THE FOREIGN SERVICE JOURNAL | JULY-AUGUST 2025 29 While this approach is built around having concrete ways to measure success, it has also strengthened a powerful tool for America that cannot be measured: trust. Through building relationships with other countries, U.S. diplomats and technical staff earn the trust of governments we aim to work with. That is why when a country’s surveillance system shows something unusual, the first call their ministry of health makes is often to the CDC. It is why if an outbreak unfolds, and a country does not have the tools to get it under control, they will ask the U.S. for help. Through these in-country partnerships, the U.S. gets early access to data and real-time information as diseases spread, informing how we prepare at home. And through the complementary, but distinctly different, strengths of experts across the State Department, CDC, NIH, USAID, Department of Defense, and other agencies, the U.S. government can mobilize quickly to stop diseases. Twenty years ago, the government of Indonesia was reluctant to share information with the U.S. about avian influenza. Today, they are one of our strongest health security partners, inviting U.S. support for data analysis and partnership to promote antimicrobial stewardship. Ten years ago, Guinea’s surveillance system could not detect Ebola. In 2021, in the midst of concurrently responding to COVID-19, Guinea detected and contained Ebola before it spread. Five years ago, the government of Nigeria needed support for health emergency management. But in 2023, when experiencing outbreaks of anthrax, the government exercised capabilities built with U.S. investment. Nigeria activated national response mechanisms to coordinate efforts across the human and animal health sectors to reduce risks for further transmission. Years of building relationships, working with nations as equals, and targeting investments to support their priorities have enabled America to be a partner of choice, stopped outbreaks before they crossed borders, and supported countries in taking ownership of their health security. Maintain and Improve Health Security Capacity As risk factors from globalization, climate change, and conflict increase, outbreaks, too, are on the rise. The Center for Global Development estimates there is a 47 to 57 percent probability that another pandemic will occur within the next 25 years. Even when health systems demonstrate they have the capacity to prevent, detect, and respond to health threats, they must maintain such capacities. Systems need to continuously evolve to address new threats and manage concurrent emergencies. If they don’t, when the next pandemic hits, these systems will fail. While institutions in the U.S. government may change, strategic functions and investments in research and public health capacities must continue. The U.S. government should prioritize these essential efforts going forward: 1. Continue measurable investments that accelerate country ownership. The U.S. government’s approach to strengthening country capacities is working, and it should continue. By identifying targets within countries, and investing Nidhi Bouri (center, putting on gloves) joins USAID and CDC colleagues, alongside local hospital staff, to enter an mpox screening and testing site at a district hospital in Bujumbura, October 2024. USAID/BURUNDI MISSION
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