W.W. Laegreid is a professor of pathobiology in the College of Veterinary Medicine and a faculty member in the Program in Arms Control, Disarmament and International Security (ACDIS). He's the author of "Impacts of Emerging Infectious Disease Research on International Security Policy," the first in a planned series of periodic briefs issued by ACDIS on topics ranging from biodefense and cybersecurity to energy security, nuclear nonproliferation and conflict management.
Are epidemics - such as the recent viral outbreak in China that has killed dozens of children and sickened thousands more - monitored in a systematic way by international health organizations?
In the case of the recent epidemic in China, the causative agent was an enterovirus, a very common infection in children. It is likely that most of the infections in China were mild to inapparent, but that there was a higher than expected number of severe and fatal cases recognized by Chinese public health officials who made the information public. This is how most disease outbreaks are detected - through old-fashioned clinical observation and laboratory diagnosis, with communication to the World Health Organization or the Office International des Epizooties (for domestic animal diseases). These organizations provide information about active disease outbreaks to all countries, which independently assess their own risk and decide upon prevention and control strategies to keep the disease from spreading into their country.
Is there a greater likelihood that new diseases may emerge when public-health and sanitation practices break down following natural disasters such as the recent cyclone in Myanmar and the earthquake in China?
It is absolutely true that natural and man-made disasters may be followed by outbreaks of disease, which may be more devastating than the disaster itself. These are not usually "new" diseases that have never been seen before but are diseases that are typically uncommon due to sanitation and other practices, but become common when those practices break down. China seems to be responding effectively to the challenges posed by the recent earthquake. It is less clear what is going on in Myanmar, but there is concern that large numbers of people are at high risk of disease due to lack of safe drinking water, food shortages and poor sanitation.
It's easy to understand why it's important for nations to have strategies in place for defending against nuclear or terrorist attacks. But how can an emerging infectious disease - or EID - compromise a nation's security?
The influenza pandemic of 1918-19 infected over a quarter of the population of the U.S., with an estimated 675,000 deaths. Suppose we had a similar epidemic now. In terms of the current population of the U.S. that would be nearly 2 million deaths in a matter of months. The fear and panic that such an event would create are hard to imagine. It is likely that all aspects of life in the United States would be affected as people tried to avoid exposure to the virus. Commerce and travel would be significantly reduced, and overall economic consequences would be severe. There would be enormous pressure on the federal government to do something to stop the epidemic. If the federal response was slow or ineffective, political instability might follow, especially given our 24/7 television and Internet news coverage and the relatively prolonged nature of an epidemic. Unfriendly or competitive countries might take advantage of the situation to gain political or economic advantage. But on the other end of the spectrum, even a single case of the right disease can have significant effects. A case of bovine spongiform encephalopathy, so-called "mad cow disease" in a U.S. cow in 2003 continues to color relationships with South Korea and other countries today. Export markets for U.S. beef have not yet recovered from the effects of that one case of disease either, a huge economic loss to one segment of the U.S. economy. Thus, emerging diseases can have serious political and economic effects, which in turn can affect the nation's security. These effects may be more direct and pronounced in the developing world.
What type of policy recommendations would you propose be adopted by governmental leaders seeking to protect their populations from disease-related international-security threats?
There are two recommendations I would make. First, that the possible consequences and the likely responses to a large outbreak of disease be communicated clearly to the public. Effective communication is even more important when we are talking about disease of food-producing animals or plants. In these cases, the control measures may have a devastating impact on farmers and livestock producers who are not directly affected by the disease, as well as on the rural economy as a whole. The second recommendation is to maintain or increase research related to detection, control and response to emerging diseases in general, including recovery.
What about recovery planning? Are we doing enough on that front?
Obviously the best way to recover from a disease outbreak is to prevent it or keep it tightly contained in the first place. However, in spite of our best efforts, a large outbreak of disease may occur. Unlike natural disasters, the physical infrastructure is likely to be intact. What would need to be rebuilt is the social and economic fabric torn by disease. Where there is high mortality, who replaces the teachers, shopkeepers, factory and other workers lost? How do we regain the sense of safety required to go to public places to shop or watch a movie? How do we regain the trust of our trading partners? There is no blinking light that goes on at the end of an epidemic signaling the "all clear"; it is much more ambiguous, increasing anxiety and confusion and further complicating the recovery process. Recognizing the difficulty and importance of the recovery phase after an epidemic is not high profile, and though there has been some effort in this area, more is needed.
