A. National Interests in the Health of the Populace

Democratic theory holds that the common defense, security, and welfare of the population are among the State’s primary obligations—goods that can be achieved only through collective action. The populace can tolerate even the most catastrophic events if they are unforeseeable and unpreventable. But if political leaders fail to take steps in advance that could have ameliorated a natural-occurring epidemic or bioterrorism, the political price would be high. The political consequences for failure to act early and decisively with respect to outbreaks of SARS, BSE and FME, for example, were evident in North America and Europe. The politics of infectious diseases can be seen in the fact that pandemic influenza planning has reached the highest levels of government, with enormous resources expended, even though Influenza (A) H5N1 has resulted in only a few hundred human deaths worldwide and none in the United States.

If governments have an obligation to ensure at least reasonable conditions of health, they have no choice but to pay close attention to health hazards beyond their borders. DNA fingerprinting has provided conclusive evidence of the migration of pathogens from less to more developed countries. In fact, more than thirty infectious diseases have newly emerged over the last 2-3 decades, ranging from Hemorrhagic Fevers, Legionnaires Disease, and Hanta virus to West Nile Virus and monkeypox. Vastly increased international trade in fruits, vegetables, meats, and eggs has resulted in major outbreaks of foodborne infections caused by Salmonella, E. coli bacteria, and Norwalk-like viruses.

Not only do emerging and re-emerging diseases increasingly affect the wealthiest countries, but also they are less able to ameliorate these harms through technologies such as vaccines and pharmaceuticals. Resurgent diseases such as tuberculosis, malaria, and HIV have developed extreme resistance to front-line medications. As microbes change genetic form, existing vaccines and pharmaceuticals become inapt. The therapeutic challenges are not limited to exotic infections, as WHO has warned that many pathogens are gaining resistance to therapies, including common respiratory, diarrheal, and ear infections.

The State’s response to disease epidemics also has profound domestic costs. Disease control measures such as travel restrictions, school closures, and quarantines can cause personal detachments, disrupt social and economic life (education, trade, business), and infringe individual rights. Powerful reasons, therefore, exist for governments to pay close attention to global health, not only for the sake of people in far away places but to prevent potentially catastrophic social, economic, and political consequences for their own citizens.