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Saskia v. Popescu, MPH, MA, CIC, is a hospital epidemiologist and infection preventionist with Phoenix Children's Hospital. During her work as an infection preventionist she performed surveillance for infectious diseases, preparedness, and Ebola-response practices. She is currently a PhD candidate in Biodefense at George Mason University where her research focuses on the role of infection prevention in facilitating global health security efforts. She is certified in Infection Control.

The Realities of Global Health Security

MAR 24, 2017 | SASKIA V. POPESCU
The role of infectious disease as a precipitator for global security issues has been an especially hot topic lately. While some experts, like Andrew Price-Smith, look to the damaging effects that disease can have on national security, others may see it as a less direct causal relationship. Regardless of where you stand on the threat that infectious diseases have on national security, it simply cannot be denied that in today’s world of globalization, there is a very real gap between preparedness, response, and the realities of outbreaks.
 
In fact, Bill Gates has recently sought to publicize the looming threat of infectious diseases, particularly in terms of the potential for biological attacks. Despite the advances in biotechnology and developments of new vaccines for diseases such as Ebola and others, he notes the actions we need to take to “protect against a naturally occurring pandemic are the same things we must prepare for an intentional biological attack. What we need to do is prepare for epidemics the way the military prepares for war. … I’m optimistic that a decade from now, we can be much better prepared for a lethal epidemic—if we’re willing to put a fraction of what we spend on defense budgets and new weapons systems into epidemic readiness.” 
 
We may have made advancements in biotechnology; however, the actual application of diagnostics, vaccines, and drugs during an outbreak is often delayed and sub-par. The growing applications of genome editing mechanisms such as clustered regularly interspaced short palindromic repeats (CRISPR) is also considered a concern for intentional bio-attacks. The do-it-yourself genome editor with nefarious intentions has many worried about what might be cooked up in some one’s home lab.

Aside from the concerns about biological attacks, Bill Gates makes a pivotal point regarding the link between health security and international security. He recently wrote an article for TIME magazine the cuts made to foreign aid and how that makes America less safe. Compared to Price-Smith, Gates is much more of a pragmatist in terms of the impacts that infectious diseases and global health issues have on American safety. Will an outbreak in Uganda result in an economic crisis or war in the United States? Chances are pretty slim, but what Gates hones in on is the rippling effect that these outbreaks and public health crises have across the globe.
 
That old saying, “an outbreak anywhere is an outbreak everywhere” has a lot of merit in today’s overly connected world. The American HIV/AIDS program, PEPFAR, is a great example in that it has helped 11 million people survive HIV diagnosis by way of providing medication. PEPFAR has some fascinating secondary outcomes though, as Gates notes, “political instability and violent activity in African countries with PEPFAR programs dropped 40% between 2004 and 2015. Where there was no PEPFAR program, the decline was just 3%.”
 
When we focus on infectious diseases and pull back the reigns they have on so many countries, we see an increase in teachers, police officers, health-care workers, and more as people are able to survive, educate, and thrive. Additionally, if children survive to adulthood, parents may decide to have fewer children since they are confident in their health and survivability, which means the burden of feeding, housing, and on resources are less strained.
 
Unfortunately, this is just the tip of the iceberg in terms of the impact infectious disease plays on global issues. Ebola is a prime example of an outbreak in a foreign country impacting American safety. Preparedness for Ebola alone cost US hospitals $360 million. The issue is that we often look at infectious diseases as single events—a single outbreak of an emerging infectious disease, a single attack with anthrax, or a single laboratory failure. It is important to address the full spectrum of infectious disease threats to global health because global health security translates to overall international security. 
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