Kenneth W. Bernard served as a special assistant to the president for security and health during the Clinton and George W. Bush administrations.
Has our national security leadership forgotten that, in 2001, anthrax-laced letters killed five and sickened 17 others in multiple states? Or that in 2014, 11 people were treated for Ebola in the United States, resulting in two deaths and widespread panic that nearly shut down the city of Dallas? Or that smallpox killed more people in the 20th century than all the wars of that century combined?
Apparently so. In eliminating the Office of Global Health Security at the National Security Council, it seems these events have slipped the mind of newly installed national security adviser John Bolton. But he is not alone.
This marks the third time that the national security community, in both Democratic and Republican administrations, has downgraded the importance of disease and bioterrorism threats in the hierarchy of national security issues. This raises a question: What is it about international epidemics and biosecurity that so offend national security professionals that their default approach to the threat is to reorganize and eliminate it as a priority focus?
In 1998, I was finishing my posting as the international health attaché at the United Nations when Health and Human Secretary Donna Shalala assigned me to report to the Clinton White House — the first time a policy expert was sent to work full time on international health issues at the NSC.
At first, no one had much of an idea why I was there. But it became clear two years later when national security adviser Samuel R. “Sandy” Berger explained that global health threats had the potential to kill huge numbers, cross borders and destabilize whole regions. “To dismiss it as a ‘soft’ issue,” Berger wrote, “is to be blind to hard realities.”
Then in 2001, the incoming George W. Bush administration abolished the Health and Security Office, deciding it was not really the business of the National Security Council. Just a year later, after the 9/11 and the 2001 anthrax attacks, former Pennsylvania governor Tom Ridge, the president’s homeland security director, called me back to reopen the White House Health and Security Office, and both the administration and Congress gave full staff and financial support to building the portfolio.
But, alas, after President Barack Obama was elected, the office was abolished yet again. In his second term, Obama eventually was convinced that creation of his Global Health Security Agenda and the unforeseen Ebola epidemic mandated the re-creation of a senior director for global health security — a position at the NSC that continued through the first year of the Trump administration.
So Bolton’s decision is nothing new; it’s just another repeated mistake of previous administrations.
By this action, the administration has broadcast that health, as a security issue, is unimportant. From my nearly 30 years in government dealing with these issues, I know what message it sends, and, more important, what message is heard around the world.
Why does this keep happening, one administration to the next? Mostly, it is tribalism. A functional disconnect exists between health and national security, and it is based on the innate differing interests and cultures of the security tribe and health tribe. By training and inclination, they just differ on what they perceive as priority issues.
But tribalism is no longer an acceptable justification for the White House downgrading leadership on the national security aspects of global epidemics and bioterrorism. We no longer live in the 20th century where international epidemic threats were relegated solely to public-health experts.
It is time to stop pretending health security is a soft issue just because some want it to be. Epidemic disease — whether natural, accidental or intentional — will predictably recur during this and future administrations, and it will affect whole populations and economies as well as individual lives. Leadership at the White House and the NSC is not the whole solution. But without it, we are fighting while handcuffed.