trade, interdependence, and security

Transcription

1 strategic asia trade, interdependence, and security Edited by Ashley J. Tellis and Michael Wills Special Studies When the Flu Comes: Political and Economic Risks of Pandemic Disease in Asia Ann Marie Kimball restrictions on use: This PDF is provided for the use of authorized recipients only. For specific terms of use, please contact To purchase the print volume in which this chapter appears please visit < or contact 1414 NE 42nd Street, Suite 300 Seattle, Washington USA the national bureau of asian research

2 executive summary This chapter examines the potential impacts of an avian flu pandemic in the Asia-Pacific, in particular the effects on regional economic integration, effectiveness of regional responses, and implications for the United States. main argument: East and Southeast Asia will be the center of the pandemic influenza that most public health authorities predict will likely sweep the global community in the near future. Such an outbreak will transform the region s relationship both among its increasingly integrated member economies and with the world at large. Though local and national public health structures are being urgently reinforced, the regional structures that are currently in place will likely prove inadequate to coordinate transnational activities in the event of a pandemic. policy implications: The ongoing process of economic integration within the region is at risk in a pandemic scenario. If a pandemic occurs within Asia s human population, regional cooperative forums on public health issues might be ineffective as many agreements are as of yet little more than declarations of intent and most are grossly underfunded. International collaboration to strengthen public health defenses and contain the pandemic threat is active but may not prove adequate. The United States has a major role to play, and how that role is played over the next decade will impact Washington s relationships in and with the region. Consensus and cooperation with strong accountability are cornerstones of successful technical collaboration.

3 Infectious Disease When the Flu Comes: Political and Economic Risks of Pandemic Disease in Asia Ann Marie Kimball Ecologically, demographically, and epidemiologically the Asia-Pacific is ground zero for epidemics of new human pathogens, both imported and home grown. The region is characterized by the collocation of dense communities of humans and animals (especially birds), a situation which creates opportunities for the emergence of new human pathogens. In addition, the World Bank has recently ranked the region as the world s most open for international trade, giving the Asia-Pacific ongoing exposure to agents arising elsewhere which make their way via travelers or commodities in global trade. The security of the Asia-Pacific region is increasingly hinging on the ability of countries to maintain the security of human populations against emergent diseases. Recurrent emergent epidemics and human pandemics in the Asia-Pacific are thus an important optic with which to examine trends in a variety of other aspects of regional change. Though the previous decade witnessed numerous new human pathogens, SARS in particular served as an important wake up call for this need for regional change. Ann Marie Kimball (MD, MPH, University of Washington) is Professor of Epidemiology and Health Services at the University of Washington School of Public Health and Community Medicine and Director of the APEC Emerging Infections Network. She can be reached at <akimball@u.washington.edu>. The World Bank, East Asia Update, March 2006, HIV/AIDS is an example of an infection that, having entered Asia through trade and travel, now creates a background condition of vulnerability to other infections in the immunocompromise it causes. The incursion of HIV/AIDS into the region and the coincident aging of the populations in many countries (such as China and Japan) are creating new vulnerabilities. Human host defenses (i.e., the ability of the body to fight off infections) decline both in people infected with the HIV virus and in people as they age; Asia has increasing populations of both types of individuals. The challenge of new disease emergence will only grow over coming years.

4 366 Strategic Asia This chapter will begin with a brief overview of the how the repeated emergence and extension of outbreaks of new infectious agents in the Asia- Pacific has transformed the regional on many levels. A second section presents a series of case studies of disease in the Asia-Pacific and examines their economic (including trade) effects. A third section then gauges the current risk of H5N1 avian influenza (or bird flu ) breaking out in the region. As a means of analyzing the potential of regional organizations to cope with such outbreaks, a fourth section contrasts the experience of the European Union (EU) and the Asia-Pacific in responding to highly pathogenic avian influenza. The chapter concludes with an analysis of the likely impact of a major pandemic outbreak in East Asia and draws implications for the United States. Epidemics: Transformative Events During the past decade numerous new human agents have emerged from the Asia-Pacific, and other emergent human agents have arrived in the region via travel and trade. These emergences have severely tested the public-health safety nets in the region. Public safety systems water, sanitation, disease surveillance, laboratory capacity, epidemic investigation and containment, and health care systems have all been tested and often found in need of urgent repair. First, neurologic illness (such as bovine spongiform encephalopathy, also known as BSE or mad cow disease) and immunocompromise and enteric disease (such as HIV/AIDS and E. Coli 0157:H7, respectively) arrive through trade and travel. Second, the region also has a propensity for spawning its own new agents. Most new human pathogens jump from other vertebrate species, and for reasons which are not clear the ecology of the Asia-Pacific favors this phenomenon. This ecological reality poses challenges to the health and public health systems of the region, both national and international. In each case of epidemic disease, ripple effects have occurred across such diverse elements of society as legal regimens, trade, and travel. Though contemporary attention is focused on the potential for pandemic flu and the incursion of H5N1 into an ever-increasing geographical range of bird populations, this is only the most recent of new pathogens to affect the region. Previous events include the introduction and spread in the 1980s Seventy percent of new agents of human infection arise from the jumping of pathogens from other vertebrates into humans. This has been true for such agents as tuberculosis and influenza. The mechanism by which pathogens successfully move from one species to another is not known, nor are the factors that might create opportunity for species jumping well delineated.

5 Kimball Infectious Disease 367 of HIV/AIDS through travel and contaminated product. Additionally, the prion agent of BSE and new variant Creutzfeldt-Jacob disease (nvcjd in humans) from Europe has reached the region both in contaminated surgical product and in animal feeds. 5 E. Coli 0157:H7, imported into Japan in radish seeds, has caused a major outbreak in the past. 6 The region has also spawned new agents, however, including the Nipah virus, Enterovirus 71, SARS coronavirus, and most recently H5N1 avian influenza. Why is this region at such high risk? The dense populations of human, birds, pigs, and other animals at or near burgeoning population centers create the spatial proximity for species jumping. 7 Intensification of agriculture, uneven sanitary infrastructure, and changes in production and food handling also likely play a role. What each of these outbreak events brings to the societies they infect is profound. When relatively unknown to science and medicine, a new pathogen is more deeply frightening to both policymakers and the general population. There are no well-known effective treatments for individuals. Efforts to limit the spread of infection are hampered by the unknown nature of how the infection is spread. Is the new illness spread person-to-person? Transferred by air or by droplet? Spread fecal-orally? Carried in food, water, or other items consumed by humans? Finally there are generally imperfect protections available against infection. Antiviral drugs for example may or may not be useful against a newly evolved viral infection such as avian influenza. Vaccines are rarely available and must be developed. Personal protective measures such as hand washing, masks, and gloves are often employed but have been poorly studied for their efficacy. From the perspective of government, measures to contain infections include both domestic control within borders and consideration of transnational transmission threats. If the infection is occurring in an economy open to trade or tourism, governments may react with measures Ann Marie Kimball, Yuzo Arima, and Jill R. Hodges, Stealth Infections and Global Trade: Farther, Faster, Quieter, Globalization and Health 1 (May 2005). 5 Kozo Mizoguchi, Japan Will Destroy 45 Cows Suspected of Having Mad Cow Disease, Associated Press, February 9, Prion (short for proteinaceous infectious particle) agents are unique because they are made only of proteins and are characterized by their hardy nature that is resistant to most techniques of sterilization. Prion agents cause progressive and fatal neurodegenerative disorders in both humans and animals. 6 H. Michino et al., Massive Outbreak of Escherichia Coli 0157:H7 Infection in School Children in Sakai City, Japan Associated with Consumption of White Radish Sprouts, American Journal of Epidemiology 150, no. 8 (October 15, 1999): Asian palates prefer fresh poultry. Thus with the ongoing urbanization of population in Asia, intensive poultry enterprises are located as close as possible to the urban markets in order to facilitate freshness and reduce transportation costs.