Copyright 2000 The Washington Post
The Washington
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April 30, 2000, Sunday, Final Edition
SECTION: A SECTION; Pg. A01
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HEADLINE:
AIDS Is Declared Threat to Security; White House Fears Epidemic
Could Destabilize World
BYLINE: Barton Gellman ,
Washington Post Staff Writer
BODY:
Convinced that the global spread of AIDS is
reaching catastrophic dimensions, the Clinton administration has formally
designated the disease for the first time as a threat to U.S. national security
that could topple foreign governments, touch off ethnic wars and undo decades of
work in building free-market democracies abroad.
The National Security
Council, which has never before been involved in combating an infectious
disease, is directing a rapid reassessment of the government's efforts. The new
push is reflected in the doubling of budget requests--to $ 254 million--to
combat AIDS overseas and in the creation on Feb. 8 of a White
House interagency working group. The group has been instructed to "develop a
series of expanded initiatives to drive the international efforts" to combat the
disease.
Top officials and some members of Congress contemplate much
higher spending levels. The urgency of addressing AIDS has also
touched off internal disputes over long-settled positions on trade policy and on
legal requirements that aid contractors buy only American
supplies.
The new effort--described by its architects as tardy and not
commensurate with the size of the crisis--was spurred last year by U.S.
intelligence reports that looked at the pandemic's broadest consequences for
foreign governments and societies, particularly in Africa. A
National Intelligence Estimate prepared in January, representing consensus among
government analysts, projected that a quarter of southern
Africa's population is likely to die of AIDS
and that the number of people dying of the disease will rise for a decade before
there is much prospect of improvement. Based on current trends, that disastrous
course could be repeated, perhaps exceeded, in south Asia and the former Soviet
Union.
"At least some of the hardest-hit countries, initially in
sub-Saharan Africa and later in other regions, will face a
demographic catastrophe" over the next 20 years, the study said. "This will
further impoverish the poor and often the middle class and produce a huge and
impoverished orphan cohort unable to cope and vulnerable to exploitation and
radicalization."
Dramatic declines in life expectancy, the study said,
are the strongest risk factor for "revolutionary wars, ethnic wars, genocides
and disruptive regime transitions" in the developing world. Based on historical
analysis of 75 factors that tend to destabilize governments, the authors said
the social consequences of AIDS appear to have "a particularly
strong correlation with the likelihood of state failure in partial democracies."
Another mobilizing factor is American politics. African American
leaders, such as former representative Ron Dellums (D-Calif.) and Rep. Jesse L.
Jackson Jr. (D-Ill)., have adopted the cause of AIDS in
Africa. Their interest is converging with that of long-standing
AIDS activists in the United States and Europe, where the
course of the epidemic has been slowed by preventive efforts and life-saving
combinations of anti-retroviral drugs. They are angry at policies that price
those medicines beyond the reach of the developing world.
In June, those
activists disrupted Vice President Gore's presidential campaign announcement in
Carthage, Tenn., and two other speeches that week--"blindsiding us completely,"
as one senior adviser put it. The activists, and several senior Clinton
administration officials, say that pressure accelerated the White House's
response.
There is no recent precedent for treating disease as a
security threat. So unfamiliar are public health agencies with the apparatus of
national defense that one early task force meeting was delayed when
Co-chairwoman Sandra Thurman, whose Office of National AIDS
Policy is across the street from the White House, could not find the Situation
Room.
For all the stakes they now describe, Clinton administration
officials do not contemplate addressing them on a scale associated with
traditional security priorities. Gore's national security adviser, Leon Fuerth,
freely acknowledged that the 2001 budget request of $ 254 million to combat
AIDS abroad--a sum surpassed, for example, by drone aircraft in
the Pentagon budget--provides "resources that are inadequate for the task." He
called the work of the task force "an iterative process" aimed at slowing the
plague's rate of increase and alleviating some of its effects. Before this year,
federal spending on AIDS overseas remained relatively flat.
Other officials noted that the United States has endorsed U.N. Secretary
General Kofi Annan's declared five-year goal of reducing the rate of new
infections by 25 percent. That falls close to the CIA's best-case, and least
probable, scenario. Because such a turn of events would demand resources from
U.S. allies and multinational bodies, the new White House group has been
instructed to "develop a series of expanded initiatives to drive the
international efforts."
Fuerth, a member of the "principals committee"
that takes up the most important foreign policy questions, told representatives
from 16 agencies on Feb. 8 that the panel wanted a package of proposals for
Clinton within a several weeks. The working group is scheduled to finish
drafting its proposals in May. Fuerth said the government is looking for "the
kind of focus and coordination on this issue that we normally strive for on
national security issues."
"The numbers of people who are dying, the
impact on elites--like the army, the educated people, the teachers--is quite
severe," he said. "In the end it was a kind of slow-motion destruction of
everything we were trying, in our contact programs and our military-to-military
programs, to build up, and would affect the viability of these societies, would
affect the stability of the region. . . . In the world that we're facing, the
destiny of the continent of Africa matters. And it isn't as if
this disease is going to stay put in sub-Saharan Africa."
Twenty-three million people are infected in sub-Saharan
Africa, with new infections coming at the rate of roughly 5,000
a day, according to World Health Organization figures. Of 13 million deaths to
date, 11 million have been in sub-Saharan Africa. In the
developing world, the disease spreads primarily through heterosexual contact.
The intelligence estimate portrays the pandemic as the bad side of
globalization. Accelerating trade and travel--along with underlying conditions
favorable to the disease--are pushing much of Asia, and particularly India,
toward "a dramatic increase in infectious disease deaths, largely driven by the
spread of HIV/AIDS," the intelligence report said. "By 2010,
the region could surpass Africa in the number of HIV
infections." The number of infections now is relatively low, but the growth rate
is high and governments have been slow to respond.
Infections are also
growing rapidly, and largely unchecked, in the former Soviet Union and Eastern
Europe. The intelligence estimate said this growth will "challenge democratic
development and transitions and possibly contribute to humanitarian emergencies
and military conflicts to which the United States may need to respond." The
report also anticipates that "infectious disease-related trade embargoes and
restrictions on travel and immigration also will cause frictions among and with
key trading partners and other selected states."
"The thing that's most
staggering, and people are just beginning to grasp, is that
Africa is the tip of the iceberg," Thurman said. "We are just
at the beginning of a pandemic the likes of which we have not seen in this
century, and in the end will probably never have seen in history."
Senior administration officials, some of them apparently frustrated,
said that the government does not dispute estimates by the Joint United Nations
Program on HIV/AIDS that it would take nearly $ 2 billion to
fund adequate prevention in Africa, and a like sum for
treatment. What the United States has been spending, by contrast, "is a rounding
error for county budgets" in Fairfax and Montgomery counties, said one disgusted
official.
"I don't have a fantasy that we're going to go to the Hill and
get $ 5 billion to build Africa's health care infrastructure,"
said one senior Africa policymaker. "We're trying to determine
effective steps that need to be taken, and can be taken, right now."
After initial resistance from U.S. Trade Representative Charlene
Barshefsky, the government has agreed in principle to encourage cheaper access
to life-saving drugs by relaxing hard-line positions that protect U.S.
drugmakers' intellectual property. Gore has said publicly that
the United States does not rule out the use by afflicted countries of locally
made or imported generics of drugs under patent by American companies. Assistant
Trade Representative Joseph Papovich has written to the governments of Thailand
and South Africa with new formulas for resolving
intellectual property disputes on such medicines.
But
several participants in the government effort said the practical meaning of the
change, if any, will have to be decided at the Cabinet level or by Clinton
personally. An early test comes in May, when Barshefsky's office decides whether
South Africa should be removed from the "watch list" of
countries facing potential trade sanctions. South Africa is on
that list because it passed a law the United States initially described as
threatening to the intellectual property of American drug
manufacturers.
With the prospect of substantial new spending, agencies
ranging from the Centers for Disease Control and Prevention (CDC) and National
Institutes of Health to the Labor Department are fighting over the allocation of
funds. Undersecretary of State Frank Loy, meanwhile, is said by participants to
be resisting the emerging consensus that the international AIDS
effort should be centered in Thurman's office.
The task force has also
battled over proposals to amend the Foreign Assistance Act, which requires all
taxpayer-funded aid to come from American suppliers. Public
health agencies want exceptions for condoms and AIDS test kits,
which can be acquired more cheaply overseas. Congress willing, the task force is
likely to recommend that change.
The high-profile attention from the top
is "raising this issue in ways that leaders [of afflicted nations] can't ignore
it," one White House official said. Richard C. Holbrooke, the U.S. ambassador to
the United Nations, used his rotation as Security Council president in January
to declare a month on Africa. He made AIDS the
subject of the first Security Council meeting of 2000 and invited Gore to speak.
When Clinton traveled to India in March, he successfully pressed the government
to issue a joint declaration on AIDS.
Pervading the
recent U.S. effort is a strong sense among participants of time misspent. The
virulence of the pandemic was accurately foreseen, and "the United States didn't
exactly cover itself with glory," said one close adviser to Clinton.
"We
saw it coming, and we didn't act as quickly as we could have," said Helene D.
Gayle, a physician who directs AIDS prevention at the CDC. "I'm
not sure what that says about how seriously we took it, how seriously we took
lives in Africa."
Peter Piot, a virologist who heads
the United Nations AIDS efforts in Geneva, said "the good news
is that the U.S. government is mobilizing. The bad news is that it took so long.
This is not a catastrophe that came out of the blue. It has been clearly coming
for at least 10 years."
Asked about those comments, Thurman looked
pained.
"Oh yeah," she said softly. "It's very late. But better late
than never. You rarely ever get a second chance in an epidemic."
Staff researcher Robert Thomason contributed to this report.
THE IMPACT OF AIDS
More than 16 million
people have died from AIDS since the 1980s, 60 percent of them
in sub-Saharan Africa. Not since the bubonic plague ravaged
Europe in the Middle Ages has there been as devastating a disease. U.S.
officials have reached the conclusion that the impact of AIDS
will be so vast that it has become a threat to U.S. national security.
Percentage of adult population infected with HIV or suffering
from AIDS. Selected countries
Zimbabwe: 25.9%
Botswana: 25.1
Namibia: 19.4
Zambia: 19.1
Swaziland: 18.5
Malawi: 14.9
Mozambique: 14.2
South Africa: 12.9
Rwanda: 12.8
Kenya:
11.6
Central African Rep.: 10.8
Ivory Coast: 10.1
India:
.82
U.S.: .76
AIDS already has
significantly shortened life expectancy and will cut more years off people's
lives by 2010.
Namibia
Life expectancy without
AIDS (years): 70.1
Life expectancy with
AIDS (years): 38.9
Change: 44.5% drop
Zimbabwe
Life expectancy without AIDS
(years): 69.5
Life expectancy with AIDS (years): 38.8
Change: 44.2
Botswana
Life expectancy without
AIDS (years): 66.3
Life expectancy with
AIDS (years): 37.8
Change: 42.9
Swaziland
Life expectancy without AIDS
(years): 63.2
Life expectancy with AIDS (years): 37.1
Change: 41.3
Malawi
Life expectancy without
AIDS (years): 56.8
Life expectancy with
AIDS (years): 34.8
Change: 38.7
Zambia
Life expectancy without AIDS (years): 60.1
Life
expectancy with AIDS (years): 37.8
Change: 37.1
Lesotho
Life expectancy without AIDS
(years): 65.9
Life expectancy with AIDS (years): 44.7
Change: 32.1
South Africa
Life
expectancy without AIDS (years): 68.2
Life expectancy
with AIDS (years): 48.0
Change: 29.6
Tanzania
Life expectancy without AIDS
(years): 60.7
Life expectancy with AIDS (years): 46.1
Change: 24.0
AIDS has left about 9
million children without their mothers or both parents, the vast majority in
sub-Saharan Africa.
Number of 15-year-olds per 10,000
of that age group who have lost their mothers or both parents to
AIDS.
Uganda: 1,100
Zambia: 890
Zimbabwe: 700
Malawi: 580
Togo: 400
Botswana:
390
Burundi: 390
Ivory Coast: 380
Thailand: 30
U.S.: 10
U.S. assistance to combat AIDS
has stayed around $ 120 million for the past seven years. But officials believe
much more is needed to halt the disease and treat those infected.
2001
budget request: $ 264 million
SOURCE: World Bank, WHO, UNICEF,
USAID
GRAPHIC: IG,,TWP
LOAD-DATE: April 30, 2000 
