Opening Address at the Advancing Global Health Security: From Commitments to Actions’ meeting

27-29 June 2016, Bali, Indonesia

Honorable ministers, distinguished representatives, dignitaries, ladies and gentlemen,

The importance of attaining global health security is more accepted today than at any other time in history.

In recent years the health security paradigm has broken through the margins of discourse to become a central concern of public health organizations as well as diplomats and foreign policy thinkers. This is a welcome departure from times past.

Since the mid-19th century, when the first set of guidelines to control the international spread of acute diseases were adopted, nation states have often dismissed health security as secondary to other strategic interests.

In the post-war era, despite legal obligations to the contrary, disease epidemics were often covered up rather than reported, leading to the punitive use of trade and travel restrictions that could decimate livelihoods and the economies on which they depend. Neither health nor ‘high’ politics benefitted.

Within this environment the role of international organizations in promoting and facilitating health security was, naturally, limited. The need for this to change has been clear for some time.

In recent years new diseases have emerged at unprecedented rates, while old diseases such as cholera and tuberculosis have made aggressive comebacks. Antimicrobial resistance, meanwhile, is already killing upwards of 700 000 people worldwide every year.

Transnational food production means industrial oversights can compromise the health of millions worldwide, while international trade and travel has the capacity to vastly accelerate a pathogen’s spread. The 2003 SARS pandemic was, after all, initiated by a single infected traveler who stayed overnight at a busy Hong Kong hotel.

Alongside these phenomena, climate change and mass urbanization have gathered pace, with significant consequences for the way each one of us lives.

For the 11 countries of the WHO South-East Asia Region, which comprise 26% of the world’s population, achieving IHR compliance and enhancing health security is vitally important.

In recent years these states have faced the full range of emerging health security threats, including from SARS, MERS-CoV, pandemic influenza (including H1N1) and Zika virus. South- East Asia is also uniquely disaster-prone. Since the 2004 Indian Ocean tsunami, which killed an estimated 230 000 people, earthquakes, floods and cyclones have ravaged the Region with varying frequency.

Breakdowns in trust and cooperation in the past demonstrate the urgency with which these values must be pursued in the present.

In 1994, for example, India was isolated and shunned overnight after it reported a suspected outbreak of bubonic plague in Surat, an industrial hub in Gujarat. Despite widespread panic and confusion, authorities controlled the situation within two months.

More devastating than the outbreak, however, was the international reaction to it. Cargo transshipments were suspended, exports were embargoed, flights were cancelled and travel bans implemented. India lost an estimated 1.7 billion dollars and suffered a record trade deficit.

The irrational zeal with which states isolated India compromised the foundations of health security and created disincentives to report future epidemics. Wisely, the revised IHR places transparency and trust at the top of its agenda.

Regulatory oversights can prove equally devastating. In 2004 South-East Asia was impacted by the H5N1 avian influenza outbreak that threatened global health and decimated core economic interests. As legitimate fears of the highly pathogenic influenza strain mounted, mass poultry culls were carried out in affected countries in a bid to limit its zoonotic spread.

Between the start of the epidemic and 2013 181 people in the Region succumbed to the disease, which also cost billions of dollars in lost revenue. The pathogen’s cross-border transmission underscored mutual vulnerabilities in food production processes that could have been avoided with better cooperation and international regulation.

The episode provides a salient example of how weaknesses in one country can threaten all. It has also become a catalyst for greater cross-border regulation between countries in the South-East Asia and Western Pacific Regions.

Importantly, threats to health security often have little to do with health systems themselves, underscoring the need for a ‘One Health’ approach that promotes multisectoral awareness and action.

In South-East Asia, as across the world, major threats to human health emerge from many places. The inappropriate use of antibiotics in the animal and agricultural sector, for example, is diminishing the effectiveness of antimicrobials in humans. To take another example, the criminal manufacturing of counterfeit drugs compromises the wellbeing of patients across the Region as well as the control of life-threatening diseases.

Both issues require coordinated, multisectoral solutions, and both require the buy-in of the whole of society. The principles underwriting health security and the One Health approach offer a way out.

Though states are, ultimately, responsible for complying with the IHR and strengthening their own preparedness and response capacities, non- state actors must step-up and assume greater responsibility in providing guidance and assistance. Indeed, as global health actors we must go beyond merely setting the rules of the game, and become active participants. That is exactly what we are doing.

As you are aware, last year’s Cape Town meeting on health security preparedness laid the groundwork for where we are today. That meeting itself was an outcome of the need for a more robust preparedness and response framework demonstrated by the Ebola outbreak in West Africa the previous year.

As we gather here today we can be proud of the fact that this constitutes the first international and global meeting organized by the new Outbreak and Health Emergencies program that was adopted at the 69th World Health Assembly. WHO now has the mandate to move forward with the design, results framework and budget that has evolved out of the reform consultation process.

The development of the emergencies program is the result of a thorough reform effort that is aimed at providing fast, effective and predictable responses to health emergencies. And it is also aimed at addressing the full risk management cycle of prevention, preparedness, response and early recovery.

Reflecting momentum at the global level, WHO South-East Asia has built on efforts to help countries strengthen health security and achieve IHR compliance. In the past few years alone this has had tremendous impact.

The retrofitting of hospitals in Nepal, for example, meant that when last year’s earthquake hit the health system was in a position to implement mass casualty management procedures and respond effectively.

In similar fashion, efforts to enhance Thailand’s surveillance system enabled health authorities to identify and halt transmission of incoming cases of MERS-CoV, a highly infectious and oftentimes lethal disease.

In Maldives, Zika preparedness and response plans are ensuring the archipelago nation is ready and able to respond to any outbreak of the vector-borne pathogen.

And right across the Region, national AMR action plans will prove vital to combating the problem.

As WHO leads the push for greater health security via its new emergency program, regional political and economic groupings are taking note. In the South-East Asia Region, ASEAN, BIMSTEC and SAARC have all, to varying extents, integrated health security concerns within their agendas.

This is also happening at the global level, as evidenced by the G-7’s recent Ise Shima Vision for Global Health, which reinforces support for IHR and the commitment of G-7 countries to facilitate international compliance.

The Global Health Security Agenda, meanwhile, is leveraging the comparative expertise of developed and developing countries across the world to advance capacities in core areas of health security via the achievement of clear and measurable targets.

As this groundswell builds, multilateral financial institutions such as the ADB and World Bank are creating new avenues for resource mobilization. The Strengthened Support for Regional Health Security initiative and the Pandemic Emergency Financing Facility, for example, will both have a positive impact on health security across the world. The momentum and commitment we are currently seeing will only grow.

Honorable ministers, ladies and gentlemen,

As we work towards greater health security we must take care to avoid undesirable side-effects. Although health security is concerned with preparing for and responding to fast-evolving threats, this tendency must not distort its proper conception, nor prejudice donor priorities and public health diplomacy.

Poor health infrastructure and endemic diseases such as tuberculosis, HIV-AIDS and malaria undermine health security as much as the specter of bioterrorism or the next great pandemic. Their banality must not lead to distraction. Weak health systems were foundational to the 2014 Ebola outbreak in West Africa, for example, and continue to imperil citizens of developing countries across the world. By extension, they imperil all of humanity.

As states move beyond narrow understandings of strategy and interest, approaches to health security must be equally far-sighted. To this end, strengthening health systems and achieving universal health coverage must occur alongside other initiatives to advance cooperation and mutual trust.

Strong health systems provide the most effective means to contain and eradicate the infectious diseases of old, and provide the first line of defense against emerging diseases of pandemic potential. They also ensure a rapid and effective response to acute public health events such as natural disasters and environmental emergencies. Stability and growth are similarly well served.

This more robust understanding of health security is something that we must all push for. Thankfully, it is gaining traction.

The Sustainable Development Goals emphasize the importance of achieving universal health coverage. The 2015 Sendai Framework makes explicit the need for strong and resilient health systems to protect against all hazards. And state-driven emergency preparedness and response frameworks are being complemented by a renewed emphasis on health system strengthening as a core part of public health diplomacy.

As WHO leads international and global efforts to further hone the health security agenda at this conference and the many others taking place in the coming year, we must all keep the overarching goal of attaining universal health coverage uppermost in our minds. Similarly, we must also reflect on the importance of the One Health approach and the role effective partnerships can play in fast-tracking its realization.

Honorable ministers, ladies and gentlemen,

As I mentioned at the beginning of this speech, the health security agenda is more important now than it has ever been. We are working on a concept that has truly come of age and which is desired by states and their citizens the world over.

We must be conscious of the responsibility which accompanies this and work to ensure that the greatest outcomes for public health are pursued with vigor and clear-headed resolve. Together we have the opportunity to hardwire altruism into the global system and make people’s health central to international affairs. History is on our side, ladies and gentlemen, but we must harness its force wisely.

With this in mind, I wish you a productive and engaging conference.

Thank you very much.