Confronting Poverty: Weak States and U.S. National Security

State Weakness and Infectious Diseases

167 The year is 1959. Within twelve months, the Belgian Congo will declare its independence and be wracked by a series of political uprisings. Private mercenaries will flood the country to protect mining interests. Six years later, a CIA-led coup will bring to power a brutal dictator named Joseph Désiré Mobutu, who will reign over the country throughout three decades of poor governance and corruption. By 1996 Congo will be entrenched in a devastating civil war that will kill millions. But all of that is still to come. The major event in the Belgian Congo in 1959 was neither an earthshattering revolution nor the rise of a corrupt leader, but a blood test. A Bantu man presented himself at a clinic in the capital city of Léopoldville with conditions indicating sickle cell disease. To identify the disease, doctors ordered a fateful test that many years later would reveal the first known case of HIV.1 The possibility that a blood test in a distant colonial capital might matter on the streets of New York and San Francisco, and ultimately all across America, could not have been fathomed by medical scientists or security officials. The methods for international disease surveillance critical to halting emerging epidemics had not been established. Such surveillance could have exposed a virus that lurked undetected for decades. It could have controlled a disease that continues to kill Americans, Africans, and people from every continent at alarming rates. Ultimately, millions of lives might have been saved. chapter six state Weakness and infectious Diseases MiriaM estrin and carl MalM 06-0390-7 ch6.indd 167 12/8/09 12:22 PM 168 MiriaM estrin anD carl MalM At the time the Congolese man contracted HIV/AIDS, Congo’s health conditions were abysmal. In 1960 life expectancy stood at a meager forty-one years, compared with seventy years in the United States.2 A long-standing history of neglect had hollowed out the health system. During the reign of Belgium’s King Leopold II from 1885 to 1908, violence and disease killed millions of Congolese.3 By the time of Congo’s independence in 1960, bad governance and poverty had left the majority of the population with little or no access to health care. At the time of the Bantu man’s blood test, Congo and its travails mattered little to most of the world. In retrospect, strong health care systems might have better fought AIDS as it unfolded. While the precise origin of AIDS is not known, this disease, which has killed a half-million Americans , clearly originated outside U.S. borders and decades before anyone in the United States recognized the threat. By then it was too late to save hundreds of thousands of American lives, much less tens of millions of African lives. None are experiences the United States or the international community can afford to repeat. Yet that is the risk when the United States fails to help poor and weak states develop the capacity to fight diseases of concern to U.S. national security. Of course, poverty is not solely responsible for all disease outbreaks , all diseases in poor countries are not a national security concern to the United States, and all diseases that threaten the nation will not come from the poorest or weakest countries. However, poor countries are more likely to have infectious diseases emerge within their borders and are less able to control them. An increasing volume of global travel and trade makes diseases in poor countries more likely to reach the United States. Thus, diseases that emerge and fester in poor, weak states can threaten Americans. This chapter is concerned with the spread of infectious diseases from poor or weak states to the United States—and the resulting public health emergency that could threaten American lives. Eradicating poverty and disease is not merely a worthwhile end in its own right. In today’s interdependent world, policies that help poor countries to prevent, monitor, and control diseases within their borders can ultimately protect Americans. InfectIous DIseases anD u.s. natIonal securIty Some infectious diseases—for example, HIV/AIDS, drug-resistant tuberculosis , and pandemic flu—are clear national security threats to the 06-0390-7 ch6.indd 168 12/8/09 12:22 PM 169 state Weakness anD infectioUs Diseases United States. They have the potential to make people sick, hurt the American economy, kill millions of Americans...