"The Global Infectious Disease Threat and Its Implications for the United States"

George Fidas, Deputy National Intelligence Officer for Economics, and Global Issues, National Intelligence Council

Lt. Col. Donald L. Noah, Armed Forces Medical Intelligence Center

April 18, 2000 - New and reemerging infectious diseases will pose a rising global health threat and will complicate U.S. and global security over the next twenty years, according to George Fidas and Donald Noah, speaking at a recent meeting hosted by ECSP. The two speakers presented the findings of a recently released National Intelligence Estimate on "The Global Infectious Disease Threat and Its Implications for the United States" to a group of Washington policymakers and NGO representatives. Fidas detailed the findings while Noah, fielded epidemiological questions on the report.

In 1996, the U.S. intelligence community was tasked with exploring the issue of infectious diseases and its impact on U.S. national security. The Department of State and National Security Council commissioned the National Intelligence Estimate, following more than a decade of indications that infectious diseases were beginning to pose a global threat. This concern came, despite earlier eradication of some infectious diseases (such as polio) in many parts of the world. Many branches of the U.S. government as well as non-profit organizations had begun to study the threat that infectious diseases pose, leading in part to their inclusion in the Department of State's National Security Strategy of 1996.
This NIC report was released at a time of particularly high policy attention. Vice President Al Gore addressed the U.N. Security Council on AIDS and nongovernmental organizations released similar publications about the impact increasing incidences of infectious diseases are having on global security. More recently, at the World Bank meetings held in Washington, DC in April 2000, World Bank President, James Wolfensohn stressed the need to provide unlimited sums of money to poor countries to combat AIDS and other pandemics.

New and Reemerging Infectious Diseases

Globally, infectious diseases remain a leading cause of death, but are particularly pernicious in developing nations. Worldwide, of 54 million deaths, approximately one-third to one-half of them result from infectious agents, with most deaths occurring in developing nations and affecting children under the age of five. Some infectious diseases, however, have reemerged or spread more widely since 1973, including tuberculosis, malaria, and cholera. Many of these reemerging diseases are far more virulent than their predecessors and are often drug resistant.
Combined with these reemerging diseases, several new infectious disease agents have been identified since 1973, including HIV/AIDS, Ebola, and hepatitis C. These new infections have no known cure and replicate quite quickly. The seven most deadly disease agents are HIV/AIDS, tuberculosis, malaria, hepatitis B and C, lower respiratory infections, and diarrheal diseases, with HIV/AIDS and tuberculosis liable to cause the majority of deaths from infectious diseases in developing nations by the year 2020. HIV/AIDS in Africa is already taking a huge toll and the spread of this plague is only projected to increase over the next twenty years. Life expectancy in parts of sub-Saharan Africa, for example, has already decreased on average by 10-20 yeas as a direct result of the AIDS epidemic.

Impact on the United States

Because microbes know no boundaries, public health threats from what were previously thought to be eradicated diseases, and newly emerging diseases are a global threat and complicate global security as they sometimes exacerbate social, political, and economic tensions. The NIC report identified several major contributing factors to the spread of infectious disease that are global in nature. Each factor has been associated with certain infectious diseases. For example, human demographics and behavior can lead to the spread of dengue fever, sexually transmitted diseases, and giardiasis. Innovations in technology and industry can cause toxic shock syndrome and hemorrhagic colitis. Other factors, which can increase incidences of disease, include economic development and land use, international travel and commerce, microbial adaptation and change, breakdown of public health measures, and climate change.
What do these trends mean for the United States specifically? Despite a lower total of deaths from infectious disease agents than in the developing world, Americans are becoming more susceptible to infectious diseases through increased travel, the deployment of armed forces overseas, changes in human behavior and diet, changes in land-use patterns, and increases in international trade. Infectious-disease related deaths per annum have almost doubled over the last twenty years after the lowest recorded deaths in 1980. Tuberculosis for example, exacerbated by multi-drug resistant strains, and an increase in HIV/AIDS infections, has made a come-back. The next serious threat to the United States may come from an unknown or new disease, such as AIDS that emerged in the early 1980s.

Three Scenarios

Fidas also discussed three alternative scenarios developed in the report on the infectious disease threat over the next twenty years. The first scenario, and least likely, according to the NIC, is what is termed "Steady Progress," whereby there is a global "health transition." In other words, given the aging global population, declining fertility rates, socioeconomic advances, and improvement in health care and medical breakthroughs, noninfectious chronic diseases, such as diabetes and cancer would predominate. It is the least likely scenario, however, because there are pernicious challenges both demographically and socio-economically.
A second, and perhaps more likely scenario is one in which progress is stymied, where no progress is made in countering deadly infectious diseases such as the Ebola virus and HIV/AIDS. Microbial resistance to drugs will rise spreading infectious disease agents among large populations such as in China and India. But, unlike the first scenario, this "Progress Stymied" scenario is overly pessimistic about political and socioeconomic opportunities.
Finally, Fidas discussed the third and most likely scenario of the report, "Deterioration, Then Limited Improvement," in which there is a worsening of the disease threat and a deterioration in health services, but will in part be overcome by improvements both in the health field and in the socioeconomic circumstances of countries. Better preventive tactics and new pharmaceutical drugs will help to counter the spread of disease in developing countries with conducive environments such as increasing urbanization and continued levels of inequity and poverty. Fidas stated that this was most likely given the demographic predictions and the social, economic, and political factors. In sum, although the "infectious disease burden will add to the political instability and slow democratic development in Sub-Saharan Africa, parts of Asia, and the former Soviet Union, while also increasing political tension in and among some developed countries," according to Fidas, yet, there is hope. What happens in the future, will depend on improvements, preventive behavior, and what the world does to address socioeconomic and demographic factors today.

Discussion

Participants questioned the motives of Thebo Mbeki's recent statement that HIV does not cause AIDS. They speculated that his political denial is in part based on cultural treatment of diseases, a and South Africa's fear of the economic consequences of negative press (i.e. declines in tourism revenues). Discussion also centered on globalization of diseases and what to do. Participants discussed five actions to ameliorate the impact of infectious diseases: (1) more funds must be spent on infectious disease research, particularly on prevention; (2) countries must educate the public on health, especially AIDS; (3) decision-makers must prioritize spending, which will require recognizing health as a security issue that can eventually affect civil society and democracy in countries; (4) cures must be found to these diseases; and (5) countries must work to improve access to health care and drugs.

Editor's Note: This National Intelligence Estimate was the third report released by the National Intelligence Council that ECSP has highlighted at Center meetings. Others included one on "The Environmental Outlook in Russia" and another on "The Environmental Outlook in Central and Eastern Europe." Excerpts of the NIC report will be reprinted as a special report in the forthcoming ECSP Report, Issue 6, due out in summer 2000.