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Newsletter:  October 2003/ Issue 5
AIDS and SARS:  The Impact of Public Health on Stability

by Kirea Jebali, PNWCGS Staff

Since the 1970s, the mood of the global health community has changed from confidence to concern as governments have steadily reduced public health funding and those in the medical field have witnessed a resurgence in old and the emergence of new infectious diseases. High among the causes for concern are the increasing microbial resistance to antibiotics; the re-emergence of diseases once believed to be relics of the past such as tuberculosis, malaria and cholera; the global spread of HIV, the AIDS virus; and the emergence of over 30 previously unknown diseases for which there are currently no cures such as Ebola and Hepatitis C.

Researchers at The National Bureau of Asian Research (NBR), a strategic partner of the Pacific Northwest Center for Global Security (PNWCGS), that conducts advanced research on issues relevant to policy in Asia, recently published articles examining the political, economic, social and military implications of AIDS and SARS, two of today’s greatest infectious disease threats.

AIDS

In his November/December 2002 article in Foreign Affairs, “The Future of AIDS,” Nicolas Eberstadt, Senior Advisor at NBR, warns that the toll of the AIDS epidemic will be more keenly felt by the global community in the near future as the center of the epidemic shifts from sub-Saharan Africa, where over 28 million of the world’s present 40 million victims live, to Eurasia. This increase in the global impact of the disease will be due to regional power discrepancies. While sub-Saharan Africa has limited economic and military power—aggregate economic output of sub-Saharan Africa is equivalent to that of Switzerland—Eurasia had a combined GNP of $15 trillion in 2000, substantially greater than that of the U.S. In addition, five out of every eight people and four out of five of the world’s armies of over one million are from Eurasia. Eurasia is home to four out of seven of the present declared nuclear states.

The question is not whether Eurasia, and particularly, China, Russia and India, will be victims of the crisis, but rather, how hard they will be hit. Eurasia has experienced a steady growth in infection rates. China, Russia and India all have in excess of one million cases. In 2000-2001, U.S. intelligence sources estimated the number of people infected with the virus in China and Russia was between one and two million. In India, the estimate was between five and eight million infected people. According to official estimates, in less than a decade AIDS cases in sub-Saharan Africa rose from seven million to 25 million. Furthermore, the responses of the Chinese, Russian and Indian governments have been insufficient to significantly reduce the spread of the disease. In China, open discussion of the epidemic is not officially permitted, and the government has denied that the disease poses a danger to the country. Russia has few resources to dedicate to the crisis and has been resistant to foreign involvement in managing the disease. And, while the Indian government is in the second phase of a ten-year program to combat AIDS, the federal system allows individual states considerable leeway in applying the program

Eberstadt warns that Eurasian nations face major military, societal and economic losses if the epidemic is not contained. Using figures from the growth and spread of the AIDS epidemic in sub-Saharan Africa and demographic and epidemiological modeling techniques, Eberstadt examined potential scenarios in Eurasia as a result of AIDS. Employing a baseline from current demographic trends in China, Russia and India, and basic assumptions about the epidemics in each country (including three estimates of disease severity—mild, intermediate, severe), he concludes that life expectancy may be considerably reduced as a result of AIDS, particularly in Russia, where the expected lifespan could decrease by as much as a decade; GDP and per capita productivity will likely decline, again, particularly in Russia, with ramifications for Eurasian economies and militaries; and the collective death toll from AIDS could be anywhere from 43 million to 155 million between 2000 and 2025 depending on the severity of the epidemic.

In the region’s favor, Eurasia has a higher level of nutrition and lower rate of endemic disease than sub-Saharan Africa, and the success of the Thailand’s anti-AIDS campaign has demonstrated that competent government monitoring, frank public education and management of curable sexually transmitted diseases—a proven indicator for HIV transmission—are all effective methods of reducing the spread of AIDS. However, the indications at this point and time, in view of the current government responses, are that AIDS may very well change the course of Eurasia’s—and the world’s—future.

“To the extent that prosperity and health conduce stability and a more desirable world, health is a (security) factor,” Eberstadt said. “We can probably say that a broad environment in which health challenges and expectations of well-being are on the decline is not consistent with the concept of a free society that open and liberal societies share,” he added.

SARS

In his essay “What Does SARS Means for China?,” Neil Beck of NBR’s Strategic Asia Project assesses the economic and political impact of Severe Acute Respiratory Syndrome (SARS) on China. Between November 2002 and early May 2003, the disease spread to 30 countries and infected 7,300 persons, killing 514. Its greatest impact was on mainland China, particularly Beijing, the medical and political epicenter of the outbreak. In China, as the government struggled to manage the economic and social effects of SARS, experts predicted that China’s economic growth for 2003 might be its lowest since 1990.

Beck argues that China’s economy did suffer as a result of the outbreak, but the effects appear to be short-term. Investors have, for the most part, retained their interest in China, and industries damaged by SARS were given a needed lift by an emergency tax break package approved on May 8, 2003. Still, certain sectors experienced sharp downturns during the second quarter. China’s service industry, which accounts for 33 percent of the country’s economy, was hardest hit. The manufacturing sector, responsible for half of all economic output in China, was less successful. Some factories did report significant drops in sales, as buyers from the United States, Australia, and Hong Kong reportedly shied away from some Chinese goods. Still, the fundamentals driving China’s manufacturing power did not change because of SARS, and Beijing’s successful efforts at containment appear to have mitigated long-term economic damage.

He also describes the political and social ramifications of SARS on China and argues that the outbreak was more politically potent than past crises because it endangered the foundation of the Communist Party’s legitimacy—meeting the public’s expectations of safety and rising living standards. He cites evidence that disappointment in the government’s handling of the outbreak cut across social strata and threatened the central government’s credibility as a caretaker of public needs. Even traditional supporters of the Party felt betrayed by government attempts to hide the extent of the SARS crisis. University students were assertive in criticizing Party leaders, and there were public protests—both in urban and rural areas—against government plans to use local facilities to treat and quarantine SARS patients. However, after disclosing the full extent of the crisis on April 20, the Communist Party moved quickly to counteract the loss in public confidence.

Beck reports that both President Hu Jintao, who has portrayed himself as a populist leader, and the party had to address several democratic principles: political accountability, transparency, and the government’s responsibility for social infrastructure. However, he points out that several important forces in Chinese politics that aggravated the crisis—the resistance of local governments and turf-conscious bureaucracies, central government control of media and online content, and factional political divisions— and that these were left unchanged.

“The political impact will continue to evolve… In the end, SARS may be an important—but not decisive—contributor to growing popular support for political reform in China,” commented Beck in the conclusion of his article.

According to Beck, the crisis also demonstrates the immediate impact that some public health issues can have on social and political stability.

“While some economic and political developments build slowly toward a crisis point, new, fast-moving public health issues can quickly spawn fear and uncertainty in an age of instant communications. Governments lacking transparency and efficient information channels are at risk of instability, partly stemming from partially-informed populations that feel compelled to take matters into their own hands,” he said.

NBR: http://www.nbr.org