Infectious Diseases: Where Delivery Meets Diplomacy

By Mariam Reda, Practice Director, Infectious Diseases

When we think of health security, we often picture fast-moving epidemics, like the 2014–2016 Ebola outbreak in West Africa. That outbreak, which killed 11,000 people and cost an estimated $53 billion, demonstrated how quickly disease can destabilize health systems and spill across borders through migration, trade, and insecurity. But while high-profile outbreaks grab headlines, endemic diseases like tuberculosis (TB) and malaria destabilize nations quietly over years. In 2024 alone, TB killed 1.25 million people, and there were 263 million cases of malaria, causing nearly 597,000 deaths. These enduring burdens weaken economies, erode governance, and reduce workforce productivity. They are just as much a health security threat as any epidemic.

The Artificial Divide

Global health actors often draw a false line between “development” diseases such as HIV, TB, and malaria, and “security threats” like Ebola and Mpox. This framing is misleading because endemic diseases claim far more lives annually than high-profile outbreaks and have profound economic and political consequences. In South Africa, workers living with HIV lost an estimated 10% of their working time in the two years before death. Malaria reduces growth by up to 1.3% annually in heavily affected countries, draining millions of dollars from national GDP. This false divide leads to underinvestment in sustained, integrated responses that save lives today and build resilience for tomorrow.

Shared Infrastructure, Strategic Value

Investments in infectious disease programs are the backbone of health security. The laboratories, data systems, and community health workers strengthened for HIV, TB, and malaria response are the same essential systems countries rely on to prevent, detect, and respond to health threats.

JSI’s “Health Hub: Men On The Move” initiative in Zambia illustrates how targeted investments create broader health security benefits. JSI, working with the National AIDS Control Program, designed the platform to deliver HIV prevention, testing, and treatment alongside basic primary health to truck drivers, and it became a trusted source of health information and care. When the Mpox outbreak emerged, this same platform was rapidly adapted by local actors to share guidance and screen for symptoms. What began as a vertical HIV-specific platform proved to be a flexible, dual-use asset that strengthened outbreak preparedness.

Infectious diseases are a public health issue, but how we address them can be a diplomatic tool and a bridge to global stability.

Turning Disease Investments into Security Dividends

JSI’s strength lies in bridging the gap between technical delivery and diplomatic impact. We transform targeted infectious disease investments into platforms that strengthen health security, foster cooperation, and build trust across borders.

In the Kyrgyz Republic, JSI, with U.S. government support, worked hand-in-hand with the national government to transform the TB response into a national and regional security asset. This effort strengthened and expanded national TB information systems by linking every facility and laboratory, secured state financing for optimized specimen transportation systems, and expanded access to rapid molecular testing and genome sequencing. As a result, 98% of all sputum samples were delivered to testing within 72 hours, the proportion of TB patients diagnosed with WHO-recommended rapid molecular tests (GeneXpert) increased from 75% in 2019 to 90% in 2023, and second-line drug susceptibility testing coverage rose from 71% to 87%. Together, we introduced routine stool testing for childhood TB, the first of its kind in Central Asia, which doubled bacteriological confirmation among pediatric cases nationwide by enabling the diagnosis of children who would otherwise have been missed. JSI supported the accreditation of the region’s only internationally accredited TB reference laboratory, while also procuring 10-color GeneXpert platforms to extensively expand drug-resistant TB testing to the local level. We also supported the installation of digital chest X-ray machines with computer-aided technology at the primary care level to expand early detection. This enabled health care providers to identify 555 presumptive TB cases and 28 confirmed cases, all initiated on treatment within the first five months of screening.

During the COVID-19 pandemic, this laboratory network and data systems pivoted to support national testing and tracking, demonstrating their value as flexible, dual-use infrastructures. What began as a disease-specific investment into a national security platform for regional leadership strengthened overall outbreak preparedness and built a stronger, more resilient health system.

A Strategic Call to Reframe

The recently released America First Global Health Strategy outlines a view that allows us to recognize and reframe the importance of durable infrastructure to combat infectious diseases. Just as the strategy focuses on promoting safety by countering emergent outbreaks and building long-term resilience, an optimized approach to infectious diseases response will address both urgent security threats and long-term economic concerns. The strengthening of laboratories, supply chains, and health workers’ skills for infectious disease programs are already defending us against the next crisis. HIV, TB, and malaria are fundamental threats to stability, prosperity, and security, and infectious disease programming must be recognized as a core element of health security. Leveraging HIV, TB, and malaria programs within these frameworks strengthens diplomacy, fosters cooperation, and ensures that investment achieves both health and security outcomes. By reframing and funding these programs with a health security lens, we move them from the sidelines of the health sector to the center of foreign policy and global cooperation. Now is the time for governments, donors, and partners to fund infectious disease programs, integrate them into diplomacy and preparedness agendas, and act before the next crisis.