commentary

(Modern Healthcare)

July 14, 2003

U.S. Foreign Policy Must Include the Eradication of Dangerous Diseases

by Kenneth Shine and C. Ross Anthony

Recent action by the World Health Organization to step up its role in combating disease and poor health around the world marks an important advance in a world war that will claim far more lives than the wars against terrorism, Iraq and the Taliban combined.

While the wars waged by soldiers and law enforcement have dominated American foreign policy so far in the 21st century, the war fought by doctors and other health professionals against killer diseases and poor health now should become a central focus of our foreign policy. This war without guns will save lives and strengthen our ties to other nations, serving both humanitarian concerns and our national interest.

Severe acute respiratory syndrome is just the latest global killer facing us in this war, following on the heels of HIV/AIDS. SARS has infected more than 8,400 people around the world and has killed at least 805 this year. AIDS has claimed an estimated 25 million lives worldwide.

Many more diseases—including malaria, cholera, dysentery and tuberculosis—continue to kill people in Third World nations every day—even though we know how to prevent them and cure them much of the time-simply because adequate healthcare is unavailable. Bioterrorism threatens to revive smallpox and spread anthrax and other fatal viruses and bacteria. All these diseases pay no attention to borders or national sovereignty, and air travelers can carry them from one side of the world to the other in a matter of hours.

By working with other countries we can come up with practical programs to reduce the spread of SARS, HIV/AIDS and other diseases; develop more effective training programs for doctors and nurses; help improve healthcare and public health delivery systems for the poor; seek cures and better treatments for many diseases; increase the production and distribution of lifesaving drugs at affordable prices; fight the hunger that leaves people vulnerable to disease and can lead to starvation; end trade policies that endanger health; and carry out other lifesaving projects.

SARS illustrates the vulnerability of Americans to new and often lethal diseases that are quickly spread to our shores by a globally mobile population when health concerns are forgotten. The rapid international response to SARS was facilitated by early warnings from the WHO, which led the mobilization of the international public health and health science communities.

The WHO now plays a key role in the global monitoring and detection process for infectious diseases, but it has been limited by insufficient funding and inadequate authority. The latter is particularly reflected in the delayed reporting of SARS cases from China.

The WHO took on greater authority May 28 to fight SARS and other diseases, along with the threat of bioterrorism. Governments now will need to give the WHO more information to help the agency monitor and control the most dangerous infectious diseases.

Global health is a national security issue for the U.S. The surveillance system operated by the WHO is the system that might first detect the emergence of new infection or a new form of antibiotic resistance introduced by terrorists. However, considerations of health must permeate every aspect of our foreign policy. We must have careful planning of our health response that includes collaboration with our military and peacekeeping responsibilities.

While the U.S. has lingering doubts about the United Nations, particularly after the way the U.N. handled policy in Iraq, it is in our national self-interest, as well as in the interest of global public health, that we find better methods to improve the global surveillance of infectious diseases. These efforts also will require increased accountability of all those concerned in this process.

Working on behalf of improved world health offers our country a chance to demonstrate our compassion and values. Secretary of State Colin Powell has indicated his personal commitment in this effort and has appointed Jack Chow as deputy assistant secretary of state for health and science.

President Bush has shown his commitment by signing a bill into law May 27 that pledges $15 billion over five years to combat the global spread of AIDS.

These are good first steps but should be followed with the allocation of more resources to improve the health of people around the world.

American foreign policy and its efforts in national defense should be carefully balanced and include defense against disease and poor health. If we can do this, maybe both the reality and the perception of our role in the world will be that we are a nation that cares about people everywhere in such fundamental aspects of life as health.

Disease—whether spread naturally or by terrorists—is a weapon of mass destruction that is universally hated by people everywhere, regardless of their nationality, race, religion or ethnicity. In the war against disease, America can lead a worldwide coalition that benefits every nation and person in the world.


Kenneth Shine is director and Ross Anthony is associate director of RAND's Center for Domestic and International Health Security, Santa Monica, Calif. Shine is a former president of the Institute of Medicine.

This commentary originally appeared in Modern Healthcare on July 14, 2003.