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SARS: A matter of national
security
By Mely Caballero-Anthony
(This article is used by permission of the Pacific
Forum CSIS)
As the threat of severe acute
respiratory syndrome (SARS) continues to spread across
the globe, countries are bracing themselves for worse to
come. According to recent figures, SARS has already
infected more than 3,300 people and killed at least 165
in at least 25 countries. With no cure in sight, medical
teams have been working feverishly to contain the
problem while the casualties grow.
Government
authorities have been deploying various strategies to
cope with the silent killer. In Singapore, for example,
mechanisms have been quickly set in place to prevent
further spread of the disease. These include quarantine
of infected patients, issuing travel advisories to
SARS-affected countries, immigration checks and border
controls, massive public information programs, and even
closure of schools.
But while Singapore and
other affected countries were prompt to act, China has
been severely criticized for initially playing down the
seriousness of the problem and its slow response to the
request by the World Health Organization (WHO) to allow
its medical team to go to Guangdong where the spread of
the infectious pathogen was said to have started. In a
recent press statement, WHO's director general, Gro
Harlem Brundtland, said that had the Chinese authorities
acted earlier and with more openness, the outbreak of
the disease would have taken a different course.
China's belated response has been attributed to
the authorities' concern about economic fallout if
information about SARS leaked. But the slow movement
from silence-denial to acknowledgement and cooperation
is not really surprising given the prevailing attitude
toward infectious diseases.
Most, if not all,
countries - China included - treat infectious diseases
as medical problems that merit a medical response. That
is probably why it took four and a half months after the
first known case of SARS before the Chinese authorities
alerted WHO. The delay was reportedly due to
bureaucratic procedures that require classification of
SARS as a Category B disease before local health
authorities are required to report it to the central
government. Then there was the problem of how to handle
this type of disease, ie, whether this would fall under
the framework of the International Health Regulations
(IHR) that make reporting of infectious diseases to WHO
mandatory.
The IHR is a global
disease-surveillance system that requires member states
to notify WHO within 24 hours of outbreaks of infectious
diseases. WHO, however, has no enforcement power and
instead relies mostly on persuasion and recommendations
to encourage countries to comply. Moreover, the present
IHR covers only three diseases - cholera, yellow fever,
and plague - and not other emerging or re-emerging
infectious diseases. As there are no multilateral
arrangements to deal with global health emergencies, the
lack of coordination at both local and national levels
in alerting the international community comes as no
surprise. Several factors account for these
shortcomings, two of which are highlighted below.
Attitudes and approaches
While
infectious diseases have been conventionally regarded as
medical problems, in a rapidly changing global
environment the threats they create are no longer
confined to medical/health risks alone. The disruption
of business, its impact on travel and tourism and
economic growth are among the serious repercussions that
necessitate defining the SARS problem in strategic
terms.
With globalization, the scale, speed, and
reach of the movement of people and goods are
unprecedented. These movements in turn have shaped the
appearance, spread, and distribution of infectious
diseases in humans and animals. The SARS case is
instructive. There is speculation that the infectious
pathogen may have come from an animal and "jumped" to
humans. In the densely populated province of Guangdong,
where human and animal contact is extremely close,
transmission and spread of infection are much more rapid
and containment becomes more difficult. Given the
massive movement of people in and out of China and the
ease of international air travel, the reach of the SARS
virus to more than 20 countries is not surprising.
Indeed, with globalization, no community can be entirely
immune from these contagious diseases.
SARS is
not the first case that illustrates the nexus between
movement of people and goods and the nature and spread
of infectious diseases. Much has already been said and
written about the HIV/AIDS pandemic. But it bears
reiterating that there is still a wide gap between the
extent of the HIV/AIDS threat and adequate and cohesive
international action. Within a few years after its
discovery, the human immunodeficiency virus (HIV) had
spread to every continent and to every country. So far,
25 million people have died of AIDS and about 3 million
people a year continue to succumb to the disease.
In 2000, the United Nations Security Council
declared AIDS (acquired immune deficiency syndrome) to
be a national security threat, and that was followed by
similar political endorsements at the Group of Eight
(G8) meetings in Okinawa and Genoa. Despite these
initiatives, AIDS, tuberculosis, malaria, and now SARS
are still seen by many countries as health
disease/problems and not as human security threats. When
the United States first pushed for HIV/AIDS to be
discussed in the Security Council, many nations
protested for procedural reasons. They felt that the
Security Council was not the appropriate forum for what
are perceived as "social and economic issues".
However, unless the linkage between infectious
diseases and human security is recognized, most
countries will still "medicalize" infectious diseases
such as SARS rather than "securitize" them until the
outbreak of the disease(s) reaches alarming proportions.
The experience of sub-Saharan Africa with AIDS reveals
that the socioeconomic and political effects are more
devastating than the effects of war.
Thus, going
beyond the medical approach to securitizing infectious
diseases must become a norm rather than an exception. In
the case of SARS, this requires more than official
pronouncements that SARS is a national-security issue.
An integrated approach that includes various ministries,
government agencies, and the medical sector in coping is
an important step. Singapore has adopted such an
approach, while Malaysia, Indonesia and Thailand are
following suit.
Iceberg of
poverty
While the linkage between infectious
diseases and human security has been forcefully
validated by the SARS outbreak, understanding the risks
and vulnerabilities posed by infectious diseases is just
the tip of the iceberg. There are underlying challenges
that also need to be addressed to cope with the threats
of infectious diseases. These are the absence and/or
lack of basic health care and the poor health
infrastructure prevalent in many developing countries.
Poverty and infectious diseases are fellow travelers.
The risks of poverty-related diseases are compounded by
malnutrition and environmental threats, especially the
lack of clean water and sanitation. Add in crowded
conditions and poor hygiene, and these become perfect
breeding grounds for infectious diseases.
Strategies for protection and
empowerment
Coping with infectious diseases
requires multi-dimensional responses. Among the
imperatives is the importance of building a good
mechanism for global disease surveillance and control.
The Global Outbreak Alert and Response Network was
initiated by WHO in 1997 and is maintained by Health
Canada. It has a network of 100 laboratories and
disease-reporting systems. However, for this to be
successful, cooperation at both the local and the
national level is crucial. For new infectious diseases
such as SARS that have several unknowns in epidemiology
and treatment, the race to discovery requires
multilateral coordination at many levels.
Unless
certain mindsets and attitudes are changed to regard
infectious diseases as more than a health problem, it
will be difficult to get certain governments to act
promptly and decisively. Health must be approached as a
security priority at all levels. Governments must be
made accountable to both the local and international
community in ensuring health and security. The
globalization of health risks also means that leadership
must be exercised by the United Nations with the support
of the global public. Reducing health threats to
security will therefore require comprehensive
cooperation among diverse actors and nations.
An
equally important issue is the need to develop the
public health system, especially in the poorer
communities that are most vulnerable. The WHO Commission
on Macroeconomics and Health has reported that 17.7
million people die every year from infectious diseases;
about half could be saved if basic health care had been
provided. Saving lives in the future does not depend on
discoveries today but on getting the basics right, eg,
getting tetanus shots for children and providing safe
drinking water for more villages. This situation is best
encapsulated by a Cambodian physician who said that "in
our country, the real killers are poverty, ignorance,
fear, and corruption ... disease just administers the
coup de grace".
Mely
Caballero-Anthony is an assistant professor at the
Institute of Defense and Strategic Studies. She can be
reached at ismcanthony@ntu.edu.sg
. This article is used
by permission of the
Pacific Forum
CSIS.
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