Bay Area Reporter - September 14, 2000
Phillip Alden, Survive AIDS Writers Pool

Lockhart said that the NSC considers AIDS a U.S. national security issue in view of the "staggering" and "destabilizing" number of deaths it is causing in some African countries.

"They have an impact on us," he said. "We have an interest in Africa, as far as our own national security, and we need to look at this problem."

The report, entitled "The Global Infectious Disease Threat and Its Implications for the United States" [1] estimates the mortality figures and the specifics of government destabilization. It states that the increasing rate of drug-resistant microbes, the lag in the development of new antibiotics, the rise of mega-cities, environmental degradation and the growing frequency of cross-border movements are the base causes of infectious disease spread.

Infectious diseases are the leading cause of death worldwide, and accounted for 54 million deaths in 1998. Recent changes in human behavior, including land use patterns and lifestyle, increased trade and travel, rapidly mutating pathogens, and the inappropriate use of antibiotic drugs are causative factors involved in worldwide disease spread.

HIV/AIDS and tuberculosis are going to account for the majority of deaths over the next 10 to 20 years. In the United States, emerging drug-resistant AIDS viruses are going to be a major factor in the mortality rate. There are currently 4 million Americans carrying the hepatitis C virus, and deaths from hepatitis C could surpass AIDS deaths in the United States over the next five years. There are also multi-drug resistant TB and AIDS-TB co-infection, influenza, emerging antimicrobial viruses, and food-born illnesses.

The United States pales by comparison to sub-Saharan Africa, which will account for 50 percent of all global deaths due to infectious agents, mostly AIDS, TB, and malaria. Asia and the Pacific, where multi-drug resistant HIV, TB, malaria, and cholera are already prevalent will wipe out large segments of the populations in those regions. The former Soviet Union is already undergoing an underreported rise in diphtheria, dysentery, cholera, and hepatitis B and C. This is caused mostly by a crumbling health-care system due to economic decline. The Middle East, North Africa, and Western Europe are facing threats posed by AIDS, TB, and hepatitis.

The gap between rich and poor countries is growing, and that gap will make it difficult for any third-party intervention. The United States simply cannot respond effectively to all these threats. As worldwide health care declines it will become increasingly difficult for the medical and activist communities to provide effective relief.

The socioeconomic impact of infectious disease in poor countries is already being felt. Losses in gross domestic product, reduced life expectancy, a weakened military, social fragmentation, and political destabilization are all factors in this growing threat. For example, there are tons of grain in sub-Saharan Africa that are not being harvested and brought to market because there are not enough healthy people to do the work. This in turn leads to greater starvation rates. In this same region, there are already over a million children orphaned by AIDS. These children often end up on the street where they are victimized and exposed to violence and the same infectious diseases that killed their parents.

While the report clearly states the facts, it fails to convey the human suffering. The loss of parents and siblings, the agony of caring for dying friends and family, starvation, lack of water, lack of medications; these are factors that cannot be enumerated.

The direct threat to the United States lies in international commerce, global peacekeeping efforts, and the presence of American military personnel and civilians overseas. Future embargoes on foreign goods and restricted entry to U.S. soil will increase friction between the U.S. and its global trading partners.

The report states that social fragmentation, political polarization, and economic decay will hamper progress in the fight against infectious disease.

Due to the damage in productivity and the resulting loss of foreign investment, AIDS will be the single greatest threat to economic development in sub-Saharan Africa, the area currently hit hardest by the epidemic. One major worry is the loss of upper-level managers and skilled workers due to AIDS. African companies are already feeling the impact of AIDS deaths in some key sectors.

The risk to U.S. citizens lies in the threat of infectious diseases. The most likely culprits will be HIV/AIDS, hepatitis C, food-borne illnesses, antimicrobial-resistant pathogens, TB, and influenza. Other lesser players may be malaria, cholera, dengue[2], and foreign animal diseases among Americans traveling abroad. Fortunately the United States has one of the best medical and research systems in the world, and U.S. citizens are unlikely to incur the majority of direct deaths.

In what will surely result as a major sore point with other governments, the United States may sharply limit entry onto U.S. soil, and the American military may also balk at engaging in peacekeeping missions in dangerous areas. The U.S. will also likely limit any imports that may carry viral pathogens. This will cause friction between the U.S. and some of its trading partners.

There will surely be a conflict between anger at the U.S. for limiting the factors mentioned above and the desire for medicines and research that will come from U.S. scientists and corporations. It's akin to wanting to bite the hand while it feeds you. It's also likely that Americans overseas could run into hostility when traveling abroad regardless of their purpose on foreign soil. The CIA is of the opinion that enmity could increase the chances of bio-terrorism on U.S. soil, and they feel that this threat might be greater than the threat of medical epidemics. Surely the greatest damage will be felt in the national psyche, when Americans want to help fight a situation that is both compelling and an uphill battle, with limited resources. t

Notes

[1] "The Global Infectious Disease Threat and Its Implications for the United States" can be viewed online at: http://www.cia.gov/cia/publications/report/nie99-17d.html

[2] Dengue is a virus that is spread by mosquitoes in tropical and semi-arid areas of the world, and is characterized by fever. Dengue can be treated by swift diagnosis and effective medical intervention.

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