Just over a year ago, Open Canada hosted an essay contest where junior scholars were asked to reflect on future defence and security challenges for Canada. In light of two major recent news stories–the coronavirus pandemic and the Canadian government’s report on foreign interference–two of those essays are especially relevant. We publish this week Dr. Jesse Kancir’s winning essay, “Time for Canada to Invest in Global Health Security”.
The importance of health security to Canada cannot be overstated. Whether it is antimicrobial resistance, bioterrorism, or the spread of disease from global transportation and migration, there is enormous potential for significant human, social, and economic impact. Consider, as an example of the seriousness of health security threats, that the Spanish Flu in 1918 ravaged populations by killing upwards of 50 million people, estimated to surpass the 40 million deaths over the entirety of World War I. One hundred years later, the threats of health security are increasing and need to be considered as a critical, ongoing defence challenge.
While Canada’s experience with Severe Acute Respiratory Syndrome (SARS) in 2003 led to a massive re-organization and strengthening of national public health infrastructure, pandemics do not respect jurisdictions and require a collaborative international approach to preparation and response. On this front, current global public health infrastructure is weak. To help mitigate these threats in the twenty first century, Canada should commit to increasing overseas development assistance focused on threat response, training of an appropriate health workforce, and in strengthening global public health and primary care systems.
ODA and global leadership
Canadian overseas development assistance (ODA) stands as the lowest percentage of GDP overall among G7 countries, fuelling a report by the House of Commons Standing Committee on Foreign Affairs and International Development for an increase in funding of ODA to 0.7 of gross national income by 2030. Simultaneously, eventually-abandoned budgetary cuts in the United States to Center for Disease Control (CDC) funding for 2019 has shown how dependent the global health community is on the institution. Channelling more financing to projects in the Global Health Security Agenda (an international partnership of governments, IGOs, and NGOs dedicated to health security) would lessen the dependency on the US in a time when the country’s willingness to participate in multilateral institutions is lessening. A focus on health security as a foreign policy objective would also strengthen Canada’s image as the current federal government looks to develop a more active leadership role in global affairs.
Health workforce training and health system strengthening
Strengthening the public health workforce is a critical way of improving responses to infectious disease outbreaks. Out of SARS was born the Public Health Agency of Canada’s Canadian Field Epidemiology Program, which has the ability to specifically train a global work force focused on detecting and responding to acute health threats. Further, the diplomatic spat in 2018 between Canada and Saudi Arabia with threats of withdrawing Saudi medical residents from Canada revealed just how much capacity there is in our system for training international medical graduates. Over time, were medical schools and federal and provincial funders willing to do so, Canada could help train an international health workforce in public health, infectious diseases, and primary care able to respond to emerging threats in high-need countries, rather than selling these seats to high-paying foreign governments. Canadian medical education — considered an international gold standard — could be used to significantly improve health security.
This training capacity could also be focused on health system strengthening. Strengthening of health systems is critical to preventing pandemics and improving responses. Untapped strengths in this area might include Royal College International or the Besrour Centre, both international branches of the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada, respectively, with an aim of advancing specialty and primary care globally. Combined, focusing on both workforce development as well as health systems could powerfully advance the health security agenda, drawing on unique Canadian strengths.
Implications for local and global equity
Finally, committing to health security internationally would come with a particular responsibility to act domestically, as well. With tuberculosis rates in Northern Canada 300 times that of other Canadians, focusing on disease outbreak would surely require the federal government to meet its pledged targets of 2030 for eliminating tuberculosis. It remains a blot on our national healthcare conscience that rates of a treatable disease like TB could remain so high amongst us. Health security, then, is also a matter of domestic reconciliation. This final point reveals the importance of health security as an important tool for advancing equity, especially among the world’s vulnerable. Disease disproportionately affects the poor, and focusing on health security ultimately is a matter of justice.
The opportunities for leadership in global health security are many. So, too, are the threats. SARS, Ebola, H1N1: disease outbreak since the beginning of the twenty first century has repeatedly taught us the importance of advancing health security. Viruses will mutate, bacteria will become resistant, and pandemics will significantly threaten population health. Reducing the potential impact of an outbreak, however, is a choice, and should be a critical focus for Canada.
Jesse Kancir is a public health and preventive medicine resident at the University of British Columbia, with graduate training in health economics from the LSE, and in public policy from the University of Cambridge. He has previously served as policy advisor to former Minister of Health Jane Philpott, and served on the boards of several national medical organizations, including the Association of Faculties of Medicine of Canada and the Canadian Medical Association.