Avoiding Global Bio-Apartheid

Peter Stoett, Toronto Star

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.]