Pandemic pandemonium.

• Author: Ruxin, Josh N.
• Position: New World Order

PANDEMIC. THE word can spread fear to billions overnight. One of the few public-health terms that gives Hollywood nightmare plotlines. Literally meaning "all people," a pandemic is an extraordinary global health event in which an epidemic of infectious disease spreads across regions and, potentially, the entire planet. Ebola, avian flu, SARS--each had the potential to spread rapidly and each received extraordinary attention during the past several years. Though they did not result in mass casualties, all wrought worldwide fear.

Throughout the course of human history, pandemics have wreaked havoc. The 1918 flu pandemic may have killed over 20 million people. Even then, 50 percent of the mortality difference among countries can be attributed to a single factor: per capita income. Thus, the poorest country hit, India, suffered the most, while Denmark suffered the least. That differential, however, has not yet made for compelling public policy. After all, science made landmark breakthroughs in the twentieth century, often applying scientific insights from previous centuries in innovative ways to control and, in the case of smallpox, eradicate disease. But in the days of porous borders and unprecedented global travel, viruses and other pathogens may once again have the upper hand. One key question on the table is: will the next pandemic be worse than the ones we currently face?

Viewed from where I live in Rwanda, it's clear that the sheer neglect of health of poor people has set an ideal foundation for pandemics to spread for years under the radar, evade surveillance and, as has been the case with HIV/MDS, enter our airspace and bodies at a startling rate. The history of global health demonstrates that wealthy nations respond best to dramatic, fast-moving outbreaks like Ebola or avian flu. Unfortunately, today wealthy and poor nations alike face pandemics that move slowly and don't necessarily show symptoms during the first few years of infection.

Today's pandemics have evolved to prey on our greatest weakness: our inability to wage sustained fights against pressing health issues. This creates a doubly challenging situation in a world where disease is often socioeconomically stratified. Rich people don't generally get sick from malaria or tuberculosis (TB), so those diseases--which kill millions each year--have until very recently received far-less attention than they deserve. But now the line between rich and poor countries, and rich and poor people within countries, is murky. Dangerous infections such as drug-resistant tuberculosis can cross the globe by air in a matter of hours. These are the new, rapidly moving vectors of disease, and they provide a direct line of transmission between the most-vulnerable and least-healthy people on the planet and the wealthiest and healthiest. It augurs for the worst that health systems for the poor have failed miserably to generate the quality and accountability needed to address even the most-basic health needs.

What happens when a poor country loses 30 percent of its adult population to AIDS or to a flu epidemic? There are plenty of military models that assess decision making when a country is attacked by an enemy, but few models to assess the chaos that cuts across all segments of society when it's a disease that acts as antagonist. Plans have also not fully taken into account the impact of rapidly changing demographics on disease spread. The poorest, precisely those most at risk, are reproducing the fastest, so the chance of pandemic is growing faster than the numbers may superficially reveal. And of course, the prevalence of megacides means more poor people are living in close proximity to each other--and with greater opportunity for disease transmission.

Leaders of poor countries appear to be completely unaware of the global connections between the health of their populations and the security and stability required to ensure that they do not fall prey to unforeseen health catastrophes. The dearth of strong and transparent leadership among the world's poorest nations augurs poorly for the health of those nations, and of the world.

Meanwhile, the rich countries also continue to think about pandemics in a very linear and scientific way, which fails to account for the comprehensive economic and political chaos that would accompany a major pandemic. The World Health Organization (WHO), Centers for Disease Control, and, for that matter, the Gates Foundation and other donors, are concentrating their...