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Emerging Infectious Diseases
Volume 2, Number 2, April-June 1996

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Commentary

Needed: Comprehensive Response to the Spread of Infectious Diseases

In his article “Globalization, International Law, and Emerging Infectious
Diseases,” Fidler recognizes that biological agents travel by themselves or
with their hosts without any recognition of, or regard for, political
borders. He notes that with the continued expansion of economic commerce
across continents and more rapid transport and travel, persons infected
with infectious diseases of very short incubation periods can act as
vectors across several nations before they even become symptomatic. The
protective effect of clipper ship travel is long gone.

Fidler examines the need for international treaties, agreements, and
policies to manage the spread of new or reemerging infections diseases. His
concern is that the current international climate requires more enforceable
treaties with adequate resources to identify, track, interfere with, and
contain the spread of infectious diseases perceived as an international or
global threat.

International cooperation within the existing legislative mechanisms has,
on occasion, been very successful. International eradication of smallpox
was successful because a specific, cost-effective, efficient vaccine was
developed; the disease attacked persons regardless of their economic,
political, racial, religious, or social affiliations; the amount of funding
was adequate; and all nations recognized the benefits of the eradication
program. A similar effort currently in progress to eradicate poliomyelitis
will also be successful because of international cooperation.

In contrast, international control of other infectious diseases, such as
malaria and tuberculosis, has been attempted for decades with considerably
less success. Notwithstanding the lack of efficacious vaccines, the reality
is that only very limited resources are being committed to prevent and
treat all infectious diseases. Outbreaks of Ebola virus infection and
plague are routinely reported in the local, national, and international
press. However, the continued increased incidence and prevalence of
tuberculosis, AIDS, and other sexually transmitted diseases are accepted by
many as problems of the poor, the immoral, and the expendable portion of
society. Local, national, and international awareness and continued
interest are significant problems.

International cooperation must extend beyond merely restricting the natural
spread of specific diseases. One also has to recognize the need for
effective international treaties to prevent the use of biological agents in
either tactical or strategic circumstances. Fear of combatants using
biological agents on military and civilian targets intensified during and
since the Gulf War. The possibility of biological terrorism is no longer
limited to the imagination of fiction writers. Fidler does not stress the
issue of nonnatural outbreaks of diseases; a global need for an improved
non-ad hoc response to emerging infectious disease agents should be
completely considered by civilian and military planners. The threat of
infectious diseases as weapons provides an additional incentive for
cooperation among governments.

Harold M. Ginzburg, M.D., J.D., M.P.H.
Department of Psychiatry and Neurology, Tulane University Medical Center,
New Orleans, Louisiana, USA