisations look for medical officers, people with clinical trial design and evaluation experience, or those with laboratory or quantitative skills. Relevant organisations include Alvea, Nucleic Acid Observatory, Oxford Nanopore, Charity Entrepreneurship and many others.

Within traditional medicine the specialities of infectious disease and public health are of obvious relevance, yet many specialities would afford similarly helpful skill sets and knowledge. Several leading figures in the field have medical backgrounds and clinical experience including Dr. Tom Ingelsby and Dr. Amesh Adalja at the Johns Hopkins Centre for Health Security, Dr. Matthew Lim who heads the W.H.O.’s Unit for Biosecurity, Max Schons at Alvea and Dr. Gregory Lewis and Dr. Cassidy Nelson who co-lead the Biosecurity Research Group at Oxford University’s Future of Humanity Institute.

Find out more 

If you’d like to find out more about anything related to the fields of health security or biosecurity, or how you might be able to get involved, here are some resources we think might be useful. 

Introductory readings

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Introductory programs

Higher commitment




Acknowledgements 

We would like to thank Akhil Basal, Abe Tolley and Erik Jentzen for their review of this document and their ongoing support, as well as Jonas Sandbrink for his broad expertise in the area. 

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