It’s Time to Separate Public Health from National Security

Coronavirus is bad, and it’s expected to get worse. In a period when confidence in the US government’s ability to handle any challenge is perhaps lower than ever, there’s a sense of profound insecurity in the face of an epidemic that seems poised to overtake the country. This is partially attributable to the Trump administration’s resolutely chaotic approach to policymaking — but it’s building on a much longer history of skewed priorities that have left the US scrambling to craft an adequate response.

The response to coronavirus so far suggests that it’s past time to develop and fund public health policy beyond its role as an aspect of national security. The connection between the two fields has been sustained for the past two decades at the institutional level, where resources are disproportionately weighted toward coping with malicious threats and civilian disasters are addressed with military solutions without receiving similar levels of funding as military initiatives. But it must also be reexamined at the level of policy planning and priorities, as in this case, when the fact that the virus originated in China seems in part to be guiding the US’s chaotic and punitive approach.

In the wake of September 11 and the anthrax attacks that followed shortly after, a new sense of vulnerability seemed to confirm latent fears about bioterrorism and brought public health firmly into the realm of national security. Funding for public health initiatives increased massively as the federal government focused its resources on preparing for potential attacks and assumed responsibility for planning and preparedness that had previously been concentrated at the state and local levels. In 2002, Congress funded the Public Health Security and Bioterrorism Preparedness and Response Act, part of an overhaul of public health in the United States that reimagined it as a key component of national security.

Most official responses to the virus betray this fatal blind spot.

In its framing and its effects, the reforms to the US public health system after September 11 privileged bioterrorism as the key large-scale threat to public health, solidifying the way we think about pandemics today: not as a frightening side effect of vulnerable human bodies living in a globalized society, but as a war against a foreign aggressor.

Most official responses to the virus betray this fatal blind spot: from cringey, unsupported insinuations that the virus is a bioweapon to President Trump’s assertions at a recent rally that “border security is also health security” to Nancy Pelosi’s call for an “affordable” vaccine in a country where nearly 30 million people are uninsured. It’s hard to avoid the conclusion that the health and safety of people living in the US is somehow secondary, that the threat posed by a pandemic has less to do with the health of the people who will get sick and die than one might initially assume.

In her often-quoted article “Sex and Death in the Rational World of Defense Intellectuals,” Carol Cohn identifies a very similar phenomenon in the speech of defense intellectuals, for whom the “real subject” is not humans who might be killed, wounded or maimed by the bomb but “the weapons themselves”:

“[…]if human lives are not the reference point, then it is not only impossible to talk about humans in this language, it also becomes in some sense illegitimate to ask the paradigm to reflect human concerns. Hence, questions that break through the numbing language of strategic analysis and raise issues in human terms can be dismissed easily.”

Similarly, the national security state is designed first of all to protect the territorial security and wholeness of the US, even over the welfare of those living there. The health insurance and pharmaceutical industries, in turn, are constructed first of all to generate profit. Producing life-saving drugs and making sure that those who need them get them is demonstrably a secondary concern — and this is a real risk factor when it comes to controlling coronavirus.

With confirmed cases in the low triple digits, an epidemic in the US is still mostly a (well-founded) fear. Now, in an election season, people in the US sizing up their chances in the event of a serious outbreak have a chance to reimagine a government that measures security first of all in the health of the people living within its borders.

This renewed sense of insecurity has prompted calls for Medicare for All, which would provide comprehensive healthcare free at the point of service to all residents of the United States. As someone who spends her workdays thinking and writing about national security policy and her nights and weekends organizing for Medicare for All, I am struck by how transformative a single-payer system would be for the health, safety and prosperity of nearly everyone living in the US.

A single-payer system would also be cheaper overall, allowing for more efficient use of resources and saving thousands of lives — and that’s when there’s no terrifying epidemic to worry about. Providing healthcare to everyone regardless of their ability to pay will allow the US to meet the disasters and public health challenges to come not by waging a war with ordinary people caught in the crosshairs, but by allowing people to lead the charge by keeping themselves and those around them healthy, come what may.

Emma Claire Foley is a Program Associate at Global Zero. The views and opinions expressed in this article are those of the author and do not necessarily reflect the views of Global Zero.