Mobilising against the pandemic threat

Talk of plagues in these gleaming modern days drags the mind back in time to the pustules, exorcisms and corpse pits of the Dark Ages. Unfortunately, the issue of global pandemics is very much one of the future: it could even turn out to be the issue of our times.

The attempt here is to look at the role of securitisation in dealing with the looming likelihood of a biological apocalypse that could leave 30-70 million people dead (according the World Health Organisation).

Discussions of the dangers the globe faces from emerging infectious diseases (EID) most often take place on a backdrop of human security. This widening of the security agenda from the traditional boundaries of national security to include the welfare of every human being tends to blur the pragmatic questions governments must ask: when does an emerging infectious disease become a threat to the survival of the state? What security issues are particular to biological threats? How do governments respond to a situation of this kind?

Disease generally belongs to the sphere of public health. However, there are immediate points of intersection with traditional security concerns. Under what circumstances then, can a naturally occurring epidemic in the civilian population become a threat to the survival of the state?

This depends firstly on the nature of the pathogen - its virulence and speed, who is infected and where it occurs. The mere existence of a disease will not be an issue of national security, but the abnormal behaviour of the disease - an epidemic - could become one.

The dangers posed by an EID epidemic could, then, be divided into primary and secondary threats. Primary threats would be immediate challenges to national security: attack by a biological weapon; an army decimated by disease. Secondary threats would be the longer-term consequences that, if not managed correctly, would have the potential to challenge the survival of a sovereign state. These could include a large civilian death toll affecting the workforce and productivity, social upheaval and trauma leading to conflict, a crisis of legitimacy for the government.

While the threat is global, it may not be uniform. In some cases, the prosperous nations may even be more vulnerable to the effects of disease epidemics than developing or declining states.

In the recent Australian Strategic Policy Institute paper on infectious disease, Peter Curson points out that in the last 30 years, about 40 new infections have been recorded, most as a result of zoonoses. These include Ebola, Legionnaires disease and mad cow disease.

The main EIDs to date, however, are HIV-AIDS, SARS, and H5N1 or “bird flu”. These are diseases for which no human has proven immunity, and for which there is limited knowledge about treatment. These three are not climate-sensitive and so have the potential to affect any country in the world: they also share a high mortality rate.

The virulence of the “big three” is undisputed, but it is important to note the characteristics that are particular to each: mode of transmission and speed of death.

HIV-AIDS is not airborne, nor can it be transmitted by droplets or skin contact. It is a slow killer and symptoms do not show for some time. This makes it easier to avoid - as contagion is linked to behaviour - and yet extremely effective in spreading, as hosts may be unaware they are affected.

The SARS virus is transmitted at close range, most effectively through coughing and sneezing. However these symptoms set in at the later stages of infection and this makes it possible to identify infected people before they are at their most contagious.

Avian influenza (H5N1), once airborne, will travel from host to host as a virus. This means it can pass through common surgical masks. It will take up to 10 days for the onset of symptoms, during which time the person is highly contagious. This leaves plenty of time for the virus to spread undetected.

The different virus characteristics must be noted because the responses need to be disease-specific to be effective. National boundaries are irrelevant to an EID, but not to the practical solutions needed to combat them. These must be trans-national in scope and the capacity for containment is key.

The long-term effects of “creeping” diseases such as HIV-AIDS are being felt in Russia and sub-Saharan Africa, where infection is beginning to impinge on the strength, productivity and stability of the nation state. Disease will mingle with existing tensions and deprivations to rock stability in the region, perhaps even to the point of total collapse in some areas.

Although these cases are at the worst end of the spectrum, they are useful in trying to understand how an extreme manifestation of even a slow-moving, non-airborne disease has the potential to affect national security.

With airborne diseases, the implications emerge almost immediately. SARS cost the Asia-Pacific region an estimated $40 billion - an epidemic that lasted six months. The economic impact of the disease was exacerbated by fear and confusion. With H5N1, the epidemic could last up to three years and would be infinitely more costly, and more deadly.

The effects of EIDs in all countries - and even within countries - will not be the same. Infection as a security challenge will likely depend on the particular disease, as its characteristics will determine how far and how fast it spreads, who its victims are, and the ratio of infection to mortality.

While prosperous nations have an arsenal of better medicine, stronger government, better health systems, education and communication with which to smite an EID, vulnerabilities may stem from these very advantages. There is more travel, trade and tourism, for example, all of which increase the chance of cross-infection.

Then there is demography. Susan Peterson has argued that countries such as China and India have large populations that could more easily cushion a huge death toll from an EID. Conversely, the same proportion of deaths per thousand occurring in Europe, where birth rates are already below replacement level, could be devastating.

Wealthier societies are psychologically less prepared for large-scale deaths from disease within their population: it follows that the trauma and economic shock could possibly then be greater. Panic and suspicion would grow as every citizen became a potential biological bomb. Confidence in the government’s custodial function would erode and could provoke a crisis of legitimacy for the power structure. People would retreat into a survivalist mindset and could begin to see the government as the visible manifestation of an invisible enemy.

Good information may do little to mitigate the situation. A study conducted in Canada during the SARS outbreak found that just exposing people to large amounts of information about the disease was not enough to strengthen their knowledge, nor to convince them to change their behaviour.

The particular properties of EIDs make them a hot candidate for securitisation. Policies for government co-operation on non-military threats remain underdeveloped and this needs to change. The government needs to be able, in a disease emergency, to marshal the resources of the state - public and private - towards fighting the viral enemy. It may be required to impose unpopular decisions on its people, including quarantine, travel restrictions, shortages of goods, a ban on large public gatherings, compulsory vaccinations and the like.

Death tolls could be massive from H5N1. A global “bird flu” pandemic would put almost every country in a protracted state of siege. Surviving this state requires detailed planning - including stockpiling of vaccines, medicine, fuel, even food - and deep co-operation with the private sector.

Private businesses have a huge role to play - indeed their co-operation is essential. The private sector manufactures all vaccines, for example, produces and distributes food, fuel and medical equipment, and so on.

A disruption of these services could not be replaced by government bodies, and nor should they be. Agreements should be made beforehand with key businesses, and the private sector involved in emergency planning. While national security is potentially the issue, the same restrictions of intelligence and clearance will not be applicable in the same degree that they are when the national security issue is a human aggressor.

Planning could begin with the production of large amounts of anti virals, very likely an effective weapon in the battle against influenza. Vaccine production would most likely have to wait until the epidemic had actually begun as the particular strain of ‘flu would first have to be isolated. “Sleeper” factories could be designated, ready to go into mass production once the vaccine had been created. This would probably make more sense than nationalising existing factories.

It is difficult to imagine the scenario being discussed in the absence of a real pandemic, but it could change the world almost overnight. Populations in Western countries would not be quarantined from the effects, as they are to a large extent from the everyday realities of the war in Iraq for instance.

There would be nothing to see on television, only emptying public spaces and growing numbers listing the dead. The globalised planet would temporarily shut down and retreat back into fortress nation states. Immigration, travel and trade would have to all but cease, at least temporarily.

The problem is real, it’s big, and it has the potential to threaten the survival of sovereign states. This does not mean that every aspect of an epidemic needs to be under the sole control of the military. Disease remains primarily a public health issue, associated with the domestic sphere and with keeping people alive, while security is usually related to the military sphere and aggression.

The inherent opposition between the domestic and the military has to be reconciled if we want practical solutions. The ethical questions - on quarantine, triage, vaccine allocation, for example - will cause deep divides and it is important to have those debates now, before a pandemic begins and fear and a ticking bomb skew our collective thinking.

Personal liberties will again be in the front trenches - as they are today in debates on terrorism prevention - but in an even more immediate and more intimate position. The need for a blanket approach - for total co-ordination of military, local and federal government, the private sector, as well as of global efforts - is far more relevant to disease than it is even to anti-terrorism measures.

Submission to disease is not an act of malicious intent; how then do we deal with the infected? How would our social capital stand up to the strain of an indiscriminate and invisible invader with a potential for devastation that could outdo the most disgruntled human powder keg?

Nation states need very visible, very practical and very well explained procedures to counteract the social and economic fall-out of the organisms themselves, which could be just as damaging to our national fabric.

Today, the greatest threat of pandemic yet to appear in modern times is on the horizon. Avian influenza, H5N1, “bird flu” is flashing early warning signs like lightning in a distant storm cloud.

The first step is to realise the threat to national security that can exist in a naturally occurring epidemic, and to understand the necessity of being able to present a wholly integrated national (and then trans-national) plan to combat it. The second is to prepare to wage total war on our own soil, to harness all resources, public and private, and to ensure other countries are doing likewise.

A worldwide pandemic will be the true test of just how co-ordinated and integrated and resilient our globalised world is. Let’s just hope the pustules and plague pits remain where they are, well behind us.