Health Security and Its Impact on International Relations

Achieving security, in its broadest sense, is considered one of the primary responsibilities of states. However, the evolution of threats has significantly changed this understanding. Since the end of the Cold War and the rise of globalization, the international landscape has become increasingly complex, with millions’ lives threatened by conflicts. Globalization has introduced a new dimension of insecurity that challenges traditional approaches, as the movement of people, money, goods, ideas, and information now occurs rapidly and across borders.

In recent decades, a wide range of emerging security threats has emerged at both national and global levels, including threats related to ethnic and sectarian conflicts, civil wars, extremism, climate change, illicit trade, organized crime, environmental threats, rising pandemics, and instability from mass displacement and migration, as well as the proliferation of weapons of mass destruction.

This enormous volume of interrelated and rapidly evolving threats has led to significant changes in national and international discourse and policymaking concerning interventions in conflicts. It has become impossible for any state to solely safeguard its citizens by merely enhancing its surveillance mechanisms. States and societies are now, more than ever, reliant on the actions of other states and communities for their security, and occasionally, even for their survival. (Fouinat, 2004)

Pandemics have posed a unique challenge and threat to human security, possessing the potential to affect individuals and control their ability to live freely and happily. Hence, a relationship has developed between pandemics and security. Due to the rapid and extensive spread of these diseases across national borders, there has been an overlap between the concepts of national security and global security. National security is defined as “the state’s capacity to provide protection and defense for its citizens,” whereas global security is inherently tied to what nature imposes on states alongside various other transformations, notably globalization—changes that no national security apparatus can address alone; hence the necessity for international cooperation. The global interconnectedness and interdependence witnessed since the end of the Cold War necessitate more robust collaboration and cooperative efforts among states. (Osisanya, N.D.)

Study Objectives:

This study aims to achieve the following objectives:

1. To explore the concept of health security, highlighting its relationship with both human and national security.
2. To demonstrate how health security influences international relations.
3. To illustrate how states respond to transnational health threats, using COVID-19 as a case study.
4. To derive appropriate conclusions and recommendations.

Study Hypothesis:

This study is based on a central hypothesis suggesting a direct correlation—both negative and positive—between the global spread of diseases and pandemics on one hand and the tension and cooperation within international relations on the other.

Study Methodology:

To achieve the study’s objectives and validate its hypothesis, a descriptive analytical methodology will be employed. This involves describing the health realities experienced globally due to the COVID-19 pandemic since late 2019, followed by analyzing the changes in international relations over this period, enabling predictions regarding the future of international relations following the emergence of new health pandemics worldwide.

Study Theories:

The study of international relations necessitates a discussion of the main theories that explain these relationships and the factors influencing them. Accordingly, this section will address two primary theories that can assist in interpreting the correlation between health security and international relations: idealism and realism.

Idealism:

The ideas of idealism in international relations took shape after World War I, emphasizing the primacy of ethics as a fundamental axis for governing international relations. This theory is rooted in the critical assertion that states must dedicate all possible efforts to achieve the common good based on values, ethics, ideals, and law. (Abu Amer, 2002)

As its name suggests, idealism relies on ethics, ideals, and human nature, advocating for the activation of law within international relations without solely relying on power. The aim is to establish justice and peace among all parties, while new idealism focuses on soft and smart diplomacy and international cooperation. (Chatnawi, 2002)

The origins of this theory trace back to the ideas of philosopher Jeremy Bentham, who emphasized the foundations of idealism in many of his writings. (Bouqen, 1980) According to the ideas embraced by theorists of this perspective, states strive to build a world characterized by justice, peace, and goodness—particularly in their reciprocal relations—endeavoring to apply international legal principles and rules based on values and ethics. (Hassan, 2002)

In analyzing this theory, we find it relies on several pillars, including religion, ethics, philosophy, law, a global orientation, a focus on moral principles, prioritizing collective interests over those of individual states, law education, and emphasizing the role of international organizations in supporting global security and peace, limiting arms, and organizing relations between states, which are essential for human relations. The nature of humans is characterized by goodwill, kindness, and equality among states as active players in international politics. (Hatti, 1985)

In the context of this theory, crises between states can be addressed by adopting several criteria, such as: (Saeed Salim, 1998)

• The existence of effective international institutions, such as the United Nations, which can assist in attaining global security and peace.
• Providing tools to maintain international security and peace, such as adhering to international legal judiciaries or arbitration.

This theory will be employed by highlighting the role of the intellectual foundations of idealism (law, values, principles, ideals, and ethics) in bridging perspectives among world states through persuasion rather than coercion—especially after suffering from the repercussions of the COVID-19 pandemic—by promoting humanitarian, ethical, and legal approaches that foster cooperation while avoiding confrontations and accusations, facilitating humanitarian and medical assistance among nations based on humanitarian grounds, which can achieve cooperation, security, and stability in international relations.

Realism:

The historical roots of realism trace back to Italian thinker Machiavelli, who, in his book “The Prince,” argued that power, through political and economic tools, is fundamental to state stability and governance. He went so far as to exclude the ethical dimension from politics with the phrase “the end justifies the means.” This idea was furthered by Thomas Hobbes, a staunch proponent of realism, evident in his book “Leviathan,” where he emphasized the role of power and its clear impact on shaping domestic policies. (Najeem, 2011)

Realism’s core revolves around national interest and power as primary factors in international interactions, grounded scientifically by Hans Morgenthau in his renowned book “Politics Among Nations,” where he framed international politics as a struggle for power, highlighting a psychological relationship between those wielding power and those subjected to it. No matter what material objectives any state pursues—such as acquiring raw materials or controlling maritime routes—certain measures must be taken to dominate others. Morgenthau views international politics as a process of reconciling states’ national interests. (Najeem, 2011)

Generally, new realism stands on several foundations, including the reliance of states—its primary active unit—on power and national interests as essential bases for this theory, regarding the state as a single unit regardless of decision-makers within it. The adoption and maximization of power lead realism to affirm that states can enhance their capability and achieve their interests through alliances formed with other states. Building on the belief in an inherent malignancy in human nature, as observed in the assertions of Morgenthau, Hobbes, and others, realism detaches from reliance on ethics and international institutions. (Najeem, 2011)

New realism emphasizes several principles, such as existing hierarchical or anarchic political systems, with the international system taking the latter shape, and that states have similar functions concerning their capabilities, with all states exhibiting selfishness, responding to relative power and the actions of others, and that anarchy in the international system compels equilibrium to achieve a balance of power. (Tawfiq, 2007)

The principles of realism will be highlighted by demonstrating how various states reacted during the COVID-19 pandemic to achieve their national objectives, reconciling their national interests with those of other nations. Accordingly, the concept of national interest does not assume the existence of a peaceful world, nor does it guarantee the inevitability of war; rather, it signifies merely the preservation of national survival, including defending the material, political, and cultural entity of the state, as this interest represents a fundamental aim that cannot be conceded or compromised.

Study Outline:

To achieve the study’s aims and validate its hypothesis, the study will be divided into three main sections as follows:

1. Theoretical Framework of the Concept of Health Security and Its Relationship with Human and National Security.
2. States’ Responses to Transnational Health Threats – Using COVID-19 as a Case Study.
3. The Impact of Health Security on International Relations.

Section One: The Concept of Health Security

Despite the widespread use of the concept of global health security, there is no clear consensus on its definition (Aldis, 2008), attributed to the prevailing lack of agreement on its most significant criteria. (McInnes, Routledge Handbook of Global Health Security, 2015) This reflects differences regarding the primary concerns to be included as threats to health security.

Numerous definitions related to health security exist, with one stating it is “the state in which the nation and its citizens are prepared to face health threats or incidents that may have negative health impacts” (International Conference on Health Security, 2018). It can also be defined as “activities and actions taken across sovereign boundaries to mitigate public health incidents and safeguard the health of populations” (WHO, Health Security, N.D.) or “necessary activities to reduce the risk of acute public health incidents and their impact on the collective health of populations residing across geographical areas and international borders.” (Aldis, 2008)

Operationally, health security is defined as the sum of necessary activities, planned or proactively prepared, directed at minimizing infringements that pose a threat to the public health of populations. It includes six dimensions: prevention, detection and reporting, health system capacity, rapid response, compliance with international regulations, and enhancement of national capacities and general risk environments.

Linking Health and Health Security to National Security and Its Various Dimensions:

Pandemics continue to present challenges and threats to human security, as they can influence individuals and control their capacity to continue living freely and happily. Consequently, a connection exists between pandemics and national security, as diseases can impact individuals, undermining their trust in governmental response capabilities. They also bear acute economic effects, potentially undermining a state’s social fabric while leading to regional instability and posing strategic threats through potential evolution into biological warfare. (Cecchine & Moore, 2006)

Numerous countries responded to the COVID-19 virus, especially at the onset of the spread and during peak times, treating it as a security issue requiring intervention from public authorities to mitigate its impacts. Many states enacted laws, imposed regulations, and took actions to curb its spread, including quarantines, curfews, and public lockdowns—measures rarely adopted for non-security crises. States heightened readiness across various sectors, particularly the security sector, intensifying scrutiny on individuals violating pandemic-related laws. Countries that witnessed significant virus spread were treated as sources of risks, justifying travel bans to and from them, as the virus appeared to be a phenomenon threatening all human, individual, and national components, akin to drugs or terrorism.

The pandemic also likely contributed to conflict outbreaks, particularly by eliciting local instability, thereby posing a threat to national security. Conversely, the emergence of what’s termed biological warfare has further emphasized the relationship between security and health, due to its ability to disseminate epidemic and lethal agents. (Tucker, 1997) Biological weapons are known to include living organisms, primarily self-replicating microorganisms such as bacteria, viruses, fungi, and rickettsia, intentionally released to induce illness or death in humans or animals. They may also include non-living and non-replicating agents produced synthetically to mimic biological agents. (Dando, 2001) This further underscores the importance of enhancing states’ capabilities to counter unconventional wars in the future.

Evidently, the challenges posed to health security highlighted the need for various state institutions to collaborate in addressing the pandemic. In some nations, the military’s role in enforcing security order became evident, raising the necessity to ensure soldiers’ health and readiness to face security challenges, supporting an assumed civil system in need of assistance during the ongoing crisis. (Brun & Gat, 2020)

Section Two: States’ Responses to Health Threats – Using COVID-19 as a Case Study

The nature of states’ responses to pandemics and epidemics varies significantly, as evidenced by the differing approaches to the COVID-19 outbreak, where some countries managed to limit its spread while others failed to do so. Two examples illustrate these state responses.

Turkey

Turkey is among the few countries commended by the World Health Organization and various world leaders for its successful handling of the COVID-19 pandemic. The nation effectively managed to contain the outbreak among its citizens, thanks to its extensive experience in crisis management and robust health infrastructure, which included a sufficient number of healthcare providers—approximately 165,000 doctors and around 205,000 nurses of both genders, supported logistically by 360,000 individuals during the pandemic’s global spread.

Turkey was one of the first countries to establish an operations center and form a scientific committee to study the virus, producing a comprehensive guide for managing it, initiating tests for travelers from affected areas, halting flights to and from China, and building field hospitals at borders with neighboring countries. Later, it closed borders with Iran, followed by halting flights to Italy. Despite the state’s lockdown measures, the economy continued to function, ensuring the supply of food and essential needs to its citizens, while uplifting their spirits through health guidance and initiatives. Instead of becoming a recipient of aid, Turkey provided assistance to over 17 countries, including Italy and Spain. (Al-Jazeera Net)

Qatar

Qatar’s experience in dealing with the crisis also deserves mention. Although the infection rate was high relative to its population, the nation managed to maintain a low death toll, implementing stringent health measures that helped contain the virus. Qatar developed a COVID-19 response plan outlining clear actions needed to safeguard the health, well-being, and prosperity of its citizens through preparation, monitoring, response, and recovery measures. This plan provided a strategy for cross-governmental leadership and collaboration, assigning each government department accountability for responding within their respective sectors, guided by guidelines and resources developed by the Ministry of Public Health.

Furthermore, priority actions were undertaken by all government departments, which included supporting the healthcare sector in implementing response actions, maintaining essential services, engaging the public and raising awareness in line with response measures, and maintaining citizens’ trust in the government. Simultaneously, the Ministries of Interior and Defense were entrusted with border management responsibilities while ensuring public safety and security, regulating citizens’ and expatriates’ entry, and protecting critical public facilities.

Additionally, the Ministry of Foreign Affairs took responsibility for caring for citizens abroad, managing international relations, and assisting countries in crisis based on priorities. Other ministries, such as the Municipalities and Environment Ministry and the Administrative Development Ministry, together with the labor and social affairs ministries, coordinated with all government entities to allocate suitable quarantine facilities. The Municipalities and Environment Ministry and Hamad Medical Corporation were tasked with maintaining public cleanliness and the sanitation of buildings and outdoor spaces. (Ministry of Public Health, 2020)

Strict enforcement of epidemic laws and preventive measures was also put in place, such as Law No. 17 of 1990, which imposes penalties, including up to three years in prison and/or a fine of 200,000 Qatari riyals for individuals not wearing masks outside their homes. Police have referred several violators to the public prosecution. (Qatar Tribune, 2020) Qatar also prohibited all gatherings at the start of the crisis under the law (Al-Arabiya, 2020).

Section Three: The Impact of Health Security on International Relations

The COVID-19 pandemic has had both positive and negative effects on international relations due to its massive political, economic, and social repercussions. On the positive side, the pandemic has reinforced the power and influence of the nation-state as a primary actor in international relations and internal and external interactions after it had seen a decline in its role in recent decades in favor of other actors, such as international and regional organizations and multinational corporations, which played a significant role in shaping many global policies to the detriment of state interests and their citizens.

Consequently, states have become more powerful and influential in achieving their citizens’ interests according to their capabilities, with an increasing role in taking precautionary and economic measures to mitigate negative effects and protect their populace. The ramifications of COVID-19 also heightened the state’s role in the economic realm and production, as it was no longer merely a protector as per the neoliberal theory, which limits state functions to law enforcement, defense, and foreign policy; instead, it has emerged as a powerful central force capable of confronting crises. This has instilled greater confidence in nation-states among their citizens, thus enhancing their power and influence on the global stage.

Notably, the COVID-19 pandemic also contributed to a decline in the roles of non-state actors, such as organizations, militias, and armed movements, which had seen a rise in recent years due to political changes in the Arab world since 2011, including ISIS, Al-Qaeda, and armed groups in Iraq, Syria, Yemen, and Libya, which challenged national states and weakened their capacities and institutions, leading to serious repercussions for addressing challenges. These militias, however, found themselves impotent in confronting the threat of the virus, receding in favor of states exerting authority in imposing quarantines, curfews, and provision of goods, reiterating the importance of the nation-state’s role.

Moreover, national armies have taken on critical roles beyond the military realm; the COVID-19 crisis has highlighted that various nations relied heavily on their armed forces for crisis management and containment of the virus’s spread, as well as emphasizing the economic roles of military forces in providing goods and services. This situation served as a reminder of the necessity for nations to deepen their interconnections and meet mutual needs to thwart the opportunities for military and sectarian organizations that have fragmented states and societies.

The pandemic has led to a kind of equilibrium and stability in international relations through somewhat structural changes in the international system, transitioning from a unipolar world led by the United States to a multipolar one. It is notable that during the pandemic, the United States leveled accusations while China and Russia provided humanitarian and medical aid to several third-world countries and even some European nations (Italy, France, Serbia) for humanitarian and ethical reasons, not for political or opportunistic ones; this fostered a sense of solidarity and collaboration among countries worldwide. (Ahmed, Al-Ahram Agency)

China could have exploited the economic and financial weakness of affected countries to create dependencies not only in Africa but also in Europe through humanitarian assistance and support for strategic infrastructure (Rogg, 2020), especially with the increasing demand for its resources. (Brun & Gat, 2020)

Additionally, there is another aspect of combating the virus related to security policy. During the crisis, Venezuela and Colombia began exploring collaborative possibilities to combat the epidemic via the Pan American Health Organization. In Libya, international actors commenced negotiations to reach a ceasefire due to COVID-19, and the world also witnessed support from the UAE, Qatar, and Kuwait for Iran with medical assistance. In the Philippines, President Rodrigo Duterte ordered a one-month ceasefire against communist rebels to allow armed forces to focus on combating the virus. Even the United States, after years of contention with Russia, sent humanitarian aid to the Abkhazia region. (Rogg, 2020)

The COVID-19 crisis demonstrated that the isolation of any state is neither possible nor viable, as trade-related disruptions, such as the closure of ports and airports, can impede essential supplies from reaching areas in need. Such solutions could lead to serious economic consequences globally, especially for countries reliant on trade or heavily dependent on tourism as a national income source, despite potential environmental benefits that may outweigh the positives for these nations. (Kevany, 2020)

In light of the pandemic’s positive impacts on international relations, it illustrated that Asian powers—led by China—are keen to gain a new centrality in the new global system through their effective management of the pandemic’s repercussions and their superior social control capabilities, contrasting sharply with many Western countries—most notably the United States—that failed to contain the outbreak and suffered significant human and economic losses. This, in turn, opens new horizons and international relationships between China and third-world nations at the expense of colonial Western powers, increasing these countries’ openness to China without considering the political and security constraints that have bound third-world nations for decades. This situation also contributes to China reshaping the global order in its image with the BRICS group. (Al-Hufayan, Admin, 2021)

The COVID-19 crisis emphasized that the cohesion and cooperation among states significantly contribute to preventing pandemics and epidemics. For instance, during the Ebola virus outbreak in West Africa in 2014, one of the critical factors that assisted in successfully containing the epidemic was the cohesion of international relations and diplomacy, alongside military support. However, this wasn’t the case with COVID-19. While the military has played a logistical role, soft power and international relations are often as effective as hard power when it comes to health security, particularly when military and humanitarian diplomatic assistance is presented as a form of smart power. (Kevany, 2020)

Ironically, during the COVID-19 crisis, European countries like the Netherlands, Slovakia, Spain, the Czech Republic, and Italy turned to China for assistance in combating the outbreak after feeling abandoned by other EU nations. (Al Jazeera, 2020) It goes without saying that their pleas for help from a country like China, considered their primary adversary in security and politics, along with their acceptance of immediate aid sought, reflects the desperation they reached. Meanwhile, China managed the initial outbreak successfully, allowing it to leverage this experience for future advantages.

On the negative side, the COVID-19 pandemic prompted numerous states worldwide—particularly the United States, Germany, the UK, and China—to impose protective restrictions on national products, raising tariffs on imports, culminating in the US imposing new tariffications of up to 25% on imports from China. China reciprocated with additional tariffs on American exports ranging from 5% to 25%. This inevitably led to a decline in cooperation between the world’s two leading economic powers, adversely affecting global trade exchanges and contributing to significant price increases, which harmed third-world countries reliant on imports for many of their needs. This situation has undermined the global system, pushing both China and the United States to reconfigure and redistribute global conflict differently. (Unified Arab Economic Report, 2021)

While curfews and border closures among many countries effectively prevented the virus from spreading to their citizens, this mechanism also reduced tourism flow between nations, which had played a vital role in fostering understanding and bridging perspectives among many populations, potentially resolving numerous global issues, given that this sector supports the budgets of several countries. The estimated losses in this sector surpassed 50 billion dollars according to United Nations World Tourism Organization estimates. (United Nations Conference on Trade and Development, 2020)

China’s stringent lockdowns directly affected global trade volumes as they impacted China’s economy, subsequently impacting the world’s largest factories. It is well-known that China represents one of the key trading partners for most nations. According to World Trade Organization statistics, China is the largest exporter and the second-largest importer of many goods, including oil and iron ore, which means that any decline in Chinese economic activity drastically affects global trade exchanges, critical for cooperation among nations. (WTO: 2023)

Significantly, the polarization policies adopted by major countries, coupled with widespread distrust among various global governments and limited cooperation on exchanging information and medical equipment, have resulted in many nations’ failures to address the pandemic effectively. This negatively impacted the global collaborative response to the crisis collectively, undermining opportunities to eradicate the epidemic conclusively.

The failure of containment efforts—globally, regionally, and locally—during and after the pandemic has led to travel and migration restrictions and disrupted international supply chains due to stringent trade constraints. The world economy has consequently entered a complete recession phase, generating economic and social pressures in many nations, leading to political instability in most countries.

In this context, several statements have been issued by officials from some countries, particularly European states that have suffered extensively from the pandemic’s repercussions. For instance, Serbian President Aleksandar Vucic denied any genuine European solidarity, indicating that such solidarity is merely a fantasy. (National Review, 2020) Meanwhile, French President Emmanuel Macron warned of the potential collapse of the European Union as a “political project” unless it supports devastated economies and aids them in recovering from the pandemic. (Financial Times, 2020) In Austria, Chancellor Sebastian Kurz reportedly said: “Once the crisis is over, difficult decisions will have to be taken within the EU.” (Reuters, 2020) Consequently, the European Union appears divided and disappointing, as member states have been unable to provide assistance to their neighbors sharing common values, with leaders failing to leverage their knowledge and experience to formulate substantive plans to combat the pandemic.

Regardless, the readiness of any state in managing health crises may become a criterion for its strength and status on the international stage and a determinant for its security and the safety of its people. If the COVID-19 pandemic represents a global crisis that disregards national borders, it simultaneously enhances national sovereignty and compels states toward self-sufficiency. The varying impacts of COVID-19 across communities, regions, and countries have sparked broader discussions on enhancing resilience and better preparing for health shocks. (OECD, 2020) Many nations, including WTO members, found themselves compelled to decide on border closures and travel restrictions to contain the pandemic’s spread. While acknowledging that these closures were motivated by health considerations rather than commercial ones, the ramifications for trade, tourism, and education sectors were significantly detrimental (World Trade Organization, 2020), requiring states in the future to be prepared to mitigate these impacts and pursue alternative local measures to strengthen self-sufficiency.

Section Four: Conclusions and Recommendations

Through the study, the following conclusions have been drawn:

1. Health security is one of the most vital dimensions of national security, as it is directly tied to individuals, who are the core component of states and the foundation for achieving desired development. Any threat to health security will undermine a state’s national security.
2. The importance of health security necessitates that states reevaluate their national policies to position health security at the top of those priorities, requiring collaboration and coordination with the international community to leverage experiences and lessons learned.
3. The nature of threats affecting health security, especially those connected to infectious and transnational diseases, underscores the necessity for international collaboration in confronting them.
4. The study validated its hypothesis, indicating that the spread of the COVID-19 pandemic led to solidarity and cooperation among multiple nations (China, Russia, Italy, Serbia, Turkey, and South American countries) which provided humanitarian and medical assistance to each other while escalating tensions among others (some Western European countries: France, Italy, Germany, and the United States).
5. The study demonstrated that the implementation of idealist concepts fostered cooperation, solidarity, security, and stability in international relations, whereas international relations leaned towards conflict, confrontation, and tension when realist principles were applied, prioritizing national interests at the expense of others.

Based on the preceding analyses and conclusions, the study recommends a reconsideration of national policies at all levels—local, regional, and international—focusing on the following areas:

1. Emphasizing health security as a critical requirement for achieving comprehensive national security by significantly increasing budgets allocated to the health sector, amplifying investment in scientific research, and reevaluating specialized health security policies.
2. Reevaluating security and defense policies through the establishment of an advanced health system capable of addressing pandemics and enhancing health security, rather than solely concentrating on armament issues.
3. Prioritizing the tenets and ideas of idealism to enable the management of transnational epidemics and diseases, ultimately contributing to stability, cooperation, and solidarity in international relations.
4. Focusing on international crisis and disaster management at both regional and international levels by: (1) Establishing an effective early warning system for epidemics and infectious diseases at an international level. (2) Creating risk management systems that serve as information sources both locally and internationally, facilitating high-level international communication for crisis management.

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