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Plagues and Politics
Infectious Disease and
International Policy

Edited by

Andrew T. Price-Smith
Assistant Professor
Department of Political Science and Public Administration
and
Director of the Program on
Environment, Health and Human Security
University of North Dakota
Editorial matter, selection and Chapters 1, 6 and 8
© Andrew T. Price-Smith 2001
Chapters 2–5, 7, 9–13 © Palgrave Publishers Ltd 2001
Softcover reprint of the hardcover 1st edition 2001 978-0-333-80066-9
All rights reserved. No reproduction, copy or transmission of
this publication may be made without written permission.
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as the authors of this work in accordance with the
Copyright, Designs and Patents Act 1988.
First published 2001 by
PALGRAVE
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175 Fifth Avenue, New York, N. Y. 10010
Companies and representatives throughout the world
PALGRAVE is the new global academic imprint of
St. Martin’s Press LLC Scholarly and Reference Division and
Palgrave Publishers Ltd (formerly Macmillan Press Ltd).
ISBN 978-1-349-42071-1 ISBN 978-0-230-52424-8 (eBook)
DOI 10.1057/9780230524248
This book is printed on paper suitable for recycling and
made from fully managed and sustained forest sources.
A catalogue record for this book is available
from the British Library.
Library of Congress Cataloging-in-Publication Data
Plagues and politics : infectious disease and international policy /
edited by Andrew T. Price-Smith.
p. cm.
Includes bibliographical references and index.
ISBN 978-1-349-42071-1
1. Communicable diseases—Political aspects. 2. World health.
3. World politics—Health aspects. 4. Epidemics—Prevention.
I. Price-Smith, Andrew T.
RA643 .P675 2000
614.4—dc21
00–066878

10 9 8 7 6 5 4 3 2 1
10 09 08 07 06 05 04 03 02 01
 I dedicate this book to my sister Adrienne Price Smith, my
mother Cynthia Smith-McLeod, my step-father Jack T. McLeod
and my father Richard Price-Smith, for all their support
through the years.
This page intentionally left blank
Contents

List of Boxes, Figures, Tables and Maps xii

Acknowledgements xiii
Notes on the Contributors xiv

1 Introduction 1
Andrew T. Price-Smith

2 Factors in the Emergence of Infectious

Diseases 8
Stephen S. Morse

Ecological changes and agricultural development 15

Changes in human demographics and behaviour 17
International travel and commerce 18
Technology and industry 19
Microbial adaptation and change 20
Breakdown of public health measures and deficiencies
in public health infrastructure 21
For our future 22
References 23

3 Climate, Ecology and Human Health 27

Paul R. Epstein

Background 28
Environmental change and opportunistic species 31
Ecosystem health 33
Environmental distress syndrome: monitoring global
change 34
Climate and emerging diseases 35
The effects of climate variability on epidemics 37
Disease clusters 39
Rodents, synergies and surprises 39
Marine coastal ecosystems 42
Is the ocean warming? 44
Discontinuities and instability 46

vii
viii Contents

The costs of climate variability and disease

outbreaks 47
An historical note on pandemics 48
What can be done? 51
A personal conclusion 52
Further reading 53
Some technical references 54

4 The Economics of Emerging Infections in the

Asia-Pacific Region: What Do We Know and
What Do We Need to Know? 59
Robert Davis and Ann Marie Kimball

Case study descriptions of four epidemics 64

Framework for evaluating risk of economic impact 69
Cost trade-offs 72
Conclusion 72
References 73

5 Economic Growth, Disruption, Deprivation,

Disease and Death: On the Importance of the
Politics of Public Health for Development 76
Simon Szreter

Economic growth and the health of the populace in

Britain, circa 1750–1870 80
Economic growth and urban deterioration in
early-nineteenth-century Britain 86
Water, health and the politics and economics of
public health in British cities 92
Conclusions: the importance of politics, the state
and social capital 100
Notes 107

6 Disease and International Development 117

Andrew T. Price-Smith

Microeconomic analysis 119

Emerging and re-emerging infectious diseases
and their legacy of orphans 123
Sectoral analysis 125
Macroeconomic analysis 136
 Contents ix

National costs 139

Notes 144

7 The Map is not the Territory: Reconceiving

Human Security 151
Jim Whitman

The international and the global 154

Human security 155
Emerging and resurgent infectious diseases 158
Conclusion 159
Notes 160

8 Ghosts of Kigali: Infectious Disease and

Global Stability at the Turn of the Century 164
Andrew T. Price-Smith

International relations theory 164

Intra-state effects of ERID 170
Notes 177
Bibliography 181

9 The Return of Infectious Disease 183

Laurie Garrett

The post-antibiotic era 183

Diseases without borders 185
The city as vector 187
The emblematic new disease 188
The real threat of biowarfare 189
A world at risk 191
Prescriptions for national health 193

10 Microsecurity 195
Sara Glasgow and Dennis Pirages

Ecological security 196

Globalization and microsecurity 200
Social transformation and microsecurity 202
Microinsecurity in sub-Saharan Africa 206
The political economy of AIDS in South Africa 208
Notes 211
x Contents

11 Beyond the Traditional Intelligence Agenda:

Examining the Merits of a Global Public
Health Portfolio 214
Loch K. Johnson and Diane C. Snyder

In search of a post-Cold-War intelligence agency 215

The significance of global public health
intelligence 219
Resources of public health intelligence 224
The future of public health intelligence 225
Conclusion 230
Notes 230

12 The International Health Regulations in

Historical Perspective 235
Simon Carvalho and Mark Zacher

Regime formation and regulatory roots:

1851–1951 236
Regulation experience and reform in the late
twentieth century: 1951–95 243
Emerging diseases and new directions: reform in
the 1990s 250
Conclusion 255
Notes 256
Bibliography 259

13 Public Health and International Law: the

Impact of Infectious Diseases on the
Formation of International Legal Regimes,
1800–2000 262
David P. Fidler

The globalization of public health and infectious

diseases 263
Brief history of international law and infectious
diseases 265
The international health regulations 269
Infectious diseases and international trade law 271
Infectious diseases and international human rights
law 274
 Contents xi

Infectious diseases, war and weapons 276

Infectious diseases and international environmental
law 277
Future international legal challenges 278
Conclusion: the concept of global health
jurisprudence 280
Notes 281
References 281

Index 285
List of Boxes, Figures, Tables and
Maps
Chapter 2
Table 2.1 Recent examples of emerging infections and
probable factors in their emergence 9
Table 2.2 Factors in infectious disease emergence 13

Chapter 3
Map 3.1 Examples of emerging and resurgent infectious
diseases in the 1990s. 29
Box 3.1 An environmental distress syndrome 35
Box 3.2 Global change in montane regions 38
Box 3.3 Marine ecosystem stresses 43

Chapter 4
Figure 4.1 International trade of agricultural products 60
Map 4.1 Microbial threats in the Asia-Pacific region, 1998–99 61
Table 4.1 Summary of economic loss from epidemic
disease 67
Figure 4.2 Impact of the Sakai epidemic on the radish
seed trade with the US 68

Chapter 5
Table 5.1 Estimates of expectation of life at birth in
provincial cities (not London), above 100 000
inhabitants in England and Wales,
1810s–1890s 84

Chapter 13
Table 13.1 Non-exhaustive list of international conferences
and conventions on infectious disease control,
1851–1951 266

xii
Acknowledgements

This book is the result of the nascent Program on Health and Global
Affairs that was based at the Centre for International Studies (CIS) at
the University of Toronto. I am particularly grateful to both Louis
Pauly (Director) and David A. Welch (Assistant Director) of the CIS for
their support of a research agenda that was regarded as being ‘ahead of
the curve’ during the late 1990s. This book grew out of a CIS confer-
ence at the University of Toronto in the latter part of 1998. I am grate-
ful to the Connaught Foundation of the University of Toronto for
providing financial assistance for that initial assemblage of contribu-
tors to this volume. CIESIN at Columbia University provided me with
generous financial assistance in the form of a post-doctoral fellowship
for 1999–2000 that allowed me to put the finishing touches to this
volume. I am grateful to both Marc Levy and Roberta Miller of CIESIN
for their support of this initiative. Furthermore, I would also like to
thank both Geoffrey Dabelko and P.J. Simmons of the Environment
and Security project in the Woodrow Wilson Center of the
Smithsonian for financial support of this initiative. My most sincere
gratitude to Christina Greenough for her exceptional diligence in copy
preparation and proofreading. I would also like to thank the entire
team at Macmillan, particularly Alison Howson and Sally Crawford, for
their continuing support of the project. Finally, I owe a debt of grati-
tude to my family who contributed both financial and moral support
during those mad years of graduate school at the University of Toronto.

Permission to reprint the following material that has been published else-
where has been kindly granted: Chapter 2 originally appeared in Emerging
Infectious Diseases, vol. 1 (1), online journal; Chapter 3 is reprinted from
Consequences, vol. 3, no. 2, 1997; Chapter 5 is reprinted with the permis-
sion of the Population Council, from Population and Development Review,
vol. 23, no. 4 (December 1997), 693–728; Chapter 6 was originally pub-
lished as a working paper by the Centre for International Studies of the
University of Toronto, June 1998; Chapter 8 was originally published in
the International Journal, vol. 54, no. 3, summer 1999; Chapter 9 is
reprinted by permission of Foreign Affairs, vol. 75, no. 1, 1996. Copyright
© 1996 by the Council on Foreign Relations, Inc; Chapter 13 of this book
is informed by David P. Fidler’s book International Law and Infectious
Diseases (Oxford: Clarendon Press, 1999).
ANDREW PRICE-SMITH
xiii
Notes on the Contributors

Simon Carvalho, at the time of writing, is Associate Researcher in the

Institute for International Relations at the University of British
Columbia.

Robert Davis is lecturer in the Department of Economics at Seattle

University.

Paul R. Epstein is Associate Director of the Center for Health and the
Global Environment, and Instructor in Medicine, both at the Harvard
Medical School.

David P. Fidler is Associate Professor of Law at the Indiana University

School of Law – Bloomington.

Laurie Garrett is a medical and science reporter for Newsday magazine,

and recipient of the Pulitzer, Polk and Peabody prizes in journalism.

Sara Glasgow is doctoral candidate in the Department of Government

and Politics at the University of Maryland, College Park.

Loch K. Johnson is Professor in the Department of Political Science,

University of Georgia.

Ann Marie Kimball is Associate Professor of Health Services and

Epidemiology and Adjunct faculty to the Department of Medicine in
the School of Medicine at the University of Washington.

Stephen S. Morse is Associate Professor of Epidemiology in the

Mailman School of Public Health at Columbia University.

Dennis Pirages is Professor in the Department of Government and

Politics, and Director of the Harrison Program on the Future Global
Agenda, at the University of Maryland – College Park.

Andrew T. Price-Smith, at the time of writing, is Adjunct Assistant

Professor in the School of International and Public Affairs, and
xiv
 Notes on the Contributors xv

Post-Doctoral Research Scientist at CIESIN, also at Columbia

University. He is currently Assistant Professor in the Department of
Political Science and Public Administration at the University of North
Dakota.

Diane C. Snyder, at the time of writing, is Adjunct Faculty in the

Department of Government at Princeton University.

Simon Szreter is University Lecturer in the Faculty of History at

Cambridge University.

Jim Whitman is Lecturer in the Department of Peace Studies, Bradford

University, co-editor of the Journal of Humanitarian Assistance, and
general editor of the Palgrave Global Issues series.

Mark Zacher is Professor in the Department of Political Science, and

former Director of the Institute of International Relations at the
University of British Columbia.
1
Introduction
Andrew T. Price-Smith

This volume sits at the cutting edge of interdisciplinary scholarly inno-

vation. It reveals fresh approaches to problems that are just beginning
to penetrate the public consciousness.
Of recent general developments in the social sciences, the newest
and most striking is the recognition of the close relationship between
health, prosperity and state stability. There is a growing awareness of
the interconnections between epidemiology, political conflict, prosper-
ity and the wellness/illness of populations. Around our troubled globe
it is increasingly apparent that the wealth of nations depends on the
health of nations.
In the post Cold-War era, the fast-changing pace of innovations in
science and technology opens up vast new realms of opportunity. But
humanity is also confronted by growing spectres derived from our con-
tinuing hubris and miscalculations, namely the long-term degradation
of the Earth’s biosphere and our continuing unwillingness to ade-
quately address entrenched poverty throughout the developing world.
It is precisely this combination of increasing environmental disruption
and deep inequities in the global distribution of wealth that has gener-
ally contributed to the current resurgence of infectious disease on a
global scale. As the articles collected for this volume attest, the return
of infectious disease has enormous downstream implications for many
aspects of human societies, including international development,
international security and governance, and international law.
The global resurgence of disease is an intriguing story that illuminates
the depth of our arrogance and ignorance when it comes to human
interactions with the natural world. Early medical successes against
infectious disease came in the form of Pasteur’s heat-processing, Koch’s
identification of the cholera bacilli, Salk’s development of the polio

1
A.T. Price-Smith (ed.), Plagues and Politics
© Palgrave Macmillan, a division of Macmillan Publishers Limited 2001
2 Plagues and Politics: Infectious Disease and Policy

vaccine, and the early (and short-lived) victories over malaria through
the use of vector-control agents such as DDT. Indeed, we have enjoyed
some lasting victories over the microbes: polio has been generally eradi-
cated from the Americas and Europe, and the once widespread killer,
smallpox, is now confined to military research laboratories in the
United States and Russia. Up until the mid-1970s, humanity had
enjoyed triumph after triumph over the microbial world, to the extent
that leading figures in the public health sciences began to comment
that there was little, if any, need to continue to train physicians in the
realm of infectious disease diagnosis and treatment.
Despite this premature celebration of victories over the microbial
threat, there were early signs that pathogens would soon begin to
reassert their normal ecological roles as the controlling agents of
human populations. One early example of disease emergence came in
the form of Legionnella (Legionnaire’s disease), which gained notoriety
for the mortality it generated. Meanwhile, immunity to vector-control
agents (e.g. DDT) began to rise in arthropod populations, 1 just as the
malaria parasites themselves began to develop increasing resistance to
chemical prophylaxis such as quinine. Of course, the true wake-up call
for humanity came in the form of the Human Immunodeficiency Virus
(HIV) that causes AIDS, and which emerged in the early 1980s. At the
start of a new century, the global HIV pandemic continues its relentless
expansion across the globe, generating both record levels of new infec-
tions and HIV-induced deaths. HIV/AIDS is thoroughly entrenched in
sub-Saharan Africa where upwards of 30 per cent of the adult populations
of some states (for example, Zimbabwe, Botswana) are currently infected
with the virus. The HIV pandemic is expanding rapidly throughout
South Asia, particularly in India where an estimated 1 per cent of the
aggregate population now tests positive for infection, and in the Indian
province of Nagaland where over 7 per cent of the populace is now
infected. HIV is also spreading rapidly throughout South-East Asia from
its established foothold in Thailand, and Beijing has gone so far as to
attempt to erect a disease wall in southern Yunnan province to keep
the infection from spilling over into its population. While new HIV
infection rates have recently begun to plateau in the developed world
(Western Europe and North America), they are soaring in the former
Soviet republics of Russia and Ukraine; there, in conjunction with the
equally rapid proliferation of tuberculosis, we are likely to observe
significant population morbidity and mortality in the near future.
After nearly 20 years of battling the HIV/AIDS pandemic there is still
no vaccine for the virus and while drug cocktails (such as AZT, etc.)
 Andrew T. Price-Smith 3

have proven effective in prolonging the lives of patients, they cannot

rid the patient of the virus completely. The greatest problem is that the
provision of such anti-viral therapies and chronic care medical services
are out of reach for the majority of the global population now infected
with HIV. Peoples in the developing world have neither access to ade-
quate health care infrastructures nor the fiscal resources required to
purchase costly anti-viral medications.
Unfortunately, the one lesson that we can take away from the emer-
gence of HIV and hepatitis, and the re-emergence of tuberculosis and
cholera, is that the microbial world will continue to adapt to human-
induced changes in the global ecology. Thus, the greater the degree of
degradation that humanity visits upon fragile ecosystems, the more
unpredictable the response from the microbial world as it is pushed to
evolve faster to compensate for its changing environment. Indeed, the
harder we attempt to push the microbes to the margin, the faster they
will continue to evolve. Many prominent epidemiologists now warn
that HIV/AIDS should be considered a shot across the bow, and that it
is precisely because of the mechanics of biological evolution (and
humanity’s increasing ability to tamper with it) that we will continue
to observe the emergence of new potentially virulent microorganisms.
Given that microbial evolution is inevitable, it would be prudent to
anticipate the emergence of lethal pathogens in the years ahead.
This book represents an attempt to bridge the disciplines, from the
natural to the social sciences, and to generate a solid scientific founda-
tion for future attempts to generate consilient knowledge.2 Edward O.
Wilson’s eloquent plea for an increase in cross-disciplinary work recalls
the endeavours of Sir Francis Bacon, who took all knowledge to be his
province. Wilson argues for a new Renaissance in the pursuit of
scientific knowledge, positing that many of the greatest scientific dis-
coveries are in fact likely to be found at the interstices between disci-
plines. It is through the gradual aggregation of interdisciplinary
knowledge that we will be able to emerge from the recesses of scientific
compartmentalisation and the charade of inter-disciplinary rivalry.
Recognising the fundamental value of interdisciplinary endeavour, this
book represents an intellectual excursion into the realms of consilient
knowledge.
As the following chapters document, the emergence of disease has
conditioned the structure of international law over the centuries, has
had negative effects on international trade and economic develop-
ment, and is a growing threat to national security in both the develop-
ing and developed world. This volume brings together a number of