Revitalizing Canada’s Commitment to the Global Health Security Agenda

Introduction  

The ongoing COVID-19 pandemic is the world’s worst humanitarian disaster since the second world war. It has overwhelmed most countries of the world, including geopolitical powers like the United States and China, elevating complex health emergencies as an international policy priority. Now in its third year, the COVID-19 pandemic has impacted every aspect of society and the economy, not just health. Additionally, the pandemic emergency has revealed structural weaknesses in the global security architecture, the short-sightedness of conventional security thinking, and the inability of multilateral institutions to manage disparate socio-economic aftershocks. 

The global pandemic experience underscores the importance of harnessing multilateral partnerships in anticipation of a more complex threat environment. To prepare Canada for a more dangerous world, special attention must be given to broadening the federal government’s security policy aperture and devising innovative ways of incorporating global health threats into its long-range, strategic planning activities. In that regard, the federal government’s much-anticipated Indo-Pacific Strategy and the forthcoming Africa Strategy, provide a momentous opportunity to revitalize Canada’s commitment to multilateral participation while safeguarding the country’s national interests in a more volatile and unforgiving world.

Impact of the Global COVID-19 Pandemic 

Worldwide, the number of serious COVID-19 infections are down but excess deaths remain high compared to other respiratory diseases. The World Health Organization (WHO) reports that as of 21 October 2022, there were 623.8 million confirmed COVID-19 cases and 6.55 million deaths¹. Weekly reporting from the WHO indicates that new COVID-19 infections increased 6% and that mortality rates decreased by 17%, suggesting a high rate of population immunity has been achieved through a combination of COVID-19 vaccination and infection. However, these figures need to be treated with caution due to limitations in COVID-19 surveillance systems (ie., uneven sequencing capacity, test reductions). Many people who die from COVID-19 in countries around the world are not tested for the disease. In fact, recent analysis shows that the COVID-19 pandemic was responsible for 18.2 million deaths (as of 31 December 2021).²  

The global COVID-19 pandemic remains a serious social and economic burden for many low-income countries. The most effected regions and countries have paid a high price for the combined effects of bureaucratic disfunction, oversimplified policy assumptions, inter-agency coordination failure, and a lack of political resolve to prepare for large-scale global health challenges. Persistent inequalities and chronic underfunding of primary healthcare services have led to excessive and preventable deaths. In many countries, the social contract between the citizen and state is being strained while emergency laws are being manipulated to stifle dissenting political viewpoints. The pandemic has also reversed human development gains for the second year in a row. More than one billion people have fallen into deep poverty and 250 million may experience extreme hunger. Furthermore, UNESCO estimates that 1.5 billion students internationally experienced learning disruptions because of prolonged school closures³. The “spillover” effects of the global pandemic also extend to traditional national security issues. In a 2021 survey of United Nations offices and affiliated organizations conducted by the United Nations Counterterrorism Executive Directorate (CTED), 44% of respondents indicated that they perceived the global pandemic had increased the terrorism threat in their respective area. ⁴

What this means is that countries with pre-existing conditions like endemic corruption, structural inequality, chronic indebtedness will have to much work smarter to maintain essential health care service delivery going forward. The International Monetary Fund (IMF) anticipates that the global economy will contract by $4 trillion between now and 2026.⁵

Lessons from the Global Pandemic Response 

In May 2021, the Independent Panel for Pandemic Preparedness and Response that was commissioned by the World Health Organization (WHO) found that countries that exhibited agile leadership qualities and which emphasized coordinated, multisectoral and science-based approaches had greater success dealing with the initial phase of the global pandemic. The experts also determined that knowledge mobilization (ie., licensing, intellectual property sharing) between high-income and low-income countries was too slow. Ultimately, what allowed the pandemic to evolve into a catastrophic human crisis was a mixture of poor strategic choices, reluctance to address persistent inequalities, and a failure of coordination.⁶ 

The panel of experts also judged that the initial pandemic response demonstrates that public health institutions largely forgot the lessons from previous infectious disease outbreaks (ie., SARS in 2002, H1N1 in 2009, and MERS in 2015). The failure to prepare adequately for the shock of the global pandemic has seriously weakened the ability of many healthcare systems to withstand another unexpected shock. Given the high probability of another infectious outbreak in the near future, the world’s fragile health systems could be wrestling with acute financial, scientific, technological, and political challenges for an indefinite period.  

Even though infectious disease outbreaks are happening more frequently in the 21st century the underlying cause of these public health emergencies is poorly understood. Several context-specific factors such as inadequate vaccine coverage, scientific modeling limitations, public skepticism about the efficacy of new vaccines, chronic mistrust of politicians and public officials, and poor working conditions can all be determinants of regional health security. The complex interaction of these social determinants can sometimes be hard to monitor and analyze in real-time, particularly when data collection is irregular, substandard, or non-existent. This can result in critical knowledge gaps about the geographic origin, transmission vector, and severity of an infectious disease outbreak. Moreover, health outcomes can be positively or negatively skewed by developments (ie., social support networks, technological advances) outside of the health system as well as covert activities beyond the control of local authorities (ie., illicit wildlife trafficking).  

Canada’s Health Security Performance  

Much like the al Qaeda attacks against urban targets in the United States on 11 September 2021, the COVID-19 pandemic is a warning sign about the urgency of enhancing global health security cooperation. Notwithstanding the fact that the 9/11 terrorist attack and the global COVID-19 pandemic belong to a rare category of catastrophic disasters, there are important distinctions which are fundamental to understanding how security threats are evolving in the 21st century and what national governments must do in preparing and adapting to them.    

Regrettably, the Canadian federal government has been less proactive and more reactive when it comes to safeguarding the country against novel security threats and high-impact disaster scenarios. Health Canada, as an example, was completely blindsided by the global COVID-19 pandemic even though in 2015, departmental representatives had taken part in a strategic foresight exercise on the future of Asia which raised the possibility of a global pandemic originating in southern China⁷. Likewise, the Public Health Agency of Canada (PHAC) – the federal department responsible for public health, emergency preparedness and response, as well as infectious disease prevention and control – failed to issue an early warning alert when the virus was first detected in the Chinese city of Wuhan (December 2019)⁸. The Public Health Agency of Canada (PHAC) also failed to assess the impact of the infectious disease outbreak denying national and local officials crucial information they needed to mobilize an effective emergency response. 

The COVID-19 pandemic immediately overwhelmed Canada’s health security architecture even though it receives $308 billion (or 12.7% of GDP) in annual funding. COVID-19 vaccinations were delayed in Canada because the country lacked an adequate vaccine manufacturing infrastructure, resulting in unnecessary excess deaths and enormous pressure on the country’s hospitals. In 2020, Canada’s health system reached a breaking point much with much fewer hospitalizations than the United Kingdom and the United States. A shortage of hospital intensive care units (ICU) in Canada forced regional health officials to impose sweeping public health restrictions (ie., social distancing, lengthy school and office closures, travel restrictions) and to redirect critical healthcare resources to deal with surging COVID-19 infections. Insufficient capacity at overburdened emergency wards translated into extended suffering and premature deaths. By January 2021, in-person visits for hypertensive heart disease and diabetes plunged by 60% and 87% respectively⁹. Although video and mobile service providers expanded the country’s telehealth infrastructure to reduce the pressure on front-line health workers, 11,581 patients in Canada died while waiting for delayed medical procedures between 2020 and 2021. 

In parallel to the deadly pandemic, Canada’s public health infrastructure and research institutions had to contend with a burgeoning cyber threat. In March 2020, the Canadian Centre for Cyber Security warned that Canadian health organizations involved in the national response to the pandemic (ie., medical research, manufacturing, distribution, and policy-making organizations) were at risk of an elevated cyber security risk¹⁰. The adverse effects of the global pandemic also extended to Canada’s national security and intelligence (S&I) community. Intelligence agencies had to work at a reduced capacity because of federal health regulations implemented to contain the spread of the SARS CoV-2 virus. Maintaining a baseline security threshold meant that the Canadian Security and Intelligence Service (CSIS), for example, had to revise its operating protocols, including rotating staff on weekend and evening shifts. Other government departments including intelligence review bodies had to revise their business continuity plans which were not suitable for a prolonged disruption on the scale of a global health pandemic.¹¹ 

Adapting to a Complex Security Future   

The future of Canada’s health security is fundamentally linked to comprehensive efforts aimed at reversing the reckless destruction of animal habitats, preventing environmental “tipping points” that could be irreversible, and even eradicating the world’s deadliest infectious diseases. An increasing amount of research suggests that zoonotic diseases (ie., Tuberculosis, Ebola, Zika, Rift Valley Fever, Avian Influenza, Dengue Fever) tend to persist in low-income countries because of the dynamic interplay of socioeconomic and environmental drivers. In fact, six in every 10 human diseases are zoonotic. Some of the most troublesome trends in zoonotic disease outbreaks are in Africa which increased 67% between 2012 and 2022.¹²   

The distressing rates of wildlife viruses infecting human populations underscores the urgent demand for improved surveillance, forecasting, and response capabilities at all government levels. In today’s hyperconnected world, an infectious disease outbreak in one part of the world can pose considerable danger to at-risk population groups everywhere. According to the World Bank, the estimated cost to implement preventative measures could vary from $10.3 billion to $11.5 billion whereas the economic impact of managing the pandemic amounts to about $30.1 billion annually¹³. For that reason, intelligence agencies and the academic research community are working in parallel to detect, monitor, and analyze potential health security risks. Although infectious diseases are far less deadly than non-communicable diseases (ie., cardiovascular diseases, chronic respiratory diseases, cancer, and diabetes), which account for 41 million premature deaths annually¹⁴, it is nevertheless crucial that national governments commit to developing a “full spectrum” understanding of today’s disease geographies and to realistically assess their internal capacity for anticipatory thinking and agile coordination. 

How the federal government plans to address the mounting uncertainty arising from the convergence of global health risks and other international security threats is unclear. Canada’s national security strategy has not been updated since it was released more than 15 years ago. Consequently, the federal government lacks a clear vision about how to best facilitate the transition to a post-pandemic recovery and to ensure the country has the resilience to bounce back from a future health emergency of an equal or greater magnitude. 

Since Canada’s security and intelligence community lacks the lawful mandate and the analytical capability to prepare integrated assessments on non-traditional threats like anti-microbial resistance or climate-induced migration, it is doubtful that national or regional policymakers are adequately informed about the strategic challenges looming in the not-too-distant future. Even more troubling, Canada’s national security thinking lacks the requisite agility to cope with the random “spill-over effects” of human (ie., cyber attacks, bioterrorism), zoonotic (ie., infectious diseases), and environmental (ie., climate change, species extinction) threats. 

Ensuring that Canada remains protected against all future infectious disease outbreaks, regardless of their geographic origin, source, or type (ie., accidental or deliberate) is a formidable policy challenge. Existential health emergencies like a virus-enabled pandemic – which could potentially strike at any time – require aggressive, coordinated, and sustained action not reactionary whole-of-government responses. Therefore, it is unreasonable for the federal government to expect that it can safeguard Canada’s democratic values and strategic interests with a conventional security framework based on a siloed approach to risk management. 

Recalibrating Canada’s Foreign Policy  

Concerns about capability gaps in the international pandemic response has prompted impressive investments designed to strengthen the global health security architecture and make it better prepared and more responsive to future emergencies. In May 2021, the World Health Organization (WHO) launched a Pandemic and Epidemic Intelligence Hub in Berlin, Germany¹⁵. Canada is also strategically placed to shape the global health security agenda given its long-standing membership in multiple international security alliances, multilateral institutions, comprehensive trade agreements, and intergovernmental organizations. For example, Canada is the fifth largest member donor of the World Health Organization (WHO), a central pillar of the global health security architecture. Canada’s $900 million in contributions for global health priorities in the past decade have included $100 million in support for the World Health Organization (WHO) Health System and Response Connector and $15 million for the WHO Strategic and Preparedness Response Plan, giving special attention to Africa. An additional $1.4 billion has been earmarked for global health programs in FY 2023-24¹⁷. Canada also supports the World Health Organization (WHO) with research funding for environmental health and non-communicable diseases at its 30 WHO collaborating centers across the country. Integrating these program supports within a recalibrated foreign policy agenda would send a strong diplomatic signal that Canada is serious about its treaty obligations under the International Health Regulations (IHR) and committed to revitalizing its bilateral and multilateral partnerships. 

Cultivating a Responsible Statecraft: The Indo-Pacific and Africa 

An unpredictable and unforgiving world in which cascading security risks are more common requires a more responsible statecraft which aims at translating the lessons learned from the COVID-19 crisis into actionable policies, cultivating a more nuanced understanding of converging security challenges, and building an enabling environment for bilateral and multilateral cooperation. 

The federal government’s pledge to develop separate foreign policy strategies for the Indo-Pacific region and continental Africa present an historic opportunity to develop a responsible statecraft framework that clarifies Canada’s role in the evolving global health architecture and defines its overarching priorities. At its core, a responsible statecraft should aim at facilitating constructive engagement on a series of overlapping security and health-related issues. Two of Canada’s most recent foreign policy announcements are positive signs that the policy thinking in Ottawa might be trending in that direction. For example, in June 2022, Global Affairs Canada (GAC) announced its intention to establish a new embassy in Kigali, Rwanda, and a dedicated mission to the African Union in Addis Ababa, Ethiopia. The addition of two diplomatic missions presents an opportunity for Canada to broaden its health security partnerships while the Africa strategy is still in the early development stage. Ensuring that each of the 22 Canadian missions in Africa are staffed with Health Attachés would be a cost-effective way to strengthen Canada’s international relations and to build a public health security network that extends far beyond the Five Eyes (ie., United States, United Kingdom, Canada, Australia, New Zealand) intelligence community. 

To that end, Canada and Japan have agreed to negotiate a General Security of Information Agreement (GSIA). The bilateral security agreement with Japan, announced in October 2022, is significant because it contains an Action Plan of initiatives covering six policy areas (ie., health security, rule of law, the environment and climate change, free trade promotion, disaster relief, and peacebuilding). Building trusted relationships at the bilateral and multilateral level may not prevent the next pandemic, but they can help to advance a strategic dialogue on ways of making the global health security architecture more agile and responsive.    

Clarifying Canada’s Role and Responsibility

Canada’s strategic engagement in the Indo-Pacific and Africa is long overdue. The federal government has not released a foreign policy statement since 2017, about three years before the onset of the global pandemic. Furthermore China was only mentioned once while India was not referenced at all. Absent a comprehensive foreign policy strategy, the Government of Canada will not have an authoritative statement which clearly articulates its intentions and interests to the rest of the world. 

This regrettable situation is in stark contrast to Canada’s security allies and trade partners which are much better at clarifying their international role and providing “roadmaps” to guide their actions. For example, both the European Union and the United States have issued multiple regional and sub-regional strategies for both the Indo-Pacific and Africa. Indo-Pacific strategies have also been issued by Japan, Australia, India, and the Association of Southeast Asian Nations (ASEAN). Other European countries such as the United Kingdom, France, and Germany have released Indo-Pacific Strategies. Given the Indo-Pacific’s vast geographic scope, it is unsurprising that the regional strategies of India, Japan, and France also recognize the centrality of Africa, especially in the technology, maritime, and health security domains. A more interesting foreign policy question is how African countries – which have long-established diplomatic relations with the European Union through the Joint Africa-EU Strategy and formal dialogues like the EU-AU summits – plan to define their role in the Indo-Pacific region. 

Ultimately, Canada’s hard-won reputation as a middle ranking global power depends on its ability to bring forward constructive policy solutions on shared human security concerns and which foster agile cooperation amidst increasing geopolitical competition. A productive first step would be to broker strategic dialogues with a view to expanding its security policy aperture. Fortunately, there is no shortage of opportunities in the year ahead. Starting in November 2022, Egypt will host the Conference of the Parties (or COP 27), a United Nations climate summit expected to attract 35,000 people including world leaders, government officials, and subject matter experts. In addition to climate finance and water security there will be a focus on Africa. 

In March 2023, the Netherlands and Tajikistan will co-host the United Nations 2023 Water Conference (formerly the 2023 Conference for the Midterm Comprehensive Review of Implementation of the UN Decade for Action on Water and Sanitation, 2018-2028). A few months later, the United Nations General Assembly (UNGA) will convene the Sendai Framework for Disaster Risk Reduction Midterm Review to assess collective progress on reducing existing disaster risk and to coordinate accelerated action. In June, Lithuania will host the annual summit of the North Atlantic Treaty Organization (NATO) where representatives of the 30-member treaty alliance will undoubtedly discuss the effects of climate change on security as well as the space technology capabilities that NATO brings to monitoring various natural hazards (ie., landslides, floods, and large forest fires). In September 2023, the SDG Summit (formally the United Nations High-level Political Forum on Sustainable Development) will study the global effects of multiple, interlinked crises and prepare policy guidance to accelerate coordinated action in advance of the 2030 deadline. 

Global health security can only be achieved with agile cooperation at all government levels. Since global cities have been at the forefront of international response operations and COVID-19 pandemic recovery plans, the Canadian federal government should consider using its convening power as a G7 country and founding member of the G20 to petition for the inclusion of cities as full-fledged partners at multilateral fora. It would be an opportunity to showcase innovative diplomatic efforts such as the Healthy Cities Research Initiative – a Canadian national research fund dedicated to improving health domestically and internationally by maximizing the health-promoting potential of cities – as well as the Partnerships for Municipal Innovation: Women in Local Leadership – a six-year project led by the Federation of Canadian Municipalities (FCM) focusing on the Indo-Pacific (Cambodia, Sri Lanka) and Africa (Benin, Ghana, Zambia). 

Today’s international security environment is crowded, and the global COVID-19 pandemic has further complicated the situation for Canadian policy makers and security practitioners. As such, the federal government must maintain a clear-eyed perspective on what it can reasonably achieve amidst a looming global recession. Even before the pandemic, the federal government embarked on a deficit spending trajectory which critics cautioned could not be justified over the long-term. Ottawa now has little fiscal room to meet its growing budgetary demands. Some security trade-offs may be unavoidable if Canada fails to prepare adequately today for tomorrow’s global health threats.   

Conclusion 

The COVID-19 pandemic has highlighted the need for greater investments in building and strengthening national capacity to better anticipate public health emergencies with plentiful lead time for proactive decision-making. In addition to the early identification of unusual health trends, particularly those emanating from countries with pre-existing insecurities and low performing healthcare systems, a responsible approach to global health security demands a sophisticated understanding of different health threats and their potential disruptive capacity. With so many different and interacting health-related security issues to monitor, containing infectious disease outbreaks close to the source as possible is ideal. As such, the promised Indo-Pacific strategy and Africa strategy represent an historic opportunity for Canada to recalibrate its foreign policy agenda using a responsible statecraft framework that creates synergies among all the processes at play in the post-pandemic transition. 

¹ World Health Organization, “WHO Coronavirus (COVID-19) Dashboard,” (accessed 24 October 2022). https://covid19.who.int/.

² Haidong Wang et al., “Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020–21.” The Lancet (10 March 2022). https://www.thelancet.com/action/showPdf?pii=S0140-6736%2821%2902796-3.

³ United Nations Educational, Scientific and Cultural Organization (UNESCO), “UNESCO’s Education Response to COVID-19,” (20 October 2022). https://www.unesco.org/en/covid-19/education-response/initiatives.

⁴ United Nations Security Council, Counter-Terrorism Executive Directorate, “Update of the COVID-19 Pandemic on Terrorism, Counter-terrorism, and Countering Violent Extremism,” (June 2021). https://www.un.org/securitycouncil/ctc/news/impact-covid-19-pandemic-terrorism-counter-terrorism-and-countering-violent-extremism-update.

⁵ The International Monetary Fund, “Navigating a More Fragile World.” Speech Delivered by Kristalina Georgieva, IMF Managing Director,
Georgetown University, Washington, D.C (6 October 2022). https://www.imf.org/en/News/Articles/2022/10/06/sp-2022-annual-meetings-curtain-raiser.

⁶ The Independent Panel for Pandemic Preparedness & Response, “ COVID-19: Make it the Last Pandemic,” (May 2021). https://theindependentpanel.org/wp-content/uploads/2021/05/COVID-19-Make-it-the-Last-Pandemic_final.pdf.

⁷ Policy Horizons Canada, “Anticipating Disruptive Change for Asia, 2030,” Future of Asia Study (1 December 2015). https://horizons.gc.ca/en/2015/12/01/anticipating-disruptive-change-for-asia-2030/.

⁸ Office of the Auditor General of Canada, Pandemic Preparedness, Surveillance, and Border Control Measures.
(March 2021). https://www.oag-bvg.gc.ca/internet/English/parl_oag_202103_03_e_43785.html.

⁹ Canadian Medical Association, “A Struggling System: Understanding the Healthcare Impacts of the Pandemic (November 2021). https://www.cma.ca/sites/default/files/pdf/health-advocacy/Deloitte-report-nov2021-EN.pdf.
.  

¹⁰ Government of Canada, Canadian Centre for Cyber Security, Alert (AL20-008 – Update 1), “Cyber Threats to Canadian Health Organizations,” (20 March 2020). https://cyber.gc.ca/en/alerts-advisories/cyber-threats-canadian-health-organizations.

¹¹ Stephanie Carvin, “Canadian National Security Operations During COVID-19,” in Leah West, Thomas Juneau, and Amarnath Amarasingam eds., Stress Tested: The COVID-19 Pandemic and Canadian National Security (2021). Calgary: LCR Publishing Services.

¹² Lisa Schlein, “WHO: Zoonotic Disease Outbreaks on Rise in Asia,” Voice Over of America, (14 July 2022). https://www.voanews.com/a/who-zoonotic-disease-outbreaks-on-rise-in-africa/6658751.html.

¹³ World Bank Group, “Putting Pandemics Behind Us: Investing in One Health to Reduce Risks of Emerging Diseases,” (October 2022). https://openknowledge.worldbank.org/handle/10986/38200.

¹⁴ World Health Organization, Newsroom, “Noncommunicable Diseases” (16 September 2022). https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases.

¹⁵ World Health Organization (WHO), “WHO, Germany Launch New Global Hub for Pandemic and Epidemic Intelligence,” Joint News Release (05 May 2021). https://www.who.int/news/item/05-05-2021-who-germany-launch-new-global-hub-for-pandemic-and-epidemic-intelligence.

¹⁶ World Health Organization, “Canada: Partner in Global Health,” (12 May 2022). https://www.who.int/about/funding/contributors/can.

^{17 Government of Canada. Global Affairs Canada, Departmental Plan 2021-22 (2021). https://www.international.gc.ca/transparency-transparence/assets/pdfs/departmental-plan-ministeriel/2021-2022-eng.pdf.}

^{18 Government of Canada, Global Affairs Canada, “Address by Foreign Minister Freeland on Canada’s Foreign Policy Priorities,” (6 June 2017). https://www.canada.ca/en/global-affairs/news/2017/06/address_by_ministerfreelandoncanadasforeignpolicypriorities.html.}