Wendy Johnson, a family practice physician in Cleveland, is a board member of Doctors for Global Health (www.dghonline.org).
Odds are good that on a plane or boat or bus somewhere in the world sits a refugee headed for the United States carrying the seeds of a weapon of mass destruction. The agent he unwittingly carries is insidious and lethal but slow acting, so the deaths it causes can come months or even years after it is disseminated in the population. It has the potential to overwhelm, to kill thousands, and there may be no vaccine, antidote or cure.
What is this ominous threat? An ingenious new biological weapon? No, it is a very old nemesis of humankind--tuberculosis, an infectious disease that kills more than 2 million people every year. Because the majority of them are poor and outside our borders, we don't hear much about them, but that may soon change. Tuberculosis is making a comeback and is conquering the treatments that have kept this killer at bay in the developed world. Multidrug-resistant tuberculosis--a death sentence in most developing countries--is becoming more common and is incurable in about half the cases, even in the United States.
Two numbers in the President's budget proposal stand in stark contrast to each other: $6 billion to fight bioterrorism versus $200 million to the Global Fund to Fight AIDS, Tuberculosis and Malaria. That works out to a little more than $1 billion per US anthrax death last year, as compared with $33 per global victim of the more common infectious scourges in 2001.
Re-emerging infectious diseases like malaria, HIV and tuberculosis continue their inexorable march, devastating poor countries in Africa, Asia and South America and ultimately threatening the richest countries. Either we are all protected or we are all at risk. It would be better to recognize that the developed world's inaction and callousness have allowed epidemics to flourish in the fertile soil of poverty, malnutrition and poor living conditions made worse by wars, internal displacements, repressive regimes, refugee crises, economic sanctions and huge debt payments that require poor countries to cut public services.
If we can possibly be unmoved by the staggering numbers affected by the AIDS pandemic alone (3 million dead in 2001, more than 40 million people living with HIV, 28 million of them in Africa), then perhaps we will be moved by fear. Of the world's 6 billion inhabitants, 2 billion are infected with latent tuberculosis. With adequate treatment, TB is 90 percent curable, yet only a fraction of those with the disease have access to this simple technology: a course of medications costing only $10 to $20 per patient. As a result, tuberculosis is now the world's second leading infectious killer after AIDS. Resistant tuberculosis, the result of inadequate treatment, is spreading at alarming rates in poor countries and in urban centers of rich countries. According to the World Health Organization, an eight-hour plane flight with an infected person is enough to risk getting TB.
Of all the rich countries, the United States has its head buried most deeply in the sand. It is the stingiest, spending only one cent on foreign aid for every $10 of GNP. Only $1 in $20 of the aid budget goes to health. A recent WHO report estimated that spending by industrialized countries of just 0.1 percent more of their GNPs on health aid would save 8 million lives, realize up to $500 billion a year via the economic benefits of improved health and help those in poor countries escape illness and poverty.
George W. Bush's recent pledge to increase foreign aid comes too late and with too many strings attached. The proposal doesn't start until 2004, making it largely hypothetical. The current budget keeps spending flat at about $11.6 billion. Even with the promised increase, US spending on foreign aid as a proportion of GNP will still pale in comparison with that of other developed nations. And along with this carrot comes a big stick: Only countries that continue to let corporations raid their economies through detrimental free-trade policies will be eligible.
Bioterrorism is a danger that should be taken seriously, but the current counterterrorism frenzy threatens to militarize the public health system, draining resources away from the research, surveillance systems and treatments needed for existing health problems. Already the political war profiteers have criticized the CDC's funding priorities, using the terrorist threat as cover in an attempt to advance their reactionary agenda. In a letter this past November to Health and Human Services Secretary Tommy Thompson, Republican Representatives Joseph Pitts, John Shadegg and Christopher Smith criticized the CDC for "inappropriate" actions. The Congressmen wrote that "we have grown increasingly concerned about some of the activities that the CDC is funding and promoting--activities that are highly controversial in nature, and funding that could be better used for our War on Terrorism." They specifically objected to AIDS prevention programs targeted at gay men and to a CDC website link to a conference sponsored by organizations promoting reproductive health, including abortions, for women. Bush was happy to oblige by cutting $340 million from the CDC's nonbioterrorism budget.
Just as a missile shield will not protect us from crazed men with box cutters, so mass vaccination campaigns and huge stockpiles of antibiotics will not keep us healthy in an increasingly unhealthy world. September 11 should make us more aware than ever of our shared vulnerability. Making the world safer and healthier means prevention and early treatment of disease, inside and outside our borders. It means building a healthcare system designed to keep people healthy instead of spending billions on bogymen while the real killers are on our doorstep.