Commentary

Dr. Seth Berkley

Senior Advisor, Pandemic Center, Brown University

For much of human history, infectious diseases were the main causes of morbidity and mortality. Advancement in the sciences of public health, epidemiology, microbiology, and vaccine and drug development have reduced the risks and increased life expectancies in high income countries by nearly 40 years over the last century, principally due to a reduction in child deaths from infectious diseases. Today, chronic diseases are the main cause of morbidity and mortality and are expected to increase over time.

However, infectious diseases and epidemic and pandemic outbreaks still pose formidable risks to human life. The COVID-19 pandemic reversed a decade of progress reducing global life expectancy between 2019 and 2021 by 1.8 years. Factors such as increasing population size, dense urbanization, global travel, climate change, and ecological pressure are making outbreaks more frequent as laid out in my new book, Fair Doses: An insider’s story of the pandemic and the global fight for vaccine equity. Deliberate attacks on vaccination programs can undo the progress in child survival and a Lancet Commission report launched at the 2024 World Health Summit estimated the probability of another pandemic of the magnitude of COVID-19 occurring in the next 25 years to be about 50%.

Despite these risks, global health funding is in a "deliberate retreat."  According to the Institute for Health Metrics and Evaluation, global health development assistance dropped 21% with the U.S. slashing global health spending by more than $9 billion, or about 67 percent, in 2025 alone with significant cuts also observed in the UK (-39%), France (-33%), and Germany (-12%). 

Conversely, global military expenditures rose 9.4% to a record $2.718 trillion in 2024, up 37% for the decade. The U.S. is on track to reach a $1 trillion military budget in 2026, and President Trump has called for an increase to $1.5 trillion in 2027. That’s a massive acceleration of a trajectory that has been rising for several years and in line with similar increases (but from lower base levels) among NATO allies.

While geopolitical tensions such as the continuing war in Ukraine and concerns about the United States’ wavering commitment to NATO drive this trend, cutting global health funding for military expansion is a false choice. Take for example, the United States. The COVID-19 crisis cost the U.S. over $16 trillion dollars and more lives than from all U.S. American wars of the last 150 years combined.[1] Furthermore, bioterrorism as a risk is increasing given improvements in synthetic biology, the general availability of the tools, the power of artificial intelligence, and the difficulty tracing biologic agents. The dramatic expansion of a Russian bioweapons site outside of Moscow has security officials concerned as has clandestine activities in other countries. 

I’m certainly not qualified to say whether or not hikes in military spending are warranted. But I can say that true global security requires investing in primary health systems and health preparedness as intensively as we do in military readiness – and we must fund these bulwarks during periods of stability, not just during active crises. 

Along with financing comes the need to connect the dots: I attended a side event at the 2025 World Health Summit Health, Security and Peace: Global Health as a Strategic Imperative, hosted by former German Minister of Health, Hermann Gröhe, with a number of global health and military leaders. I made the point there that at the current time, because of the siloed nature of these communities, their programming and even their language, it is awkward as a health expert to participate in the Munich Security Conference as I am sure it is for military experts to participate in the World Health Summit. But given that Germany is hosting these two leading events in Global Health and Security, more joint programing and cross attendance might help bridge this critical divide improving outcomes. Planning and preparing for military security are well-honed skills in military circles; public health should learn from and adopt these principles for global health security. The World Health Summit, working with the Munich Security Conference, can play a leading role in creating synergy in these communities, making the world healthier and safer.   

Because we simply must acknowledge: There is no global security without global health security. Pandemic and bioterrorism preparedness are critical global public goods that cannot be ignored—right now we are under investing and deprioritizing these at our collective peril. 

The views expressed in this commentary are those of the author and do not necessarily reflect the views of the World Health Summit (WHS). This commentary is part of the ongoing WHS Perspectives series on health security. Additional perspectives from other contributors will be published in the coming weeks.

[1] Over 600,000 deaths occurred in the 10 conflicts since the Civil War; WHO lists the reported COVID-19 deaths from the United States to be 1,232,898 as of 4 January 2026.