US Investment in Global Health Security—A Good Return

Last summer, I wrote about why the Global Health Security Agenda (GHSA) matters for American clinicians and why health care workers and public health personnel need to know about this pivotal program. The vision of the GHSA “is to achieve a world secure from infectious disease threats, whether naturally occurring, accidental, or deliberately released;” a lofty goal; however, despite the importance of global health security and the GHSA, its future is in jeopardy as funding is set to run by the end of 2019. This means that 80% of our global health security funding abroad will be compromised.

Beth Cameron, PhD, vice president of Global Biological Policy and Programs at the Nuclear Threat Initiative noted in a recent article that, “without sufficient funding of $208.2 million a year for the Centers for Disease Control and Prevention (CDC) and $172.5 million a year at the United States Agency for International Development (USAID), we [will] weaken the global network of protection, increase risk to American lives, and threaten investments from other governments and the private sector.”

Like many components of public health and infectious disease, the importance of prevention is often forgotten until an outbreak occurs. Hospital preparedness and infection prevention were not necessarily “big ticket” items in the United States until we had Ebola in Dallas, Texas, but it only takes 1 laboratory incident to remind us of the importance of biosecurity and biosafety.

Currently, there are 60 countries that participate in the GHSA, and the United States either leads or significantly contributes to several of its action packages. It can be hard to truly understand the scope of the GHSA and what US participation really means, though. You could argue the answer is readily apparent: “An outbreak anywhere means an outbreak everywhere,” and “disease knows no borders,” but, what’s going on behind the scenes?

Recently, USAID released their report on implementing the GHSA and the progress and impact of US government investments. This report comes at a pivotal time—reminding the world of the importance of the program while also providing concrete examples of the life-saving efforts that come out of such investments.

Some of the examples of programs that have benefited from US GHSA assistance are apparent across all Action Packages (Prevent, Detect, and Respond). Within the Antimicrobial Resistance Action Package (Prevent), for example, they note that in India, hospital staff have been able to strengthen their ability to detect and prevent the spread of multidrug-resistant organisms and infections through outbreak investigations, isolation and transmission-based precautions, and laboratory-based efforts. Furthermore, in biosecurity efforts, senior lab technicians in Liberia have been trained on biosecurity and biosafety measures, as well as internal auditing.

Within the Detect Action Packages, US GHSA assistance has helped strengthen national laboratory systems and real-time surveillance in areas such as Vietnam, where they launched a pilot of an event-based surveillance program with community engagement that resulted in the reporting of over 100 local outbreaks within the first 6 months.

In addition, in the Workforce Development Action Package (Detect), 79 universities in Africa and Asia have facilitated One Health training for more than 11,500 professionals.

Lastly, Emergency Operations Centers were created within the Respond Action Packages, which facilitated Cameroon’s development of stronger emergency management capabilities. The US also supported the Medical Countermeasures and Personnel Deployment Action Package (Respond) through the provision of 2000 personal protective equipment (PPE) kits to the Democratic Republic of Congo, 300 PPE kits to Uganda, and 100 PPE kits to Guinea, in response to outbreaks that ranged from Ebola to avian influenza and anthrax.

These are but a handful of the contributions that the GHSA has made across the world with US investments. It is a remarkable thing when investment is made in global health security efforts, but without the United States leading and encouraging such efforts, the future of global health security and American biodefense is at stake.