Protecting the Nation from Health Security Threats

Events in the United States and internationally have shown the kinds of great stakes and consequences that often follow epidemics and disasters. Consider the series of health security shocks since 2001: National fear during the anthrax letters events, with impact on all 3 branches of the US government. The respiratory transmissible SARS and MERS viruses spreading via airplanes and hospitals, sometimes by super-spreading individual patients. Human cases of H5N1 bird flu with a case fatality rate of 50%. The sudden emergence and global spread of 2009 H1N1. The congenital malformations following Zika infections—the first mosquito-borne illness to cause such malformations. The terrible mortality and wide spread of Ebola across multiple countries in West Africa, with imposition of largescale quarantines and costly economic disruptions to trade and travel. The widespread disabling of the healthcare system during major US hurricanes. The use of chemical weapons in war in the Middle East, breaking years of international taboo against it. Discovery of smallpox in an insecure box in a US government lab. The radiation risks and uncertainties over large areas following the Fukushima tsunami and nuclear power plant accident. High-containment laboratory accidents involving important live pathogens. Beyond these events, there are other important potential threats that could cause great harm and test our systems of health preparedness in the United States and internationally, including large earthquakes, substantial terrorist attacks, and nation state or terrorist use of biological, chemical, radiological, or nuclear weapons—events that could have the potential for great loss of life. In the realm of synthetic biology, the possibility of generating novel laboratory strains that have both high lethality and are readily transmissible is an important new challenge that the world needs to manage. These are problems that have the potential to cause sickness, mortality, and disruption on a large scale. But the consequences are not limited to health. Outbreaks and other disasters can come with the potential to have an impact on economies by shutting down commerce, or by causing widespread anxiety that affects the public in ways that have ripple effects on work and spending. Some outbreaks have caused governments to make bad choices to quarantine people in ways that did not end epidemics but that did cause loss of trust in government. Some of these events have reduced confidence in and credibility of political leaders. Health security is the collective effort to prevent, mitigate, and recover from the health consequences of these kinds of epidemics, disasters, and catastrophes. In many of these events, major initial impacts are related to health and loss of life. But when health consequences of this nature and potential scale occur, or are legitimately feared, then economic, governance, political, and security consequences can quickly follow. The US government—working with partners at the state and local levels, the NGO community, the private sector, and the public—has done an enormous amount in the past 15 years to prepare for these kinds of events at home and, to a lesser extent, to help build strength abroad in ways that