In sum, infectious disease operates in a number of ways to destabilize a state from within or to weaken a state to the extent that its ability to project power, and indeed to defend itself, is significantly compromised. The balance of evidence suggests that contagion does not start wars between sovereign states (although it does seem to possess the historical capacity to immobilize military forces, and could thereby result in a cessation of hostilities).
At the domestic level, infectious disease acts to undermine state capacity, and therefore the stability of the polity, through the following mechanisms:
Mortality and morbidity Disease-induced death and debilitation deplete the endogenous base of human capital, undercut the productivity of workers, and generate negative effects at the micro, sectoral, and macro levels of the economy. The destruction of the population also compromises military recruitment, and generates the loss of skilled personnel. Declining ingenuity Disease-induced erosion of human capital limits a society's capacity to generate ingenuity, eroding downstream social and technical innovation, impeding economic productivity, and undercutting the state's resilience (ability to respond to crises).
Diminished revenue Disease-induced declines in productivity result in economic contraction that will consequently limit the tax revenues and other resources that are extracted from the people by the state. As the tax base erodes, the capacity of the state to provide public goods for its own citizens declines correspondingly, as does its ability to project martial power.
Reduced social capital Disease generates in/out group behavior, results in the stigmatization of infecteds and/or vectors, and generates hostility between ethnic groups and/or classes. This generates destabilization within the polity and thereby undercuts the stability of the state as a macro entity.
Reduced legitimacy Widespread contagion may induce economic contraction, and cause the provision of public services to decline.54 State institutions may become increasingly brittle and sclerotic. The people may then see the state as ineffective and in violation of the social contract. Collectively, this may foster perceptions of the state as increasingly illegitimate, and thereby exacerbate internal social destabilization. Ultimately, the state may retaliate in draconian fashion against its own people (as in modern Zimbabwe).
Changes in relative power The destruction of important personnel throughout the bureaucracy, and the apparatus of coercion (i.e., the military and police forces), will jeopardize the state's ability to protect itself from external aggression. Further, the erosion of the state's fiscal resources will limit its ability to project power abroad and its ability to defend itself in the face of aggression. Such changes in relative power may affect downstream relations between states after the contagion has passed.
Connectivity As a result of the increasing interdependence resulting from accelerating globalization, the interests of the great powers are now profoundly linked to processes and events occurring in developing countries, such that destabilization of a polity in Central Asia can lead to externalities that directly affect and undermine the security of the United Kingdom. Thus, disease-induced destabilization in one region may compromise the prosperity and the security of all.
Furthermore, I argue, certain pathogens constitute significant and perhaps imminent threats to security, whereas other agents do not. For example, the re-emergence of a devastating H1N1 influenza virus, which in 1918 killed 50 million people, crippled armies, destabilized economies, and contributed to sclerotic governance, surely constitutes a direct threat to all countries. Globalization may, in fact, result in a pandemic of even greater scope and perhaps even greater lethality. On the other end of the spectrum is Lyme disease, which is endemic, is not transmissible from human to human, and often can be treated by antibiotic prophylaxis. I find it inconceivable to argue that Lyme disease constitutes a threat to the security of any polity. The following criteria constitute benchmarks for evaluating whether a pathogen constitutes a "security" threat to a given sovereign state:
• The negative health effects produced by the pathogen induce a minimum 1 percent/annum drag on the national GDP.
• The pathogen accounts for the mortality of 1 percent of the total adult population (15-55 years of age) per annum.
• The pathogen results in the severe debilitation of 10 percent of the total adult population per annum.
Doubtless, these criteria will provoke enormous debate among the "health and security" community, and that is my intent.55
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