While the World Health Organization’s International Negotiating Body (INB) continues to negotiate a global Pandemic Agreement, the US has issued its own vision for global health security and expanded its bilateral partnerships with countries across the world.

Following the release of this revamped US global health security strategy, Health Policy Watch spoke with Stephanie Psaki, the inaugural US Coordinator for Global Health Security and Deputy Senior Director for Global health security and biodefense at the US National Security Council.

Health Policy Watch: The COVID-19 pandemic illustrated that weaknesses in the public health response in one part of the world can be a threat globally. Why did the US Administration release a Global Health Security Strategy now?

Stephanie Psaki: The goal is to build on and learn from the lessons of the COVID-19 pandemic. We started working on this new strategy as we emerged from the acute phase of the COVID pandemic feeling like it’s going to be enough in our rearview mirror that we can understand and learn from the lessons and have a more forward-looking approach with how we can prevent and address the next pandemic. 

We tried to not just assume that the next pandemic or the next biological threat will be the same as COVID-19 because chances are it will take a different form. We wanted to develop a system and a process that works quickly and is adaptable, depending on different threats that can easily bring in the different parts of the inter-agency that have relevant expertise to inform decision-making.

The last global health security strategy was released in the previous administration in 2019. So the idea was to build on that, five years later. Very practically this is something that was called for in a national security memorandum as well as the Global Health Security Act, passed as part of the NDAA [National Defense Authorization Act] last year. So both Congress and the President asked us to do it.

HPW: What is remarkable about the new strategy is the expansion of global partners from 50 to over 100 countries. Partners now include countries across almost all continents. How are these countries chosen?

Psaki: There are a number of different criteria we use to select partners. You’ll see that some of them are countries where we’ve been working with for a while in global health broadly or global health security, specifically, and then some are countries where this is a new global health security partnership. 

Need is top of the list in terms of where there are gaps in their global health security capacity and their ability to detect, prevent, and respond to an outbreak. There also is political will. So these are partnerships that we formed with the countries – with the government directly to just make sure that there was interest, not just in getting government support, but also investing them domestically in global health security so that we can move the goal forward together.  

And then the third criterion is risk both to the United States and to the rest of the world in terms of an outbreak. So looking at countries where there’s emergence of pathogens that pose a pandemic threat or you know, otherwise have expressed concern about their own preparedness.

We also launched a website that lays out who the 50 countries are, how long we’ve been working with them, what we’re working with them on. 

HPW: What lessons and successes has the US learned from past partnerships that have informed expanding these bilateral agreements to new countries?

Psaki:  A long list, but I would say, you know, one of the areas that has been a priority for this administration is what what USAID [United States Agency for International Development] calls localization – really shifting the power dynamic – so that we are working in partnership with other countries rather than it being a development program or a priority that’s imposed on countries. 

The way that these partnerships are designed, and the way that we have developed, a partnership from the outset – identifying countries that have interest from the political leadership level in collaborating with the US on closing gaps that have been identified – is key to success. There needs to be political ownership at the leadership level, and then down to the level of the health workers who are working in communities. 

HPW:  The strategy also discusses evolving risks like spillover events from animals to humans, climate change, urbanization. How is One Health informing the strategy? 

Psaki: This is a really important piece of the strategy. We’ve seen that a lot of emerging pathogens are zoonotic diseases. At a basic level, in terms of how we do the work, the strategy lists the roles of different departments and agencies across the US government, and it includes US Department of Agriculture (USDA), Food and Drug Administration (FDA), and others whose primary role is animal health. That’s making sure you have the right people at the table with the right expertise and that there’s a collaborative approach to not just identifying risks, but responding to risks. 

If you take a look as well at the areas of partnership with the 50 countries, you’ll see that zoonotic disease is a common area partnership because this is something that has been identified by many other countries as well. So that includes collaboration with our traditional health departments and agencies like Health and Human Services (HHS) and USAID but it also includes technical support and assistance from USDA and some of those other parts of the government that have expertise in animal health and zoonotic disease. If you look across the departments and agencies, there’s a lot of focus on developing cohesive One Health strategies. So I know for example, the Center for Disease Control and Prevention (CDC) has a One Health office and they’ve developed a strategy on One Health to make sure that their work is informed with that perspective.

HPW: You mentioned a variety of agencies across the federal government are coordinating together. What does this inter-agency cooperation look like in the implementation of the strategy?

Psaki: Part of my role as the US Coordinator for Global Health Security is to coordinate the interagency efforts and implement the strategy. We have a structured decision-making process that has been long standing within the US government, between the agencies when we develop new policy. Much of what we spend our time on is also responding to emerging risks. 

For example, we were talking recently about the Marburg outbreak in Equatorial Guinea that happened a couple of years ago. We received identification of the risks through our CDC colleagues and also through our Embassy in Equatorial Guinea. We then worked through CDC and through USAID, which has a lot of staff and presence in the region and through the State Department and its ambassador on the ground, to engage with the government to understand what is needed to figure out how we can respond. 

That is really just pulling everyone together, having regular conversations and making sure that we’re exchanging information and leveraging the strengths of each of the different departments and agencies. 

The way that each department and agency works and even the way that we coordinate depends a lot on whether we’re responding to a threat like that or we’re responding to the need to develop a new policy. In terms of responding to threats, part of what this administration has done – and this is also quite a rigorous process – is to identify threats, assess the level of the threat and make decisions about what our response to the threat should be. And that I think is an area as a big improvement from the systems that were in place when we came in.

HPW:  Thinking more about the current Pandemic Agreement negotiations, how does the US Global Health Security Strategy fit in? 

Psaki: This strategy is really what guides the work that we are doing in global health security. It lays out a set of priorities across the administration that we are pursuing through a number of different avenues – including bilateral support. It also includes our support to multilateral institutions like Gavi, and of course, our participation in multilateral negotiations, including on the pandemic accord and the International Health Regulations. 

We’ve been really clear about what our goals and priorities are for those negotiations. Our overarching goal for our participation is protecting the American people and protecting our national security. Any decision we make, throughout those negotiations, but also through our bilateral support, is through that lens, within the pandemic accord and IHR negotiations. 

Specifically, we’re looking at a set of three key outcomes that we need to see in the final agreements and in order to support it. 

The first is to enhance the capacity of countries around the world to prevent, prepare for, detect, and respond to pandemic emergencies and provide clear, credible, consistent information for their citizens. 

Our second priority is to ensure that all countries share data and laboratory samples from emerging outbreaks quickly and transparently to facilitate response efforts, including the rapid vaccines, tests and treatments. Again, that connects directly to our bilateral support. It also connects to our national bio defense strategy, which overlays our work. 

And then the third area is to support more equitable access to and delivery of vaccines, test treatments and other mitigation measures to quickly contain outbreaks, reduce illness, and minimize impacts on economic and national security in the US and around the world. We are actively participating in these negotiations and hope that we can land the Accord and [implement] the IHR amendments to advance those goals. 

HPW:  One of the biggest points of contention in the pandemic agreement negotiations is pathogen access and benefit sharing, governing how World Health Organization (WHO)  member states share the biological material of pathogens that may cause pandemics. How has the US addressed this in its global health security strategy?

Psaki: This goes back to the point that every experience is not going to be exactly like the COVID pandemic. But if we think for example, about some of the other outbreaks that I mentioned before, Ebola, in particular, we’ve had very, very few Ebola cases in the US. It is not a major threat to the United States. And so when we are thinking about how to respond to Ebola and how to ensure that countermeasures are developed and available, to date, it has largely been to ensure that those countermeasures are available to people living in the countries where the outbreak is emerging. 

We have had a really forward leaning approach, not just in this Administration, but historically from the United States to make sure that vaccines, therapeutics and countermeasures are available when there is an outbreak based on a pathogen with pandemic potential. But also other disease outbreaks with existing vaccines, thinking about cholera, dengue, and other outbreaks around the world. 

We are by far the leading donor to respond to these outbreaks, most of which don’t have a direct impact on Americans. So when we talk about the importance of access to samples and the data early on in an outbreak, that is the quickest way to make sure that medical countermeasures are developed and available, not just to Americans but to the rest of the world. The only impact of constraining access to pathogens and data will allow the pathogen to spread more widely, and delay access to countermeasures. I would pose it the other way: what is the upside to holding back access to pathogens?

Image Credits: CSIS, US Department of State, CDC Thailand, JT Square, US Department of State, USAID .