April 13, 2003

Thanks to the rapid pace of globalization and inadequate health facilities for the poor, the burden of infectious diseases will aggravate in the coming years and may provoke economic decay, social fragmentation and political destabilization in the hardest hit countries

The world is poised to suffer a major health disaster from new and re-emerging infectious diseases, over the next 20 years, which, a CIA report fears, will complicate global security and exacerbate social and political instability in some countries. And an effective international response to the threat is not available at the moment and may, if at all, be in place at least after 2010.

The latest outbreak of severe acute respiratory syndrome (SARS), a flu-like atypical pneumonia, which first appeared in China in February and by mid-March raised its head in Hong Kong, is a harbinger of the predicted threat. It reflects a new pattern of disease outbreaks in which the disease is no more restricted to a certain geographical entity as it used to be in the past, nor is its cause easily identifiable. These diseases are to spread by travel, thanks to the rapid pace of globalization. The World Health Organization has already issued a global health alert.

The developing and ex-communist countries are to experience the most devastating effects of the new disease outbreaks because of malnutrition, poor sanitation, impure water and inadequate healthcare. But the US intelligence community would prefer to ignore the harsh reality that the worsening health conditions in the Third World countries are a direct outcome of neo-liberal policies imposed on them by the IMF, World Bank and WTO, under which state-run cheap medical facilities are terminated and healthcare is privatized and made expensive.

The CIA report, released recently, is an estimate of the dimensions of a non-traditional threat to the world and its impact on the US. It examines the future course that the most lethal diseases may take globally and in certain regions, and international capacity to deal with them. What the report fails to highlight is that despite having a highly developed health infrastructure, the rich West cannot escape an equally disastrous impact of the new, unknown and revived diseases that the developing countries are destined to suffer from. Needless to point out, the disease-causing agents cannot distinguish between an affluent American and a poor African. And some of the new viruses are too quick to kill before any medical aid could be made available.

One may recall that the medical advances made to contain infectious diseases in the decades after the Second World War had given rise to earnest hopes that the global disease threat was about to be neutralized. It was this optimism that led the UN member states to sign “Health for All 2000” accord, with emphasis on primary healthcare, at Almaty, Kazakhstan in 1978. This optimism was still intact as recent as 1996 when a study had projected a dramatic reduction in the infectious disease threat.

According to the CIA study, it led the world to complacency and factors such as fast-expanding trade and travel and growing microbial resistance to existing antibiotics were overlooked, paving way for return of some of the old scourges. But Halfdan Mahlar, the then WHO chief (1973-1988) and architect of primary healthcare approach, does not agree. He blames the World Bank for “hijacking of health” from WHO in 1993 and subsequent abandonment of primary healthcare strategy which has plunged public health managements in the developing countries into a deep crisis.

As such, infectious disease remain a leading cause of death. Of the 54 million deaths worldwide in 1998, about one-third were due to these diseases. At least 29 previously unknown diseases have emerged since 1973. Many of them are incurable. Twenty well-known diseases have rebounded, after a period of decline, in deadlier forms.

The seven infections diseases which will remain a global threat for a long time to come are HIV/AIDS, TB, malaria, Hepatitis B and C, lower respiratory infections, diarrheal diseases and measles. AIDS, which shows no signs of abating in Africa and is sure to invade Asia in a few years, killed 2.3 million people in 1998. By 2010, over 120 million will be suffering from this disease. WHO declared tuberculosis a global emergency in 1993. Now it is multi-drug resistant. It prevails mostly in Russia, India, Southeast Asia, sub-Saharan Africa and Latin America. About two million die of TB every year. It will rank second only to HIV/AIDS as a cause of death by 2020.

Malaria, which seemed to be on the way out in 1960s and 1970s, has made a deadly comeback. It kills more than a million every year. Sub-Sahara will experience 20% annual increase in malaria deaths in next several years. Hepatitis B caused six lakh deaths in 1997 and some 350 million people are believed to be chronic carriers. Hepatitis C, identified in 1989, is less prevalent but far more lethal. Over 25 per cent of chronic patients of Hepatitis B and C will die of liver cancer and cirrhosis in next 20 years. Flu and pneumonia kill about 4 million people annually. This rate of death will drastically increase. Diarrheal diseases cause three million deaths. And despite substantial progress against measles in recent years, the disease still infects some 42 million children annually. It will continue to cause periodic epidemics in South America.

With few exceptions, the reappearance of infectious diseases owes its origin as much to dramatic changes in human behaviour such as population movements, living styles, immigration, sexual practices, and increased travel and trade as to mutations in pathogens. A major contributor to this threat is claimed to be the misuse and overuse of antibiotics that has made microbes drug-resistant. The other factors are the emergence of megacities with severe healthcare deficiencies and rapid rise in cross-border movements of people and produce.

The West often blames the Third World doctors and public health establishments, as does the CIA report, for increased and unnecessary use of antibiotics leading to drug resistance. No Western government or agency would, however, concede that the main culprit in this case is the Western drug industry. The misuse is primarily promoted by the drug companies which often influence the doctors in all possible ways to prescribe their antibiotics in most of the conditions. The companies compete fiercely with each other to sell their brands and feel no moral qualms to make false claims.

The infections disease burden, it is assumed, will aggravate in the coming years and, in some cases, may even provoke economic decay, social fragmentation and political destabilization in the hardest hit countries. The continued spread of HIV/AIDS and malaria will reduce GDP in some sub-Saharan countries by as much as 20 per cent by 2010. The life expectancy may reduce by 30 years. AIDS will kill a quarter of the population in some countries over a decade, producing a huge orphan cohort. Nearly 42 million children in 27 countries (19 in sub-Sahara Africa) will lose one or both parents by 2010.

The annual GDP growth in heavily affected countries is already suffering a one percentage point reduction in case of HIV/AIDS and one to two percentage points for malaria, according to World Bank studies. Namibia experienced eight per cent decline in its GDP because of AIDS in 1996. However, Kenya will suffer a fall of 14.5 per cent in its GDP by 2005. The annual cost of malaria to Kenya’s GDP is two to six per cent and to Nigeria’s one to five per cent. A recent study by Zimbabwe Farmers Union estimated production losses due to HIV/AIDS at about 50 per cent. South African companies will begin to feel the full impact of the AIDS epidemic by 2005, substantially eroding corporate profits.

Although the relationship between the disease and political instability is not direct, it is a real one. A study on the causes of state instability suggests that infant mortality correlates strongly with political instability particularly in countries which have already achieved a measure of democracy. The burden of diseases is likely to intensify the struggle for political power to control scarce state resources.

These diseases, HIV infection in particular, are also bound to weaken military capabilities of some countries and induce some officers to launch coups aimed at plundering state coffers. The most affected by AIDS are army officers in African states and ex-Soviet bloc countries. The United States, being a major hub of global travel, immigration and commerce and with a large civilian and military presence overseas, will also face a greater health threat. The infectious diseases will continue to kill at least 170,000 Americans annually. US military personnel deployed at NATO and US bases overseas will remain prone to infectious diseases but at the highest risk will be the American troops engaged in humanitarian and peace-keeping operations in developing countries.

It is difficult to make a direct connection between disease prevalence in military forces and their performance in battle. But, in a scenario in which a large number of officers and other key personnel happen to die or become disabled because of AIDS, the combat readiness and soldiers’ morale is bound to deteriorate. The greatest sufferer will be the sub-Saharan militaries among whose ranks AIDS victims are 60 per cent — the prevalence higher than civilian population. Peacekeeping efforts will badly suffer. Although the UN seeks “disease-free” troops for this task, it is difficult to enforce this rule.

The ever-increasing international air travel, trade and tourism makes the outbreak of epidemics easier these days. At present, there is a cross-border movement of some two million people each day and of one million people between developed and developing countries each week. This movement will accelerate with the passage of time. Hence, travel and commerce will remain key factors in the spread of diseases.

The diseases will adversely affect inter-state relations as related embargoes and boycotts to prevent their spread will create trade frictions, as was recently witnessed in the case of three-year EU embargo on British beef following Mad Cow disease eruption in Britain. The controversy over drug-related intellectual property rights is likely to aggravate and end up in a major political crisis. The drug multinationals will not agree to reduce prices of AIDS drugs and the ultimate production of generic drugs on mass scale by violating patent regime will exacerbate serious conflicts between developed and developing countries.

The rapid pace of globalization and introduction of structural adjustment programmes in developing countries by the IMF and World Bank has played havoc with the health of the poor. Since governments have been the main providers of health service since colonial days, the poor did enjoy some health status till recent years. The privatization of healthcare which, if not reversed at some stage, will lead to an unimaginable social upheaval. However, the CIA report expects things to become better in the second decade (2010-2020), as the first decade’s experiences will lead to several improvements in the management regime.

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