IR3001

1
IR3001

• Health and Global Security

2
The threat of illness

• Health not traditionally defined as a security
  issue in IR
• Management of preventable killing in wars
• Illness seen as important but a question of
  medical science, not diplomacy!
• BUT acknowledgement that by posing a threat to
  millions of lives, it is de facto a security
  issue
• E.g. black plague in 14th C. killed 75 million
• Threats of pandemics were always there (viruses
  and bacteria do not recognise state borders)
• BUT Globalisation means that through shipping
  and air travel a pandemic can spread much faster
  and more extensively

3
Global Dimensions

• Transmissible infections
• Threat is not constant peaks (pandemics) are
  unpredictable
• Vaccination/treatment controls some infections
  (TB) but access is unequal
• No vaccination for AIDS or the flu!
• Emphasis on transmission through migration
• Leads to support of health screening of
  immigrants from the Global South
• Evidence suggests that travel abroad is where
  most infections take place, e.g. Malaria, STIs
  from sex tourism
• Animal to human infection spread through
  increased cross-border trade (e.g. BSE)
• Mechanisms quarantine, culling
• War and natural disasters sanitation issues
  leading to dysentery, TB

4
Global Infectious Disease Threats see Hough
p.155

• 3.9 Million annual deaths
• 2.9
• 2.1
• 1.7
• 1.1
• 0.8
• 0.6
• 0.3

• Respiratory Flu, Pneumonia
• AIDS
• Diarrhoeal cholera, dysentery
• TB
• Malaria
• Measles
• Hep B
• Tetanus

5
The AIDS Epidemic in South Africa

• Fits into wider patterns of the epidemic in
  Sub-Saharan Africa, the worst affected region in
  the world
• 29,400,000 people living with HIV/AIDS in 2002,
  including 10 M aged 15-24yr and nearly 3M under
  the age of 15.
• approx. 3.5 Million new cases in 2002 (adults and
  children)
• 2,400,000 HIV-related deaths in 2002 (out of 3.1
  M deaths world-wide)
• In South Africa
• The enormous majority of cases of infections are
  in the black population, in poor areas
• In 2000, only 10,000 out of 4.2 M HIV positive
  population could afford HIV treatment
• Fastest growing trend is the infection of young
  heterosexual women (16-24) and their children
• Retroviral drugs to pregnant women in antenatal
  clinics could halve the number of infections to
  newborns.

6
AIDS and Politics in South Africa

• General problem of access to expensive
  medicines that make HIV more manageable in the
  developing world
• reluctance of drug companies (based in the USA)
  to give free drugs or allow for cheaper
  alternatives to be developed or distributed
• Unique case in South Africa - erratic official
  policy
• Refusal to recognise the size of the epidemic -
  Mbeki denying the link between HIV virus and AIDS
• victims of HIV/AIDS speaking out to increase
  awareness of the disease and demystify the AIDS
  taboo - Nkosi Johnson, Gibson Kente, Edwin
  Cameron
• Refusal to make HIV treatment available on the
  basis that they are dangerous and toxic drugs
  being tested out on black people (cost is
  another issue)
• Mandela taking a stand against Mbeki and
  Activists groups (Treatment Action Campaign)
  fight for treatment.

7
AIDS in Africa - impact on security

• K.Annan the impact of HIV/AIDS is no less
  destructive than warfare itself.
• Loss of productive generation
• Care for significant infected population and
  orphans
• Social and economic pressure
• This in turn threatens political stability and
  economic development.
• International Responsibility generic drugs
• Geneva talks in February 2003 on drug patents
  stalled due to influence of pharmaceutical
  industry in the US
• Infection patterns follow patterns of wealth
  internationally and within states
• SAPs create a fertile environment for the spread
  of HIV/AIDS
• AIDS has been called South Africas new
  Apartheid.

8
A Flu Pandemic? Some Myths

• It is a benign infection
• 36,000 death/yr in the US (mostly the elderly)
• Medical progress means that there cannot be
  another flu pandemic
• virus mutates and jumps species - no vaccine
  could be ready in time for a pandemic
• We can quarantine the disease
• Exponential population growth and air travel mean
  that infections and fatalities would be much
  higher than in previous pandemics an estimated
  180-360 million.
• Scientific extrapolation from 1918 patterns of
  infection

9
Flu Pandemics

• Spanish Influenza 1918
• Estimated 50-100 million deaths, half the worlds
  population infected
• 80 death rate in Samoa
• More deadly than WWI - and it was spread by and
  killed soldiers
• Asian Flu 1957 1 million deaths
• Hong Kong Flu 1968 750,000 deaths
• Limited by commonality with 1957 virus (immunity)
• H5N1 Bird Flu is next? Outbreaks controlled since
  1997.
• Pandemic projected to sweep the world from Hong
  Kong to Tehran in less than 180 days

10
International responses to health threats

• World Health Organization (WHO) provides advice,
  warnings, data, coordinate between states
• Eradication of smallpox in 1970s through
  immunisation campaign
• UN responds on ad hoc basis (project/issue based
  - UNAIDS)
• NGOs are focused on single diseases (e.g.
  Malaria)
• Respiratory infections are much harder to control
  and predict
• Decisions on SARS epidemic were made by states -
  quarantine
• Despite an effective response, clusters spread to
  Canada from Hong Kong from a handful of
  individuals
• There is no international body that can
  effectively manage a health crisis of pandemic
  size WHO is inter-governmental

11
Health as Security

• Genocide through irresponsibility?
• Some of the biggest killers can be cured, or
  vaccinated against
• HIV cannot be cured, but it can be managed
  patent laws mean rapid death
• In states where deadly infections are 30 of pop
  minimum, this defines the national interest,
  security, survival!
• But these states do not define international
  security
• Health inequalities kill more people than wars