Recent months have seen a rise in geopolitical tensions and discord, much of which has material impacts on biological and health security: the USA have withdrawn from the World Health Organization; the largest donors of humanitarian aid, including the UK, the Netherlands, France, Germany, and the USA have reduced or cut funding for critical development and health programmes; and the USA have imposed tariffs on every other nation, leading to rapid escalation in retaliatory measures.
These macro-geoeconomic shifts risk directly affecting the health of millions of people. Rapid modelling and analysis of the consequences of the aid cuts to HIV programmes alone predict up to almost 3 million HIV deaths by 2030–primarily in sub-Saharan Africa. Beyond the moral or ethical considerations involved, allowing diseases to spread uncontrolled through populations threatens cross-border biological security. These actions will undoubtedly result in morbidity and mortality in populations and countries beyond those where cuts to programmes will be immediately felt.
As an independent think tank with a mission to transform global resilience to extreme risks, we are deeply concerned by the biological risk that cutting development assistance presents. We understand that the economic conditions motivating these cuts are not easily fixable. Institutional donors face prioritisation decisions requiring meaningful tradeoffs, which means that shrinking budgets must work smarter to support coordinated approaches to cross-border health challenges. Cutting health programmes abroad is a false economy: infectious diseases which proliferate abroad will ultimately reach patients at home, carrying high costs to healthcare systems, with antimicrobial-resistant infections already costing the NHS 180 million GBP per annum; and severely affecting workforce productivity, with up to 75% of the economic burden of influenza-like illnesses in the USA coming from productivity losses.
When it comes to infectious disease, no one is safe until everyone is safe. Every infection is an opportunity for pathogens to mutate, regardless of whether they are bacterial, viral, parasitic or fungal. More infections lead to more mutations. More mutations lead to the development of mechanisms to evade medical countermeasures (i.e. a rise in antimicrobial resistance) and even evade our immune systems. In short, we will reap what we sow.
Thus far, medical countermeasures have been spared from the escalating trade war. We welcome this and urge continued restraint on all sides, with a permanent exemption of critical health and biological security materials from tariffs. In war, healthcare facilities are notionally protected from attack under Article 18 of the Geneva Convention (although legal experts have pointed to loopholes exploited in recent years). The supply of medical countermeasures should likewise be protected from the ongoing trade war. Wars have a propensity towards unintended escalation, so we urge all nations to explicitly keep critical health supplies out of the fray.
Like-minded countries can take steps today to mitigate the potential future inclusion of medical countermeasures in this trade war. For example, European countries have found the political will to draw close and form a “coalition of the willing” in support of the defence of Ukraine; they must do so again in the context of biological security. The geopolitical headwinds facing the international community strongly signals that the era of “minilateralism” has dawned. This consists of flexible and fluid groupings of countries coming together for defined purposes or to achieve common aims, regardless of their broader political alignment–mirroring the “Pathway 1” predictions made in the UK Ministry of Defence’s Global Strategic Trends document.
Just as Western European nations formed a small coalition of partners with similar aims and founded the European Coal and Steel Community, open trading economies must today consider a “Guns and Drugs Community” (to put it crudely). Industrial strategy must be carefully coordinated to ensure effective friendshoring–as we recommend in our recent report, “Boosting UK supply chain resilience to mitigate catastrophic biological risks“. Through minilateral collaboration, partner nations can mutually bolster each other’s resilience to biological events while stimulating trade and inward investment. Such minilateral arrangements also open the door to novel ways of strengthening biological resilience in those countries worst affected by development assistance cuts, including by building manufacturing capacity in the Global South for medical countermeasures and opening up new markets for existing manufacturers.
Ministers declaring that “the globalisation era has ended” may seem like a signal of bleak times ahead. Instead, we urge policymakers in all countries dedicated to open trade and biological resilience to see this time of flux as an opportunity to draw closer to allies and to build new partnerships in pursuit of collective approaches to cross-border threats. Biological security is national security; by working in tandem with like-minded partners, we can improve the security, prosperity, and resilience of our countries.
