Chikungunya what?” asked a newspaper headline in Singapore last week.
Chikungunya fever, a cousin of dengue fever, is caused by a mosquito-borne virus that may have originated in Africa, or at least it was named there.
Since its re-emergence in India in 2005, the disease, which causes fever and acute joint pain, has afflicted 200,000 people here, and reached Italy last summer.
Yet, in Singapore, barely three hours by flight from some of the worst-affected cities in southern India, the virus has hardly been a health scare. Sure, there were 10 cases last year. But they were all introduced by infected foreign travellers.
That changed last week. A day after the newspaper headline, the island-state’s health ministry said it suspected a local outbreak of Chikungunya. The 27-year-old who contracted the bug hadn’t been abroad for several months.
Meanwhile, India is grappling with bird flu, an imported disease that it didn’t know much about until recently.
In the developed world, the discontent with freer cross-border movement of goods, services and people centres on job losses and declining competitiveness of the subsidized sectors of the economy, especially agriculture.
In low- and middle-income countries, the most common complaint about globalization concerns the loss of monetary policy autonomy in the face of fickle-minded inflows of overseas capital and excessive exchange rate volatility.
Adequate attention isn’t being given to the other big risk associated with increased international economic integration: a global pandemic. The threat, as the 2003 outbreak of Sars (Severe Acute Respiratory Syndrome) demonstrated in so chilling a manner, is real enough. At about one billion journeys a year, international travel has made the world “tightly coupled,” said Lonnie King, who directs the fight against pathogens that are transmitted from animals to humans at the Atlanta-based Centers of Disease Control and Prevention. An intertwined world is, in turn, a source of “unprecedented vulnerability” for global health, King said in an October presentation to the World Bank in Washington. And travel is just one element of globalization. Research has even linked imported used-car tyres—which often carry mosquito eggs—to dengue outbreaks.
Science and law
But trade and travel have always been known to spread malady alongside prosperity. So why should we be alarmed now? Science today is much more advanced than in the late 19th century when Roland Ross proved the link between mosquitoes and malaria in his lab in India. Public health-care systems are much more robust and better-funded than at the previous peak of globalization a century ago.
If as many as 25 people are now crossing national borders every second, then information about diseases and knowledge of remedies, too, are getting disseminated faster than before.
The real challenge lies in the realm of international law. That became apparent in a most bizarre manner in late 2006 when Indonesia refused to share samples of the avian-flu virus with the World Health Organization. The country claimed a sovereign right to the samples under the Convention on Biological Diversity, an international legal treaty.
A lethal disease that threatens humanity can’t reasonably be viewed as any nation’s sovereign property.
Indonesia took recourse in this argument to make a point.
Its position was this: Why should pharmaceutical companies get their samples from developing countries, develop patented products based on them and then price them out of reach of poor nations, including the original providers of vital information? “The incident involving Indonesia’s actions with virus samples illustrates both the importance and the limitations of international law in global health diplomacy,” says David Fidler, a law professor at Indiana University in Bloomington.
As long as the legal position remains unsettled, other developing countries may adopt a stance similar to Indonesia’s to negotiate better terms for the drugs they need to combat pandemics. And pharmaceutical companies won’t be able to shirk the bargaining.
More than the increased speed at which diseases can spread in a shrinking world, the bigger risk is the absence of an international order that has legal authority over both recalcitrant nation states and profiteering drug makers.
Just as there’s no global institution to either regulate the quality of cross-border capital flows or judge the fairness of currency manipulation by central banks, the job of apportioning responsibilities for cross-border disease prevention, too, currently isn’t being done by anyone.
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