In the post-Cold War era the policy-making community is increasingly confronted with significant new challenges to the security and prosperity of the citizens over which they preside. Policy-makers must now address diffuse threats to state interests, particularly renewable resource scarcities, environmental degradation, and international migration. Indeed the rise of 'low politics’ to the national security agenda of the modern state requires that international relations theorists design new ‘tools of analysis': models that explain current developments (such as chronic state failure in sub-Saharan Africa) and that predict future outcomes in order to guide policy. This paper develops a novel ‘tool’ of international relations theory, a framework that examines the effects of emerging

and re-emerging infectious disease (ERID) at the unit level, and then analyzes the implications of

these findings for interstate relations at the systems level.

Arguably, the primary raison d’etre of International Relations theory is to construct models that will assist in averting the premature loss of human life and productivity as a result of war. Indeed, as Thomas Hobbes claimed, it is the central function of the state to guarantee the physical safety of its citizens from both internal and external forms of predation. However, traditional concepts of security have traditionally ignored the greatest source of human misery and mortality, the microbial penumbra that surrounds our species. I argue here that it is time to consider the additional form of ecological predation wherein the physical security and prosperity of a state’s populace is directly threatened by the global phenomena of emerging and re-emerging infectious disease. The following definition of ERID is useful,

Throughout recorded history infectious disease has consistently accounted for the greatest proportion of human morbidity and mortality, easily surpassing war as the foremost threat to human life and prosperity. Even in the era of modern medicine, states annually suffer much greater mortality and morbidity from infectious disease than from casualties incurred during inter and intra-state military conflict. According to the World Bank, of the global total deaths recorded in 1990 (49 971 000), infectious disease claimed 16 690 000 lives (34.4 percent of deaths), while war killed 322 000 (0.64 percent of total deaths). These statistics demonstrate the relative destruction wrought by disease when compared to deaths from military actions, and in terms of a ratio the deaths resulting from infectious disease compared to war are a significant 52:1 in this year. Infectious disease accounts for greater morbidity and mortality (globally) than any other single cause. According to the World Health Organization, of the 51 000 000 global deaths in 1993, infectious disease (ERIDs) caused 16 445 000 deaths (32.24 percent of the total). By comparison, 'motor and other-road vehicle accidents', accounted for 885 000 deaths ( or 1.7 percent of global mortality), and 'homicide and violence' contributed to 303 000 deaths ( 0.6 percent of global mortality).

A recent report by the CDC warns that "the spectrum of infectious diseases is expanding, and many infectious diseases once thought to be controlled are increasing." Furthermore, during the past two decades at least thirty-three completely new pathogens have emerged to compromise the health of the human species. For the majority of these new diseases there is no vaccine, therapy, or cure and the ability to anticipate, prevent or control them is extremely limited. The best known examples of emerging pathogens are HIV, ebola, and the BSE prion; however, old scourges such as tuberculosis, cholera and malaria are becoming increasingly resistant to our anti-microbial armamentarium due to rapid microbial evolution, and are spreading across the globe.

In the spring of 1996 WHO declared a global health emergency, as the global spread of ERID reached crisis proportions, and now exceeds the organization's capacity to monitor, let alone contain the various pandemics currently spreading across the globe. A synopsis of the spread of the most important known pathogens is appropriate, to give the reader an idea of the scale of the problem. While it is true that the WHO has several diseases near the point of eradication (smallpox and leprosy), new pathogens and resurgent diseases have undermined the advances made by medical science over the past few decades. The most notable example of a new pathogen is the human immunodeficiency virus (HIV), the existence of which was unknown until 15 years ago.

According to statistics gathered by the Harvard-based Global AIDS Policy Coalition, 4.7 million new HIV infections occurred globally during 1995. Of these new infections, 2.5 million occurred in Southeast Asia and 1.9 million in sub-Saharan Africa while the industrialized world accounted for approximately 170 000 new HIV cases.

Mann’s predictions for the spread of the HIV/AIDS pandemic are sobering, "If the current epidemic trends persist through the end of the century, it is most likely that between 60 million and 70 million adults will have been infected with HIV by the end of the year 2000. Of these adults, about 50 percent will be in Southeast Asia and about 40 percent in sub-Saharan Africa. By the turn of the century, more HIV infections are likely to have occurred in adults in Southeast Asia than in any other (region)."

Tuberculosis (TB) has also been making a steady comeback as a global scourge, and WHO declared the TB pandemic a global crisis in 1993. WHO estimates that "8.9 million people developed tuberculosis in 1995, bringing the global total of sufferers to about 22 million, of whom about 3 million will have died in the same space of time." Furthermore, in the absence of increased effectiveness and availability of tuberculosis control measures, over 30 million tuberculosis deaths and more than 90 million new TB infections are forecast to occur by the turn of the century. Tuberculosis is making inroads into the industrialized nations, particularly Canada and the United States, where it infects disadvantaged urban populations and then spreads throughout society. The incidence of tuberculosis in the United States is climbing rapidly. For example, in the U.S., reported cases of TB had declined from 84 300 in 1953 to 22 200 in 1984, a drop of approximately 4 percent per annum. However, from 1985 to 1993, the number of cases increased by a cumulative 14%, and the pace of increase continues to accelerate.

Other pathogens are also re-emerging on a global scale throughout the developing world and are increasingly penetrating the porous borders of the industrialized states. For example, a new strain of cholera (designated 0139 El Tor) appeared in south-eastern India in 1992 and is now endemic throughout South and South East Asia, Africa, South and Central America and is spreading rapidly through Oceania. Moreover, mosquito-borne dengue fever has re-established itself in Central America and Mexico and is currently making inroads into the southern United States, particularly in Florida and Texas. Furthermore, malaria vectors are again expanding beyond the tropics and the parasites have evolved a resistance to many anti-malarial drugs. Malaria currently debilitates approximately 500 million people annually, and kills at least 2 million. Numerous other grisly pathogens have recently emerged to cause widespread trepidation.

Meanwhile familiar pathogens continue to exact their toll on humanity with relentless vigor. For example, acute lower respiratory infections slay nearly 4 million children annually, while diarrhoeal diseases such as adnovirus and rotavirus kill nearly 3 million infants every year. Viral hepatitis is another global scourge as a minimum of 350 million people are chronic carriers of the hepatitis B virus, and an additional 100 million harbor the hepatitis C virus. According to WHO projections at least 25 per cent of these carriers will expire due to related liver disease. To make matters worse, many of the ten million new cases of cancer diagnosed in 1995 were caused by viruses, bacteria and parasites. WHO calculates that 15 per cent of all new cancer cases (1.5 million) are the result of exposure to infectious agents, and this percentage of ERID-induced cancer mortality is estimated to increase as our knowledge of both infectious disease and cancer advances.

A central problem with emergent pathogens is that new zooneses (defined as disease agents that cross over from other species into human populations) are likely to exhibit increased lethality as they are poorly adapted to co-existence in their human hosts. Additionally, these new pathogens do not tend to debilitate and kill only the weak, the elderly and the young. As McNeill points out "…infections, when invading a human population without any previous exposure to them, are likely to kill a high proportion of those who fall sick. Young adults in the prime of life characteristically die more frequently than other age groups. In other words, when invading virgin populations, these are the infections capable of destroying or crippling entire human communities…"

Redefining Security

The skeptic will ask, why should international relations theorists be concerned with what essentially amounts to a public health problem? As William McNeill proposed in Plagues and Peoples, microbes have been relentless adversaries of human societies since time immemorial. Current anthropological evidence suggests that the expansion and collapse of various societies throughout history resulted from the transmission of lethal and/or debilitating pathogens. McNeill argued that the collapse of the Byzantine Roman empire in the sixth century AD resulted from the ‘plague of Justinian’ which was a consequence of the merging of previously isolated disease 'pools' via Asian trade routes (the Silk Road). Thucydides’ account of the eventual fall of Athens during the Peloponnessian Wars pays particular attention to the devastating effect that ‘the plague’ had on Athenian society, and by extension the Athenian war effort.

Additionally, the destruction of feudalism resulted in large part from the Black Death that swept Europe in the 1300s up until the imposition of the Westphalian system. Alfred Crosby and William Denevan have constructed detailed accounts of how the merging of the American and European disease pools permitted the rapid and absolute conquest of the Americas by relatively modest European military forces. This demographic catastrophe derived from the importation of 'civilized' diseases (smallpox, etc.) to a immunologically naive population, and resulted in the collapse of the Aztec and Incan empires and centuries of subjugation of the Amerindian peoples.

Why should infectious disease concern us now in the modern era near the end of the twentieth century? The world has changed significantly since the medical ‘golden era’ of the mid-1900s. Humanity currently finds itself in a state of profound ecological disequilibrium, where factors such as the rapid destruction of the biosphere, changes in the speed and availability of transport technologies, rapidly increasing global population density and migration, economic development, and the overuse and misuse of antibiotics, have all contributed to the emergence of new pathogens and the re-emergence of diseases previously thought to have been under control.

The inclusion of disease in the security agenda poses a challenge to orthodox theories of international relations, particularly to Neo-Realism and Realism. This type of inter-disciplinary research agenda requires a fundamental reconceptualization of standard definitions of national interest and security. Constrictive definitions that focus exclusively on the relative military capability of states are increasingly sterile in the face of the many global challenges of the post-Cold War world. Threats to human welfare such as global environmental degradation, resource scarcity, and ERID present policy makers with difficult policy dilemmas in the form of collective action problems. Richard Ullman argued that "defining national security merely in military terms conveys a profoundly false image of reality....it causes states to concentrate on military threats and to ignore other and perhaps more harmful dangers." The same can be said of Realist concepts of international security, which focus exclusively on military threats and the relative power of states within the context of an eternal security dilemma.

Of particular interest is the recent work of Kalevi Holsti on the changing nature of conflict in the post-1945 era. Holsti has found that the incidence of interstate war has declined precipitously since the 19^th century, and that the current principle foci of conflict are at the intra-state level wherein state failure and civil wars have become the dominant norms of violence. If Holsti’s calculations are correct then political scientists concerned with the study of conflict must shift their focus to concentrate on the growing incidence of intra-state violence, and develop theoretical models that explain the recent collapse of states like Zaire, Rwanda and Haiti. Holsti emphasizes the need for this conceptual shift in security studies.

Liberal theory, which emphasizes co-operation between states, holds an optimistic view of human nature, sees international organizations as significant actors, and argues that states seek prosperity and stability in addition to survival and power, is likely to provide a better theoretical basis than Realism in tackling the problems posed by the resurgence of infectious disease. Liberal solutions to ERID would take the form of a global multilateral health regime that would seek to prevent, monitor and control the spread of ERID. Unilateral efforts that focus on limiting the spread of ERID within one' s own state are bound to fail over the long term, as ERID is a transboundary phenomena. Jessica Tuchman Mathews writes, "On the political front, the need...for new institutions and regulatory regimes to cope with the world’s growing environmental interdependence is...compelling. Put bluntly, our accepted definition of the limits of national sovereignty as coinciding with national borders is obsolete". Despite the enormous technological and economic power of the North, it is extremely unlikely that the developed world would be able to remain an island of health in a global sea of disease. Global interdependence applies to the microbial threat just as it applies to the pervasive degradation of the biosphere, and unilateral, isolationist policies will only compromise the prosperity and well-being of all peoples over time.

American policymakers are increasingly cognizant of the threat that the resurgence of infectious disease poses to U.S. interests. Within the Clinton administration’s national security strategy of ‘engagement and enlargement’ infectious disease (as a function of global environmental degradation) is noted as a particular threat to American foreign policy interests, particularly economic growth and democratic stability in the developing world.

Emerging and Re-Emerging Infectious Diseases (NSTC) to determine the direct and indirect threat of infectious disease to U.S. security and prosperity and to further evaluate the potential impact of ERIDs on American foreign policy interests at the global level. The report of the NSTC states that, "the improvement of international health is a valuable component of the U.S. effort to promote worldwide political stability through sustainable economic development. Thus, the effort to build a global (ERID) surveillance and response system is in accord with the national security and foreign policy goals of the United States."

Undersecretary of State for Global Affairs Timothy Wirth is also keenly aware of the threat that HIV/AIDS poses to state stability and prosperity. He argues,

The resurgence of ERID has significant implications for state survival, stability and prosperity, and ramifications for interstate relations as well. The premature death and debilitation of a significant proportion of a state’s population erodes worker productivity and undermines state prosperity, induces high levels of psychological stress in the populace, fosters internal and out-migration, threatens the state’s ability to both defend itself and to project force, generates institutional fragility and undermines the legitimacy of authority structures which impairs state capacity to govern effectively. At the system level, ERID-induced poverty creates a significant drag on both regional development and global prosperity. Disease-induced poverty and instability may exacerbate migration from the biologically onerous regions of the South to the prosperous and relatively benign regions of the North. Furthermore, as ERID-induced shortcomings in the realms of governance and defense impair state survival, the international community may be called on to intervene and restore order to affected states.

Therefore, the increasing prevalence of ERID (the independent variable) impairs state capacity (the dependent variable) and thus diminishes prospects for state survival, stability and prosperity. Any meaningful concept of state capacity must be both dynamic in nature and encompass the state’s ability to satisfy, in hierarchical order, its most important needs: (1) survival; (2) the protection of its citizens from physical harm as a result of internal, external, and ecological (microbial) predation; (3) economic prosperity and stability; (4) effective governance; and (5) territorial integrity. According to this framework, state stability and prosperity is at greatest risk in the developing world where many state institutions are nascent, particularly in the tropics where the burden of disease is onerous. However, pathogens such as HIV, hepatitis, and e-coli have the capacity to damage developed states as well.

As the independent variable (ERID prevalence) increases in value, we can expect to see a negative correlation with the dependent variable (state capacity). The outcomes range along a continuum from economic prosperity and enhanced state power at one end where the independent variable is at minimal value, to the other extreme where high values of the independent variable erode state functional capacities. At this negative end of the spectrum ERID produces significant morbidity and/or mortality of the citizenry, which in turn causes severe economic retardation, spurs internal and out-migration, produces psychological stress, impairs defense capacities, generates institutional fragility and weakens state ability to govern, and in extreme cases may facilitate the collapse of the state itself. Such effects are not purely hypothetical possibilities, as there is growing evidence that increasing ERID incidence and lethality has impaired state capacity in Cambodia, Zaire, Rwanda, Haiti, Liberia, Burundi, Somalia, and Sierra Leone (among others) during the past decade. Thus increasing ERID incidence and lethality may be a significant causal factor in the growing list of ‘failed states’ during the post-Cold War era.

Analytical Structure

As stated above, this paper argues that increasing ERID prevalence and lethality impedes state capacity. Initially, I examine the effect that ERID (the independent variable) produces at the unit level within four 'domains': economic productivity, demography, defense, and governance. The four 'cells' at the unit level of analysis within the matrix correspond to the four domains of analysis, and the effect of ERID on SC is analyzed within each cell at this level of analysis. I also examine the effect that outcomes within each ‘cell’ exert on the other cells within other domains. Following the demonstration of the effects of ERID on SC at this level, I analyze the effects of ERID at the systems level in the singular domain of global governance that encompasses the four unit level domains.

I investigate the processes taking place in each cell with the object of determining the possible interactions between cells across domains and across levels of analysis. Of course, these are extremely complex processes, and this project will not provide a reductionist grand predictive theory of causality that argues that all poverty,

migration, and international instability is the sole product of one independent variable

(ERID). Rather, the goal of this analysis is to map out the terrain of a new field of inquiry in international relations theory, in short, to develop a research agenda for further work in this area.

Economic Productivity

A brief description of the hypothesized effect of ERID within each domain at the unit level is in order. Robert Fogel has argued that much of England's prosperity, if not the Industrial Revolution itself, resulted from the conquest of high morbidity and mortality in Britain during the late 18th and early 19th century. Taking Fogel’s argument one step further, it is hardly surprising that the first states to industrialize were in the immunologically benign temperate north, where the burden of disease was less of an obstacle to overcome.

The negative effects of ERID in the domain of economic productivity include reductions in national GDP, decreases in worker productivity, labour shortages and increased absenteeism, higher costs imposed on household units (particularly on the poor), reductions in per capita income, reduced savings, capital flight, and increases in income inequalities within a society which may in turn generate increased governance problems. ETID also generates disincentives to invest in child education, impedes the settlement of marginal regions and the development of natural resources, negatively affects tourism, and results in the embargoing of infected goods. All of these effects, taken together, demonstrate how the global resurgence of infectious disease is likely to produce negative outcomes for the prosperity of states.

The destructive effects of ERIDs are many and varied and reverberate throughout all sectors of the economy from the household to sectors such as resource extraction, agriculture, insurance, and banking. Infected workers are debilitated or killed which reduces the productivity of the workforce, this is particularly true of labour-intensive sectors such as agriculture or mining. Infectious disease imposes additional costs on the household (loss of revenue, loss of savings, and labour substitution), particularly those in the lower economic strata of society, such that income inequalities between the lower and upper classes are exacerbated. ERIDs also change expenditure patterns in the household, such that money is increasingly spent on medication instead of food, clothing, shelter, etc. This ultimately generates an economic shock to the household which changes savings and consumption patterns, erodes aggregate household wealth, and makes significant labour substitution necessary. Rising levels of infectious disease also decrease incentives to invest in child education, as the children must spend more time working to support debilitated or bereaved family members. As well, there is little incentive to allocate resources in order to educate a child when it is likely that they will die of some infection in the near future.

John Cuddington has projected that HIV/AIDS alone will reduce the Tanzanian GDP in the year 2010 by anywhere from 15 to 25 percent. If many states are similarly affected within a region (like Sub-Saharan Africa), the net effect will be the underdevelopment of the region as a whole, which in turn imposes a net drag on global economic productivity and trade.

Population and Migration

In the domain of population and migration at the state level ERID can be expected to produce significant effects that impair state capacity. Infectious disease undermines SC by impeding the state’s ability to settle new areas, by exacerbating rural-urban migration and generating increasing urbanization, by provoking fear-induced internal migrations, and by restricting immigration by infected persons into their sovereign territory. ERID also impedes the settlement and development of certain areas where pathogen virulence and transmissibility are high. This effect has been observed in rural areas of Brazil and Colombia where malaria incidence is increasing, and in the Thai-Burmese border region where multi-drug resistant malaria is now entrenched. Migrants from these rural areas where pathogens are endemic serve as vectors for disease transmission to urban centers where new ‘disease pools’ are created, while ‘urban’ diseases (such as HIV and TB) may in turn be transmitted back to rural regions. Additionally, as diseases like malaria, dengue, and yellow fever re-establish themselves in rural areas the net effect will be to generate increased urbanization, as people in affected regions seek to escape the burden of disease by fleeing to the cities. Unfortunately, as the absolute population and population density of citizens rises, urban citizens will become exposed to new pathogens that can circulate and thrive within the larger population pools.

It is increasingly clear that rising levels of infectious disease will not significantly ameliorate global overpopulation problems, as opposed to the common assumption that diseases will in fact act as a population control. As ERID incidence and lethality increases, families will seek to replace dead and debilitated offspring, and they tend to overcompensate due to risk-aversion. Thus as ERID levels rise, particularly in the developing world, we will see a significant increase in fertility rates. The net demographic effect of the globalization of disease will be a generally debilitated and impoverished global population. However, the fact remains that a new lethal pathogen may enter the human ecology and become a global pandemic, which could rapidly reduce global population

levels if it went unchecked.

States also seek to prevent the immigration of infected persons into their territory, as they grow increasingly wary of the potential establishment of new disease pools in their populations. The United States, Russia, China and other states all prohibit the entry of individuals from other states who are infected with HIV, and immigrants and travelers are increasingly screened for pathogens like malaria, dengue and tuberculosis. ERIDs may also generate high levels of fear when they manifest during an outbreak event. During the outbreak of pneumonic plague in Surat, India in 1994 and the later incarnation of Ebola in Zaire in 1995, both countries experienced massive internal migration as people fled the afflicted areas and attempted to cross into neighboring states. Migration resulting from outbreak events, and from those fleeing pathogen-induced poverty generates negative outcomes that cross-over into the domains of defense and governance.

Thomas Homer-Dixon has argued that "(a)s population and environmental stresses grow in developing countries, migration to the developed world is likely to surge." Similarly, ERID-induced economic, psychological, and physical stress will prompt similar tides of migration from South to North. To paraphrase Richard Ullman, countries like Canada will be seen as ‘islands of health in a sea of disease’. Thus, ERID-induced stresses will eventually combine with overpopulation, environmental degradation, and resource scarcities to induce mass-migrations from South to North. Aside from the obvious problems (xenophobia, racial conflict, poverty) that such migrations would entail for the receiving state, the establishment of infected populations within a 'virgin' population would create new disease pools within large urban centers, and exact a significant (physical, economic, and psychological) toll on relatively immunologically-vulnerable host populations.

Defense

The presence of ERID in foreign military theaters has in the past and continues to result in the exposure of troops to previously unknown pathogens. During World War I malaria was transmitted as far north as Archangel because of the troop vectors involved in the war. Subsequently, the influenza and typhus pandemics of 1918 claimed almost 40 million lives as they circled the globe along with the moving armies. The Second World War saw enormous morbidity of Allied troops in the Pacific theater due to malaria. During the Korean War, U.S. troops were exposed to the Seoul Hantaan virus, that then traveled via troop supply ships to the United States, where it is now endemic. Therefore, war may act as a disease 'amplifier', in that conflict creates physical conditions (poverty, famine, and large population movements) that are conducive to the spread and mutation of ERID. Troop movements frequently serve as ‘vectors’ (modes of transmission) for diseases to move rapidly around the globe to areas where the new host population has little natural immunity to the new pathogen that is introduced into the local ecology.

The presence of ERIDs in military populations is consequential as it jeopardizes military readiness, international cooperation, national security and the ability of a state to preserve its territorial integrity. At the intra-state level, ERIDs deplete force strength through the loss of skilled military personnel, reduce the supply of able draftees or recruits and impose costs which constrain military budgets, all of which impairs the state’s capacity to defend itself towards a potential aggressor, and limits the state’s ability to project power for peacekeeping or coercive measures.

Governance

At the unit level, in the domain of governance, high levels of ERID incidence undermine the capacity of political leaders and their respective bureaucracies to govern effectively as the infection of government personnel results in the debilitation and death of skilled administrators that oversee the day to day operations of governance. The destructive impact of ERID-induced mortality in human-capital intensive institutions generates institutional fragility that will undermine the stability of nascent democratic societies. In Zimbabwe an estimated 25 per cent of urban adults in the 19 to 45 age group are HIV positive, and at least three government ministers have succumbed to AIDS in recent years.

Additionally, as the burden of disease increases on the population of a state, the resulting poverty and physical destruction visited on the populace may over time erode the government’s legitimacy. Therefore, ERID-induced poverty, morbidity and mortality, migration, and psychological stresses wear upon the economic and social fabric of society, and will contribute to repression and the collapse of democracy as the weakening state seeks to maintain order, while the government’s legitimacy erodes and as governmental institutions become increasingly fragile. This is problematic for the Clinton administrations strategy of ‘engagement and enlargement’ which places a premium on the establishment and strengthening of democratic regimes on a global level.

Systems Level Effects

ERIDs negative effect on state capacity at the unit level produces related pernicious outcomes at the systems level. Within the domain of economics, as ERID produces a significant drag on the economies of affected countries, we will see chronic underdevelopment, which will exert a net drag on global trade and impair global prosperity. In all likelihood, ERID's negative effect on the economies of developing states will increase the economic divide between North and South. The negative effects of infectious disease are not confined to the developing world. At the systems level, trade goods from ERID-affected regions may be subject to international embargo (e.g. BSE in beef and influenza-infected chickens). This has been the keystone of recent discord between the UK and its European partners, as many British beef products continue to be embargoed by the rest of the European Community due to fear of contamination by the BSE prion that causes a lethal new variant of Creutzfeld-Jacob disease (V-CJD) in humans. This trade embargo has strained London’s relationship with Brussels, to the extent that Prime Minister John Major recently declared ‘diplomatic war’ on the rest of the European Community in an attempt to disrupt the agenda of European unification. As infectious agents continue to emerge and re-emerge, and as agricultural crops and animal stocks become increasingly infested, we should expect that trade goods from affected states will be embargoed, tourism to affected regions will decline, and economic damage to affected states will intensify.

In the domain of migration, ERID-induced poverty, and morbidity/mortality, will generate significant patterns of out-migration from affected areas of high ERID endemicity (i.e. the South) to regions where the disease gradient is relatively benign (the North). The resulting establishment of new disease pools within particularly vulnerable northern populations would generate increased morbidity and mortality of the host state's population, weaken the economy of the host state, and heighten xenophobia and racial tension on a global scale.

In the domain of defense at the systems level we should see increased incidence of state failure and collapse (similar to that of Zaire, Rwanda, and Burundi in recent years). State collapse produces chaos in affected regions, as neighboring states seal their borders to prevent the massive influx of ERID-infected refugee populations. Adjacent states may also attempt to fill the power vacuum, and seize certain valued territory from the failed state, prompting other proximate states to do the same, exacerbating regional security dilemmas.

In the domain of governance at the systems level, I argue that as ERID incidence and lethality increase, the number of failing states will rise, necessitating increased humanitarian intervention by U.N. security forces to maintain order in affected regions. As we have seen from recent experiences in Central and West Africa, the U.N. is unlikely to have a lasting effect in restoring order to areas where ERID incidence and lethality remains high. Ultimately, the states of the North may simply be forced into setting up a military cordon to prevent the chaos of the South from destabilizing their own states. This chaos could outstrip the U.N.'s capacity to regulate international conflict (which is already stained to the limit), and further undermine the reputation of the organization as an actor capable of maintaining world order.

Causation

The concept of pathogen emergence is critical to this project as new disease agents tend to exhibit the greatest virulence when first introduced to immunologically naive populations. To paraphrase Morse and Schluederberg ‘emerging’ pathogens refer to disease agents that either have recently appeared in the population or are rapidly expanding their range. Morse argues that known disease agents "...are only a fraction of the total number that exist in nature." Furthermore, ‘newly evolved’ disease agents are most often the descendants of parent strains that already exist, this is a function of Darwinian evolution through processes of natural selection. "Given these constraints of organic evolution, then, there are fundamentally three sources (which are not necessarily mutually exclusive): (1) evolution de novo of a new virus (more precisely, usually the evolution of a new viral variant); (2) introduction of an existing virus from another species; (3) dissemination of a virus from a smaller population in which the virus might have arisen or originally been introduced." Similar processes also hold for bacteria, parasites and possibly infectious proteins (prions).

However, according to Morse, pathogen evolution is not the most significant driver behind the emergence of ‘new’ infectious diseases. "(O)ver the period of recorded history, then, ‘emerging viruses’ have usually not been newly evolved viruses. Rather, they are existing viruses conquering new territory. The overwhelming majority are viruses already existing in nature that simply gain access to new host populations." These pathogens exist in nature in disease ‘reservoirs’ and may jump the species barrier to humanity from the "zoonotic pool" (i.e. the vast plethora of diseases that pervade all niches of life in the biosphere). While the chance that any one particular ‘zooneses’ is pathogenic to humans is relatively low, the sheer magnitude of infectious agents that exist in the zoonotic pool makes the ‘emergence’ of human pathogens more likely. Morse coined the term viral traffic to demonstrate how infectious agents move between different species and individuals, and he argues that the majority of outbreaks of ‘new’ diseases tend to be the result in changes of patterns of viral traffic. Viral traffic is altered by changes in the ecological, economic, and social environment which I will hereafter refer to as facilitating variables, in that they may exacerbate both the lethality and transmission of ERIDs, and thereby intensify the negative effects of ERID on state capacity.

Microbial pathogens evolved from the primordial soup of life millions of years ago, along with other single-celled creatures, and thus have existed far longer than human societies (much less human societies), preying on all manner of flora and fauna over the eons. Thus, pathogens predate humanity, tend to exist independently of humanity in nature, and will continue to exist whether the human species endures or not. Therefore, pathogens should be correctly seen as exogenous and independent variables that can be affected by human actions (facilitating variables) that may alter microbial transmissibility and lethality.

Facilitating Variables

• Ecological Disruption:

Environmental destruction releases new pathogens into the human ecology as the disruption of habitat brings humans into contact with new pathogens from the zoonotic pool. Additionally, overpopulation, urbanization and flooding all aid in pathogen transmission and make the human population increasingly vulnerable. Climate change increases the range of pathogen vectors and environmental changes fuel the rapid evolution and dissemination of microorganisms. Furthermore, large-scale water development projects, particularly irrigation systems that augment agricultural productivity, have contributed to the diffusion of schistosomiasis (blood flukes) to formerly unaffected regions. "The construction of dams in three African river deltas - the Nile, the Senegal and the Volta - has led in recent years to schistosomiasis infection in up to 75% of local villagers, and even among people as far as 500 kilometers upstream of the dams." Furthermore, ozone depletion compromises the immune systems of animals (including the human species) making it far easier for microorganisms to colonize new hosts, while increasing radiation levels may accelerate the rate of pathogenic evolution.

• Migration:

International and intra-state migration is playing a significant role in the global diffusion of pathogens as travelers to and from previously isolated regions may distribute previously contained microorganisms into the global population, many of whom will be immunologically naïve to the emerging infectious agent. Furthermore, travelers from the developed world bring pathogens from their sojourns abroad back into their home countries where these agents may eventually take hold within that new population. Rapid advances in transportation technologies (the ship, railway, car, airplane) have accelerated this process of global pathogen diffusion and the profusion of international travelers for both recreational and business purposes is bound to exacerbate the problem of ERID dissemination in the coming decades.

• Trade:

Throughout history, trade has been implicated in the diffusion of pathogens on a global scale. For example, "…(b)oth the yellow fever virus and its principal vector the Aedes aegypti mosquito, are believed to have been spread from Africa via the slave trade. The mosquitoes were stowaways in the ships, possibly in containers that were kept to provide water for the slavers’ human cargo." Additionally, the Pan American Health Organization believes that the transmission of cholera to South America was facilitated by a Chinese freighter which jettisoned its contaminated bilge water into a Peruvian harbor, after which the disease spread through seafood products and tainted regional water supplies. Infected foodstuffs and livestock transported across borders have resulted in the dissemination of the BSE infective prion agent into beef cattle in France, Germany, and Switzerland. Infected berries (cyclospora) from Guatemala were also recently implicated in a large outbreak of diarrhoeal disease throughout North America during the summer of 1996.

• Human Ecology:

• Misuse of Antimicrobial Drugs:

The consistent misuse of antimicrobial drugs within both the developed and developing world has resulted in the emergence of drug-resistant strains of parasites, bacteria, and viruses. For example, the Thai-Burmese border region is practically uninhabitable due to the recent spread of drug-resistant strains of malaria throughout the region. Meanwhile in the developed world bacterial strains such as Vancomycin-resistant enterococci (VRE) and Methycillin-resistant staphyloccoccus aureus (MRSA) are plaguing our hospitals, and multi-drug resistant tuberculosis (MDRTB) is spreading through the marginalized portion of the population. The problem stems from the fact that organisms develop drug resistance through evolutionary pressures when the pathogens in question are exposed to antimicrobial drugs.

• Disasters:

In addition to the above facilitating variables, both natural and human-induced disasters (e.g. earthquake, flood, war, famine) may also affect viral traffic in a manner that leads to disease amplification through increased transmission and/or lethality of the infectious agents, and which may result in epidemics and even pandemics. The single greatest case of this occurred during 1918-19 when the global movements of armies served as vectors for the distribution of influenza and typhus. The resulting ‘Spanish Flu’ pandemic claimed an estimated 20 million lives, while the typhus pandemic also resulted in almost 20 million deaths, dwarfing the mortality caused by military action during the war itself.

Similarly, the breakdown of food distribution within a region which results in famine will also deplete the basal health of a population such that infectious agents may have an easier time colonizing their hosts and may cause greater morbidity and mortality in the weakened population, as it takes the weakened host a longer time to mount an effective immune response to the invading pathogens. The greatest known example of this synergy between famine and disease is the Great Hunger which struck Ireland (and the rest of Europe) in 1845. This catastrophe was generated by a fungus (phytophthora infestans) which destroyed the potato crops of Europe, caused massive starvation and governance problems in Ireland, and led to terrible outbreaks of typhus and cholera in affected regions, which were subsequently carried overseas to North America and Australia via infected immigrants who fled the devastation in the Old World.

Figure 1 displays the complex system of linkages between disease pathogens, facilitating variables, and state capacity. (see link).

A detailed explanation of the causal relations detailed in the above chart is appropriate at this point. Pathogenic microbes exist independently throughout the earth’s biosphere with the vast majority of them present in the zoonotic pool and outside of the human ecology. In a very real way these pathogens are independent variables and are exogenous to the state as they are truly global phenomena (existing at the system level). These pathogens may cross over from the zoonotic reservoir into the human ecology at any time with emergence being largely governed by the principles of chaos.

After pathogenic agents enter the human ecology (and become endogenized within human societies) their effects are amplified by what I have designated ‘facilitating variables’. The FVs generate changes in viral traffic that result in emerging and re-emerging infectious diseases (ERIDs). Thus ERIDs are a product of the synergy between the independent variable (pathogens) and the intervening FVs. These ERIDs in turn have a pervasive negative impact on state capacity (the dependent variable) which ranges from poverty to instability.

States and societies may at this point use adaptive resources (detailed below) to mitigate the effects of ERIDs on state capacity. The state’s ability to adapt is limited by several factors. First, the initial level of state capacity will determine the scale of adaptive efforts that may be mobilized to deal with the ERID problem. States with higher initial capacity will therefore have greater technical, financial and social resources to adapt. Furthermore, state adaptation will also be affected by exogenous inputs of capital, and social and technical ingenuity by actors such as IOs and NGOs. Finally, state adaptation may be compromised by certain outcomes generated by facilitating variables, such as war, famine and ecological destruction/

State Adaptation

As stated above, this analysis uses empirical data to evaluate the impact of ERID on SC at the unit level, and addresses the various capacities of different states to adapt to the ERID threat. The adaptive capability of states is dependent on their current and future supply of technical and social ingenuity, on their endogenous reservoirs of capacity, and on the contribution that exogenous actors make in the form of capital, goods, and technical assistance. Thomas F. Homer-Dixon's concept of ingenuity is a partial factor in the ability of states to adapt to crises. While the ingenuity model that Homer-Dixon has constructed deals with the issue of economic development in a climate of resource scarcity and environmental degradation, the concept of ingenuity may be useful in determining the capacity of a state to adapt in the face of significant challenges (such as the ERID threat). Homer-Dixon argues that "resource scarcity can simultaneously increase the requirement and impede the supply (of ingenuity), producing an 'ingenuity gap' that may have critical consequences for adaptation and, in turn, social stability." Similarly, the negative economic and social effects as a result of ERID can also increase the requirement for ingenuity while limiting its supply. The lesson to be drawn from the ingenuity argument is that the longer we wait to address the problem of infectious disease, the greater the costs required to generate the levels of ingenuity that will be required to resolve the problem. It is clear that in this case ingenuity is both endogenous and exogenous in terms of adaptation to ERID. The obvious example is the case of Uganda which saw the implementation of massive anti-HIV programs by the Museveni government with a strategy tailored to the needs of Ugandan society. However, some adaptation is exogenous as the technical knowledge and financial assistance to deal with the problem is frequently provided by external actors such as the World Bank, WHO and various NGOs.

State adaptation is also likely to be facilitated by a greater supply of state capacity in the first place which the heads of state may then draw upon in order to come up with adaptation strategies. Thus, the endogenous supply of state capacity in Canada (measured in terms of social, technical, and economic capital) is far greater than that of Sierra Leone and thus Canada requires far less exogenous inputs in order to deal with ERID problems. Obviously, regardless of the initial state capacity and the exogenous assistance provided, successful adaptation rarely, if ever, takes place in states where the government is unaware of or in denial of the ERID problem, or if it is reluctant to invest sufficient resources to tackle the problem. It is clear that different types of societies (Islamic, Confucian, Secular) affect viral traffic in such a manner that the local culture may either magnify or inhibit the diffusion of certain pathogens. For example, viral traffic patterns in North America and Sub-Saharan Africa are greatly dependent on societal customs and norms, and have facilitated the diffusion of the HIV virus in those regions. Islamic culture tends to exert a different effect on viral traffic that has inhibited the diffusion of HIV and other STDs within Muslim societies.

It is wrong to think of ERIDs as some kind of static phenomenon that can be targeted easily and remedied by simple resource reallocation. As different pathogens emerge, mutate and spread via changing global vectors of transmission there is the danger that a 'threshold' will be reached after which the costs of supplying the ingenuity to solve the problem are too high, rendering successful adaptation difficult, and perhaps impossible for some societies. At some point, if many states were to cross such a ‘threshold’ the entire system (including the ecological and political subsystems) could shift to a new equilibrium, generating widespread poverty and instability. For example, significant deterioration of the biosphere and overpopulation could contribute to the emergence of lethal and formerly unknown or innocuous pathogens, resulting in a new global pandemic that might significantly reduce human population levels.

It is valuable to differentiate between outbreak events and attrition processes (author’s terms) as these two phenomena may generate dissimilar but significant effects at both the unit and systems level. Examples of classic outbreak scenarios are the plague in Surat, India (Fall 1994) and the ebola epidemic in Zaire (spring/summer 1995). These outbreaks generated fear and panic on a global scale, mass out-migration, military quarantine to contain the exodus of infected persons, and economic damage. Attrition epidemics (HIV, tuberculosis, malaria) do not generate similar levels of fear and out-migration as 'outbreak' events, but usually result in greater actual human morbidity and mortality, and significant long-term economic and social erosion. The distinction between these two types of phenomena is important because outbreak events and attrition processes result in somewhat different outcomes depending on the level of fear generated by the pathogen in question.

One conclusion we can draw from the emergence of V-CJD, ebola, HIV, and plague is that people are extremely risk-averse when it comes to the emergence of new pathogens, and that emergence tends to generate paranoia, hysteria, and xenophobia that may manifest itself in the foreign policy of a state, impairing rational decision-making. The recent epidemic of pneumonic plague (yersina pestis) in western India during the fall of 1994 gives an idea of how the psychological effects of infectious disease (in the form of outbreak events) may affect both SC and an afflicted state's relations with its neighbors. The very rumor of plague in Surat prompted the frenetic exodus of over 300 000 refugees from the city who then carried the pestilence with them to Bombay, Calcutta, and as far as New Delhi. Out of fear, Pakistan, Bangladesh, Nepal and China rapidly closed their borders to both trade and travel from India, with some going so far as to restrict mail from the affected state: India had become an instant international pariah. As the plague spread, concern mounted and international travel to, and trade with, India became increasingly restricted. On September 22, 1994 the Bombay stock exchange plunged and soon thereafter many countries began to restrict imports from India, placing impounded goods in quarantine or turning them back altogether at the border.

As the crisis deepened, the Indian army was called in to enforce a quarantine on the affected area in western India, and doctors who had fled Surat were forced back to work under threat of legal prosecution by the government. In the aftermath of the epidemic that killed 56 people, the Indian government was notified by the CDC in Atlanta that the yersina pestis bacillus was an unknown and presumably new strain. This information was interpreted by Indian authorities as 'unusual', and they promptly accused rebel militants (Ultras) of procuring the bacillus from a pathogen-manufacturing facility in Almaty, Kazakhstan with the object of manufacturing an epidemic in India. This paranoia on the part of Indian officials resulted in the transference of the inquest of the epidemic from public health authorities to the Department of Defense. Beyond the acrimony that the plague fostered between India and its Islamic neighbors, the economic toll of the plague has been estimated at a minimum of $1 billion in lost revenue from exports and tourism. While the loss of $1 billion may seem trivial, to a developing state like India it represents a serious blow to the economy with negative repercussions throughout numerous sectors.

As we can see in the Surat event and the current BSE scare in Europe, infectious disease and the irrational behavior that it generates may worsen relationships between states, and or cultures. For example, the recent panic in Britain over bovine spongiform encephalopathy (BSE) or 'Mad Cow Disease' has resulted in the embargo of many beef-derived British products, and dictated the cull of a significant proportion of the U.K's beef stocks. The BSE scare has frightened the British population as scientists talk about the possibility that thousands of Britons are infected with a new variant of Creutzfeld-Jacob disease (human BSE), and the U.K's European partners have summarily banned the import of British beef in violation of EC trade law.

It is important that we understand disease emergence not as a singular isolated ‘event’, but rather as part of a global process. The concept of emergence as a process is important because ‘outbreak events’ like the plague in Surat, and ebola in Zaire, are really just ERID manifestations that rise above the lower threshold of our perceptions just long enough to alarm us momentarily. It is best to think of these ‘outbreaks’ as being akin to upward spikes on a stock market graph. While the spikes penetrate the threshold of our perception and then retreat, the process of ERID evolution and emergence continues to grow inexorably, just beyond our ability to monitor it. Eventually, ERID emergence, prevalence and lethality may cross a crisis threshold and we will be forced to take serious action. The only question is, will we still have the ingenuity needed to deal with the problem when we realize the significance and magnitude of the threat?

One caveat here, the exact nature of pathogens as independent variables is difficult to determine as other factors (human ecology, climate, evolution, environmental change, etc.) exert influences on the emergence and re-emergence of pathogens. While I attempt to incorporate much of this non-linear complexity through the use of the facilitating variables not all the complex processes involved may be known by the scientific community at this time. Undoubtedly, as our understanding of the natural world grows so will our comprehension of the extremely complex bio-social relationship between humanity and the microbial penumbra that surrounds and influences all life in the biosphere. Notwithstanding the fact that pathogens are part of this incredibly complex ecological system, I believe that it is still a worthwhile exercise to examine the relationship between ERIDs and state function.

The development of new strategies to deal with these problems requires that we study the possible impact of emerging threats before we are faced with a crisis situation. It is more than a question of simply throwing money at the problem, political will is required, state health infrastructure must be improved on a global scale, and certain trends of human ecology will need to be addressed and reversed (particularly environmental degradation, overpopulation, and the widespread misuse of antibiotics). The following policy recommendations can be made at this time:

• The policy community must acknowledge the ERID problem and develop political will to deal with the situation before it deteriorates much further.

• Nascent global disease surveillance regimes must be strengthened and enlarged. Furthermore, a global ERID containment regime should be designed and built, requiring active cooperation by all states and leadership by the G-7 nations.

• Environmental degradation and overpopulation must be addressed and slowed, as these two processes affect viral traffic as disease amplifiers and increase the chance of lethal new zooneses taking hold within the human ecology.

• Misuse and abuse of anti-microbial drugs, particularly their use in feedstock, must be curtailed.

• All effort must be made to mitigate the effects of natural and human-induced disasters.

In conclusion, this analysis develops a new theoretical framework that examines the effects of ERIDs on state capacity, and may assist in the prediction of state failure in the future. Such a conceptual tool will help to explain the breakdown in governance within states like Zaire, Haiti, Rwanda, Burundi and Cambodia. This framework will not, nor does it seek to, explain all civil and interstate conflict, rather it seeks to shed light on the increasing instability and state failures that we are currently observing throughout the developing world, and to warn the peoples of the developed world that they are also vulnerable to the various negative effects of infectious disease.

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