Operationalising a new definition of health security

Progress in line with the proposed twenty-first Century re-definition of human health security
can already be seen in the Columbian policies towards Venezuelans at its border16; in regional protocols
for HIV, tuberculosis and mental health universal access and uniform standards of care in the Southern
African Development Community (SADC);17 and in Thailand’s extension of its model (s) of universal
health care (UHC) to migrants18 now being touted at the UN Global Health and Foreign Policy Initiative
(UNGHFPI). How then, can the guarantee of global health security function in this twenty-first Century
global age? Three options present themselves. These are: delegate, integrate and extend. All are
predicated on coordination, between states or between states and non-state actors. The ordering
principles of each resulting cooperation are irrelevant beyond the creation of a space wherein health
security is universally claimed (Ottersen et al., 2014).

a) Delegate: This option presumes states consolidated enough to (a) devolve particular elements
of their responsibilities to the rights of the population within their borders to another actor –
and to (b) if and when the state or the other actor decides, reassume those responsibilities. This
option would reinforce a state-based system, at least initially. It might, however, in the longer-
term, be adaptable to governance at the regional levels. This could make it flexible in the face of
changing ideational and geopolitical orderings, possibly able to cope with consolidat ing or
deconsolidating participating states, as well as potentially nimble in terms of disease
sur veillance, deployment of medical professionals, and (regionally) integrated health systems.

b) Integrate: Integrate NSAs. This option can work, under three conditions. First, states invest in
health systems strengthening (HSS) and Universal Health Coverage (UHC).19 This is foreseen in
the IHRs. Second, states coordinate the tides of medical professionals – both in- and out-flows.
Third, state-based instruments such as the IHR and the WHO are given the clout by states to be
independent of states’ priorities in order to prescribe and implement actions and sanctions. This
would have to mean, among other things, an end of earmarked voluntary funding; the creation
of a deployable force of medical professionals independent of their states (and of their states’
medevacking); and the ability to impose sanctions for noncompliance in all efforts to create a
space for the universalisation of health security claims Image 1.

c) Extend: At the global / regional levels. This option would extend the responsibility for health
security explicitly beyond states and NSAs, but bind them together in a new space. Building on
the European Union’s European Council’s 2003 Security Strategy (ESS, 2003) and the Euro pean
Union’s External Action Global Strategy (European Union External Action Service, 2016), both of
which affirm the centrality of human security to (state) security, it would centralise health
security at the Centres for Disease Control (CDC) and Prevention. The US CDC, estab lished in
1946, is now complemented by the establishment in 2004 of the European Centre for Disease
Control, and the 2017 establishment of the African Centres for Disease Control. These in turn
are connected to legal structures at the US, EU – which in 2013 promulgated the Decision on
Serious Cross-Border Threats to Health – and global levels, as well as a series of regional and
global laboratories, including the Centre for Viral Zoonoses in Pretoria, established in 2016.20
Infused with legal authority, imposable on states and NSAs alike, applicable to all people, such
an extensively webbed network could be the creation of a new health security space.
 All three options are based on compromise between aspiration and political and practical
possibility. Health security is a choice. It is a possibility. Health security is a choice between an uneven
and unequal playing field in health security that tilts in favour of state security and the human and
health security of citizens. Or it is a choice to bridge the gap between citizens and non-citizens to create
a space to claim health security and a means to guarantee this space.