Health plays an influential role in fostering economic growth and sustainable development. Because of its indirect impact on human development, better health boosts rates of economic growth and contributes to wealth creation. In the past decades, new healthcare challenges and emerging infectious disease outbreaks have drawn global attention particularly in developing countries like Pakistan. Traditionally, health and security occupied separate domains, but in recent years the imperative fusion between health and national security has been recognized by policymakers, security and defence analysts in both developed and developing countries. The last two or three decades have seen sharp rise in non-traditional threats to national security, such as infectious diseases. There are many lines of attack that infectious diseases can intimidate national security i.e. increased rates of morbidity and mortality, massive damage on public health and health infrastructure, political instability, and economic volatility.
Emerging and reemerging infectious diseases, and their pandemic potential, pose a challenge to national security in the 21st century that cannot be overlooked. Though, the historical threat to national security by epidemic diseases is not new; the threat has increased in recent past and is growing rapidly in Pakistan. Correspondingly, reemergence of mosquito-borne infections such as dengue, chikungunya, zika, and more virulent forms of malaria and new more severe forms of viral respiratory infections have evolved. Pakistan is one of several countries, which together bear 95% of the burden of infectious diseases, and the trend is on the rise. According to statistics, Pakistan had not been able to control the burden of communicable diseases like tuberculosis, malaria, dengue fever, typhoid, hepatitis, cholera and other infectious diseases. Malaria, dengue, polio, and tuberculosis, are among the top killers. Pakistan is ranked fifth on the list of high-burden TB countries, and worst of all; Pakistan is one of the three remaining countries where poliomyelitis, also called polio, is still endemic. An average of about one million lives claimed yearly by malaria (estimated 12% of the rural population is believed to carry malaria parasites in their blood) and anticipated mortality rate of 48 thousand deaths per year as a result of TB cases. Similarly, infectious diseases are the biggest killers of children in Pakistan, causing 60% of all child deaths under 5 years of age.
At present, Pakistan is facing multiple challenges in healthcare, which can be broken down into social issues, technical constraints, lack of trained human resources, infrastructure, effective legislation and policymaking, awareness and negligence. The structure and function of the current healthcare system in Pakistan is far below international standards and ranked at 122 out of 190 countries in terms of healthcare standards. Pakistan does not have an organized healthcare system; even health priorities are not properly defined by present government (except Health-card). There is no evidence of strong political will, and inter-ministerial and inter-departmental conflicts, corruption, awful governance, and lack of correspondence are rampant to cope with national health security issues.
Epidemiologically, the behavior of epidemic is usually compared to previous outbreaks. The reemergence of Dengue virus (year-to-date, thousands of dengue cases are reported and hundreds of deaths in last few months) along with the dispersion of infectious diseases geographically throughout Pakistan demonstrate that Ministry of Health (MoH) and Ministry of Defence (MoD) are not incorporated and interconnected to address the national health security issues. Likewise, research and development (R&D) for new tools and technologies to prevent, detect and respond to emerging disease threats and outbreaks have not been considered by authorities with growing need in the country. As seen with the Dengue and Chikungunya outbreaks, there is a shortage of appropriate diagnostic equipments and vaccines to manage the response and lack of regulatory framework for fast-tracking and surveillance technology, tools and techniques when rapid respond is indispensable.
To cut a long story short, health security has become a national priority in many countries, supported by loyal and devoted leadership. They are approaching health security in a holistic manner, including, social, technical, economic, diplomatic, military and intelligence-related aspects. On the contrary, the link between infectious diseases and national security is relatively a new concept in Pakistan. A new paradigm is needed that links infectious diseases to national security and recognize the broad effects of diseases on society. Response to infectious disease threats should be strategic priority of health and security agencies in Pakistan. Ministry of Defence needs to acknowledge its role in ensuring that the state’s population is fit and healthy since there are no signs that the Ministry of Defence is awakening to this responsibility. At a time when our conception of national security is evolving rapidly, we must look hard at uncertain and non-traditional threats, specifically. Today, Pakistan is facing a wide range of threats to national health security, including disease outbreaks and pandemics. As health threats are evolving, protecting Pakistan from 21st century health security threats need a clear strategic direction and teamwork between Ministry of Defence and Ministry of Health. Of course, with uncertainty and ambiguity, a large amount of work is needed to bring analytical clarity to the national health security paradigm.