But we may have more to fear from biology than from physics in the hands of barbarians. No human achievement has done more to lessen suffering for a larger number of people than has the conquest of infectious diseases, such as smallpox. And nothing more succinctly sums up the odiousness of our enemies than their contemplated reintroduction of some of these indiscriminate, promiscuous killers into the human story.
But as we focus, quite properly, on ways to prevent the use of infectious diseases as instruments of war, we may be paying insufficient attention to a terrifying phenomenon unrelated to terrorism. It is a phenomenon potentially more destabilizing than any act of terrorism has ever been. And it is no more secret than a steam calliope. It is the coming crest of the wave of AIDS in the three largest countries of Eurasia–Russia, India and China.
The onrushing crisis is outlined in an article published this week in Foreign Affairs, “The Future of AIDS” by Nicholas Eberstadt of the American Enterprise Institute. He says the coming pandemic “threatens to derail the economic prospects of billions and alter the global military balance.”
It is a truism that an epidemic requires not only a microbe but also a receptive social context. Eurasia’s future may be foreshadowed by sub-Saharan Africa’s present. As of a year ago, 28 million of the world’s 40 million persons who were HIV-positive were sub-Saharans, among whom AIDS accounts for one in five deaths–perhaps 20 million so far. The world’s reaction to this cataclysm has been mild because the region is of marginal political and economic importance. By many measures, Eberstadt writes, it contributes less than Switzerland to the world economy. But Eurasia holds five eighths of the world’s population, and its combined GNP exceeds that of the United States.
In Russia, says Eberstadt, the AIDS epidemic has already “exploded,” driven by increased poverty and economic and social dislocation, and new freedom–more geographical mobility, more extramarital sex, more prostitution, more drug use (perhaps 1 million drug users in Moscow alone, including 150,000 needle-using heroin and cocaine addicts). Russia’s prison system has 1 million inmates, and prison camps are, Eberstadt says, “virtual incubation dishes” for HIV.
In India AIDS is transmitted primarily by prostitutes and the truckers they serve. In China the sale of unsafe blood is what is called an “epidemiological pump,” driving the spread of the contagion. Already there may be 12 million HIV-positive people in Russia, India and China. And globally, the most pessimistic projections of the epidemic’s trajectory have proven to be insufficiently pessimistic.
Eberstadt believes that in the next 25 years the magnitude of the Eurasian epidemic will match that of the entire worldwide epidemic to date. “Under the assumptions of even a mild epidemic, the cumulative total of new HIV cases in China, India and Russia from 2000 to 2025 would be about 66 million, compared to UNAIDS estimates of about 65 million infected worldwide to date.”
The world’s current AIDS death toll is about 3 million a year. So far, AIDS has killed about 25 million. A mild epidemic would kill 43 million in India, China and Russia by 2025. Their combined populations would be 90 million fewer than anticipated, absent the epidemic, and 44 million of those deaths would be among the “economically active” population between the ages of 15 and 64.
All this points toward stagnation, or even reduction, of life expectancy at birth. Eberstadt says that under the scenario for a severe epidemic–and, again, pessimism has been realism concerning AIDS–“Russian life expectancy would be a full decade lower a generation hence than it is today.”
The economic consequences include the cost of caring, for years, for sufferers from this debilitating, incapacitating disease. The epidemic will alter the context of all major economic decisions, from spending on education to direct private investment. The net effect could approximate cutting off afflicted countries from globalization, which means from the great commercial engine of wealth creation that supports lifestyles essential to public-health improvements. For Russia, especially, this is a recipe for a radically reduced importance in world politics.
The eruption of AIDS in developed societies in the 1980s disturbed the emotional equilibrium of those societies because they had come to believe that the control, even the eradication, of infectious bacterial and viral diseases was in sight. Since then, AIDS has been a cruel new teacher of a cruel old truth: life is regressive. That is, people–and societies–with serious problems are especially apt to acquire other, even more serious problems.
