Expanding Global Health Engagement through Multilateral Security Organizations

ABSTRACT Introduction Many countries around the world employ defense capabilities in support of global health engagement (GHE) through bilateral and multilateral organizations. Despite this, there does not appear to be a strategic approach and implementation plan for U.S. DoD GHE in support of and through multilateral organizations. The purpose of this research is to identify which security multilateral organizations are engaged in GHE, as well as how and why. These findings could inform an interoperable approach for doing so going forward. Methods A systematic review was conducted to develop a list of multilateral security organizations and agreements which engage in GHE, or could potentially play a role in GHE. Results Of the 3,488 agreements and organizations identified, 15 met the inclusion criteria. Among them, 87% (13/15) of the multilateral organizations are regional and 13% (2/15) are international, all established between 1948 and 2020. The 15 organizations cover all DoD Geographical Combatant Commands. Among them, 20% (3/15) are a legally binding alliance, 73% (11/15) have a treaty, and 7% (1/15) have a diplomatic partnership. Twenty percent (3/15) have an explicit intent to improve health in either their mission statement or as part of their goals, priorities, and/or objectives. Eighty percent (12/15) engage in at least two GHE domains outlined in DoD Policy, 67% in three (10/15), and 47% in all four (7/15). The most common domain is humanitarian assistance and foreign disaster response at 100% (15/15) and least common is Nuclear, Chemical, and Biological Defense Programs at 53% (8/15). Conclusions Although there is high demand for GHE, resourcing to enable implementation has not been prioritized. Therefore, multilateral organizations continue to support what is funded (e.g., disaster response) versus prioritizing capacity building or modifying authorities and appropriations to match demand. It is also worth noting most organizations included in this review support the European theater aligning to historical defense priorities, versus emerging threats in the Indo-Pacific region. Identifying a forum within these multilateral institutions to convene GHE policy makers and practitioners is a logical next step. The forums could guide and direct priorities, devise solutions, and implement best practices. Near term efforts could include GHE financing, governance, assurance, and technical assistance within and across multilateral institutions. Recent ef