[Julie Fischer of the Henry L. Stimson Center is guest blogging for Victoria Holt, who is currently on vacation.]

The current conflagration in the Middle East has understandably diverted attention from less conspicuous security issues.  In quieter times, the re-emergence of a truly stateless enemy of civilized nations – potentially pandemic influenza – in Southeast Asia might have attracted a headline or two.  Less than a year ago, President Bush identified pandemic influenza as a serious threat to national security demanding billions of dollars and real international collaboration.  Avian influenza joined HIV as the second disease to acquire its own U.S. ambassador. 

After the H5N1 strain of avian influenza moved from Southeast Asia into Europe in late 2005 without the catastrophic plague presaged in 24-hour non-news coverage, experts deployed by the U.S. and the World Health Organization to avian influenza hotspots settled down to a Herculean task: building capacity to detect and contain emerging disease threats in regions hobbled by desperately uneven resources.  Their relative anonymity brings respite from the political pressures that shape U.S. efforts to confront the 20th century’s great failure of disease surveillance, the global HIV/AIDS epidemic, and the realistic fear that their fledgling disease-fighting programs will starve if an outbreak stubbornly refuses to hew to election-driven deadlines.

In his July 25th blog, Eugene Gholz identified altruism and self-interest as the dual bases of President Bush’s “vision for transforming the world.”  The same imperatives underlie U.S. motivations for sustaining bilateral and multilateral global health partnerships.  Historically, global public health advocates have appealed mainly to altruism (the moral obligation of affluent nations to remedy disparities in health and life expectancy in developing nations).  Security and foreign policy debates framing global public health as a matter of self-interest (the desire to contain devastating disease threats before they affect American economic security directly) have emerged more recently. 

Public health – protecting the population, rather than treating the individual – requires a sustained commitment of decades to build human resources and laboratory capabilities, inimical to the U.S. focus on specific short-term health threats (tuberculosis in immigrants, SARS in airports, avian flu in poultry).  A slew of Congressional hearings on avian influenza this year acknowledged the profound economic and human consequences of disease anywhere in the world on U.S. interests, an epiphany that would have been more impressive if we hadn’t experienced it collectively in the wake of the 2001 anthrax assaults.  Last week, G8 leaders renewed their pledge to combat the top three scourges – tuberculosis, malaria, and HIV – that undermine stability in the developing world.  Past experiences suggest that commitments to fighting these amorphous enemies dwindle quickly during lean economic times.

Congressional debates on global public health issues have previously broken down into predictable partisan lines (bilateral or multilateral aid? abstention or safe sex?).  Now is the time, before the next epidemic emerges, to discuss the larger question:  is global public health a matter of foreign aid, national security, or both?  

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