Global Governance and the UN: An Unfinished Journey

9 Protecting against Pandemics

9 Protecting against Pandemics •฀Antecedents:฀Smallpox฀as฀a฀Model •฀Knowledge฀Gaps:฀From฀Ignorance฀to฀Ignorance •฀Normative฀Gaps:฀A฀Missing฀Prelude฀to฀Action •฀Policy฀Gaps:฀The฀Need฀to฀Scale฀Up฀the฀Attack •฀Institutional฀Gaps:฀Necessary฀but฀Insufficient฀Organizations •฀Compliance฀Gaps:฀Who฀Is฀Listening? •฀Close฀Calls:฀SARS฀and฀Avian฀Flu •฀Conclusion:฀Fitful฀and฀Halting฀Progress The rapidity with which some diseases can spread to become global pandemics ; the emergence of new, deadly, and highly contagious diseases; the absence of border defenses to protect against such diseases; and the greater vulnerability of poor countries and poor people because of virtually nonexistent preventive and negligible therapeutic care are among the down sides of globalization. a deadly cocktail of exotic diseases crosses borders free of passport and visa regulations due to the back-and-forth movement of business travelers, tourists, traders, soldiers, migrants, and refugees; the modes of transport they use; incubation periods that ensure that many who contract diseases develop symptoms only after borders have been crossed; and the ability of some diseases to jump across plant, bird, and animal species. over the last decade, the world has witnessed four potential scares: severe acute respiratory syndrome (sars, 2002–2003), the Ebola virus (2000–2008), avian influenza (bird flu, 2005–2006), and theh1n1 flu (swine flu, 2008–2010). in combination with hiv/aids, they pushed to the very top of the international agenda the issue of the global governance of health. The task is huge, ranging from gathering statistics to creating codes of conduct about breast feeding, from finding ways around patent rights Protecting AgAinst PAndemics 287 so that poor countries can have access to expensive drugs to efforts to halt smoking. in the case of the latter issue, efforts range from Who lobbying to halt smoking inside un buildings to the 2008 pledge by u.s. billionaires michael bloomberg and bill Gates to devote $500 million to public education in developing countries about the lethal consequences of smoking.1 We have chosen the example of pandemics, more particularly the hiv/aids pandemic, because they illustrate mark Zacher and Tania keefe’s insight that the planet is “united by contagion.”2 While other international efforts have certainly contributed to increasing life expectancy and improving health in many ways, we concentrate on the acute difficulties in dealing with contemporary pandemics because they suggest lessons for global governance in general. These lessons include the need to monitor infectious diseases, the need to implement emergency medical controls during outbreaks, the need for rules that inhibit the spread of diseases across borders, the need for financial and material assistance to facilitate long-term health programs, and the need for international legal reforms that promote improvements in access to health programs. almost 40 million people in the world—approximately 1 percent of the world’s total adult population—were living with hiv at the end of 2005. in 2005, 2.8 million died of the disease and another 4.1 million were newly infected.3 Every day in 2007, almost 7,000 people, including around 1,500 children, mostly newborn, were infected with hiv around the world. as many as 6,000 people die of aids every day.4 The security council held a summit meeting on hiv/aids in january 2000 with u.s. ambassador richard holbrooke as president. Later that year it adopted resolution 1308, which declared the pandemic a threat to international peace and security.5 aids is a human security issue because of the vicious chain of infection, communal devastation, and social-national disintegration.6 it is a personal security issue because as prevalence rates reach 5–20 percent, gains in health, life expectancy, and infant mortality are wiped out; agricultural production and food supplies decrease; and families and communities start breaking apart. it is an economic security issue because a 10 percent prevalence rate of hiv/aids can reduce the growth of national income by one-third, while a 20 percent infection rate will cause Gdp to fall by 1 percent per year.7 it damages communal security by breaking down national and social institutions and decimating the ranks of the educated and mobile, such as civil servants, teachers, health professionals, and police. it damages national security by 288 hUmAn rights enfeebling security forces and corroding the pillars of economic growth and institutional resilience that protect nations against external and internal conflict. it is arguably an international security issue because of its potential...