Global Health Security is National Security

René F. Najera, MPH, DrPH
5 min readOct 10, 2017
Cholera patients in Haiti, courtesy of CDC.

When I was a child, I remember seeing the men in the town I grew up in getting ready to travel into the United States. Most of them didn’t have “papers” to get into and work in the US, but they did it anyway. They gathered their few belongings and headed into the desert to make the treacherous trip into a foreign land.

It wasn’t until I was a teenager that it became clear to me why they did it. Mexico is not exactly a poor nation, but it is deeply affected by income and social inequality. The rich are very rich, and the poor are very, very poor. As it turns out, the men and women leaving Mexico for the United States belong to the very poor. Their situations were dire, so they looked to the north to jobs that pay relatively well. That is, when faced with an intolerable situation, they picked up and left for a better place.

The hardships they faced on the way there didn’t deter them.

The flow of undocumented immigrants continues to this day. People in very poor places of the world get up and go, and many come to the United States. They endure some very horrible situations, all the horrible things that come with being cargo in the human trafficking machine. Against all odds, the majority of them get here.

Last year, we saw an acute version of what happens in the Americas happen in Europe. Refugees from the Syrian Civil War made the treacherous march from Syria, through Turkey and into the rest of Europe. In some places, they were met with violence. In others, they were met with kindness. In either case, they’re in Europe, and — much like undocumented immigrants in the United States — they’re not going home any time soon.

The United States is lucky that vaccine rates in Latin America are reasonably high. All of those cases of measles popping up lately? They’re not caused by immigrants. Rather, they’re caused by “freedom loving” Americans refusing to vaccinate. The current outbreak of hepatitis A in San Diego is also not because of undocumented immigrants but because of a system where homeless people are treated like third-class citizens. Both measles and hepatitis A are vaccine-preventable infections, by the way. If all parents whose children can be vaccinated did, and all homeless people received comprehensive health care, those two outbreaks would likely not have happened.

There is currently a civil war occurring in Yemen, a country on the southern tip of the Arabian Peninsula. The war is so terrible that all the basic services are broken down to barebones or just non-existent. As a result, a man-made epidemic of cholera is well underway. In the six months since the beginning of the epidemic, over 750,000 cases of cholera have been repeated.

Once Yemeni refugees begin to march out of their country, they’re taking cholera with them.

Then there is the island-nation of Madagascar. It is dealing with an outbreak of Yersinia pestis, the Plague. (Yes, the same plague of the Black Death.) While it is endemic (naturally occurring at a consistent rate) in Madagascar, Plague is also treatable with antibiotics. A good surveillance system with a quick distribution of pest control and antibiotics would likely keep it under control, or even eliminate it. But Madagascar is a poor country in the Indian Ocean, off the east coast of the African Continent. They cannot afford an adequate response.

While there is no current refugee crisis out of Madagascar, anyone can go there and back to the US in about 24 hours for about $1,500. Anyone from Madagascar can be in Europe in 12 hours for much less. Or they can travel to any number of African nations in less time and much, much less money. (I used to look at airfare out of Ivato International Airport.) If you remember from history class, Plague got to Europe on ships. It’s not outside the realm of possibilities that it makes its way there, or here, on airplanes.

Finally, for the purposes of this post, there is Venezuela. While Venezuela is not in a full-fledged civil war, it might was well be. Civil unrest and political strife has caused their economy to all but collapse. Medical services are scarce. Measles is making a comeback. If things don’t turn around there soon, measles won’t be the only infectious disease becoming epidemic. Like other places in the world, people will make their way away from violence and toward stability, carrying those infections with them.

A lot of the national security concerns in the United States are associated with terrorism or rogue regimes (or a combination thereof). Very little is being done about these health crises around the world. (Very little when compared to what could be done.) To make matters worse, there are several plans out there to cut funding from the Centers for Disease Control and Prevention. Cut those funds, and CDC cannot work at home or abroad to contain these diseases, allowing them to make their way here.

But we have a robust healthcare system, right? Well, we do and we don’t. Medical technology is of the highest class here in the United States, but access to it is sorely lacking. Just ask all the people within a few miles of Johns Hopkins Hospital in Baltimore who have diabetes, high incidence/prevalence of HIV, and other conditions if being that close to a world-class hospital has prevented or controlled their diseases.

In the event of a major epidemic in the United States, the public health system and hospitals/clinics would be strained to the maximum. Emergency declarations would be made, budgets would be shifted, and people would be scared. (Politicians would make idiotic pronouncements about quarantines, or they would deny science in favor of popular/populist stances.) As Indiana learned with their recent HIV epidemic, delays in public health responses cost lives and livelihoods. An epidemic of plague, measles, or cholera, no matter how big or small, would be a major disruptor.

So what do we do? The best way to stop these things from coming here is to stop them from happening at all. Diplomacy to contain civil unrest and prevent war must include aid to stand-up public health and health care systems. Aid to foreign nations should include verifiable interventions against diseases and conditions that can spread and cause trouble. Spreading Democracy without spreading good public health and infrastructure is worthless.

Anything short of that is useless.



René F. Najera, MPH, DrPH

DrPH in Epidemiology. Associate/JHBSPH. Adjunct/GMU. Epidemiologist. Father. Husband. (He/Him/His/El)