Public Health Engagement Aff Notes

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The Trend Towards Establishing Vertical, Disease Specific Global Health Programs May Be At The Cost Of Strengthening Basic Public Health Infrastructure And Development In The Long Term”

1AC Pandemic Control Advantage

Scenario 1 is Disease

Current Chinese systems in place for pandemic control is insufficient—they lack training and the resources for research

Wang et. al '08 (Langde Wang, Yu Wang, Shuigao Jin, Zunyou Wu, Daniel P Chin, Jeffrey P Koplan, Mary Elizabeth Wilson, researchers of the WHO, "Health system reform in China 2: Emergence and control of infectious diseases in China", World Health Organization, published October 20, p. 40,, CL)

As China looks ahead to deal with existing and new infectious diseases, it is also important to address the challenges and weaknesses in the present infectious disease control efforts. We now have new and different challenges in this millennium. Continuation in the use of the old methods, even if they have been successful, will not be sufficient. Public-health and hospital systems: The public-health workforce in many areas remains poorly trained and unmotivated. Incentives for community-based health workers to undertake disease control activities is insufficient. A substantial amount of time will be needed to train a workforce capable of further controlling existing infectious diseases and dealing with new infectious diseases. This drawback is especially serious in the poor parts of China where the burden of infectious disease is the greatest. Hospital staff have an insufficient understanding of the role they should have in disease control. They need to be better trained and motivated to participate in proper diagnosis, reporting, and management of infectious diseases. Hospitals should become part of the network to control and prevent epidemics of infectious diseases. An increased sense of professionalism and the idea and practice of life-long learning needs to be developed and inculcated in hospital staff. Development of education programmes to change the present treatment-focused mindset of hospital personnel will take time and creativity. Strengthen collaboration between and within governmental sectors: As in many countries, responsibilities for health issues in China are separated into several different ministries and levels of government. The Chinese Government can clearly respond effectively and efficiently when confronted with a crisis (eg, SARS). The state council has the authority to enforce collaboration between ministries and between different levels of government. An improved leadership by the state council is needed to address infectious disease control through multisectoral involvement as part of routine work instead of as a part of crisis management. Population mobility: More than 10% of China’s population has moved away from their original residence, mainly from poor rural areas to urban centres in search of better economic opportunities. Migration promotes transmission of infectious diseases and creates major challenges for detection and control of epidemics of infectious diseases. The diagnosis and treatment of some infectious diseases like tuberculosis are already free for migrants in some areas; however, much more assistance is needed. Inadequate access to health services: The high cost of health care severely restricts access to health-care services in China. In some of the poor rural areas, this difficulty is magnified by the absence of basic health-care coverage. Patients with infectious diseases who delay or do not seek treatment because of the cost or difficulty of accessing services will be at increased risk of developing more severe and chronic forms of the disease and will be much more likely to infect other people. Health-system and health-financing reforms are discussed in this Series.47 These issues are an essential component of the effort to control infectious diseases in China.

Another pandemic is imminent and easily spreads—also causes a positive feedback loop and increases risk of other diseases emerging again

Sparrow '16 (Annie Sparrow, a medical doctor and Assistant Professor at the Arnhold Global Health Institute at the Icahn School of Medicine at Mount Sinai Hospital in New York, "The Awful Diseases on the Way", The New York Review of Books, June 9,, CL)

Pandemics—the uncontrolled spread of highly contagious diseases across countries and continents—are a modern phenomenon. The word itself, a neologism from Greek words for “all” and “people,” has been used only since the mid-nineteenth century. Epidemics—localized outbreaks of diseases—have always been part of human history, but pandemics require a minimum density of population and an effective means of transport. Since “Spanish” flu burst from the trenches of World War I in 1918, infecting 20 percent of the world’s population and killing upward of 50 million people, fears of a similar pandemic have preoccupied public health practitioners, politicians, and philanthropists. World War II, in which the German army deliberately caused malaria epidemics and the Japanese experimented with anthrax and plague as biological weapons, created new fears. In response, the US Centers for Disease Control (CDC), founded in 1946 to control malaria domestically, launched its Epidemic Intelligence Service in 1951 to defend against possible biological warfare, an odd emphasis given the uncontrolled polio epidemics raging in the 1940s and 1950s in the United States and Europe. But in the world of public health, the latest threat often takes precedence over the most prevalent. According to the doctor, writer, and philanthropist Larry Brilliant, “outbreaks are inevitable, pandemics are optional.” Brilliant, a well-known expert on global health, ought to know, since he has had much to do with smallpox eradication. Smallpox, arguably the worst disease in human history, caused half a billion deaths during the twentieth century alone. The strain called Variola major—the most lethal cause—killed one third of all infected and permanently scarred all survivors. In 1975, Rahima Banu, a two-year-old Bangladeshi girl, became the last case of V. major smallpox. Two years later, Ali, a twenty-three-year-old hospital cook in Somalia, became the last case of V. minor. Rahima and Ali survived. Smallpox did not.

Forty years later, smallpox is still the only disease affecting humans ever to have been eradicated. (Rinderpest, a virus affecting cows—literally “cattle plague”—was eradicated in 2011.) There is optimism that polio and guinea worm may soon follow. Meanwhile, dozens of new infectious diseases have emerged, including the pathogens behind the twenty-first-century “pan-epidemics”—a term coined by Dr. Daniel Lucey to describe SARS, avian flu, swine flu, MERS, Ebola, and now Zika. The fear, fascination, and financial incentives that these new diseases create divert attention and resources from ancient diseases like cholera, malaria, and tuberculosis, which infect and kill far more people. Ebola has caused relatively few deaths, while TB infects 9.6 million people each year and kills 1.5 million, and malaria infects more than 200 million, killing nearly half a million. (Ali, smallpox’s last survivor, later succumbed to malaria.) Zika virus was first discovered in 1947 in Uganda in monkeys bitten by forest mosquitoes. In recent years, monkeys have sought food outside the forests, and Zika virus has diversified: its carriers now include Aedes aegypti, a tough mosquito with a preference for human blood and urban environments, and it has spread to the Americas. A. aegypti also carries dengue, yellow fever, and West Nile virus, but it is the evolving pan-epidemic of catastrophic birth defects that makes Zika particularly terrifying. In Brazil there have been 1,271 confirmed cases of microcephaly—babies born with severely stunted brains, blindness, and other congenital defects. Cases identified in Colombia, French Polynesia, Panama, Martinique, and Cabo Verde provide advance notice of the likely scale of the damage being wreaked. Zika provides a devastating backdrop for Sonia Shah’s Pandemic: Tracking Contagions from Cholera to Ebola and Beyond. But far from opportunism, the book represents six years’ work and considerable prescience on Shah’s part. A science writer and investigative journalist, she has a history of taking the long view. Her last book, The Fever, describes how malaria, an ancient parasite acquired from apes, has affected humans for half a million years, becoming a dominant influence on the success or failure of human efforts such as the colonization of North America. The success of the slave trade, for example, depended on the malaria resistance developed over centuries in Africa.

As a doctor of pediatrics and public health, I have treated several hundred malaria patients on three continents during two decades, managed UNICEF’s malaria program in Somalia for the Global Fund to Fight AIDS, Tuberculosis and Malaria, and even contracted malaria myself. I wasn’t convinced I would learn much from Shah, nor did I have time for extraneous reading. Then last year, I found myself on Idjwi, a remote island in the Democratic Republic of Congo, treating scores of seriously ill children with malaria. Lacking electricity for lights, I read The Fever in the last hours of daylight after the clinic had closed. Shah’s synthesis of public health and politics, science and social behavior, provided new insight into malaria’s systematic contagion of mankind. When light faded each evening I dodged mosquitoes to take a brief bath in a lake infested with schistosomiasis, the second-most-common parasitic disease after malaria. Despite Brilliant’s position that pandemics are optional, the prevailing view in global health is that pandemics are inevitable. Shah’s thesis is that pandemics are the product of complex human behavior. In her view, development, urbanization, and population growth transform harmless animal microbes into human pathogens. Empire-building takes humans into animal habitats, while climate change caused by human activity and deforestation forces animals into urban areas; industrial poultry, cattle, and pig farms also bring humans into greater contact with animals. The “cholera paradigm” is a term coined by the microbiologist Rita Colwell. It means that the environment—biological, social, political, and economic—is both the source and driver of today’s emerging diseases in ways resembling the spread of cholera. Pandemics are caused by zoonoses—diseases that “jump” from animals to humans. Historically, this was a slow process, requiring considerable personal contact. Malaria took millennia to make the leap from primates to mankind. About ten thousand years ago, the dawn of agriculture and the domestication of livestock led to new levels of intimacy between humans and animals, which encouraged the emergence of our most familiar microbes. Cows gave us measles and TB; pigs gave us pertussis; ducks gave us influenza. Shah notes that, like us, microbes undergo natural selection for survival. Around the same time as the extinction of the smallpox virus, another virus was under threat. When the logging industry in Cameroon reduced the chimp population, simian immunodeficiency virus jumped from chimps to humans—a consequential choice since humans offered a host population of billions. When HIV appeared, rumors circulated of sexual congress between chimps and people as the means of transmission. In fact, we have our most intimate contact with animals when we consume them. On this point, Shah takes us to the wet markets of Guangzhou, China, where the SARS pandemic started in 2002. The markets flourished in the 1990s, as the rising incomes among China’s elite fed the demand for the wild game cuisine called yewei—including swans, peacocks, snakes, and turtles. Animals that would never be seen next to one another in the wild were forced into close proximity. Shah gets a good look at the scene in a market in Guangzhou—a turtle in a bucket next to wild ducks and ferrets, snakes close to civets. This unnatural confinement and proximity provides pathogens with the opportunities not only to mutate rapidly but also to jump species. The virus causing SARS spread from horseshoe bats to raccoon dogs, snakes, and civets, mutating along the way until it evolved sufficiently to infect humans. For centuries, cholera lived undisturbed in tiny crustaceans in the Bay of Bengal, until the arrival of the East India Company in the 1760s. Fishermen and rice farmers colonized five hundred square miles of wetlands, half-immersed in the natural habitat of the bacteria called Vibrio cholerae. Constant exposure to humans led to two important mutations: first, Vibrio grew a long tail that allowed it to, in Shah’s words, “stick to the lining of the human gut like scum on a shower curtain.” A second Vibrio mutation resulted in the toxin that causes massive diarrhea—and that makes cholera stool so infectious.

In 1817, the first cholera pandemic started when Vibrio took advantage of the international traffic on the Spice Route. Since then, there have been seven separate cholera pandemics and hundreds of millions of deaths. Cholera spreads twice as fast as Ebola and kills considerably more quickly. People without detectable symptoms can carry the disease for several weeks, such as UN peacekeepers from Nepal who imported it into Haiti in 2010 with catastrophic and ongoing consequences. Today, cholera infects roughly three million people each year and kills almost 100,000. The seventh pandemic has been underway since 1961 and shows no signs of abating. In less than two hundred years, cholera has become the most successful and enduring of all pathogens. It is the ultimate traveler’s diarrhea. The cholera bacteria colonized Europe during the second pandemic of 1829–1851. Europeans called it “Asiatic cholera,” assuming Western civilization would be immune. Echoes of this complacency are seen in the modern response to Ebola, which was considered an African disease unworthy of investment until it arrived in Texas in September 2014. Human arrogance was cholera’s advantage: Paris, for example, was completely unprepared for its arrival in March 1832. Bizarrely, in the evenings, the elite dressed up as corpses for “cholera balls,” the inspiration for Edgar Allan Poe’s “Masque of the Red Death.” Shah writes that “cholera killed them so fast they went to their graves still clothed in their costumes”—a detail consistent with the typical onset of cholera’s diarrhea after midnight, followed by massive dehydration and death within hours. By mid-April, cholera had killed more than seven thousand Parisians. Fifty thousand fled, taking cholera with them. Thousands took advantage of the recently established transatlantic shipping service financed by the Bank of the Manhattan Company, more familiar now as JPMorgan Chase. Many fled to Montreal. The Erie Canal, connecting the Hudson River to Lake Erie, had opened a few years earlier, contributing to New York’s phenomenal commercial success. It also fast-tracked cholera’s journey from Montreal to Manhattan, where conditions for its rapid spread were already in place. Shah describes those conditions in “Filth,” a chapter devoted to human excrement. She attributes the decline in sanitation in the Middle Ages to the rise of Christianity. Hindus, Buddhists, Muslims, and Jews all have built hygiene into their daily rituals, but Christianity is remarkable for its lack of prescribed sanitary practices. Jesus didn’t wash his hands before sitting down to the Last Supper, setting a bad example for centuries of followers. Christians wrongly blamed plague on water, leading to bans on bathhouses and steam-rooms. Sharing homes with livestock was normal and dung disposal a low priority. Toilets took the form of buckets or open defecation. The perfume industry, covering the stink, thrived. During the seventeenth century, these medieval practices were exported to Manhattan, where wells for drinking water were only thirty feet deep, easily contaminated by the nightly dump of human waste. Nineteenth-century New Yorkers tried to make their water palatable by boiling it into tea and coffee, which killed cholera. But the arrival of tens of thousands of immigrants overwhelmed these weak defenses, and the city succumbed to two devastating cholera epidemics. Corrupt economic gain, a recurrent theme in the history of cholera, is illustrated by the story of how a powerful Manhattan company—the future JPMorgan again—was established by diverting money from public waterworks to 40 Wall Street. This resulted in half a century of unsafe drinking water as the city abandoned plans to pump clean water from the Bronx and substituted well water from lower Manhattan slums. In a more recent case, the 2008 subprime mortgage collapse fostered by JPMorgan Chase and others in the banking industry left thousands of homes abandoned in South Florida. Their swimming pools of stagnant water provided ideal breeding grounds when Aedes mosquitoes arrived in 2009 carrying dengue fever. In part as a result, this tropical disease is now reestablished in Florida and Texas, transmitted by the same mosquito that carries yellow fever, West Nile, and Zika virus. Similarly corrupt schemes by governments have a long history of covering up infectious disease to avoid interrupting trade or tourism. New York’s mayor and board of health denied there was a cholera epidemic in 1832. Italy hid the cholera epidemic of 1911. Assad’s Syria concealed cholera outbreaks in 2008 and 2009. Mugabe’s Zimbabwe denied the 2008 cholera outbreak for months, facilitating its spread to South Africa, Zambia, Mozambique, and Botswana. The Cuban government suppressed reports of its cholera outbreak in 2012. While it is common knowledge that the Chinese government covered up initial reports of SARS in 2002, Shah reveals that the Saudi Arabian government tried to silence the doctor who reported mers, forcing him to resign and relocate to Egypt.

The structure of the World Health Organization (member states elect the same regional directors who must issue quarantines and sanctions against them) lends itself to giving priority to governmental preferences over public health needs, illustrated by WHO’s acquiescence to governmental cover-ups in reporting polio’s reemergence in Syria in 2013 and the Ebola outbreak in Guinea in 2014. The cover-up in Zimbabwe was assisted by the United Nations, which has also consistently denied its role and responsibility in importing cholera into Haiti. Shah’s book should be required reading for anyone working in global health. It should also alert a much wider audience to the ways that many kinds of the microorganisms called pathogens have caused Western pandemics of chronic, or so-called noncommunicable, diseases. Many of our most familiar diseases are set off or directly caused by pathogens. Viruses lie behind at least 25 percent of all cancers. Cervical cancer, for example, the second-most-common cancer among women worldwide, is caused by human papillomavirus (HPV). Infestation by the bacteria Helicobacter pylori is a common cause of ulcers, but also causes gastric cancer and lymphoma. Epstein-Barr virus causes Burkitt’s lymphoma, leukemia, and gastric, breast, and ovarian cancer. Hepatitis B and C cause liver cancer. Herpes virus can cause brain tumors and Kaposi’s sarcoma. Even psychiatric diseases are linked to pathogens: a few years after influenza outbreaks, schizophrenia is more commonly diagnosed. Babies exposed to flu and herpes in utero are at greater risk of autism. Lyme disease can cause depression and dementia. Moreover, the phenomenal success of the HPV vaccine in protecting teenage girls from infection shows us that cervical cancer is a disease that can be prevented by vaccine. H. pylori infestation is readily treated with two weeks of antibiotics and acid-blocking agents. The smallpox vaccine was developed in 1796, but it took 170 years and mandatory vaccination to eradicate this pox. Measles is the most contagious disease on earth, and the measles vaccine the most cost-effective public health intervention we have, but the false and financially motivated connection made in 1998 between the measles vaccine and autism has permanently damaged the eradication effort. The consequence goes well beyond a global measles revival: several studies show that the measles vaccine, known as a live or attenuated vaccine, also reduces child mortality from infectious diseases such as malaria, pneumonia, and pertussis by 30 to 80 percent. But that effect lasts only until an inactivated vaccine is given—usually a diphtheria-pertussis-tetanus booster—at eighteen months. This suggests that changing the childhood vaccination schedule could have deep effects. Universal measles vaccinations in adulthood might protect us from Zika, future pathogens, even the viruses behind today’s cancer epidemics. It could also provide important protection for populations in disaster and war, such as the millions in Syria, with immunity compromised by malnutrition, crowding, and contaminated water.

Much of human history can be seen as a struggle for survival between humans and microbes. Pandemics are microbe offensives; public health measures are human defenses. Water purification, sanitation, and vaccination are crucial to our living longer, better, even taller lives. But these measures of mass salvation are not sexy. While we know prevention is better and considerably cheaper than cure, there is little financial reward or glory in it. Philanthropists prefer to build hospitals rather than pay community health workers. Pharmaceutical companies prefer the Western market to the distant and poor Global South where people cannot afford to buy treatments. Education is a powerful social vaccine against the ignorance that enables pathogens to flourish, but insufficient to overcome the corruption of public goods by private interests. The current enthusiasm for detecting the next panic-inducing pathogen should not divert resources and research from the perennial threats that we already have. We must resist the tendency of familiarity and past failures to encourage contempt and indifference. The ideal in public health is to protect everyone. Shah explicates why as the rich get richer, the poor get infectious diseases, and also reiterates that pathogens with the means to travel respect neither class nor position. When it comes to susceptibility to new organisms and biological weapons, in a hyperconnected world we are all vulnerable. The first case in a pandemic is most likely to emerge from war and poverty. Current conflicts in the Middle East and Africa have created the biggest population of refugees and displaced people since World War IIa flood of malnourished people highly vulnerable to new and old pathogens. Investments in public health in those areas that are likely to be the source of new pandemics will protect not only the 99 percent but also the one percent. Preventing pandemics requires pragmatic solutions—doing what works—to protect people from infectious diseases. This means investing in a global supply of vaccines for cholera, hepatitis, tuberculosis; funding local people to implement vaccination campaigns in the populations at risk; sterilizing mosquitoes, which would help control not only Zika but also dengue, yellow fever, and malaria; and universal measles coverage. Such practical solutions are likely to be cost-effective, as well as provide the broadest feasible protection against current and future pathogens.

U.S. aid towards China is key to fight pandemics on a large scale—the two countries align in both their vulnerabilities and capabilities

Erickson '07 (Dr. Andrew S. Erickson, Assistant Professor in the Strategic Research Department at the U.S. Naval War College in Newport, Rhode Island and a founding member of the department’s China Maritime Studies Institute (CMSI). His research, which focuses on East Asian defense, foreign policy, and technology issues, has been published in Comparative Strategy, Chinese Military Update, Space Policy, Journal of Strategic Studies and Naval War College Review, "Combating a Truly Collective Threat: Sino-American Military Cooperation against Avian Influenza", Global Health Governance, published January 2007,, CL)

Avian influenza, poses a large and growing threat to international security. No nation is safe from the pandemic influenza threat, and every nation is essential to defense efforts. In one indication of the importance of such efforts to international economic stability, Robert R. Morse, Citicorp’s Asia-Pacific head, has stated, “We do not view the possibility of avian flu as an Asian issue, we view it as a global issue.” In response to this world-wide challenge, important progress has been made already. At a major international conference to combat avian influenza, China’s Vice-Foreign Minister Qiao Zonghuai noted that “…our destinies are interconnected. In the fight against avian influenza, no country can stay safe by looking the other way.” Cooperation is vital to defend against pandemic influenza. Robust partnerships involving the U.S., Japan, South Korea, Australia, New Zealand, ASEAN nations, other Asia-Pacific allies, and nations around the world will be critical. Indeed, important progress has been made already. Several factors, however, make China worthy of particular focus for U.S. policy makers and medical experts. China will likely be at the center of a pandemic influenza crisis. It is home to some 800 million people who live in close contact with over 15 billion poultry, and thus possesses a potential reservoir for the incubation of avian influenza that is perhaps unequaled anywhere in the world. China also has “1,332 species of migratory birds, over 13 per cent of the world’s total.” The persistence of conditions analogous to those detailed above over decades explains why “most flu pandemics in recorded history originated in South China (e.g., 1918, 1957 and 1968).” China’s massive scale and vulnerable populations thus give it a unique importance in disease control measures. Despite continuing challenges in relations between the United States and China, therefore, no effort to stem the spread of infectious disease will be complete without cooperation between what are respectively the world’s largest developed and developing nations. As two Asia-Pacific nations potentially threatened by pandemic influenza, the United States and China have significant shared interests in the area of the prevention of large-scale outbreaks of devastating infectious disease. The two nations also share a strategic interest in fighting other unconventional threats such as terrorism. Thanks to its largely apolitical and nonreligious nature, the combating of pandemics, even more than counter-terrorism, offers common ground upon which to build a basis for bilateral and multilateral cooperation. Given the important work that remains to be done before effective cooperation between the United States and China can be fully realized, however, this essay will be devoted to suggesting the extent to which the two great powers share an interest in combating avian influenza, and how robust collaboration toward this end can more fully be realized.

Higher population movement and density makes the transfer of disease and the emergence of pandemics increasingly lethal and uncheckable—goes global

Long ’11 (William Long, Professor and Chair at the Sam Nunn School of International Affairs Georgia Institute of Technology, “Pandemics and Peace: Public Health Cooperation in Zones of Conflict", published June 2011, CL)

The spread of avian influenza and other naturally occurring or man-made biological threats presents a grave security and humanitarian threat regionally and globally? Dramatic increases in the worldwide movement of people, animals, and goods; growing population density; and uneven public health systems worldwide are the driving forces behind heightened vulnerability to the spread of both old and new infectious diseases.18 Since the global spread of the human immunodeficiency virus (HIV) began in the early 1980s, twenty-nine new bacteria or viruses have been identified, many of which are capable of global reach.° Commenting on this trend in 2007, the United Nations' World Health Organization warned, "Since the 1970s, newly emerging diseases have been identified at the unprecedented rate of one or more per year. . . . It would be extremely naïve and complacent to assume that there will not be another disease like AIDS, another Ebola, or another SARS, sooner or later."" Senior World Health officials have noted that "inadequate surveillance and response capacity in a single country can endanger national populations and public health security of the entire world."2' With more than a million travelers flying across national boundaries every day, it is not an exaggeration to say that a health problem in any part of the world can rapidly become a health threat to many or 02—what one author calls the microbial unification of the world.23 The outbreak of severe acute respiratory syndrome (SARS) in 2002 and 2003 demonstrated how a previously unknown but lethal virus could spread by modern air transport, traveling from Hong Kong to Toronto in fifteen hours and eventually reaching twenty-seven countries.24 The increased speed of transmission also means that contagion is likely to be well established before governments and international organizations are aware of the presence of the disease." SARS, in turn, focused attention on the ability of public health systems worldwide to cope with an anticipated pandemic associated with the next major antigenic shift in the influenza A virus. Although the influenza A virus mutates regularly (antigenic drift), every decade or so the virus undergoes a major change, or shift, for which most people have little or no protection. The threat is magnified today by the ability of such diseases to spread worldwide very rapidly." For example, since emerging in 1997, avian influenza—which to date has infected more than 400 people and killed more than 200—could create, if it becomes capable of human-to-human transmission as a new influenza. A virus, a global pandemic of unprecedented lethality. Avian influenza could, if it becomes capable of human-to-human transmission as SARS did in 2002, kill somewhere between 200,000 to 16 million Americans. Countries with less robust public health systems would lose an even larger percentage of their population to such a disease.27 The relatively benign H1N1, or swine flu, outbreak provides a harbinger of this future danger.

Kills millions—it’s the biggest threat to humanity

Boseley '16 (Sarah Boseley, health editor of the Guardian and has won a number of awards for her work on HIV/Aids in Africa, including the One World Media award and the European section of the Lorenzo Natali prize, awarded by the European commission "Millions could die as world unprepared for pandemics, says UN", The Guardian, February 8,, CL)

A global epidemic far worse than the Ebola outbreak is a real possibility and could kill many millions if the world does not become better prepared to deal with the sudden emergence and transmission of disease, the UN has said in a hard-hitting report. The report has emerged in draft form, as experts rally to deal with the rapid spread of the Zika virus across Latin America, which has been linked to thousands of cases of brain damage in babies. Countries in the region have again been caught off-guard because of the lack of scientific knowledge about the virus and the absence of good data on microcephaly, a condition in which babies’ heads fail to grow properly in the womb. The report comes from the high-level panel on the global response to health crises, set up by the UN secretary general in April 2015, as the Ebola epidemic that killed more than 11,000 people finally waned. Several other inquiries into what occurred, and the slow and inadequate response by the World Health Organisation (WHO), have reported and fed into the UN panel’s conclusions. “The high risk of major health crises is widely underestimated, and … the world’s preparedness and capacity to respond is woefully insufficient. Future epidemics could far exceed the scale and devastation of the west Africa Ebola outbreak,” says the panel’s chair, Jakaya Mrisho Kikwete from Tanzania, outlining their findings in the preface.

Too often, global panic about epidemics has been followed by complacency and inaction. For example, the 2009 influenza pandemic prompted a similar review of global preparedness, but most of its recommendations were not addressed. Had they been implemented, thousands of lives could have been saved in west Africa. We owe it to the victims to prevent a recurrence of this tragedy.” The report, which has been posted online in advanced, unedited form in the UN’s Daily Journal, is not just about the mishandling of Ebola, but about the crucial need for the world to put in place systems to detect and fight new disease threats. “Notwithstanding its devastating impact in west Africa, the Ebola virus is not the most virulent pathogen known to humanity,” says the report. “Mathematical modelling by the Bill and Melinda Gates Foundation has shown that a virulent strain of an airborne influenza virus could spread to all major global capitals within 60 days and kill more than 33 million people within 250 days.” Other diseases that have recently caused widespread suffering include four major outbreaks of Middle East Respiratory Syndrome (Mers) in Saudi Arabia and the Republic of Korea, the pandemics of avian and swine flu and severe acute respiratory syndrome (Sars). “These all serve as stark reminder of the threat to humanity posed by emerging communicable diseases,” says the report. The panel says surveillance and response to outbreaks must be led by the WHO, but the key role should be played by a centre for emergency preparedness and response. The centre “must have real command and control capacity”, says the report, and it should have the best technology available to identify, track and respond to an emerging threat. The report also says countries must report on their state of compliance to WHO every year and must be regularly reviewed. All countries must give the WHO more money, says the report – an increase of at least 10% in their funding. In addition, they must put $300m for a contingency fund for emergencies, not $100m as recently set up. A further fund worth $1bn must be set up for the development of vaccines, drugs and testing equipment. Prof Jeremy Farrar, director of the Wellcome Trust, said: “Epidemic and pandemic diseases are among the greatest of all threats to human health and security, against which we have for too long done too little to prepare. After four inquiries into the preventable tragedy of Ebola, there is now a strong consensus about what must be done. The WHO’s leadership and member states must make 2016 the year of decision and act now to build a more resilient global health system. “As the UN panel and the other inquiries recommend, the cornerstones of better health security must be a strong, independent WHO centre to lead outbreak preparedness and response, new mechanisms and financing for developing vaccines, drugs and diagnostics for potential epidemic threats, strong community engagement and investment in basic health infrastructure in every country, not just those that can afford it.”


Meyer 5/2 (Robinson Meyer, associate editor and writer for The Atlantic, "Human Extinction Isn't That Unlikely", The Atlantic, May 2,, CL)

Yet natural pandemics may pose the most serious risks of all. In fact, in the past two millennia, the only two events that experts can certify as global catastrophes of this scale were plagues. The Black Death of the 1340s felled more than 10 percent of the world population. Eight centuries prior, another epidemic of the Yersinia pestis bacterium—the “Great Plague of Justinian” in 541 and 542—killed between 25 and 33 million people, or between 13 and 17 percent of the global population at that time. No event approached these totals in the 20th century. The twin wars did not come close: About 1 percent of the global population perished in the Great War, about 3 percent in World War II. Only the Spanish flu epidemic of the late 1910s, which killed between 2.5 and 5 percent of the world’s people, approached the medieval plagues. Farquhar said there’s some evidence that the First World War and Spanish influenza were the same catastrophic global event—but even then, the death toll only came to about 6 percent of humanity. The report briefly explores other possible risks: a genetically engineered pandemic, geo-engineering gone awry, an all-seeing artificial intelligence. Unlike nuclear war or global warming, though, the report clarifies that these remain mostly notional threats, even as it cautions: [N]early all of the most threatening global catastrophic risks were unforeseeable a few decades before they became apparent. Forty years before the discovery of the nuclear bomb, few could have predicted that nuclear weapons would come to be one of the leading global catastrophic risks. Immediately after the Second World War, few could have known that catastrophic climate change, biotechnology, and artificial intelligence would come to pose such a significant threat.

Scenario 2 is the Economy

Another pandemic will devastate the economy more than 50% of current growth—it goes global and disproportionately affects impoverished populations and creates lasting changes in human behavior which spillover to other impacts

Begley '13 (Sharon Begley, senior science writer at various news correspondences including Reuters, Newsweek, The Daily Beast, The Wall Street Journal, and regular public speaker for science writing, neuroplasticity, science literacy at Yale University, the Society for Neuroscience, the American Association for the Advancement of Science, and the National Academy of Sciences, "Flu-conomics: The next pandemic could trigger global recession", Reuters, Jan 21,, CL)

A high body count is not the only meaningful number attached to a pandemic. The potential cost of a global outbreak of the flu or some other highly contagious disease, however ghoulish to calculate, is essential for government officials and business leaders to know. Only by putting a price tag on such an occurrence can they hope to establish what containing it is worth. The financial damage by itself can be devastating. The expense of major epidemics is evident every time a health agency totes up the cost of treating infected people — the outlays for drugs, doctors' visits, and hospitalizations. But that spending is only the most obvious economic impact of an outbreak.

Consider the effect on international airlines. During the 2003 SARS (severe acute respiratory syndrome), which began in southern China and lasted about seven months, business and leisure travelers drastically cut back on flying. Asia-Pacific carriers saw revenue plunge $6 billion and North American airlines lost another $1 billion. The tourism industry also took a beating. The net revenue of Park Place Entertainment, owner of Caesar's Palace in Las Vegas and other gambling and hotel complexes, plunged more than 50 percent in the second quarter of 2003 compared with the year before, mainly because Asian high rollers hunkered down rather than risk infection while traveling. Fear even hurt businesses dependent on sales calls. AIG, which pulled almost 30 percent of its revenue from Asia back then, was hobbled when the epidemic kept its agents from visiting potential customers.

That's just the easily measured stuff; the indirect costs pushed the total SARS bill much higher. "The biggest driver of the economics of pandemics is not mortality or morbidity but risk aversion, as people change their behavior to reduce their chance of exposure," says Dr. Dennis Carroll, director of the U.S. Agency for International Development's programs on new and emerging disease threats. "People don't go to their jobs, and they don't go to shopping malls. There can be a huge decrease in consumer demand, and if (a pandemic) continues long enough, it can affect manufacturing" as producers cut output to align supply with lower demand. If schools are closed, healthy workers may have to stay home with their children. People afraid of becoming infected are less likely to go out to stores, restaurants or movies.

Most of China was essentially on lockdown in the first half of 2003 as the government did everything in its considerable power to minimize human-to-human contact and, hence, the spread of SARS. Beijing was shut down tighter than at any time since martial law was declared during the 1989 Tiananmen Square protests. Discos, bars, shopping malls, indoor sports facilities, and movie theaters were closed, and 80 percent of the capital's five-star hotel rooms were vacant. By May 2003, Singapore Airlines had cut capacity 71 percent and put its 6,600-member flight staff on unpaid leave. Tourism to Singapore fell 70 percent, and the country's gross domestic product took a $400 million hit that year. From Asia, where the disease was largely confined, the ripples spread in all directions. Toronto recorded 361 SARS cases and 33 deaths, and the World Health Organization issued an advisory against traveling there — surely a factor in the $5 billion loss Canada's GDP suffered in 2003.

It's not surprising that a pandemic hurts businesses dependent on employees or customers moving from point a to point b (as AIG and the airlines learned), but SARS also set back transport companies such as FedEx (closed airports; fewer people doing business), telecom equipment-makers such as Nortel (vendors and customers staying home) and cable-TV-box maker Scientific-Atlanta (multiple parts made in Asia). It even cut deeply into profits for Estee Lauder, which under normal circumstances sells a lot of cosmetics in Hong Kong, Singapore and China, and in duty-free airport shops. In our interconnected world, a farmer running a fever in Southern China can reduce the income of a baggage handler in Frankfurt, and hence all the businesses that worker patronizes. "Within hours or days, an event that starts on one side of the world can establish itself on the other," says Carroll. Lufthansa saw demand for flights to and from the Far East tumble 85 percent that year, and grounded a dozen planes. With planes grounded, oil demand fell by 300,000 barrels a day in Asia, dinging the revenues of oil companies from Kuwait to Venezuela.

A COST BEYOND MEASURE? The World Bank estimated China's SARS-related losses at $14.8 billion, and although the United States and Europe were largely spared its ravages, the pandemic reduced the global GDP by $33 billion. And here's a scary thought: As health crises go, SARS wasn't that bad: It killed just 916 people and lasted well under a year. The Department of Health & Human Services estimates that the ho-hum seasonal flu is responsible for 111 million lost workdays each year in the United States. That's $7 billion in sick days and lost productivity. A global pandemic that lasted a year could trigger a "major global recession," warned a 2008 report from the World Bank. If a pandemic were on the scale of the Hong Kong flu of 1968-69 in its transmissibility and severity, a yearlong outbreak could cause world GDP to fall 0.7 percent. If we get hit with something like the 1957 Asian flu, say goodbye to 2 percent of GDP. Something as bad as the 1918-19 Spanish flu would cut the world's economic output by 4.8 percent and cost more than $3 trillion. "Generally speaking," the report added, "developing countries would be hardest hit, because higher population densities and poverty accentuate the economic impacts." The majority of the economic losses would come not from sickness or death but from what the World Bank calls "efforts to avoid infection: reducing air travel … avoiding travel to infected destinations, and reducing consumption of services such as restaurant dining, tourism, mass transport, and nonessential retail shopping."

The really bad news is that we may not be hearing all the bad news. Economists who study pandemics worry they may be underestimating the financial toll because they haven't been considering all the ramifications. "Research to understand the indirect costs of an epidemic has been growing, focusing on how to accurately incorporate productivity losses and effects on economic activity," says Bruce Lee of the University of Pittsburgh Medical Center, where he is an associate professor, director of the Public Health Computational and Operations Research Group, and an expert in the economics of infectious diseases. Take workplace vaccination. Public health officials recommend it, but does it help the bottom line? Would targeted shots bring a higher return on investment? Should employers vaccinate only their older employees? Or just those, say, in the shipping department? Lee and colleagues found that for the 22 main occupations defined by the U.S. Bureau of Labor Statistics (legal, management, food preparation, education, and 18 more), when the employer footed the bill, "employee vaccination was cost-saving for the median wage" if contagion was on the low side (one case producing 0.2 to 0.6 additional cases). It was almost cost-neutral for low-paid occupations, and a clear benefit for high-paid ones. The biggest payoff is for older workers, since they are more likely to become ill and miss work if infected. As a result, "employers could gain money" by underwriting flu shots, Lee says, adding that "a flu virus does not have to hospitalize or kill a lot of people to have a large effect on society." Analyses of epidemic-related school closings can also inform policy. In 2009, as the H1N1 influenza (swine flu) epidemic gathered force, the U.S. Centers for Disease Control and Prevention (CDC) as well as state and local public health officials considered closing schools in order to reduce transmission of the virus. Taiwan did so, closing schools for one week.

Lee and colleagues analyzed what closing schools in Pennsylvania would cost. Reducing transmission of a virus saves healthcare expenditures, not surprisingly, and averts deaths. "But closing a school has a lot of ripple effects," Lee says. "You not only have teachers and staff not working, and having to make up the lost time in July, but parents have to stay home with their kids." Bottom line: It would cost as much as $51,000 to avert a single case of a very transmissible flu. As a result of the Taiwan school closings for SARS, one study found, 27 percent of households reported workplace absenteeism and 18 percent suffered an average wage loss of five days' pay. A 2009 study by economists at the Brookings Institution analyzed the direct economic impact of closing schools during a flu pandemic. Since about one-quarter of civilian workers in the United States have a child under 16 and no stay-at-home adult, closing all the nation's K-12 schools for two weeks would result in between $5.2 billion and $23.6 billion in lost economic activity; a four-week closing would cost up to $47.1 billion dollars — 0.3 percent of GDP. "Those are only the first-order effects," says Ross Hammond, who led the Brookings study. "There are also multiplier effects from a multibillion-dollar decline in economic output." He looked only at lost wages, but people whose income falls because they don't work for several weeks don't spend as much, and the people who don't receive that spending cut their own in turn. In addition, he said, "The decrease in supply of some goods as factories run at less than full capacity might lead to inflation." Also tricky is deciding how to account for outbreak-related spending. For instance, Hong Kong spent $1.5 billion on a "We love HK" campaign to get residents out of their homes, facemasks in place. Note that such economic activity counts toward GDP. Similarly, hospital charges, doctors' fees, medication, and other epidemic-related costs add to GDP.

A pandemic causes economic decline and politically destabilizes countries—only cross-country collaboration can solve

Long ’11 (William Long, Professor and Chair at the Sam Nunn School of International Affairs Georgia Institute of Technology, “Pandemics and Peace: Public Health Cooperation in Zones of Conflict", published June 2011, CL)

Global economic and political stability could fall victim to a pandemic too. Today, nations must provide for their citizens' health and well-being and protect them from disease. Health provision has become a primary public good and part of the social contract between a people and its government." Accelerating transnational flows, especially pathogens, can stress and could overwhelm a state's capacity to meet this essential function. Weak states could fail economically or politically, thereby creating regional instability and a breeding ground for terrorism or human rights violations." Statistical studies reveal that declining public health substantially increases the probability of state failure,30 and historical examples of the correlation between disease outbreak and political instability and violence extend from the fall of ancient Athens to recent violence in Zimbabwe. Even in the strongest states, leaders must be prepared, in an integrated way, to respond to the full spectrum of biological threats that could impede essential social functions such as food supply, transportation, education, and workforce operation and result in huge economic costs.31 Reducing the danger of influenza or other infectious diseases requires a focus on preparedness and monitoring. Rapidly identifying the problem, sharing information, and coordinating response are each critical to limiting the perils of pathogenic threats. Although the peril is great, so too is the promise of building cooperation through regional disease surveillance, detection, and response. Here is the positive potential of globalization: it can facilitate the rapid response to health challenges by quickly mobilizing health professionals, medicines, and supplies, and by deploying information technology for disease surveillance and sharing best health practices across nations.32 These exchanges, between neighboring states and even between traditional adversaries, could contribute to reducing disparities in health and help improve regional relations. Armed with a theoretical understanding of the basis for such cooperation, the regional and international practitioner and policy communities can respond more effectively to this critical transnational security and humanitarian concern.

Economic decline causes nuclear war and extinction

Kemp ’10 [Geoffrey Kemp, Director of Regional Strategic Programs at The Nixon Center, served in the White House under Ronald Reagan, special assistant to the president for national security affairs and senior director for Near East and South Asian affairs on the National Security Council Staff, Former Director, Middle East Arms Control Project at the Carnegie Endowment for International Peace, 2010, “The East Moves West: India, China, and Asia’s Growing Presence in the Middle East”, p. 233-4, CL)

The second scenario, called Mayhem and Chaos, is the opposite of the first scenario; everything that can go wrong does go wrong. The world economic situation weakens rather than strengthens, and India, China, and Japan suffer a major reduction in their growth rates, further weakening the global economy. As a result, energy demand falls and the price of fossil fuels plummets, leading to a financial crisis for the energy-producing states, which are forced to cut back dramatically on expansion programs and social welfare. That in turn leads to political unrest: and nurtures different radical groups, including, but not limited to, Islamic extremists. The internal stability of some countries is challenged, and there are more “failed states.Most serious is the collapse of the democratic government in Pakistan and its takeover by Muslim extremists, who then take possession of a large number of nuclear weapons. The danger of war between India and Pakistan increases significantly. Iran, always worried about an extremist Pakistan, expands and weaponizes its nuclear program. That further enhances nuclear proliferation in the Middle East, with Saudi Arabia, Turkey, and Egypt joining Israel and Iran as nuclear states. Under these circumstances, the potential for nuclear terrorism increases, and the possibility of a nuclear terrorist attack in either the Western world or in the oil-producing states may lead to a further devastating collapse of the world economic market, with a tsunami-like impact on stability. In this scenario, major disruptions can be expected, with dire consequences for two-thirds of the planet’s population.

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