Public health: what can we learn from the defense sector?

By: Aaditya Kumar

The current COVID-19 pandemic has brought a global structural problem to the limelight: a lack of infrastructure to help the world deal with epidemics. If there was an unexpected terror attack or a sudden cause for warfare, many advanced countries throughout the world would be prepared as they already have a suitable infrastructure. The same case cannot be made for epidemics, which can be far more disastrous than wars. With that being said, public health must begin to adapt to look more like the defense sector if countries want to better prepare for the next epidemic. If the repercussions of COVID-19 are examined, it becomes clear that very conservative estimates predict total deaths to be 200,000 people with an upper estimate between 1-2 million. Compare that to the number of deaths due to terrorism since 2001, roughly 265,000 people. From this data alone, it would not be a far step for one to think that global health and counterterrorism receive similar levels of funding. However, this is far from the case. In the United States, for example, counterterrorism received average financing of 186.6 billion dollars per year between 2002 and 2017, while the Center for Disease Control (CDC) received roughly 120 million dollars per year between 2014 and 2019. Which is about two-tenths of a percent per year of the defense budget. Likewise, the total budget for NATO in 2019 was approximately 950 billion dollars, while the annual funding for the World Health Organization (WHO) hardly sees numbers above 5 billion dollars

The discrepancies between public health and defense do not just end at funding. Every Organisation for Economic Cooperation and Development (OECD) country, and even NATO, runs simulations called “war games.” In these war games, a party assesses what their weak points are, where they are, and how to strengthen them. Strangely, we do not have a similar tool in the global health domain, which leaves us vastly underprepared for epidemics of any type. A “stress-test” that countries or the WHO frequently use to see how ready the world is to deal with the next epidemic would go a long way. Tests could range from how prepared physicians and hospitals are to handle a bulk of patients to things such as how supply chains can withstand the immense demands. 

The Bill and Melinda Gates Foundation outlined a comprehensive plan that could be used to help prepare the world for future epidemics. The first thing that must be established is a team of epidemiologists on the ground. This group would be tasked with visiting countries where the disease first strikes; a group like this would be instrumental in alerting governments and the public about what is likely to happen in the near future. Imagine them as the public health version of the marines. The next point mentioned is to have a more robust supply of health workers around the globe or at least some kind of reserve, perhaps affiliated with the World Health Organization, to boost numbers in times of crisis. Similar to how the United States has a reserve corps for the army that gets numbers up during wartime. Another component mentioned in the Gates Foundation plan is to strengthen health systems in poorer countries, as many outbreaks that get out of hand tend to start in developing nations. Think of them as you would the CIA, in charge of monitoring high-risk areas. There are two final parts of Gate’s proposed plan. The first is to pair health workers with the military to aid in improving response times, and the second is to have a noticeable increase in research and development, especially with regards to vaccines and diagnostics. While this plan would be particularly expensive, a pandemic we are underprepared for could cost the global economy anywhere from 1-4 trillion dollars. While it may be unpopular with politicians, a potential source of such funding is the defense budget. Imagine if the United States, for example, gave one percent of its defense budget towards public health. That would be an increase in funding from 20 million per year to 116 million per year, almost a 6x increase. Likewise, if the WHO asked NATO for one percent of its funding, it would have effectively doubled its budget.

While the world did not take Gates’ suggestion seriously in 2015 after the Ebola outbreak, it is apparent in light of COVID-19 that it should have. Imagine if the world had a system that resembled Gates’ idea before the spread of the novel coronavirus. The current hypothesis regarding COVID-19’s emergence is that it was transmitted via unsanitary animal consumption in a Wuhan wet market. If there was an increased level of public health in more impoverished areas, such as Wuhan, the use of unsanitary animals might not have occurred. Thus, COVID-19 might not even have emerged. However, if the virus emerged with the Gates Foundation’s plans considered, a team of epidemiologists that encountered the virus early in its spread would have been able to better prepare countries around the world. A group like this would provide the world with a head start with regards to developing adequate tests for the virus and efficient methods to flatten the curve. Such a head start, coupled with advances in research and development, would help countries avoid harsh measures such as closing their borders and instituting quarantines. Hopefully, countries around the world will reflect on this time and recognize their potential overconfidence. Perhaps, this will push us towards being able to build a global health defense system that will better prepare us for the next epidemic.