Health Security Intelligence

Michael S. Goodman, James M. Wilson, Filippa Lentzos

• Publisher: Routledge
• Year: 2021
• Print ISBN: 9781032157382
• eBook ISBN: 9781000532470
• Topic: History
• Subtopic: Military & Maritime History
• Index: History

Health Security Intelligence introduces readers to the world of health security, to threats like COVID-19, and to the many other incarnations of global health security threats and their implications for intelligence and national security.

Disease outbreaks like COVID-19 have not historically been considered a national security matter. While disease outbreaks among troops have always been a concern, it was the potential that arose in the first half of the twentieth century to systematically design biological weapons and to develop these at an industrial scale, that initially drew the attention of security, defence and intelligence communities to biology and medical science. This book charts the evolution of public health and biosecurity threats from those early days, tracing how perceptions of these threats have expanded from deliberately introduced disease outbreaks to also incorporate natural disease outbreaks, the unintended consequences of research, laboratory accidents, and the convergence of emerging technologies. This spectrum of threats has led to an expansion of the stakeholders, tools and sources involved in intelligence gathering and threat assessments.

This edited volume is a landmark in efforts to develop a multidisciplinary, empirically informed, and policy-relevant approach to intelligence-academia engagement in global health security that serves both the intelligence community and scholars from a broad range of disciplines.

The chapters in this book were originally published as a special issue of the journal, Intelligence and National Security.

The West Africa Ebola outbreak (2014-2016): a Health Intelligence failure?

Robert L. Ostergard Jr.

ABSTRACT

The role of health intelligence (HI) has received little assessment in the West African Ebola outbreak (2014-2016). Using newly declassified information on the outbreak, this research finds significant HI problems that hindered an appropriate response to the outbreak. The Guinean government’s low capacity to deal with the crisis, the government’s misleading assessments of the crisis, the US embassy’s failure to contextualize the information properly in terms of the risks the virus posed, and the US embassy’s willingness to accept the Guinean government’s assessment without criticism were contributing factors in the HI failure in the opening months of the Ebola outbreak.

Introduction

In the aftermath of the 2014–2016 Ebola virus outbreak in the three West African countries of Guinea, Liberia, and Sierra Leone, the international community, public health officials, and other analysts have dissected the events to discover how the crisis escalated and what could have been done to prevent it. While much of these analyses have focused on institutional responses from the international community, few analyses have examined whether problems focused in the area of health intelligence may have contributed to problematic assessment of the crisis unfolding in West Africa. This research focuses on the role of health intelligence and the assessment of that intelligence in understanding how the outbreak got so far out of control in such a short period of time.

The research unfolds in three parts. First, the paper examines the concept of health intelligence and its usefulness in assessing risks from epidemic outbreaks. Next, it highlights the important problem of risk assessment when the risk comes from a human security issue and not a direct overt military threat. Then it surveys the unfolding events of the Ebola outbreak from March of 2014 when the Guinean government announced that there had been an Ebola outbreak to September of 2014 when the US President Barak Obama declared the outbreak a national security concern to mobilize a US military response. In doing so, this research focuses on newly released classified documents obtained from a Freedom of Information Act request that highlight the Guinean government’s insufficient response to the outbreak, and the reaction of US embassy personnel in Conakry to Guinea’s response. These documents highlight significant deficiencies in the assessment of the situation as it unfolded during this period of time.

Health intelligence & surveillance

Typically, our information with regard to ‘health security’ is centered on the notion of public health surveillance. The World Health Organization (WHO) defines surveillance as ‘ … the continuous, systematic collection, analysis and interpretation of health-related data needed for the planning, implementation, and evaluation of public health practice.’¹ The intent is for surveillance to serve as an early warning system, to document interventions or to track progress toward public health goals, and to monitor the epidemiology of health problems that allow for policymakers to make informed decisions on public health policies and strategies.² Even before the West Africa Ebola outbreak and in the plethora of post-Ebola assessments, the term ‘health intelligence’ has been brought into the discussions about what ‘went wrong’ and ‘how to prevent it.’ While the meaning of the term is not so clear, the myriad of subjects and approaches termed ‘health intelligence’ have potentially important applications for better information and forecasting. Such applications have been the subject of recent research that expands the horizons of the approaches to health intelligence.

In recent research, Shaban-Nejad et al. aligned the notion of health intelligence with artificial intelligence and the theories and models that have applications in patient education, geocoding, health data, social media analytics, epidemic and syndromic surveillance, predictive modeling, and health policy decisions.³ Morse conceptualized the term as an element of surveillance but focused specifically on ‘useable information on events of public health significance.’⁴ Morse has characterized existing surveillance systems as disease-specific and passive, maybe reactive, at best.⁵ Such systems are hampered by the usual policy problems: (a) health is a low priority for governments, (b) governments are hesitant to release health information because of the political fallout potential, (c) conflicting policy issues such as conflicts between agricultural output and potential health impacts.⁶ The presentation of such information has been in such a fragmented state that the effectiveness of the information obtained is reduced.⁷

My intent here is not to review the problems with surveillance systems, but to draw a distinction between surveillance and a broader information gathering process that involves intelligence and its analysis. French and Mykhalovskiy focus on health intelligence as the detection of public health events as they unfold or even before they unfold.⁸ Health intelligence thus emphasizes the concepts, methods, practices, and apparatuses assembled to monitor and detect health events.⁹ More recently, the movement is toward extending health intelligence beyond surveillance into more contemporary activities such as blogging and data mining social media networks. These activities capture the nature of pandemic surveillance and health intelligence by transcending a static conceptualization of metrics in data counts to

… reflect a broader set of time-space relations that are characteristic of contemporary thinking about pandemics. On the one hand, these relations involve a high degree of sensitivity to the spatial dimensions of health events, especially their potential to extend beyond local settings. On the other hand, they are beset by deep anxiety about the timeliness of response, the outcome of which is an immense effort to detect, pre-empt or rapidly respond to health events to prevent them from having trans-local effects.¹⁰

These approaches and definitions have a common thread through them; namely that they represent a need for more, better, and earlier forms of information and for decision makers to act upon that information. From outbreak surveillance to prediction of such outbreaks, the objective of surveillance and health intelligence is to mitigate risk on a number of levels. How we understand risk in this context is worth reviewing.

Risk and perceptions of threat

Risk perception is at the center of decision making for political leaders confronting epidemic outbreaks.¹¹ The scope and depth of the risk from any human security issue arises as a function of two factors: the perceived importance (saliency) associated with the risk and the likelihood of the state incurring significant losses (however those losses may be defined by the leaders). The scope of the issue that the leader is most concerned with includes the principle focus of the state’s objective security characteristics: territory, the state, and population. The value or importance of these targets is both calculated, meaning that states may be able to quantify the potential losses due to the event or action, and symbolic, in that these targets are the personification of the state and its legitimacy to act on behalf of its population to confront those risks (the principal-agent issue).

When problems that are typically in a sphere of domestic public policy affect the population (such as a public health problem), the leader’s perception of whether the problem constitutes a risk for the state may hinge on how the risk to the population will affect the state’s capacity, the time-frame of the risk itself, and its immediacy (i.e. whether the risk to the population is an immediate short-term or a distant long-term risk). What these types of issues have in common is that they have a potential to damage the state’s capacity to function. State capacity embodies the capability to carry out specific governmental functions including, its own survival (first and foremost), protection of its citizens from physical harm, economic prosperity and stability, effective governance, and territorial integrity. The most recent coronavirus pandemic presents a prime example of how a state’s leadership risks political damage if its judgement of the risks associated with the outbreak are not attentive to the perceptions of other states and its own population. The inability of China’s government to contain the outbreak has caused not only substantial harm to its governing credibility inside of China, but also to its global relations as the international economy slows down in response to supply chain disruptions and the increasing risks to the stability of China’s markets.

For decision makers to perceive a non-military risk to the state or to the state’s capacity, the potential, recognized loss, or disablement of the state and its population has to be substantial and sustained to the extent that the state’s capacity and the functions related to its capacity are significantly hindered or even abrogated. For this to happen, in the short term, the state must face a cataclysmic incident or action that highlights the state’s vulnerability to the risk and poses a significant risk of population destruction or displacement. History is replete with examples that reflect this situation to varying degrees.

Volcanic eruptions, earthquakes, and even hurricanes have effectively crippled states and cities. Such events are almost self-evident in terms of how they can affect the population, the state and the state’s capacities and capabilities. The key factor here is that these types of incidents are typically risks that are acute (i.e., short-term causal though the ramifications of those events may extend temporally well beyond the actual event itself to create long-term consequences). The incident itself is seen as the immediate risk, and decisions are predicated upon dealing with the immediate risk. The decision makers’ perceptions of such incidents are reflected in preparations and contingencies made to the extent that the immediate crisis can be weathered. In other words, there is a temporal end to the incident and decisions can be made to manage the risks during the incident and to minimize likely losses in its wake.

At any given moment, leaders may perceive an outbreak, particularly in its initial stages, as non-threatening at time t; given changing circumstances, they may reconsider that judgment at time t + 1. Issues that leaders perceive to be a security risk require a rapid response from them, particularly if they have downplayed the initial threats from the outbreak. As leaders address the incident, these issues may become less of a risk, instilling more confidence in the affected population and causing the leaders to reassess their risk from the outbreak as it dissipates. Thus, the immediacy and the perception of the risk to the regime ultimately are significant factors in determining whether leaders may perceive an issue as passing the threshold into the realm of a security risk. The 2014–2016 Ebola outbreak represents a strong case for how a mild and low-level outbreak quickly evolved into a major security threat to individual states and the international system. To understand this process fully, we need to understand the role of global health intelligence in the period leading up to the point where states declared Ebola a national and international security threat and emergency.

Intelligence and global health intelligence

Risk is based on info...

Table of contents

• Cover
• Half-Title Page
• Title Page
• Copyright Page
• Contents
• Citation Information
• Notes on Contributors
• Preface
• Introduction: Health Security Intelligence: engaging across disciplines and sectors
• 1 The West Africa Ebola outbreak (2014-2016): a Health Intelligence failure?
• 2 The use of HUMINT in epidemics: a practical assessment
• 3 Influenza pandemic warning signals: Philadelphia in 1918 and 1977-1978
• 4 The 1999 West Nile virus warning signal revisited
• 5 Rapid validation of disease outbreak intelligence by small independent verification teams
• 6 Threat potential of pharmaceutical based agents
• 7 Towards understanding cybersecurity capability in Australian healthcare organisations: a systematic review of recent trends, threats and mitigation
• 8 Improving ‘Five Eyes’ Health Security Intelligence capabilities: leadership and governance challenges
• Index