A new report by the US Intelligence Community highlights what the world stands to lose if it fails to cooperate on global health. The National Intelligence Estimate (NIE) “Dynamics Shaping Global Health Security In the Next Decade” outlines the dire effects of climate change, changing demographics, and the erosion of trust in institutions on global health security. The NIE on Global Health Security was made publicly available in April 2024, on the heels of the Biden-Harris Administration’s launch of a new Global Health Security Strategy.

Looking out to 2033, the NIE assesses global health security dynamics in the wake of the COVID-19 emergency. “As the international community moves on from the COVID-19 pandemic,” notes the report, “strained national and international health systems, pandemic fatigue, contested narratives and misinformation, and competing global priorities, including shifting donor attention and funding, are increasing the risk of backsliding on gains made in health security since 2021.”

The NIE illustrates progress the intelligence community has made in recognizing security risks outside of a traditional military framing and applying a transdisciplinary lens to their analysis. Unfortunately, the report fails to apply that same transdisciplinary lens to solutions, instead focusing narrowly on emerging technological advances and the expansion of COVID-19 era responses.

Climate Looms Large

“During the next decade, climate and societal changes almost certainly will strain global health resources and increase the risk of significant health emergencies,” warns the report. Fifty years of health gains will potentially be reversed by shifting disease patterns, extreme weather, increased food insecurity, and infrastructure destruction. The impacts of climate change will likely widen health inequities within and across countries and increase the fragility of socioeconomic systems.

As the downstream effects of climate change hasten declines in biodiversity, we are likely to see novel diseases emerge and lose critical ingredients for cancer drugs, antibiotics, antimalarials, and antifungals. The report notes that “nearly half of all medicines—including 70 percent of cancer drugs—are derived from natural sources.”

Climate change is altering landscapes in ways that could introduce new risks, as well. For example, melting permafrost is releasing microbes that “raise the risk of rare, reemerging, or novel pathogen spillovers.” The report references the 2016 anthrax outbreak in western Siberia that killed a child and 2,000 reindeer in the midst of soaring temperatures. That outbreak is believed to have been caused by a thawing reindeer carcass that allowed bacteria to become active again. The carcass had been frozen since 1941—the last time there was an anthrax outbreak in the region.

The Risks Changing Population Dynamics Pose

The report spotlights the impact of shifting demographics, including aging populations and rapid urbanization, on a growing prevalence of infectious disease and non-communicable diseases (NCDs). The dramatic shifts in global population witnessed over the last couple of decades have big implications for the economic and security interests of the United States, including the trajectory of global health. “Expanding populations and increasing internal migration are expected to result in 1.3 billion new urban residents worldwide by 2040,” states the NIE, “and about 80 percent of this urban growth will happen in poorer regions, including in Sub-Saharan Africa and South Asia.” Oxford Economics forecasts that the number of megacities–cities with populations over 10 million–will grow from 44 today to 67 in 2050, with the fastest growing in Africa. Yet many of these cities don’t have the resources and capacity to provide basic services for their burgeoning populations. Almost 40% of urban dwellers lack access to safely managed sanitation, notes the NIE, and outbreaks of infectious disease “are likely to become more frequent because of uncoordinated urbanization, population growth, and the expansion of international travel and trade.”   

The NIE misses an opportunity to make a salient point about the intersecting demographic and climate dynamics driving global health insecurity. People are not just moving to cities; as climate change upends livelihoods people are moving into previously wild habitats for food and livelihood sources. Further, the potential for “spillover” events (when a virus moves between animals and people) is not just driven by the movement of people; climate change is also forcing animals to seek out new habitats, bringing them in closer contact with humans, and driving biodiversity loss, a significant driver of infectious disease outbreaks.

Conflict, Public Mistrust, and Geopolitical Competition Strain Health Systems 

Climate change and shifting demographic trends are reshaping the global health landscape in new ways, but the NIE also emphasizes the global health impacts of record levels of conflict and prolonged humanitarian crises, eroding trust in governments, and disregard for international norms.

In its 2023 Global Peace Index, the Institute for Economics and Peace found that between 2022 and 2023, the total number of conflict-related deaths increased by 96%. While Russia’s war in Ukraine was a large contributor to that increase, in fact, the number of conflict deaths was higher in Ethiopia than in Ukraine in 2023.

Also driving global health insecurity is the increase in the duration of conflicts–from an average of 13 years in the mid-1980s to more than 20 years today.   

The impacts of conflict on global health are immediate and long-lasting, and not confined to conflict zones. Destroyed health infrastructure and disrupted health supply chains diminish people’s access to services. Forced displacement heightens risk of infectious diseases and limits access to basic and essential services. Food insecurity and malnutrition rise with disruptions in agricultural production, trade, and supply chains. Conflict disrupts routine immunization programs, disease surveillance, and outbreak response efforts, leading to the resurgence of preventable diseases like measles, polio, and cholera. 

The NIE also finds that health system vulnerabilities will be further compounded by a staffing shortage of at least 10 million healthcare workers by 2030 and continued public mistrust, fueled by the “uneven public health response” to COVID-19 and the pervasiveness of misinformation spread online and through state-sponsored disinformation.

How Far We’ve Come, How Much Further We Must Go

In 2022, Carol Dumaine, a former intelligence analyst, reflected on the “lost opportunity” of a new NIE on the national security impacts of climate change. That NIE, she wrote, perpetuated a narrow climate and security framing instead of taking the opportunity to “look beyond a traditional state-centric national security lens to grapple with the larger ecological, social, political, and intergenerational dynamics already arising due to climate changes and other complex, transnational challenges.” In fact, the climate and security-focused NIE failed to include any mention of COVID-19, at that time a global emergency whose impacts on health systems and supply chains were further compounded by climate change.

Two years later, the NIE on global health security dynamics manages to take a more transdisciplinary approach to assessing risks to global health security. Yet it falls short in a few areas. While it recognizes the risks posed by climate change and changing demographics, it doesn’t apply that same transdisciplinary lens to responses, instead focusing narrowly on expanding COVID-19 era investments and emerging technological advances. With climate finance ramping up, for example, why not consider the potential for climate adaptation investments to align with global health priorities?

Gender also gets short shrift, mentioned only in the context of Russia’s efforts “to weaken or block language on LGBTQIA+ and gender issues.” But as a recent WHO report points out, gender, in particular gender inequality, plays a significant role in shaping global health outcomes.

The NIE notes that the forces shaping global health security dynamics will likely widen health inequities between and within populations. This is a significant point and one that deserves further exploration, especially as inequity, perceived or real, is likely to further undermine public trust in institutions and feed the very geopolitical tensions contributing to strained health systems.

And while the NIE does put a spotlight on rising rates of non-communicable diseases, like cancer, heart disease, stroke, and chronic lung disease, it fails to mention the growing impact of the environmental pollutants, like PFAS and plastic additives, on both human and ecosystem health.

Today’s headlines already reflect the global health security dangers the NIE foresaw. In recent weeks, flooding has killed 100 people in Brazil and nearly 500 in East Africa. Brutal heat waves have forced school closures in Asia, and the US saw its second highest number of tornadoes for the month of April. A new form of mpox (previously known as monkeypox) is surging in the Democratic Republic of Congo, and last month, a Texan man became infected with the avian flu virus, which is spreading among dairy cows in several US states.

As the US intelligence community’s most authoritative written assessments of specific threats to national security, NIEs are essential for shaping policies and the allocation of resources to address emerging challenges to national interests. As governments continue to negotiate a pandemic agreement ahead of this month’s World Health Assembly, we can only hope that decision-makers will take the potential risks spelled out in this report seriously.