What is Health Security in 2023?

Overview

Health security has become the dominant framework through which pandemic preparedness and response are understood, shaping global health priorities, policies, financing, and measures of preparedness. Yet the concept remains contested and inconsistently defined. Its development since the 1990s has been closely tied to the security priorities of Western states, with infectious diseases often framed as threats to national stability, economies, and borders, and addressed predominantly through technical solutions, surveillance, stockpiling, and biomedical countermeasures.

Tracing the evolution of health security through HIV/AIDS, 9/11 and bioterrorism, SARS and the International Health Regulations, Ebola, Zika, and COVID-19, the paper highlights persistent tensions over what is being secured, from what, for whom, and by what means. While securitisation has brought substantial political attention and resources to infectious disease preparedness, it has also reinforced national and Western-centric priorities, sidelined other forms of health insecurity, and often privileged technological interventions over political, social, and structural approaches.

The experience of COVID-19 further exposed these limitations. Despite decades of investment in health security, major failures were political and social as much as technical, while vaccine nationalism, intellectual property barriers, export restrictions, and unequal access to medical countermeasures demonstrated how national security approaches can undermine global solidarity and cooperation. The paper therefore calls for critical reflection on whether health security, in its current form, is fit for advancing pandemic readiness, and considers how its useful elements might be rethought or reconceptualised to support a more equitable, inclusive, and effective approach to pandemic preparedness.