U.S. Global Health and National Security Policy

The emergence of HIV/AIDS, SARS, extensively drug-resistant tuberculosis, and avian influenza, as well as the Aum Shinrikyo sarin gas attack and anthrax letters, have demonstrated the threat that certain global health issues pose to U.S. national security. The related threats of infectious disease epidemics and bioterrorism are being driven by trends related to globalization. Increased travel, trade, development, and land use are creating new infectious disease threats, and the rise of nonstate actors and the global dissemination of advances in biology and technology are facilitating the potential use of biological weapons. Underlying both threats is a growing acceptance of global interdependence on health issues. U.S. policymaking to address global health threats is complicated by a rising dependence of U.S. security on health conditions in other countries as well as weak health knowledge among foreign policy and national security decisionmakers. Overall, the U.S. response to infectious diseases and bioterrorism has overemphasized defensive medical countermeasures and treatment while underinvesting in prevention, strengthening of public health systems, and the surveillance and response capacities of developing countries. This paper recommends an increased focus on global surveillance and response capacity, heightened attention to the World Health Organization’s International Health Regulations, and putting a high priority on meeting the health needs of developing countries as core elements of a U.S. strategy to address the national security threats of emerging infectious diseases and bioterrorism.