The balance of evidence suggests that contagion will not generate conflict between sovereign states, despite disease-induced shifts in relative power,5 but may actually hasten an end to bellicose behavior. Relatively healthy countries will wisely avoid infected regions, insofar as armed conflict functions as a vector of disease transmission, increasing the probability of importing the pathogen in question to one's homeland through demobilization. Conversely, the evidence suggests that contagion has the capacity to breed political and economic acrimony between sovereign states but will not generate inter-state war. For example, negative outcomes in the domain of economics radiate as externalities to affect the domain of governance. As contagion obstructs international trade and commerce, it may induce political acrimony between affected states and/or regions, or between states and international organizations (as in the case of SARS).

Visitations of contagion expose persistent problems in cooperation between sovereign states and other agents in the realm of global health governance. Over time, differential levels in the aggregate burden of disease on populations may affect the relative power of those countries. Therefore, if a country A experiences serious burdens on population health resulting from the synchronous burden of malaria, onchocerciasis, and HIV/AIDS (for example) its economic productivity will be limited relative to a healthier country B over time. Disease will also likely compromise the infected country's institutional cohesion and efficacy, and the very capacity of the state to defend itself and to project power. Therefore, ceteris paribus, as a result of the heavy burden of disease on A, its aggregate power is diminished relative to B. Again, this does not seem to generate warfare between the parties in question, but it certainly may affect other political dimensions of country A's relationship with country B. For example, disease may reinforce existing structures of material inequities between countries. The burden of disease in tropical regions, due to pathogenic endemicity, reinforces the poverty of those affected countries, and traps them in a mutually reinforcing cycle of illness and poverty.

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