HIS ROYAL HIGHNESS
SULTAN NAZRIN MUIZZUDDIN SHAH
INDO-PACIFIC MILITARY HEALTH EXCHANGE
DATE: TUESDAY, 26 SEPTEMBER 2023; TIME: 10.00 AM
VENUE: SHANGRI-LA HOTEL, KUALA LUMPUR.
“Achieving Health Solutions Through Diversity and Inclusivity”
Ladies and Gentlemen, Distinguished Guests,
1. Since long before the Covid-19 pandemic, many in the health and military communities have been well aware of the urgency of addressing such globalized health threats together. The Covid pandemic then brought home to us all unequivocally just how important collective action is in times of crisis, based on the links forged through longer-term efforts. It is now irrefutable that unless humanity does approach pandemics and other global health security threats together, we will all suffer the consequences. We really are living in a global commons, in which developments in one part of the planet unavoidably impact other areas, however distant. But while we did act cooperatively in some key ways during the pandemic, it also laid bare many of the flaws of our current approaches to global health security.
2. Some elements of our collective response highlighted clearly just how effective global cooperation can be, at its best. Despite its shortcomings, the World Health Organisation played a crucial role throughout, fulfilling its mandate as the focal point for information-sharing and for organizing responses. Perhaps most impressively, public and private sector actors around the world came together to develop vaccines in record time. This was only possible because of collaboration across borders, as scientists, medics, government officials, and even financiers, all worked together towards a common goal, using existing and expanding global channels of cooperation. Another global institution, Gavi, the Vaccine Alliance, then took the lead in vaccine distribution, albeit again facing many limitations.
3. So cooperation also fell very short in many areas, as epitomised by the hugely unequal distribution of vaccines. Richer countries monopolised supplies by buying up vast stocks in advance, way beyond their own needs, and to the great detriment of poorer countries. Quite apart from the resulting inequity, this also prolonged the crisis, as new variants were able to emerge and spread from areas with low vaccine coverage. The consequences of a non-collective approach thus became very clear. Even with the widespread lockdowns and the unprecedented travel restrictions that were put in place, the virus was not going to respect the political borders imagined by humanity. And so unless we were all safe, none of us would be safe.
4. This is a lesson that should have been learned long ago, as infectious diseases have long had global impacts. They have been shaping human interaction since our very earliest migrations. From the Black Death, which raged across Europe in the Middle Ages; to the diseases carried to the Americas by colonialists, which wiped out indigenous populations due to their lack of immunity; and the Spanish influenza of a century ago, which spread along international transportation routes in the aftermath of the first world war, causing almost as many deaths. But while globalization processes have thus always been accompanied by such dangers, the intensification of trade and migration flows over the past few decades means that these risks are escalating.
5. The pandemic also laid starkly bare the huge inequalities of health outcomes. Education, housing, jobs and income levels – the so-called social determinants of health – all shaped how individuals were affected. So as was oft-repeated, while we were all in the same storm, our boats varied enormously in their ability to withstand it. Similarly at the national level, those countries with stronger institutions and sturdier safety nets were better able to cope. We are very lucky here in Malaysia to have such structures in place, including our Malaysian Armed Forces and its Royal Medical and Dental Corps. I would like to take this opportunity to pay tribute to the absolutely critical role that the Medical Corps played during the pandemic, helping the country greatly in our efforts to confront the grave challenge that was faced.
6. This vital contribution to our response to Covid underscores the growing contributions from military forces and their healthcare divisions in addressing such challenges. These go far beyond pandemics. One closely related and so-called ‘slow burn’ issue is antibiotic resistance, which poses serious challenges over the longer term. As with the Covid pandemic, this issue has global health implications. So our understanding of security must be expanded to encompass such non-traditional threats, as recognised in ASEAN’s concept of comprehensive security.
7. The unchecked spread of infectious diseases across borders is unfortunately not the only health-related security threat we face. The growing number of adverse climate-related events such as floods, fires, hurricanes, landslides, and storm surges, together constitute another area of non-traditional health-related security threats. Military forces and their healthcare operations are increasingly being called on in this context, both to respond to immediate emergencies and their aftermath, and to contribute to prevention and preparedness, and to building resilience. This role is underpinned by the unique strengths that military forces bring to such crisis situations, especially the ability to mobilise fast through highly efficient Command and Control structures. Warming temperatures are also contributing to the spread of infectious diseases into previously unaffected areas, with major implications for the military and beyond.
8. This expansion of global health security threats thus has significant ramifications for military healthcare systems. These will have to evolve considerably, so they can continue to respond effectively. This process will be shaped by the fast-advancing technologies associated with the Fourth Industrial Revolution, including the significant recent leap forward of generative AI. It is by now evident that the next stage of the digital revolution has arrived and is already transforming our world and our lives. The military, military healthcare, and the healthcare sector, are all very much at the forefront of this process, driving forward application in numerous areas including robotics and AI. But for all the immense opportunities that the current wave of advances undoubtedly presents, there are also immense associated challenges.
9. These can be illustrated by taking just one example out of the exponentially growing number of applications of the various 4th IR technologies. This is ‘precision medicine,’ or the increasingly individualised medical care that is now becoming possible, due to advances in everything from nano-technology, the Internet of Things, and wearable devices which collect real-time physiological data, to bio-technology and neuroscience. These and other advances are enabling ever more accurate diagnoses to be made, which take pre-existing social, environmental and genetic factors into account, and allow highly tailored treatment plans to be developed in response. Precision medicine also contributes to far more effective preventive strategies. It is a key element of the broader transformation of healthcare, the so-called digital health revolution.
10. The vast amounts of health data being collected and stored are fuelling an acceleration of medical research, including in military healthcare. This is contributing to better health outcomes, and even to greater equity, due to the expanded coverage of population groups that are usually neglected. But despite the major effort put into data protection including through anonymisation, these enormous repositories of personal data also carry huge risks. And as the type and amount of data expands, so too will the danger of its misuse and abuse for a wide variety of criminal, economic, and political purposes. For the military, data thefts and leakages have major direct security implications, as was demonstrated when a fitness tracking app inadvertently advertised the location of exercising service members. While this incident might have been relatively minor, the capture of military health-related data presents a considerable security risk.
11. This brief illustration of just one aspect of the current wave of 4th IR technologies highlights the significant potential positive and negative impacts. And I have not even touched on their direct military applications, with the changing nature of warfare already apparent in the standard use of drones in the Ukraine war, for example. One thing that does quickly become clear following even a cursory discussion of the impacts of technological advance in any field, is the importance of collective governance. But while the need for stronger regulation of technology is widely acknowledged, as is the importance of responding collectively to global health security threats, practice in both areas is greatly lagging. So it is up to us all to push these agendas forward. And for those of you in this field of military healthcare, the development of greater cooperation in our responses to the global health security threats that we collectively face, must be an urgent priority.
Ladies and Gentlemen, Distinguished Guests,
12. We have with us here today representatives of a wonderfully wide range of countries, all of which have differing capacities and strengths, and face different challenges. By working together, including through fora such as this one, we can contribute from our own individual perspectives to the broader collective effort that is so necessary. We can all benefit greatly from sharing our respective expertise and experience in this way. By putting our heads together, drawing on our own abilities, and ultimately by pooling our resources, we will be far better equipped to address global health security challenges of all kinds.
13. As encapsulated in the theme of this gathering, it is through such inclusivity and diversity that we can develop optimal solutions to the many difficult challenges we face. Such inclusive approaches bear fruit at the domestic level as well, as we saw so clearly during the pandemic. Medical Corps here and around the world played an absolutely vital role supporting and complementing civilian efforts. Our Medical Corps have made valuable contributions elsewhere too, including in refugee camps in Cox’s Bazaar in Bangladesh, and most recently in response to the earthquake in Turkiye at the start of this year. The military healthcare operations of many of the countries represented here will have played similar roles in emergencies around the world by working together in such settings, we can also develop closer connections with each other.
14. Military healthcare is thus a key element of the coalitions that are necessary to mount effective responses in crisis situations, whether domestically, regionally, or internationally. This humanitarian role will only expand as such emergencies increase in the coming years and decades. So we must continue to strengthen our ability to respond effectively to them, through greater collaboration and through collective action. Military healthcare operations must also remain at the forefront of the current wave of technological advance, while ensuring that the associated risks are taken seriously. This will allow the potential positive impacts of these technologies to be maximized, while the negative ones are regulated and controlled.
Ladies and Gentlemen,
15. The existential risks posed by technological advance such as generative AI; the gravity of global health security threats brought home so forcefully by the Covid pandemic; and the increasing occurrence and severity of adverse climate events. Not only must all these issues be confronted collectively, but such a collaborative approach is required at a time of shifting and uncertain geo-political dynamics, which create additional constraints to effective collective action. I believe, however, that military healthcare is one area in which we may be able to overcome such constraints. This is because when it comes to the health and even survival of our own citizens, and those of other countries in times of crisis, we are all compelled to respond as best we can. And so we are more willing to work together towards this higher goal.
16. This event, and those of past years, illustrates one important means by which such collaborations across the geo-political spectrum are possible. Initiatives such as these enable us to leave politics to one side, and to focus instead on our shared objective of developing more effective responses to the issues that threaten the well-being of the populations of all our countries. Such collaborations even allow us to capitalise on our differences, contributing from our own strengths while benefitting from the inputs of others. And with that, it gives me great pleasure to declare this event open, in the hope that it will continue to play an important role in boosting inclusion and diversity, as we work together to address the many threats we face in global health security and beyond.