By Stevie Kiesel, Biodefense PhD Student
In 2013, before becoming Donald Trump’s Secretary of Defense, retired General Jim Mattis testified to the Senate Armed Services Committee that “if [the US doesn’t] fund the State Department fully, then I need to buy more ammunition.” Mattis went on to say that “the more we put into the State Department’s diplomacy, hopefully the less we have to put into a military budget as we deal with the outcome of an apparent American withdrawal from the international scene.” Though Mattis was expressing worry about an American withdrawal during the Obama administration, the US’s failure to lead (or indeed, even muster an adequate domestic response) a COVID-19 response also demonstrates the downsides of an isolated America. From the first emergence of the novel coronavirus, the US response has been confused, clouded by other interests, and continually divorced from scientific reality. Diplomacy and coordinated international action have taken a backseat precisely when they are needed most, in the realm of global health security. However, Senator James Risch (R-ID) has introduced a bill hoping to clarify and improve the US’s global health security and diplomacy objectives.
Senate Bill 3829, introduced in May 2020 and currently titled the Global Health Security and Diplomacy Act of 2020, aims to “advance the global health security and diplomacy objectives of the United States, improve coordination among the relevant Federal departments and agencies implementing United States foreign assistance for global health security, and more effectively enable partner countries to strengthen and sustain resilient health systems and supply chains with the resources, capacity, and personnel required to prevent, detect, mitigate, and respond to infectious disease threats before they become pandemics.” The bill endorses a “One Health” approach to global health security, which brings together stakeholders from the local to the global level, across all relevant sectors, to achieve optimal health outcomes by recognizing health implications inherent in the interconnected nature of today’s world.
As currently written, the bill calls for several actions to meet its objectives. First, the President should maintain a comprehensive Global Health Security Strategy with clear objectives and evaluation mechanisms. The bill acknowledges that the 2019 Global Health Security Strategy is sufficient for 2021, but also lays out a framework for improvements in the next iteration of the Strategy. Second, the bill establishes a new position within the State Department to coordinate US government activities to advance global health diplomacy and security overseas. Third, the bill recognizes the importance of supporting partner country efforts to strengthen their own public health systems and supply chains, which would foster outbreak detection earlier in a disease’s progression.
Fourth, the bill calls for “accelerating progress under the United States Global Health Security Strategy, the Global Health Security Agenda, the World Health Organization (WHO) International Health Regulations, and other relevant frameworks.” Unfortunately this may pose a bit of a challenge now that the US has begun the process of withdrawing from the WHO. Going forward, this bill should be modified to address how to adhere to the spirit of the International Health Regulations, even if the US is no longer a member of the WHO.
Finally, the bill contains several provisions regarding funding. It calls for enhanced support for public-private partnerships on research, development, and deployment of diagnostic tools and medical countermeasures – a sound strategy in line with other US government agencies that should not falter once we feel like we are safely past the current pandemic. Section 107 of the bill authorizes $3 billion for fiscal years 2021-2025 to advance the Global Health Security Strategy, while Section 201 authorizes the Secretary of State to begin negotiations with the World Bank or the International Development Association to establish a Trust Fund for Global Health Security. This fund, overseen by member states who are both donors and participants, would provide resources for a wide range of initiatives related to global health security, pandemic preparedness, and infectious disease control. Such a fund would provide further incentives for countries to strengthen their public health infrastructure, reducing the likelihood of pandemic disease by improving detection and response capabilities at the source.
The Senate Foreign Relations Committee held a hearing to discuss this bill with experts from the Department of State, the US Agency for International Development (USAID), and the Department of Health and Human Services (HHS) on June 18, 2020. All three of the men who provided testimony reiterated how quickly infectious diseases can go global and how strengthening indigenous public health systems will go a long way toward lessening the impact of future outbreaks. They also stressed the importance of transparency, accountability, and clearly defined objectives and metrics, themes that are present throughout the bill.
Many times, this hearing returned to the question of the WHO’s role and what shortcomings the pandemic exposed. Chairman Risch argued that the WHO has an extremely important role, but this pandemic revealed significant weakness when trying to respond to a fast-moving international crisis. On the other hand, Garrett Grigsby, who testified as the Director of the Office of Global Affairs at HHS, repeatedly returned to the theme that the WHO’s failure to call out the Chinese government early in the crisis represented an egregious error, repeating a mistake made during the 2002 outbreak of Severe Acute Respiratory Syndrome (SARS).
Now that the US has announced its intention to withdraw from the WHO, what country will step in to take the United States’ place as a heavyweight player? Senator Murphy (D-CT) expressed concern that this vacuum of leadership presents an opportunity for China to gain a great deal of influence, nixing any potential US push to improve secrecy around infectious disease outbreaks. However, Senator Barrasso (R-WY) argued that withdrawing from the WHO gives the United States leverage to place conditions on their return, allowing the US to push harder for transparency measures. Time will tell if the withdrawal was a tempered tactic to gain more leverage for reform, or simply a temper tantrum. Until then, it will be interesting to see how the language of Senate Bill 3829 changes, and indeed whether it goes anywhere at all.