This study demonstrates that Asia faces high risks for global health security (GHS). The risk is made greater because of uneven capacities to respond among different countries and fragmented public health networks beyond influenza response, further demonstrated by the impacts of the coronavirus disease 2019 (COVID-19) pandemic. The study provides a comprehensive review of the capacity and gaps in Asia's GHS networks and U.S. agencies' GHS efforts in the region. The study includes recommendations aimed at helping U.S. policymakers develop practical steps to reassert GHS leadership in Asia with a whole-of-government approach under the 2024 U.S. Global Health Security Strategy (GHSS).
In this study, we demonstrate that Asia faces high risks for global health security (GHS). The risk is made greater because of uneven response capacities among different countries and fragmented public health networks that lack capacities to respond to health risks beyond influenza. Our analysis (Table 1) leads us to conclude that the region could benefit from a new regional agency, such as the Africa Centres for Disease Control and Prevention (Africa CDC) or the Pacific Public Health Surveillance Network (PPHSN). Efforts to establish such an agency would undoubtedly face geopolitical challenges, which would affect the funding and connectedness of the new agency with country-level and multilateral agencies. We highlight that the United States has been the world's leading donor and technical supporter for GHS and has a long history of strengthening Asia's public health systems through the work of multiple health, development, security, and diplomatic agencies. However, we also note that U.S. agencies' coordination and missions could be better aligned to support the region's health security agenda. Overall, our study provides a comprehensive review of the capacity and gaps in Asia's GHS networks and U.S. agencies' efforts, including those of the U.S. Department of Defense (DoD), with recommendations aimed at helping U.S. policymakers design and implement practical steps to reassert GHS leadership in Asia under the 2024 U.S. Global Health Security Strategy (GHSS).
Table 1. Summary of Research Questions and Associated Findings
Research Question
Findings
Why is Asia a GHS hot spot?
High population density, rapid economic growth, increased mobility, and climate change all contribute to Asia's global connectivity and its potential for disease transmission.
The challenge of responding to a pandemic or other disease outbreak can have varying impacts across the region, as the countries in Asia possess uneven capacities for disease prevention, detection, and response.
Other factors influencing countries' preparedness include the uneven distribution of economic resources and infrastructure, as well as idiosyncratic styles in risk communication.
What are Asia's existing global and regional health security networks, and what are the gaps?
The longest-running and most-comprehensive health security networks in the region are global influenza networks, including the OFFLU animal influenza network and scientific data platforms.
Main regional health networks include World Health Organization (WHO) regional offices and WHO's initiatives, PPHSN, the Indo-Pacific Centre for Health Security, the Mekong Basin Disease Surveillance cooperation, the Association of Southeast Asian Nations (ASEAN), and the ASEAN Plus Three cooperation.
Key gaps in existing networks include a lack of effective mechanisms and willingness to share resources and information across different platforms, a singular focus on influenza, insufficient capacity and a slow pace of action, complex dynamics between WHO regional offices and other local stakeholders, and a lack of coordinated efforts to combat misinformation.
How have U.S. development, diplomatic, and military agencies contributed to Asia's health security?
The U.S. Centers for Disease Control and Prevention (CDC) has been a global leader in facilitating public health emergency management. CDC's Field Epidemiology Training Program has provided 80 countries with skilled field epidemiologists. The agency has 12 country offices and three regional offices in Asia and can galvanize regional coordinators to enhance training and capacity regarding infectious disease response.
The U.S. Agency for International Development (USAID) is another key implementer of the GHSS; at the time of publication, USAID was working with 24 Asian countries and funding programs on bilateral and multilateral health projects.
The U.S. Department of State (DOS) coordinates the U.S. President's Emergency Plan for AIDS Relief and houses the Biological Engagement Program, which focuses on biological security assistance and capacity building. DOS established the U.S. Bureau of Global Health Security and Diplomacy (GHSD) to provide government strategy development and streamline interagency global health efforts.
DoD generally plays a secondary role to civilian organizations in enhancing pandemic preparedness but is able to provide assets and resources that extend the reach and effectiveness of other U.S. agencies in Asia. DoD also facilitates civil-military collaborations with Asian partners.
What health security challenges and opportunities lie ahead for the United States in Asia after the coronavirus disease 2019 (COVID-19) pandemic?
One persistent obstacle has been the lack of a regional comprehensive organizing structure or venue for collaborating among the many GHS stakeholders in Asia.
Critical barriers to functional U.S. interagency collaboration include (1) global health activities that are embedded in many programs, with disparate planning cycles, funding sources, and local partners; (2) lack of a standard information-sharing platform; and (3) lack of standard global health language and knowledge across different U.S. agencies.
Other challenges include geopolitical tensions and trust issues, the tarnished reputation of U.S. and international health organizations after the COVID-19 pandemic, and regional funding constraints.
Recommendations
Build on the new GHSS's whole-of-government approach and the establishment of the GHSD to support better coordination, data platforms, and communication channels among key U.S. global health stakeholders in Asia.
Strengthen U.S. global health leadership and engagement in Asia to improve regional communication and cooperation mechanisms and enhance collective resilience against future health threats.
Focus on building relationships, depoliticizing public health, and enhancing transparency in data sharing.
The research described in this article was sponsored by the Cyrus and Michael Tang Foundation and conducted by the Community Health and Environmental Policy Program within RAND Social and Economic Well-Being.
