Umlazi, Durban, SOUTH AFRICA (June 2010) In the last ten days traveling from Los Angeles to South Africa through Amsterdam I have crossed dozens of borders. Whether driving across the border in a car or flying over them in a plane, crossing borders is a commonplace modern reality. When I am sitting on the tarmac waiting for a flight to take off, my thoughts more frequently turn to the germs I am sharing with my fellow passengers than any terrorist threat.
One of the realities of our current age is the shrinking of our planet. It is only very recently that masses of people routinely traveled thousands of miles and crossed national boundaries frequently. Pandemics had fewer opportunities to spread globally until the last thirty years.
All of the global pandemics we are aware of were spread primarily through jet travel.
AIDS spread from Africa to the US via a flight attendant that Randy Shilts of And the Band Played On identified as "patient zero." Unfortunately, the 21st century problem of global public health, and specifically viruses, is being dealt with on the basis of 19th century attitudes. Each nation has its own policies in dealing with a disease such as AIDS. The periodic spasms of xenophobia, like the anti-immigrant laws recently passed in Arizona, make an already weak international public health system even weaker. The United States was the last First World nation to abolish a ban on travel by HIV positive people into the country.
Viruses do not acknowledge or respect national borders. Viruses exist at the most basic level of our cells. As the world continues to get smaller as mass migration and international travel continue to expand, a new framework is needed. Firstly, disease fighting is as important as national defense. Arguably, it is a version of defense. Yet, public health budgets are always slim and prone to being cut. Secondly, global health must be managed on a worldwide basis. AHF struggles with different procedures in every country, even in different states. If air traffic control were handled the way we deal with public health policy, planes would be colliding in the air every day.
The world's failure to stop AIDS despite the fact that we currently have all of the tools we need to do it is just one indicator of the danger that we face. If we continue to be in denial about the fact that rapidly spreading pandemics are a certainty and are not something that happens to other people we will be doomed to epidemiological disasters. The United States has a lot to offer as a world leader in public health. The Bush administration, whatever else you think about them, made an historic commitment to fighting AIDS that has resulted in the saving of many millions of lives -- this is undeniable and set an excellent example of how the world should combat killer viruses. Both domestically and internationally, Obama has so far ignored the issue.
Fighting viruses is not only a noble cause it is a modern day necessity. The cost of delaying or selling this effort short will surely be measured someday in the loss of tens of millions of lives from new viruses just it has been with AIDS. So, whatever your views are on immigration policy, I would counsel you to make one big exception -- fighting viruses. The thin line that keeps us safe from infection can and will be breached. Human nature is to ignore these threats until they are already in our midst. I believe we can and must do better than that.