Advancing the Global Health Security Agenda To Achieve a World Safe and Secure From Infectious Disease Threats

Overview

Introduction

Executive Order 13747, issued by President Barack Obama on November 4, 2016, focuses on enhancing global health security through the advancement of the Global Health Security Agenda (GHSA). This initiative aims to accelerate the enhancement of partner countries’ capabilities to prevent, detect, and respond to infectious disease threats, whether they occur naturally or are deliberate or accidental. The EO seeks to coordinate efforts across various U.S. agencies and international bodies to support the goals established by the International Health Regulations (IHR) of the World Health Organization (WHO) and other global institutions.

Purpose and Scope

This directive mandates the establishment of the GHSA Interagency Review Council to ensure the United States' commitments are fulfilled in coordination with other nations and international organizations. By requiring collaborative efforts across different federal departments and agencies, the EO sets forth the responsibility to carry out activities pertinent to the GHSA goals. Specifically, it emphasizes the need for strategic partnerships and integrated action plans, highlighting the interdependence of global health systems in countering biological threats.

Strategic Context

The EO underscores the notion that health security is a component of national security, reflecting the lessons learned from past outbreaks, such as the Ebola crisis in West Africa. By embedding GHSA within the strategic planning and budgeting processes of U.S. agencies, the directive makes health security a federal priority. Its multifaceted approach implicates a variety of stakeholders, including public, private, and international partners, to collectively mitigate and manage health risks that could transcend borders.

Mechanism of Implementation

Key to the implementation of this EO is the systematic coordination among agencies like the Departments of State, Defense, Health and Human Services, and others. Each body is tasked with distinct roles, ranging from diplomatic engagement and financial oversight to on-the-ground technical expertise and programmatic functions. The Council, convened by the National Security Council staff, acts as a hub for policy development, progress review, and interagency coordination, meeting at least quarterly to deliberate on policy-level guidance and dispute resolution.

Global and Domestic Coordination

This directive integrates U.S. efforts with international frameworks, promoting collaboration with organizations like the WHO, Food and Agriculture Organization (FAO), and INTERPOL. The EO provides a framework for shared support among nations toward achieving GHSA targets, fostering a collective responsibility to bolster global and domestic health capacities. Furthermore, it outlines the necessity for an external evaluation of U.S. domestic efforts to reassure public accountability and transparency.

Legal and Policy Implications

Constitutional and Statutory Implications

While the EO operates within the executive branch's powers to direct foreign relations and national security policy, it does not explicitly alter statutory frameworks or contravene congressional authority. It exercises presidential powers to organize the executive branch’s approach to international health security under existing laws and constitutional provisions related to national defense and the welfare of the nation.

Impact on Federal Agencies

The EO necessitates significant administrative adjustments within federal agencies, mandating a reevaluation of strategic priorities to align with the GHSA objectives. Federal departments are required to assign senior officials to oversee GHSA-related activities and ensure that these are embedded in strategic planning and budgetary allocations. This represents both a procedural shift and a commitment of agency resources to fulfill the EO’s objectives.

Policy Changes and Interagency Dynamics

By creating the GHSA Interagency Review Council, the EO implements a structured forum for policy-level guidance and coordination amongst agencies. This facilitates a cohesive federal response to global health threats, reducing overlap and enhancing the efficiency of U.S. contributions to international health initiatives. There is an implicit expectation for improved interagency cooperation and information sharing, which can have long-term benefits in standardizing practices across agencies.

Relationship with International Law

The EO aligns U.S. policy with international health standards, particularly the WHO’s IHR, reinforcing compliance with global health security initiatives. It complements international legal frameworks by integrating U.S. commitments into broader global objectives and leverages international partnerships to achieve collective health security goals. This interconnection reinforces U.S. leadership in global health policy and establishes pathways for reciprocal international cooperation.

Budgetary Considerations

The directive underscores the need to evaluate U.S. financial commitments to the GHSA in the context of other donor inputs. While it does not specify funding levels, it implicitly requires a reallocation of existing resources within the federal budgetary process to support GHSA activities. This highlights a potential area of inter-branch discourse, especially in negotiations over federal appropriations to sustain these activities.

Who Benefits

Global Health Community

The primary beneficiaries of Executive Order 13747 are the international community and global health systems, particularly those in low- and middle-income countries that receive support to strengthen their health security capabilities. By bolstering the health infrastructure in these nations, the EO indirectly benefits global health by reducing the likelihood of widespread infectious disease outbreaks.

U.S. Federal Agencies

Federal agencies with mandates related to public health, defense, and international development stand to gain from a clear framework guiding their efforts. Agencies such as the Department of Health and Human Services and the Centers for Disease Control and Prevention benefit from institutional clarity and interagency support, allowing for more focused and efficient use of resources in combating global health threats.

Private Sector and NGOs

The EO's call for coordination with nongovernmental stakeholders, including the private sector, offers businesses and nonprofits opportunities to contribute to global health security initiatives. Companies involved in health technologies, pharmaceuticals, and healthcare delivery can find new markets and collaborative prospects, enhancing their business opportunities while contributing toward public health goals.

International Institutions

Organizations like the WHO, FAO, and INTERPOL benefit from the U.S.'s formalized commitment to coordinate efforts in responding to infectious diseases. The EO reinforces these bodies' missions by aligning U.S. resources and policies with global health standards, supporting their objectives through technical expertise and financial commitments.

U.S. Public and Global Populations

Ultimately, the EO aims to safeguard populations globally, including U.S. citizens, from the threat of infectious diseases. By mitigating risks at their source, improving global health infrastructure, and fostering early detection and response, populations worldwide benefit through enhanced safety and reduced incidence of pandemics that could threaten lives and disrupt economies.

Who Suffers

Resource Allocation Conflicts

While the EO does not explicitly harm any group, it may indirectly impact those reliant on existing federal programs if resources are redirected towards GHSA initiatives. Agencies might face internal budgetary pressures and prioritize GHSA targets over other programs, potentially affecting domestic health initiatives or other areas deemed less critical relative to global health security goals.

Federal Agencies' Workload

Staff within federal agencies may encounter increased workloads owing to new responsibilities and the emphasis on interagency collaboration. This could lead to operational strain without corresponding increases in workforce or budget, complicating efforts to meet both global health objectives and domestic responsibilities.

Potential Critics and Opponents

Critics of international collaboration frameworks may view the EO as prioritizing international obligations over domestic needs. Skeptics who argue against global interdependence and advocate more insular policies could see the increased commitments as conflicting with national interests, especially if perceived economic or policy concessions are made to fulfill international targets.

Healthcare and Pharmaceutical Sectors

Despite potential benefits, there is a possibility of friction within sectors incompatible or slower to adapt to the harmonized standards and practices that the EO seeks to promote. Entities that are slow to align with new regulations and coordination efforts could experience transitional adversities, potentially affecting product development cycles and market dynamics.

Budgetary Constraints Across Agencies

Competing priorities within the federal budget mean that agencies seeking additional resources to fulfill GHSA objectives might encounter constraints, leading to scaling back of other initiatives. This can unintentionally harm communities that depend on federal programs now constrained by reallocated funding or diluted administrative focus.

Historical Context

Precedents in Global Health Policy

Executive Order 13747 builds upon a lineage of U.S. commitment to international health security, echoing earlier initiatives like PEPFAR (President's Emergency Plan for AIDS Relief) and the Global Health Initiative. It represents continuity in integrating public health as a key component of foreign policy and national security frameworks.

Obama Administration’s Health Legacy

Coinciding with the Affordable Care Act's domestic transformations, the EO underscores the Obama administration's agenda to link health with broader policy priorities, demonstrating comprehensive strategies that encompass both local and international dimensions of health security and prevention.

Influence of the Ebola Crisis

The directive is a direct reaction to crises such as the 2014-2016 Ebola outbreak, which exposed vulnerabilities in global response systems. The spread and impact of Ebola highlighted the need for strengthened international preparedness and collaboration, reinforcing lessons on the interconnectedness of health systems worldwide.

International Collaborations under Evaluation

The EO contributes to an evolving global narrative, advocating for integrated health systems and cross-border collaborations. It reflects ongoing debates about sovereignty, international responsibilities, and the efficacy of multilateral approaches in addressing health challenges that exceed national capacities.

Political Landscape and Attitudes

Amid rising nationalist sentiments globally, the EO’s emphasis on multilateralism reflects a counter-narrative promoting global cooperation. It navigates the political complexities of advancing U.S.-led health initiatives while balancing diplomatic considerations and international partnerships.

Potential Controversies or Challenges

Budgetary and Resource Allocations

One central challenge is aligning the necessary budgetary and resource commitments with the ambitious objectives outlined in the EO. Legislative backing may be required to ensure sustainable funding, potentially facing scrutiny from Congress, where competing budgetary priorities may overshadow international health commitments.

Interagency Coordination Issues

The need for proactive and seamless coordination across various federal agencies introduces complexity, posing risks of bureaucratic inertia and interdepartmental disagreements. The efficacy of the Interagency Review Council will be tested in its capacity to harmonize diverse agency agendas and facilitate coherent policy implementation.

International Diplomatic Engagement

While the EO promotes international collaboration, it may encounter diplomatic sensitivities, especially concerning sovereignty and the extent of U.S. influence in partner countries’ health systems. Balancing leadership in global health with respect for national boundaries can pose intricate challenges in diplomatic relations.

Potential Legal Disputes

Legal challenges could arise if any perceived overreach of executive authority occurs, particularly in cases where agencies push the boundaries of their mandates under GHSA. Opposing interests may litigate against perceived infringements on autonomy or shifts in agency focus that neglect congressional priorities.

Effectiveness and Implementation Critiques

The EO's success largely hinges on tangible outcomes in health security improvements, which may face scrutiny regarding actual progress versus intended objectives. Critics may question the effectiveness of such policies, especially if external assessments reveal gaps or deficiencies in achieving desired health security infrastructure enhancements.