The Politics of Emerging and Resurgent Infectious Diseases Also by Jim Whitman

AFTER RWANDA: THE COORDINATION OF UNITED NATIONS HUMANITARIAN ASSISTANCE (co-editor with David Pocock) The Politics of Emerging and Resurgent Infectious Diseases

Edited by

Jim Whitman Lecturer, Department of Peace Studies Bradford University First published in Great Britain 2000 by MACMILLAN PRESS LTD Houndmills, Basingstoke, Hampshire RG21 6XS and London Companies and representatives throughout the world A catalogue record for this book is available from the British Library. ISBN 978-1-349-40135-2 ISBN 978-0-230-62930-1 (eBook) DOI 10.1057/9780230629301

First published in the United States of America 2000 by ST. MARTIN’S PRESS, LLC, Scholarly and Reference Division, 175 Fifth Avenue, New York, N.Y. 10010 ISBN 978-0-312-22854-5 Cataloging-in-Publication Data The politics of emerging and resurgent infectious diseases / edited by Jim Whitman. p. cm. Includes bibliographical references and index.

1. Epidemiology. 2. Epidemics—Political aspects. I. Whitman, Jim. RA651 .P66 2000 614.4'2—dc21 99–058996

Selection, editorial matter and Chapter 1 © Jim Whitman 2000 Chapter 2 © Manuel Carballo 2000 Chapter 3 © Debarati Guha-Sapir 2000 Chapter 4 © Publications Scientifiques, Institut Pasteur 2000 Chapter 5 © Kraig Klaudt 2000 Chapter 6 © Michael J. Toole 2000 Chapter 7 © Renée Danziger 2000 Chapter 8 © Malcolm Dando 2000 Chapter 9 © David Heymann 2000 Chapter 10 © Yves Beigbeder 2000 Chapter 11 © Donald A. Henderson 2000 Chapter 12 © William Foege 2000 All rights reserved. No reproduction, copy or transmission of this publication may be made without written permission. No paragraph of this publication may be reproduced, copied or transmitted save with written permission or in accordance with the provisions of the Copyright, Designs and Patents Act 1988, or under the terms of any licence permitting limited copying issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1P 0LP. Any person who does any unauthorised act in relation to this publication may be liable to criminal prosecution and civil claims for damages. The authors have asserted their rights to be identified as the authors of this work in accordance with the Copyright, Designs and Patents Act 1988. This book is printed on paper suitable for recycling and made from fully managed and sustained forest sources. 10987654321 09 08 07 06 05 04 03 02 01 00 Epigraph

On this chill uncertain spring day, toward twilight, I have heard the first frog quaver from the marsh. That is a sound that Pharaoh listened to as it rose from the Nile, and it blended, I suppose, with his discontents and longings, as it does with ours. There is something lonely in that first shaken and uplifted trilling croak. And more than lonely, for I hear a warning in it, as Pharaoh heard the sound of plague. It speaks of the return of life, animal life, to the earth. It tells of all that is most unutterable in evolution – the terrible continu- ity and fluidity of protoplasm, the irrepressible forces of reproduction – not mystical human love, but the cold batrachian jelly by which we vertebrates are linked to the things that creep and writhe and are blind yet breed and have being. More than half it seems to threaten that when mankind has quite thor- oughly shattered and eaten and debauched himself with his own follies, that voice may still be ringing out in the marshes of the Nile and the Thames and the Potomac, unconscious that Pharaoh wept for his son.

Donald Culross Peattie, An Almanac for Moderns (Washington: The Limited Editions Club, 1938) p. 9.

v

Contents

Acknowledgements ix

Notes on the Contributors x

Abbreviations xii

1 Political Processes and Infectious Diseases Jim Whitman 1

2 Poverty, Development, Population Movements and Health Manuel Carballo 15

3 Case Studies of Infectious Disease Outbreaks in Cities: Emerging Factors and Policy Issues Debarati Guha-Sapir 39

4 The Role of International Law in the Control of Emerging Infectious Diseases David P. Fidler 62

5 The Political Causes and Solutions of the Current Tuberculosis Epidemic Kraig Klaudt 86

6Refugees and Migrants Michael J. Toole 110

7 The HIV/AIDS Epidemic: Public Policies and Possessive Individualism Renée Danziger 130

8 Technological Change and Future Biological Warfare Malcolm Dando 147

9 Non-Medical Aspects of Emerging and Re-emerging Infectious Diseases: Maximum Protection with Minimal Disruption David Heymann 170

10 Challenges to the World Health Organization Yves Beigbeder 178

vii viii Contents

11 Knowledge, Information and Intergovernmental Cooperation Donald A. Henderson 200

12 Surveillance, Eradication and Control: Successes and Failures William Foege 213

Index 220 Acknowledgements

An edited book depends on the support and goodwill of the contrib- utors, and in this case, because I do not have a scientific or medical back- ground, on an unseen network of scholars and practitioners who kindly suggested the most appropriate individuals or institutions to approach. It was a rewarding process, and I am grateful for the generosity of spirit shown to me by so many. Amongst the contributors, I am particularly grateful to Debarati Guha-Sapir for her early, enthusiastic support, which included a seemingly endless range of contacts. My thanks to Publications Scientifiques, Institut Pasteur, for copyright consent to reprint the chapter by David Fidler, which first appeared in the Bulletin of the Institute Pasteur, 95 (1997), pp. 57–72. Colonel John O’Shea, Director of the Strategic Outreach Program at the Strategic Studies Institute, US Army War College, was instrumental in securing a place for me at the Cantigny Conference ‘Strategic Implica- tions of Global Microbial Threats’, 14 June 1996. I am indebted to the officers and staff of the Cantigny Foundation for a most interesting and worthwhile conference. Then and in subsequent communication, Pro- fessor Stephen Morse kindly furthered my rudimentary understanding of virology and bacteriology. In Cambridge, Parmjot Bains, Rebecca Eldridge and Amanda Rees shared the findings of their own researches, which were a great help to me. As always, Jack Shepherd, Jane Brooks, Angela Pollentine and Kath- leen Shepherd provided the kind of support that arises from friendship as much as shared endeavour, something I will always prize.

ix Notes on the Contributors

Yves Beigbeder holds a doctorate in Public Law. A former WHO official, he is now an Adjunct Professor at Webster University, Geneva. He lec- tures on international organization and administration there and for UNITAR as a Senior Fellow. He has written several books and articles on UN organizations and their management, including WHO.

Manuel Carballo is the Coordinator of the International Centre for Migration and Health, Geneva.

Malcolm Dando is Professor of International Security at the School of Peace Studies, Bradford University. Trained as a zoologist, Professor Dando’s current research interests include arms control and disarma- ment, biological and chemical weapons and global prohibition regimes.

Renée Danziger is a Lecturer in Health Policy at the London School of Hygiene and Tropical Medicine. She has been working on social and policy aspects of HIV/AIDS for the past ten years. During this time she has acted as a consultant for the New York City Human Rights Commis- sion (AIDS Discrimination Unit) and the World Health Organization Global Programme on AIDS. She has also served as a member of the Technical Advisory Team of the Copenhagen-based Migration, Health and AIDS Project. Her other interests include the development of new conceptions of political power and powerlessness.

David P. Fidler obtained his JD from Harvard Law School and his BCL from the University of Oxford. He is currently Associate Professor of Law, Indiana University School of Law. He has written extensively on the international legal and political aspects of infectious diseases.

William H. Foege is an epidemiologist who is widely recognized as a key member of the successful campaign to eradicate in the 1970s. After serving as Chief of the CDC Smallpox Eradication Program, he was appointed Director of the US Centers for Disease Control in 1977. Dr Foege joined the in 1986 as its Executive Director, Fellow for Health Policy and Executive Director of Global 2000. In 1992, he resigned as Executive Director of the Carter Center, but continues in

x Notes on the Contributors xi his role as a Fellow and as Executive Director of the Task Force for Child Survival and Development.

Debarati Guha-Sapir is a Professor in the Department of Epidemiology, Faculty of Medicine, and the Centre for the Epidemiology of Disasters, University of Louvain.

Donald A. Henderson has served as Dean and Professor of Epidemi- ology and International Health at the Johns Hopkins School of Hygiene and since 1977. Prior to this, he served as Chief Medical Officer for the smallpox eradication programme of the World Health Organization in Geneva from 1966 to 1977.

David L. Heymann is the Director, Division of Emerging and other Communicable Diseases Surveillance and Control, at the World Health Organization. His distinguished career has also included extensive work on the Global Programme on AIDS, first as Chief of the Epidemiological Support and Research Unit and then as Chief of the Office of Research for four years. He has also published nearly one hundred scientific articles.

Kraig Klaudt directs the policy, strategy and promotion efforts of the World Health Organization’s Global TB Programme in Geneva. Previ- ously, he developed advocacy campaigns on international development, childhood nutrition and global militarization issues in the United States.

Jim Whitman is a Lecturer in the School of Peace Studies, Bradford University. He is the co-editor of the Journal of Humanitarian Assistance and general editor for the Macmillan Global Issues series.

Michael J. Toole is an epidemiologist with extensive field experience throughout the world, particularly in Africa and the Asia-Pacific region. As well as extensive periods as a medical director and adviser in Thai- land and Somalia, he served in the International Health Program Office of CDC, responsible for providing and coordinating technical leader- ship to CDC’s response to complex humanitarian disasters. He current- ly coordinates professional support for community health projects from the International Health Unit, Macfarlane Burnet Centre for Medical Research in Australia, with special emphasis on child survival and HIV/ AIDS. Abbreviations

ACT UP AIDS Coalition to Unleash Power APEC Asia Pacific Economic Cooperation APOC African Programme for Control ARI Acute Respiratory Infection AIDS Acquired Immunodeficiency Syndrome AZT Zidovudine BCG Bacille Calmette-Guérin [TB vaccine] BTWC Biological and Toxin Weapons Convention BW Biological Weapons CASU Comité d’Action Sanitaire d’Urgence CDC Centers for Disease Control CFR Case Fatality Rate CHW Community Health Worker CMR Crude Mortality Rate CNN Cable News Network COHRED Council on Health Research for Development COU Concepts of Use CRI Community Research Initiative CSM Cerebro-Spinal Meningitis CVI Children’s Vaccine Initiative CW Chemical Weapons DANIDA Danish International Development Assistance DNA Deoxyribonucleic Acid DOTS Directly Observed Treatment, Short-course ECHO European Community Humanitarian Office ECJ European Court of Justice EID Emerging infectious disease EMC Emerging and Other Communicable Diseases Surveillance and Control ENHR Essential National Health Research EPI Expanded Programme on Immunization [WHO] EU European Union FAO Food and Agriculture Organization FDA Food and Drug Administration GATT General Agreement on Tariffs and Trade GPA Global Programme on AIDS

xii Abbreviations xiii

HIV Human Immunodeficiency Virus ICMH International Centre for Migration and Health ICO Intensified Cooperation with Countries IDP Internally Displaced Person IEC Information, Education and Communication IHR International Health Regulations ILO International Labour Organization IUATLD International Union Against TB and Lung Disease KNCV The Royal Netherlands Tuberculosis Association MCH Maternal and Child Health MDR TB Multidrug-Resistant Tuberculosis MDT Multidrug Therapy MIRV Multiple Independent Re-entry Vehicle NAFTA North American Free Trade Agreement NGO Non-Governmental Organization NICD National Institute of Communicable Diseases [India] NIH National Institutes of Health OCP Onchocerciasis Control Programme PAHO Pan-American Health Organization PHARE Poland, Hungary: Aid for Reconstruction of the Economy PHLS Public Health Laboratory Service RNA Ribonucleic Acid RVF Rift Valley Fever SIDA The Swedish official aid agency TACIS Technical Assistance for the Community of Independent States and Georgia TB Tuberculosis UK United Kingdom UN United Nations UNDP United Nations Development Programme UNESCO United Nations Educational, Scientific and Cultural Organization UNFPA United Nations Fund for Population Activities UNHCR United Nations High Commission for Refugees UNICEF United Nations Children’s Fund US United States VEE Venezuelan Equine Encephalitis WHO World Health Organization WMD Weapons of Mass Destruction WTO World Trade Organization