Swine Flu and Harley Feldbaum's report on US Global Health and National Security Policy

I am plugging away through the recently posted reports on the CSIS Global Health Policy Center page (see link on right hand bar). The first one up (picked because I am a long-time fan of the author and because of it's attractive slimness) by Harley Feldbaum, Associate Director of the Johns Hopkins SAIS Global Health and Foreign Policy Initiative, is a report on the U.S. policies addressing global health threats. Take the swine flu as a perfect example of what could be considered a "national security" threat.

Harley's report is really interesting though covers a tremendous amount of ground in a very brief period. His basic premise is:

1. That U.S. policymaking is complicated by dependence on health conditions in other countries, and a lack of understanding both domestically and abroad about health issues and their implications;

2. That the U.S. response to infectious disease/bioterrorism has over emphasized defensive medical countermeasures and treatment and under-invested in prevention, strengthening of public health systems and surveillance;

3. That improvements would be an increase in focus on global surveillance and response, attention to the WHO's International Health Regulations, and "putting a high priority on meeting the health needs of developing countries".

Wow. I am especially stunned by the final sentence. What Harley means is not really what the sentence says plucked out of the report like I have done here. Put in context, the essence of the argument is that instead of focusing on specific diseases which threaten the U.S., we would do better to examine the health needs of other countries and identify common ground. In the end making other countries more able to detect and deter disease will only help us. He uses Indonesia as an example--the Indonesian government will no longer participate in the WHO program for bird flu arguing that the U.S.'s program of developing drugs from virus samples donated by poor nations, which then are made available only to wealthy western nations is inequitable.

In theory I'd like to agree that we should place a high priority on meeting the health needs of developing countries. But I'm not sure I do.

For example, at the recent CSIS launch of their commission, there was discussion about chronic disease being one of the biggest looming health threats. Should we focus on assisting other countries with chronic diseases? If not, why not? Should we focus on tropical diseases that are not endemic to the U.S.? Why not? As Harley's report says: "Other major global health problems that do not directly threaten the U.S. population or strategic interests, including negelected tropical diseases, weak health systems, and maternal health, do not share the political spotlight and thus have received little attention or funding." (pg. 11) But, why is that bad? Or, why is that good? It's my tax money, after all. I can make arguments both ways on this sentence.

I think my issue here is that the report is too brief and covers a vast amount of territory. While it's attractive to make uncomplicated arguments, and I admittedly picked his report because it was thin, I am aware of the sweeping language and all the dangers that can attend such language.

The report is really well worth a read, and it touches on the most pressing contemporary problems relating to biosecurity. These are THE problems of today, elegantly presented.