Wednesday, April 24, 2013

The Congress Should Give the President Authority to Move Quickly if Appropriate.

The Economist has an article documenting that H7N9 flu has infected at least 82 people and killed 17 of them in China; a new coronavirus (the family of viruses that SARS belongs to) is circulating in the Middle East. It has killed 11 people since it was noticed in September. Either might evolve into a global pandemic.
These cases illustrate both how far the world has come, and how far it still has to travel, on the journey towards building a system that can identify new infectious diseases and snuff them out before they become threatening. As the case of AIDS shows, a novel pathogen that spreads around the world unnoticed by the medical authorities can wreak havoc. More recently, cheap air travel has proved a boon to pathogens keen for a global tour. Fortunately the world has learned from the cases of SARS, H5N1 bird flu (in 2005) and H1N1 swine flu (in 2009). Systems are being put in place to spot potentially pandemic diseases and stop them quickly. These systems, though, are still piecemeal. At present it looks unlikely that either H7N9 or the new coronavirus will become pandemic. But if they do—or if some other powerful new virus or bacterium emerges—it is unclear whether the world will be ready.
I recall how an outbreak of polio in Nigeria in 2003 resulted in reinfection of an estimated 20 countries, costing the global eradication program some $500 million. Globalization has made the potential spread of infectious diseases ever more rapid and threatening.

The initiation of a focus of polio in Nigeria was in part due to the divisions within that country and the inability of the Nigerian central government to effectively carry out its own eradication program in its northern states. More generally, the threat of a disease emerging to trigger a global pandemic is most severe in failed states, states in conflict, states involved in civil wars, and similar disrupted states. Unfortunately there have been many states raising such threats in recent decades, and there is every reason to believe that there will be others in the future.

The World Health Organization is the most important international organization to deal with the threats of global spread of infectious diseases. Other UN organizations are also involved -- FAO for zoonoses, WIPO for intellectual property rights for vaccines and medicines, UNIDO for the development of manufacturing capabilities for vaccines and medicines, ITU for the communications infrastructure needed to spread information on epidemics, the International Civil Aviation Organization, etc.


The United States is currently withholding funding from UNESCO due to a provision of law which states:
"The United States shall not make any voluntary or assessed contribution - (1) to any affiliated organization of the United Nations which grants full membership as a state to any organization or group that does not have the internationally recognized attributes of statehood, or (2) to the United Nations, if the United Nations grants full membership as a state in the United Nations to any organization or group that does not have the internationally recognized attributes of statehood, during any period in which such membership is effective."
This provision would apply to all of the UN agencies mentioned above. The nominal impact would be either to keep each and every agency from recognizing a state under a wide variety of conditions, or would force the United States to withhold funding from any agency that recognized the state. Note too, that were WHO, FAO or another agency to refuse to recognize a group holding power over a region as a member state, that group might also prevent the agency from functioning in the area it controls. Thus the impact of the provision of law might be very contrary to U.S. national interests and indeed to world health.

Of course, the Congress could change the legislation were such an situation actually to occur, but such changes can take time to negotiate. In the case of an infectious disease with the potential of becoming a global pandemic, time is of the essence. The obvious solution is for the Congress now to change the regulation adding authority for the president to waive the provision if doing so would be in the national interest. He could then act quickly if the need arose.

Obviously there are many other possible situations where speed in needed, such as the spread of a disease of livestock or crops, problems in civil aviation, conflict over water resources or ocean routes, or the control of piracy, human trafficking or drug trafficking. In the face of such uncertainty, giving the administration some flexibility seems prudent.

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