A New, Global Approach to Pandemics and National Security

by Dr. Harvey Rubin
May 30, 2006

We live in a world of pandemics, some potential and some quite real; both are unmistakably threats to national and international security.  Whether or not H5N1 Avian influenza materializes as a human pandemic it is crucial to consider the full pandemic panorama. The issue is global and the solution must be global and enforceable.

Here are some of the realities. Each year 300 million cases of malaria kill two million people. An estimated 3% of the world?s population - 170 million people - is chronically infected with hepatitis C virus. About four million people are newly infected each year, 80% of whom will progress to a chronic infection associated with cirrhosis in about 20% and liver cancer in about 5%. One third of the world is infected with the bacterium that causes tuberculosis with 10 million cases every year accounting for two million deaths. 

Approximately 40 million people worldwide are infected with HIV, which killed 3.9 million people in 2005.  In Russia, Vladimir Putin just recommended financial incentives to citizens to increase fertility because the death rate outstrips the birth rate. While cardiovascular deaths lead the list, the incidence of HIV/AIDS and tuberculosis are on the rise. In recognition of this demographic nightmare, Russia will make the prevention and control of infectious diseases one of the priorities of the upcoming G8 summit in St. Petersburg.

Some lethal pandemics are still not as well known to the general public. For example, an ongoing cholera pandemic started in Indonesia in 1961 is causing close to 120,000 deaths per year.

That pandemics are now recognized as national security threats reflects the dramatic change in theories of national security. Richard Ullman, of Princeton University, observed in Redefining Security in 1983 that national security threats are actions that can degrade the quality of life for the inhabitants of a state or significantly narrow the range of policy options available to the government or private citizens of a state.  This broadened notion of national security is now commonplace. For example, an unclassified report from the National Intelligence Council in 2000 examined "The Global Infectious Disease Threat and Its Implications for the United States", and an unclassified 2003 CIA document analyzes "The Darker Bioweapons Future" in which the great good that modern molecular biology has brought is compared to the possibility that "the effects of engineered biological agents could be worse that any disease known..."

We are faced with a daunting challenge of the 21st century and it calls for solutions that integrate new ideas in science and technology with social and political realities. It involves optimizing the tradeoffs in the dense interplay between international security,   tracking, preventing, detecting, and treating naturally occurring infectious diseases on the global dimension, the potential for nefarious use of existing or newly engineered biological agents, the need for vigilance in laboratory bio-safety, maintaining and enhancing the positive role of modern molecular biology on the economy and health of the developing world, and stimulating the creation and open dissemination of new knowledge.

This vexing problem was raised quite clearly in the 2006 National Security Strategy: "Public health challenges like pandemics (HIV/AIDS, avian influenza) ... recognize no borders. The risks to social order are so great that traditional public health approaches may be inadequate, necessitating new strategies and responses (italics added).

We propose a counter offensive and it involves the creation of a new international public health treaty that would:

1. Establish and maintain international standards for surveillance and reporting of infectious diseases using advanced information technology to ensure timeliness,  interoperability and security. This recommendation would significantly expand  the International Health Regulations revised in 2005 that were unanimously adopted by the World Health Assembly and which are scheduled for implementation in June 2007.

2. Establish and maintain international standards for best laboratory practices.

3. Build and maintain a primary facility and one backup facility for the production of vaccines and therapeutics expressly for emerging and reemerging infections. These international facilities would be awarded to the country with most convincing offer with additional funding provided by member states. This organizational structure would remove many of the economic and legal constraints on the production and distribution of drugs and vaccines for specific infections of concern.

4. Establish and maintain an international research center for emerging and re-emerging infections awarded to the country with the most convincing offer with additional funding by member states. The research center would foster a culture of research responsibility internationally and serve as the nucleus for safe applications of modern molecular biology globally.

These recommendations are made with full knowledge of the inherent legal, political, diplomatic and economic difficulties of international treaties.  The drawn-out process that led to the adoption of the World Health Organization Framework Convention on Tobacco Control, frequently referred to as the first public treaty which the United States has signed but not yet ratified, serves a painful reminder.

The immediate challenge is to draft, debate, sign, and ratify a serious Framework Convention on Infectious Diseases with the urgency that the situation demands. It will be hard, but we have no other option.

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