Published on Sunday, October 23, 2005 by the Toronto Star (Canada)
Avoiding Global Bio-Apartheid
We need to avoid a pandemic scenario where the wealthy foot bill to cordon off the infected.
by Peter Stoett
It is a scenario with variations reproduced in countless science fiction novels and films: A world bifurcated according to immunization. Those with the proper vaccines or genetic codes live, insecurely, in protected areas; those without are doomed to die in the forbidden lands.
Such a dystopian image may be less fictional, however, if the international community does not establish clear ethical guidelines in its response to pandemics. Of course, many would argue that the mixed approach to HIV/AIDS already belies such a discriminatory response to killer diseases.
Add to this the so-called "neglected diseases," such as malaria and yellow fever, affecting mainly states also struggling to deal with the AIDS pandemic, land and forest degradation, and civil or international military conflict, and it is obvious we are not sharing the burden of global health, but making squalid contributions while hoping to be minimally affected.
However, the striking emergence of the H5N1 virus, or avian influenza, is again raising the question of just how separated the world may become by biosecurity concerns.
When George W. Bush offered his characteristically militaristic foray into disease control earlier this month (he asked Congress to allow him to "bring in the troops" to quarantine affected areas), it was surely a harbinger of what could come: entire communities, perhaps even countries, quarantined through military force, to protect the rest of us. No one gets in or out; or so the idea goes.
Beyond the impossibility of such a step (consider, for example, the task of putting an effective quarantine around China), the ethics demand discussion.
While we should not panic over H5N1, it does have the potential to jump the species barrier and spread like wildfire.
Who will be most visibly affected — or, rather, infected — if a major human-to-human outbreak occurs?
Even at this stage, when the main modes of transmission are migratory birds, we can glimpse the future: The poor, many of them engaged in the poultry industries of Asia, eastern Europe, and northern Africa, are going to be hurt first. While it is an easily defensible truism that disadvantaged persons should receive extra protection during episodes of severe health crises, it is equally clear this is rarely the case. Two tragic events this summer, famine in Niger and Hurricane Katrina along the Gulf Coast, have demonstrated the disproportionate impact such disasters have among the least advantaged members of society.
With a pandemic there will be strong and virtually undeniable calls for strict quarantines of impoverished areas, and international agencies will scramble to provide vaccines (this could take up to six months) to adjoining areas.
Disease containment will become a military exercise and perhaps a permanent feature of international politics.
Sadly, this may be inevitable; our collective record on AIDS suggests we can't overcome political and economic obstacles to provide a greater public good.
But we can start working now toward establishing a new global ethic, articulated through multilateral institutions such as the World Health Organization, that accepts the harsh realities of the need for quarantine but rejects the option of letting entire communities go to waste.
We can reward, not punish, farmers who report H5N1 and other virulent strains; we can better equip the WHO with the ability to intervene as early as possible, assisting poor and rich alike; we can continue, as Canada is doing, to contribute to the development of vaccines and the science of epidemiology; we can contribute more to disease surveillance .
Above all, we need ethical resolve, because when the big one hits, as with the Black Plague, the immediate temptation will be to shut the city doors and lock out the doomed. This won't work this time around, and we can do better. We need to avoid the bio-apartheid scenario, where the infected are cordoned into what are essentially large-scale concentration camps, while the wealthy pay for oppressive measures to keep them there.
We may be on the verge of a major humanitarian disaster that will reveal in the starkest terms possible the differences between rich and poor, both between North and South, East and West, and within each.
The time for dialogue is now.
Peter Stoett is professor of international relations at the Department of Political Science at Concordia University. He is working on a book on global biosecurity issues.
© 2005 Toronto Star