420 CHAPTER ElEvEn ■ TransnaTional issues
failed to take preventive mea sures for several months. While fewer than 1,000 indi-
viduals died, the potential for a global pandemic was widely recognized and the
economic repercussions on the most affected states, including China, Vietnam, Sin-
gapore, and Canada, were significant. When the avian flu broke out in 2005–06
and H1N1 virus in 2009, the new Strategic Operations Center for the Global Out-
break Alert and Response Network was in place; WHO regulations were revised in
2007 to address global health emergencies in a more effective, better- coordinated
manner.
ebola and hIv/aIDs as transnational Issues
The outbreak of Ebola in the West African states of Liberia, Sierra Leone, and Guinea
tested the new system of quick response and alerts, and the system failed. Ebola was not
new; there had been known outbreaks in 1976 and in 1995, both in Zaire (now the
Demo cratic Republic of Congo). In each case, the outbreaks occurred in a rural area,
there was high mortality, and the disease died out relatively quickly. This time, in
the words of global health specialist Laurie Garrett:
There was still no vaccine, no treatment, no field diagnostic tools, limited
supplies of protective gear, nearly non- existent local health- care systems
and trained medical personnel, no clear lines of national and global author-
ity for epidemic response, few qualified scientists capable of and inter-
ested in being deployed, no international law governing actions inside
countries lacking the capacity to stop epidemics on their own, and no
mone y.^14With broken domestic health systems unable to contain the outbreak, Doctors With-
out Borders and a few other NGOs found themselves the primary international groups
organ izing assistance on the ground. They had stocks of protective gear and well-
trained personnel immediately available. Neither the WHO nor governments were
in charge. WHO itself did not issue its Public Health Emergency of International
Concern until over four months after the outbreak! Bud get cuts affecting outbreak-
and crisis- response programs—20 percent in a two- year period— and poor adminis-
trative practices at the regional level explains the poor international response. Over
11,000 people died; the economies of the affected states have been damaged. The dif-
ficulty of dealing with Ebola is an order of magnitude diff er ent from the prob lems
faced with the de cades-long battle against HIV/AIDS.
Of all communicable diseases, the history of HIV/AIDS is the most illustrative of
the challenges facing the world’s peoples in the twenty- first c entury. Since the begin-
ning of the epidemic, 78 million people have been infected. HIV/AIDS is the quin tes-