The Global Threat of New and Re-Emerging

This study offers a comprehensive analysis of the security implications of the spread of infectious diseases, including case studies of HIV/AIDS in South Africa and major public health challenges currently confronting the United States.

Preface

iii

Figure

ix

Tables

xi

Summary

xiii

Acknowledgments

xxiii

Abbreviations

xxv

Disease and Human Security

1

(12)

The Changing Nature of Security in the Post--Cold War Era

1

(3)

The Concept of Human Security

4

(3)

The Transnational Spread of Infectious Disease as a Threat to Human Security

7

(6)

Factors Associated with the Increased Incidence and Spread of Infectious Diseases

13

(18)

Globalization

14

(3)

Modern Medical Practices

17

(4)

Accelerating Urbanization

21

(2)

Environmental Factors

23

(3)

Changes in Social and Behavioral Patterns

26

(5)

Aids in South Africa: Extent, Implications, and Response

31

(30)

What Is AIDS?

32

(1)

Scope and Spread of HIV/AIDS in South Africa

33

(5)

Main Factors Associated with the Spread of HIV/AIDS in South Africa

38

(4)

Heterosexual Sex

38

(1)

Low Status of Women

39

(1)

Prostitution

40

(1)

Sexual Abuse and Violence

41

(1)

Prevalent Risk-Prone Attitudes

41

(1)

Impact on South Africa

42

(12)

The Human Cost

42

(3)

The Economic Impact

45

(2)

The Social Cost

47

(2)

Military Preparedness

49

(3)

Civil Law and Order and Crime

52

(2)

The Response to the HIV/AIDS Crisis in South Africa

54

(5)

The Government Response

54

(3)

Nongovernmental Responses

57

(2)

The International Relevance of the HIV/AIDS Crisis in South Africa

59

(2)

U.S. Security and the Risk Posed By Infectious Diseases

61

(14)

Impact and Spread of Disease in the United States

62

(1)

Factors Affecting the Scope and Spread of Infectious Disease in the United States

62

(13)

Globalization---Travel, Migration, and Trade

64

(3)

Changes in Agricultural Practice

67

(1)

Behavioral Changes

67

(2)

Misuse of Antibiotics and Other Medicines

69

(1)

Donated Blood Products

70

(1)

Climatic Change

70

(2)

Tainted Water Supplies

72

(1)

Bioterrorism

72

(3)

U.S. Capabilities to Counter Infectious Diseases

75

(26)

Resources for Fighting Infectious Disease

76

(9)

Surveillance and Detection

77

(3)

Investigation

80

(3)

Response (Prevention and Control)

83

(2)

Other Federal Programs and Interagency Initiatives

85

(8)

Foodborne Disease

85

(1)

Antimicrobial Drug Resistance

86

(1)

Biodefense Resources for Countering Infectious Disease

87

(2)

Research

89

(2)

Global Surveillance and Response

91

(2)

Assessment of U.S. Capabilities to Counter Infectious Diseases

93

(8)

Surveillance

93

(1)

Fiscal Neglect

94

(2)

Personnel

96

(1)

Lack of Experience with Exotic Infectious Diseases

97

(1)

Shrinking Vaccine Production Capacity

97

(1)

Insufficient Attention to the Provision of Global Healthcare Aid

98

(2)

Lack of Coordination

100

(1)

Conclusion

101

(6)

Appendix CDC Surveillance and Collection Systems

107

(12)

Bibliography

119

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The Global Threat of New and Re-Emerging Infectious Disease: Reconciling U.S. National Security and Public Health Policy

Summary

Table of Contents

Supplemental Materials