418 CHAPTER ElEvEn ■ TransnaTional issues
Health and Communicable Disease—
Protecting life in the Global Commons
Public health and communicable disease are ancient issues that have never respected
national bound aries. But, when thinking about disease as a transnational threat, we
should remember that, like other threats, global health also provides opportunities for
cooperation.
The threat of plagues crossing state bound aries cannot be ignored. Around 1330,
for example, the bubonic plague began in China, transmitted from rodents and fleas
to humans. Moving rapidly from China to Western Asia and then to Eu rope, by 1352
the plague had killed one- third of Eu rope’s population, about 25 million people. The
epidemic, like others before and after, followed trade routes. During the age of discov-
ery, Eu ro pe ans carried smallpox, measles, and yellow fever to the distant shores of the
Amer i cas, decimating the indigenous populations. Expanding trade and travel in
the nineteenth century within Eu rope and between Eu rope and Africa accelerated the
spread of deadly diseases such as cholera and malaria, leading to the first International
Sanitary Conference in 1851.
Between 1851 and 1903, a series of 11 International Sanitary Conferences devel-
oped procedures to prevent the spread of contagious and infectious diseases. As eco-
nomic conditions improved and medical facilities expanded, the prevalence of diseases
such as cholera, plague, yellow fever, and, much later, polio declined in the developed
world.
Other diseases have continued to ravage the developing world. The World Health
Or ga ni za tion (WHO), founded as one of the specialized UN agencies in 1948, tack-
led two of the most deadly diseases with its 1955 malaria eradication program and its
1965 smallpox campaign. Malaria eradication proved successful in the United States,
the Soviet Union, Eu rope, and a few developing countries, using a combination of the
insecticide DDT and new antimalarial drugs. Yet in most of the developing world, the
program failed to curb the disease, as the number of cases of malaria soared in Burma
(Myanmar), Bangladesh, Pakistan, India, and much of Africa. Efforts in malaria erad-
ication focus today on low- cost mosquito netting to protect sleeping children, the most
vulnerable victims. In contrast, the smallpox campaign was a stunning success. When
the vaccination campaign began, there were an estimated 10 to 15 million smallpox
cases a year, including 2 million deaths and 10 million disfigurements in the develop-
ing world. The last reported case of smallpox occurred in 1977.
Buoyed by the success of smallpox eradication, WHO tackled polio. In 1988, when
the campaign began, this disease was estimated to paralyze 350,000 children a year.
By working with state officials, WHO has immunized most of the world’s population
using an effective and inexpensive vaccine, leading to a 99 percent reduction in cases,