On America’s Doorstep: Disease Migration in Latin America and the Caribbean
Dr. Stephen Corber is Director of Disease Prevention and Control Division for the Pan American Health Organization, and Regional Office of the World Health Organization. The Division’s Regional Program on AIDS and Sexually Transmitted Diseases provides technical collaboration and expertise for the prevention and control of HIV/AIDS and other sexually transmitted diseases in the Region of the Americas.
George C. Fidas is Intelligence Officer-in-Residence at The George Washington University's Elliott School of International Affairs. He was the principal author of two recent National Intelligence Estimates entitled “The Global Infectious Disease Threat and Its Implications for the United States” and “Growing Global Migration and Its Implications for the United States.”
Increased population migration encouraged by globalization has been a double-edged sword. With this new mobility comes economic opportunity and greater opportunity for the spread of infectious diseases.
On April 25, 2002, the Wilson Center’s Conflict Prevention, Environmental Change and Security Projects and the Latin America Program co-sponsored a meeting on this topic with the Better World Campaign.
Julie Hughes, Director of Outreach for the Better World Campaign, introduced the speakers and noted that they drew most of their material from a forthcoming World Health Organization report on disease migration.
According to Corber, economic development, international travel, urbanization, and microbial adaptation are the primary contributors to the spread of infectious diseases. He elaborated on the effects of migration, noting that the 800 million or so migrants worldwide are at increased risk for contracting diseases while simultaneously posing an increased risk of infection to their host populations.
Often public health authorities have difficulty reaching migrant communities because of those communities’ fear of authority, language barriers, and the perception that health care is not as critical as other services, he said. Such barriers to treatment and prevention have contributed to the spread of tuberculosis, HIV/AIDS, and dengue hemorrhagic fever, among other diseases.
Approximately one third of the world’s population is infected with tuberculosis, and alarmingly, the prevalence in migrant populations is five to six times greater than in countries of destination. As infection rates in host countries drop, it becomes crucial for public health workers to reach migrant communities—a task made all the more difficult when compounded by the fact that an increasing number of cases show resistance to multiple-drug therapy.
While the adult prevalence rate of HIV/AIDS in the Caribbean is 2.2 percent, several countries face generalized epidemics with infection rates at twice that level. The primary challenges in fighting HIV/AIDS in the Caribbean include finding the necessary resources, destigmatizing the disease, joint planning and programming among countries with high population flows, and ensuring continuity of services across international borders. During the question and answer period, Corber noted that treatment is becoming an increasingly important component of disease prevention, especially with HIV/AIDS. By providing treatment, public health officials are able to identify infected populations and educate them about preventing disease transmission to their families.
Dengue hemorrhagic fever, noted Fidas, is easily preventable. Spread by mosquitoes, larval eradication or simple netting can stop the disease. Combating the disease is simple and ought to be given higher priority, he said.
Fidas also addressed the effects of Latin American diseases on the United States. Citing regional movement of infected people, goods and foodstuffs, he noted that infectious disease deaths in the United States have nearly doubled since 1980. Most of these deaths occur in migrant communities, and yet there has not been a “clamp-down” on migration because of disease. These days, restricted movement is results from national security concerns. Recently however, leaders of developed countries are reacting to the potentially catastrophic impacts of infectious disease by establishing the Global Fund to fight AIDS, tuberculosis, and malaria.
Fidas believes there are three key challenges for leaders in the Western Hemisphere. First, they must determine whether diseases are “merely” a health threat or whether their wider political consequences (such as reducing funding for areas like education) are serious enough to warrant an immediate counterattack. Second, the global coalition to fight these diseases remains fragile, and if donors’ pledges to the Global Fund are not fulfilled, the coalition may collapse. Third, just as donors must remain committed to the cause, recipients must show resolve by making sincere efforts to use whatever resources they have on hand to combat the infectious disease threat.
By Brienne Ramer, Conflict Prevention Project
Contact: Anita Sharma, Deputy Director, Conflict Prevention Project, 202-691-4083