The Foreign Service Journal, December 2004

rity crisis. UNAIDS, along with the World Health Organization and World Bank, have begun glob- al programs to mitigate the impact of HIV/AIDS on affected societies. The Global Fund to Fight AIDS, Tuberculosis, and Malaria — a wide-ranging independent effort to combat the three pervasive endemic diseases that sap the abil- ity of developing nations to improve the lives of their people — has made outstanding progress in identifying pro- grams to stem the spread of these diseases and treat those afflicted. The U.S. President’s Emergency Program for AIDS Relief is another program designed to target critically affected nations and speed their response. Such efforts can succeed. Smallpox has been eradi- cated (with the exception of those worrisome vials reserved for biological warfare research, hopefully well-secured) and poliomyelitis may be next, depend- ing on the outcome of the current mass vaccination campaign centered in West Africa. Thailand and Brazil are recognized globally for addressing the HIV pan- demic early and making remarkable progress in stem- ming the spread of the disease. In Africa, Uganda and Senegal are two examples of states that recognized the security implications of HIV at different stages — Senegal before the disease reached critical levels, and Uganda at the height of its epidemic — and marshaled national resources to protect their citizens and dramat- ically lower infection rates. All of these nations, and the other examples of hero- ic response to the threat of infectious disease, repre- sent the victory of political will translated into mean- ingful action. However, given the depth and breadth of the HIV pandemic, massive resource outlays are required merely to cope with the disease, let alone beat it back. U.N. Secretary General Kofi Annan has esti- mated that it will take $8 billion to $10 billion per year over the next decade to adequately address the HIV pandemic in Africa. A combination of limited funds and donor fatigue may make it difficult to meet that target, especially when one considers the myriad other diseases that demand attention across the globe. In addition, conceptual issues also undercut response programs. Key among these is the controversy over tar- geting of resources for prevention versus treatment programs. Given the limited funds available, a battle has emerged within the donor and recipient community pitting those who want to target aid for preven- tion, to stem the growth and spread of HIV and other diseases, versus those who prefer increased funding for treatment of those already afflicted. Even among those insisting on a con- centration on prevention, controversy over approaches has decreased the potential effectiveness of response programs. The optimistic talk heard a generation ago predict- ing the imminent end of infectious diseases (much like the confident belief after our victory in the Cold War that we had reached the “end of history”) has proved naïve and dangerous. Such talk actually misrepresents the nature of our struggle to preserve human health and security. We are in combat with an adversary far older than we, and with a greater ability to evolve and adapt than we will ever possess. As Dennis Pirages commented in a 1996 report, “Microsecurity: Disease Organisms and Human Well-Being,” issued by the Woodrow Wilson Center’s Environmental Change and Security Project: “Infectious diseases are potentially the largest threat to human security lurking in the post-Cold War world. … Educating people to think about this struggle with microbes in an evolutionary way is the ultimate solution. … [P]olicy-makers need to understand the potential seriousness of the problem and reallocate resources accordingly.” Fortunately, there is reason for hope that policy- makers have indeed realized the importance of this struggle and are beginning to take action globally to combat the threat of infectious disease. Western gov- ernments have begun to direct their development pro- grams toward increasing the capacity of developing nations to provide for the basic public health needs of their citizens. The Global Fund has seen dramatic increases in contributions from a variety of sources, including the European Union, the United States and the Gates Foundation. The Global Fund has also taken steps to diminish the gap between contributions F O C U S 28 F O R E I G N S E R V I C E J O U R N A L / D E C E M B E R 2 0 0 4 HIV is much more than a social or developmental threat — it is a concrete threat to stability and security.