Fighting Health Security Threats Requires a Cross-Border Approach

Recent multicountry infectious disease outbreaks of Ebola (2014) and Zika (2016–present) have raised global awareness of the importance of health security and the systems and capacities needed to prevent, detect, and respond to global health threats. Several mechanisms exist through which individual countries can plan and frame health security strengthening, such as the World Health Organization’s (WHO) International Health Regulations (IHR), the Joint External Evaluation tool, and the Global Health Security Agenda (GHSA). The IHR came into force in 2007, manifested in the form of bilateral agreements between individual countries and the WHO. They aim to reduce the spread of diseases internationally while minimizing disruption of travel and trade. Regional and multisectoral cooperation, however, has not yet been systematized or institutionalized in a manner befitting a security threat that crosses borders easily and indiscriminately. We know that an infected individual can travel from country to country and continent to continent in a matter of hours—and that health security is unachievable without a regional coordinated response. Nowhere is this more evident than in the countries and territories of the Caribbean. The Caribbean comprises some 30 small island and mainland countries and territories with 40 million Spanish, French, English, and Dutch speaking residents and over 50 million cruise and international tourist arrivals per year principally from North America and Europe. Diversity and vulnerability to external shocks, whether manmade or natural, characterize the region. With our small health systems and deeply intertwined and tourism-dependent economies, we recognize that uncontrolled disease outbreaks pose an existential threat. Our region is the first to take on the challenges and opportunities of multisectoral, regional planning, cooperation, coordination, and monitoring of global health security strengthening. Given the small sizes of our