SS+Disease+neg+-+Solvency+FL+2

1) The US has already initiated disease surveillance programs in sub-saharan Africa
 * States News Service,** Washington, June 4, 20**07**, p. lexis [Jenna]

The activities of the U.S. Agency for International Development (USAID), the U.S. Department of Agriculture (USDA), the U.S. Department of Health and Human Services (HHS) - including the centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) -- the U.S. Department of State (DoS) and the Broadcasting Board of Governors (BBG) have focused on building sub-Saharan Africa's capacity in animal and human health sectors through preparedness and response planning, strengthening laboratory diagnostics, increasing the level of public awareness and information, and enhancing disease surveillance and detection and reporting systems. The U.S. Department of Defense (DoD) also provides medical technical assistance and has purchased sets of personal protective equipment (PPE) for combatant command use in military-to-military and international humanitarian assistance globally.

2) USAID is already committed to increasing disease surveillance
__The__ __United States____, working in partnership with other nations, has undertaken a variety of initiatives to help improve the capability for disease surveillance and detection in other nations in a shared strategy that has emerged from a series of international meetings over the last six months. USAID is responsible for distribution of more than $150 million in assistance to improve disease containment capabilities in other nations,__ Hill said. He showed the committee a flat cellophane packet called a PPE – personal protective equipment. USAID has sent 20,000 of the packets abroad, with another 1 million now on order.
 * __Porter 06__** (Charlene, staff writer, Washington Post, March 2, “United States, Partners Build Global Disease Surveillance,” http://usinfo.state.gov/xarchives/display.html?p=washfile-english&y=2006&m=March&x=20060302154057cmretrop0.1840326)

Jonathan R. **__Davis and__** Joshua **__Lederberg__**, //Editors// Forum on Emerging Infections/Board on Global Health, 20**__01__**, The National Academies Press: Emerging Infectious Diseases from the Global to the Local Perspective: Workshop Summary. As a region, Africa is characterized by the greatest infectious disease burden and, overall, the weakest public health infrastructure among all regions in the world. Frequently, vertically oriented __disease surveillance programs at the national level and above in Africa often result in too much paperwork, too many different instructions, different terminologies, too many administrators, and conflicting priorities. Streamlined communications, strengthened public health surveillance, the use of standard case definitions, criteria for minimum data requirements, and emphasis on feedback through integrated forms, as well as research and training opportunities, are among the important tools available to improve the situation. Yet, efforts to establish fully more effective public health infrastructures may take a period of years to decades__.
 * 3) Their card concedes that disease surveillance in Africa is inefficient and will take years to be fixed**

4) Surveillance fails - high costs and false alarms. __CDC Evaluation Working Group__ on Public Health Surveillance Systems For Early Detection of Outbreaks, 5-7-__04__ (Chair: Dan Sosin, M.D., Division of Public Health Surveillance and Informatics, Epidemiology Program Office, CDC; Morbidity and Mortality Weekly Report, “Framework for Evaluating Public Health Surveillance Systems for Early Detection of Outbreaks: Recommendations from the CDC Working Group”, 53(RR05);1-11; http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5305a1.htm)

Outbreaks typically have been recognized either based on accumulated case reports of reportable diseases or by clinicians and laboratorians who alert public health officials about clusters of diseases. Because of the threat of terrorism and the increasing availability of electronic health data, enhancements are being made to existing surveillance systems, and new surveillance systems have been developed and implemented in public health jurisdictions with the goal of early and complete detection of outbreaks (3). The usefulness of surveillance systems for early detection and response to outbreaks has not been established, and substantial costs can be incurred in developing or enhancing and managing these surveillance systems and investigating false alarms (4). The measurement of the performance of public health surveillance systems for outbreak detection is needed to establish the relative value of different approaches and to provide information needed to improve their efficacy for detection of outbreaks at the earliest stages.

5) Double bind: Programs are either too passive to work or they’re too expensive and violate privacy laws. Louis __Jacobson____,__ associate editor at National Journal, wrote on infectious diseases for The Economist and Science, May, 19__95__ (National Journal, Government Executive, Section: Health, “Disease Detectives”, Lexis)

And none of the traditional surveillance techniques are foolproof. The main method, "passive" reporting by doctors to health officials, can be bothersome for harried physicians. Even CDC acknowledges that such reports capture only 1 of every 15 or 20 actual cases. While a doctor who has just helped a patient beat salmonella may have little incentive to report the case to CDC, there is good reason to do so. The patient might yet spread the bug to others, or he or she may have been part of an unusual -- and otherwise unnoticed -- cluster of poisonings. If the patterns are caught early on, an outbreak can be halted before it turns into an epidemic, saving both lives and money. More proactive surveillance methods -- testing high-risk groups, ordering mandatory reports from testing labs and slogging through hospital-discharge records -- work better. But they are expensive and labor-intensive and can violate privacy laws.

6) Countries refuse to report to the surveillance systems. David L. __Heymann__, Director, emerging and other communicable diseases surveillance and control – WHO, 5-15-__97__ (Federal News Service, In The News, Before the Senate Committee on Appropriations Subcommittee on Foreign Operations, Lexis)

Five global monitoring and alert systems are being strengthened by WHO: The International Health Regulations (IHR) are the only international public health legislation which requires mandatory reporting of infectious diseases. Currently the IHR cover cholera, plague and yellow fever, though countries often refuse to report these diseases because of the resulting negative impacts on trade and tourism. Under the direction of the World Health Assembly, and in order that the IHR may serve as a working global alert system, WHO is revising them to make them more effective and comprehensive. Through electronic links with quarantine officers in the 191 WHO member countries the system will become proactive, providing immediate reports of disease and syndrome outbreaks of international importance and permitting timely provision of recommendations on what measures should and should not be taken in response.

7) New centers are not the solution- infrastructure is still lacking
On June 15, the revised International Health Regulations became effective, bringing a comprehensive set of rules and procedures into force for WHO and its member states, and changing the way the global community responds to infectious disease threats. The revisions updated 1969 regulations that addressed only cholera, plague, yellow fever and smallpox, a disease now eradicated. Most countries have adopted the revised regulations as legally binding rules to contain disease threats like avian influenza and SARS that could spread rapidly from country to country. The regulations have been the focus of discussions among GDD and WHO about the degree to which the GDD centers can be used to help implement the new regulations. __The regulations “put a big burden on countries,” Dowell said. “In many ways, they require all member states to be able to detect new outbreaks, report them right away and contain them,” but many do not have the resources or expertise to do so.__ __“Positioning these well-resourced GDD centers in different regions is not the__ whole __answer,__” Dowell added, “but we hope it’s a contribution toward that.”
 * __Pellerin July__** __20__**__07__** (Cheryl, staff writer, USINFO, July 2, Dr. Scott Dowell- CDC director of global disease detection and emergency response, “Global Disease Detection Program Key Part of Worldwide Network,” http://usinfo.state.gov/xarchives/display.html?p=washfile-english&y=2007&m=July&x=20070702154502lcnirellep0.4805261)

8) Lack of capacity kills solvency Don **Noah**, Armed Forces Medical Intelligence Center **and** George **Fidas**, NIC (National Intelligence Council), The Global Infectious Disase Threat and Its Implications for the United States, 20**01**, http://www.fas.org/irp/threat/nie99-17d.htm [Jess Metlay]

Development of an effective global surveillance and response system probably is at least a decade or more away, owing to inadequate coordination and funding at the international level and lack of capacity, funds, and commitment in many developing and former communist states. Although overall global health care capacity has improved substantially in recent decades, the gap between rich and poorer countries in the availability and quality of health care, as illustrated by a typology developed by the Defense Intelligence Agency's Armed Forces Medical Intelligence Center (AFMIC), is widening

9) Remote sensed epidemic surveillance can’t forecast disease effectively James M. __Wilson__, MD, Adjunct Professor of Microbiology & Immunology and member of the Center for Infectious Disease at Georgetown University Medical Center, 2/12/__03__, “Use of Satellite Imagery for Epidemic Surveillance and Response”, p.3, http://ams.confex.com/ams/pdfpapers/55300.pdf (Victor)

Much of the excitement generated in the early days of RSEPI research revolved around the notion of ‘forecasting disease’ or ‘forecasting human morbidity and mortality’. This description placed undue emphasis and reliance on the data by public health officers and physicians who lacked the training to understand the limitations of the data and the manner in which it is produced. Epidemic triggering and propagation is the result of a complex interaction between a multitude of variables such as the type of pathogen involved, immunity of the effected population, where the pathogen is transmitted by a vector, meteorological parameters, and so on. RSEPI systems have the potential to monitor one or a couple of these variables but not all of them. Without a comprehensive analytic system that can draw upon all of the variables involved, ‘forecasting’ will remain an elusive and perhaps unrealistic goal.

10) Expensive and inefficient tests prevent accurate and thorough diagnosis
Improving people's access to tests for the major diseases of the developing world and making the tests more accurate could save hundreds of thousands of lives, say researchers. __Millions of people in developing countries die each year from illnesses that are preventable or treatable because the diagnostic tests are too expensive, complex or inefficient to use.__
 * __Ngandwe and Tallaksen 06__** (Talent and Eva, December 8, “Better diagnostics could save thousands of lives,” SciDev Net, http://www.scidev.net/News/index.cfm?fuseaction=readNews&itemid=3274&language=1)

11) Workers lack understanding of the data surveillance gathers
Much of the excitement generated in the early days of RSEPI research revolved around the notion of forecasting disease or forecasting human morbidity and mortality. __This description placed undue emphasis and reliance on the data by public health officers and physicians who lacked the training to understand the limitations of the data and the manner in which it is produced.__ Epidemic triggering and propagation is the result of a complex interaction between a multitude of variables such as the type of pathogen involved, immunity of the effected population, where the pathogen is transmitted by a vector, meteorological parameters, and so on. RSEPI systems have the potential to monitor one or a couple of these variables but not all of them. Without a comprehensive analytic system that can draw upon all of the variables involved, .forecasting. will remain an elusive and perhaps unrealistic goal.
 * __Wilson__** **__03__** (James M. MD, adjunct professor @ Georgetown University Medical Center, “USE OF SATELLITE IMAGERY FOR EPIDEMIC SURVEILLANCE AND RESPONSE,” February 12, http://ams.confex.com/ams/pdfpapers/55300.pdf)

12) Disease surveillance centers won’t do anything until health workers are more educated
__Many health care providers do not fully understand their role in infectious disease surveillance, including their role as a source of data__ (IOM, 2000). __Health care providers receive little formal education in infectious disease surveillance: few medical or other health science schools include the importance of and requirements for reporting diseases of public health significance to public health authorities in their curricula; residency programs seldom address the need for provider participation in public health surveillance; and little, if any, continuing medical education exists on the topic, nor is it widely integrated into board certification exams.__ __Cox News Service__, __4-26__-07 (Alison Young, staff writer, “Global jobs at CDC go unfulfilled”, http://www.ajc.com/search/content/shared/money/stories/coxnews/2007/CDC_JOBS_0426_COX.html [T Chenoweth])
 * __Committee on Emerging Microbial Threats to Health 03__** (“Microbial Threats To Health: Emergence, Detection, And Response,” Mark S. Smolinski, Margaret A. Hamburg, and Joshua Lederberg, editors, Institute Of Medicine Of The National Academies, p. 166-7)
 * 13) The plan can’t solve –** **CDC can't fix shortages of qualified personnel**

Facing a tangled bureaucracy and a lack of qualified staff, nearly half of the overseas jobs at the Centers for Disease Control and Prevention are vacant despite an urgent need to guard against foreign health threats. Many of the jobs will remain unfilled for another year, according to an internal CDC memo obtained by The Atlanta Journal-Constitution. "This is a critical time for global health," wrote Dr. Stephen Blount, director of the CDC's Coordinating Office for Global Health, in an April 13 memo to CDC Director Julie Gerberding. The potential of an influenza pandemic, the current HIV/AIDS pandemic and the threat of a bioterrorist attack from abroad "fuels the urgency to make overseas assignments in a timely manner," he wrote. Only 166 of the CDC's 304 overseas positions in 53 countries are filled, according to the memo. At least 85 positions likely will remain unfilled until 2008, Blount said. Among the causes he cited: Delays at a federal human resource center in Atlanta and an additional bureaucratic layer that requires CDC foreign postings be approved by a senior political appointee's office in Washington. CDC job postings include openings in China and Indonesia — locations where outbreaks of the H5N1 avian influenza virus have caused significant concern. Blount was in China and unavailable for comment. CDC spokesman Tom Skinner said global health is a top priority, that the agency is doing everything it can to deploy staff and that progress is being made. Backlogs at the Atlanta human resources center for the CDC's parent agency, the U.S. Department of Health and Human Services, have contributed to the vacancy of about 800 of the CDC's 9,000 positions, Skinner said. Agency officials say they are acting to help streamline that process. "Federal employment in general takes time. On the average it can take several months," Skinner said. "And filling overseas positions presents unique challenges." One of those unique challenges, according to Blount's eight-page memo, is the CDC must request special approval for every overseas assignment from the HHS Office of Global Health Affairs. This adds an additional two to three months of delay in hiring staff for foreign postings, according to the memo. "Some positions have been delayed for so many months that our partners doubt our commitment and credibility," Blount wrote. William Steiger, director of HHS' Office of Global Health Affairs, was out of the country and unavailable for comment, said spokesman Bill Hall. Steiger has come under fire in the past for allegedly micromanaging the overseas work of the department's scientific divisions. Steiger, the godson of former President George H.W. Bush, is President George W. Bush's nominee to be the next U.S. ambassador to Mozambique. Hall did not respond to requests for other department officials to explain the hiring policies. Jeff Levi, executive director of the Trust for America's Health, questioned why HHS officials in Washington are contributing to the CDC's hiring delays. "CDC isn't sending political people abroad to do global disease detection. They're sending scientists," said Levi, whose Washington-based group examines public health preparedness. Levi said having CDC scientists overseas is important in creating a stronger global disease detection system. The vacancies create the risk that "we won't get the warning we need and we won't be as prepared as we should be," he said. U.S. Sen. Charles Grassley, the ranking Republican on the Senate Finance Committee and a CDC watchdog, said it's in the best interest of the world to get the positions filled. "We need to do what it takes to cut through red tape in the hiring process and encourage seasoned CDC leaders to fill important positions overseas," he said. "The global public health threats we face are high stakes." In addition to bureaucratic delays, Blount's memo says that HHS sets unusually short assignment lengths for foreign postings, making it difficult for the CDC to recruit and retain qualified staff. While the U.S. Department of State lets staff remain abroad for 12 years, the memo says, HHS limits foreign postings to eight consecutive years — and only six years in one country. "We are currently bringing fully qualified staff back from overseas" because of the time limits, the memo says. The memo states that hiring within the CDC has become difficult: "Most highly qualified CDC staff interested in overseas assignments have been placed. It is now a challenge to hire experienced staff with sufficient institutional knowledge to work in other countries." The result, the memo says, is that the CDC is being forced to put new hires in important leadership positions abroad. Meanwhile, for vacancies in such difficult locations as Angola, Burkina Faso and Rwanda, the CDC is seeking permission to hire non-U.S. citizens.

14) No solvency- Plan action is too slow to stop an epidemic Jonnathan **Busko**, MD, MPH, EMT-P, February 20**__07__**, Cygnus Business Media Inc., p.lexis [Jenna]

Surveillance systems must also notify the appropriate individuals quickly. Most health departments receive notable laboratory results as they become available but do not have around-the-clock staffing, so response delays may exist. These public-health surveillance systems are not real-time and are slow to process information, resulting in delays in detection. Although these delays may be fine for traditional diseases, they are unacceptable for highly communicable bioweapons in the era of rapid world travel. There are EMS systems using continuous call data monitors (described below) that achieve near real-time surveillance. Additionally, a few emergency department-based systems and ?drop-in? surveillance systems at special events have almost-real-time capability. Traditional surveillance works by looking for a disease with a ?gold standard? laboratory test confirmation. A patient must have an exposure, develop signs and symptoms, see a clinician who suspects the disease and have the appropriate laboratory test ordered. This process can take days or even weeks, depending on the disease, the suspicion of the practitioner and the availability of the laboratory study. Since only true cases are identified by the laboratory study, this method does not produce many false alarms. However, extensive training of EMS providers on signs and symptoms of bioterrorism diseases would be required for field personnel to effectively participate in this type of surveillance.

**15)** Gilbert **__Welch__****__,__** a professor of medicine in the Department of Veterans Affairs and Dartmouth Medical School, Washington Post, 7/1/**__04__**, (“Dangers in Early Detection”, http://www.washingtonpost.com/wp-dyn/articles/A19323-2004Jun30.html)[Elisabeth]
 * 16) Early detection kills healthy people**

Why? Because __early disease detection means more people become patients. Inevitably some will be treated needlessly and suffer as a result.__ To understand this, you need to understand __that each of us harbors early forms of disease.__ Even in middle age, many of us who feel well have evidence of diabetes, heart disease, osteoporosis, hepatitis, vascular disease and cancer. __Just because we harbor these early forms of disease doesn't mean that they will ever affect our health.__ Some diseases progress so slowly that people die of other causes long before the diseases generate symptoms. Other diseases may not progress at all. __Unless we were tested, we'd never have known we were sick.__ __Prostate cancer is the classic example. Among men age 60, around half have microscopic evidence of prostate cancer if we look hard enough. Yet only four in 1,000 will die from prostate cancer in the next 10 years.__ How can this be? Because prostate cancer isn't just one disease: It's a spectrum of disorders. Some forms of prostate cancer grow very rapidly and kill men. Some grow slowly and men die of something else before the cancer ever causes symptoms. And others look like cancer under the microscope but never grow at all. A little over a decade ago, doctors started looking hard for prostate cancer using the PSA and lots of needle biopsies. And we found a great deal: Roughly 2 million cases were diagnosed in this period -- almost a million more than would have been without the test. Did prostate cancer screening help men? To be honest, we aren't sure about the net effect. There has been a small decline in the death rate from prostate cancer, but this may simply reflect that our treatments are better. While screening probably has helped a few men live longer, it has also clearly hurt others. Millions have been biopsied who otherwise wouldn't have been. Many with nonprogressive disease have been turned into cancer patients unnecessarily. Most have been treated, and many have suffered ill effects. A few have even had their lives shortened by treatment. __This is the reality of early detection__. A few may be helped, because their disease is destined to cause problems and because early treatment is able to solve those problems in a way that later treatment cannot. But __many simply are told earlier that they have a disease and gain nothing, because their disease could have been treated just as well later, when symptoms appeared. And others are hurt by treatment for a disease that would have otherwise never affected their health.__ What's next? Consider CAT scans of the chest to look for lung cancer. During mass screenings in one region of Japan, CAT scans found 10 times as many patients with lung cancer as had been found a few years earlier using chest X-rays. Incredibly, nonsmokers were almost as likely to have lung cancer as smokers. Is smoking getting safer? Of course not. Everyone agrees that smoking is far and away the most important cause of lung cancer. The CAT scans were simply labeling some people as lung cancer patients who otherwise would never be affected by a few abnormal cells. __Why not treat__ these __patients -- just to be safe? Because some people die from treatment__. __In the Mayo Clinic study comparing lung cancer screening__ (using chest X-rays__) to standard care, more people in the screening group were told that they had lung cancer. It didn't help them live longer; in fact, slightly more people in that group died.__ And some think we should scan the whole body. But the harder we look, the more we find. CAT scans of the chest lead more people to be told they have lung cancer, and there are even more abnormalities to find in the abdomen. As one radiologist who has read thousands of these scans put it, "With this level of information, I have yet to see a normal patient." Millions of healthy Americans are being told that they are sick (or "at risk"). More are undergoing invasive evaluations with needles, flexible scopes and catheters. And more are taking drugs for early forms of diabetes, heart disease, osteoporosis, hepatitis, vascular disease and cancer. __We need to start asking hard questions about whose interests are served by the relentless pursuit of disease in people who are well.__ Clearly __it's good business -- for test manufacturers, hospitals, pharmaceutical companies. And__ it's good for __some doctors.__ But is it in society's interest? Many suggest that it saves money by lowering the cost per patient. But the savings per patient (if they exist) are overwhelmed by the increased expense of having so many more to treat. __Is it in the interest of sick patients? Absolutely not, as caring for the well increasingly distracts doctors from caring for the truly sick.__ And what about the well? Is it in their interest? Only they can decide -- after they have been informed that early detection is a double-edged sword.

17) Humanity does not face extinction from disease
Malcolm **__Gladwell__****,** The New Republic, July 17 and 24, **__1995__** excerpted in Epidemics: Opposing Viewpoints, 1999, p. 31-32 Every infectious agent that has ever plagued humanity has had to adapt a specific strategy but __every strategy carries a corresponding cost and this makes human counterattack possible.__ Malaria is vicious and deadly but it relies on mosquitoes to spread from one human to the next, which means that draining swamps and putting up mosquito netting can all hut halt endemic malaria. Smallpox is extraordinarily durable remaining infectious in the environment for years, but its very durability its essential rigidity is what makes it one of the easiest microbes to create a vaccine against. AIDS is almost invariably lethal because it attacks the body at its point of great vulnerability, that is, the immune system, but the fact that it targets blood cells is what makes it so relatively uninfectious. Viruses are not superhuman. I could go on, but the point is obvious. __Any microbe capable of wiping us all out would have to be everything at once: as contagious as flue, as durable as the cold, as lethal as Ebola, as stealthy as HIV and so doggedly resistant to mutation that it would stay deadly over the course of a long epidemic. But viruses are not__, well, __superhuman. They cannot do everything at once.__ It is one of the ironies of the analysis of __alarmists__ such as Preston that they are all too willing to point out the limitations of human beings, but they __neglect to point out the limitations of microscopic life forms.__

18) No impact – anything virulent enough to be a threat would destroy its host too quickly
Joshua **__Lederberg__****,** professor of genetics at Stanford University School of Medicine, **__1999,__** Epidemic: The World of Infectious Disease, p. 13 The toll of the fourteenth-century plague, the "Black Death," was closer to one third. If the bugs' potential to develop adaptations that could kill us off were the whole story, we would not be here. However, with very rare exceptions, our __microbial adversaries have a shared interest in our survival. Almost any pathogen comes to a dead end when we die; it first has to communicate itself to another host in order to survive. So historically, the really severe host- pathogen interactions have resulted in a wipeout of both host and pathogen.__ We humans are still here because, so far, the __pathogens__ that have attacked us have willy-nilly __had an interest in our survival.__ This is a very delicate balance, and it is easily disturbed, often in the wake of large-scale ecological upsets.

__Much of the literature on the public health-national security linkage works hard to make the case that infectious disease-related damage in developing countries threatens the national security of the__ __U__nited __S__tates __and other developed countries. The persuasiveness of this "indirect threat" thesis is, however, questionable__ from the realpolitik perspective on national security. __Whether HIV/AIDS__ cripples Botswana or __contributes to instability in southern__ __Africa__ __does not address the main concern__ of the realist - __does the weakening of individual African countries__ or regional instability in sub-Saharan Africa __threaten__ __U.S.__ __military or strategic interest__s (for example, access to critical resources or essential markets)? __The answer to these questions would be in the negative because sub-Saharan__ __Africa__ __is not currently either strategically or economically vital to the great powers__. In this regard, Eberstadt provides a classic realpolitik analysis of HIV/AIDS in sub-Saharan Africa: __Africa____'s AIDS catastrophe is a humanitarian disaster of world historic proportions, yet the economic and political reverberations from this crisis have been remarkably muted outside the continent itself__. The explanation for this awful dissonance lies in the region's marginal status in global economics and politics. By many measures, for example, __sub-Saharan__ __Africa____'s contribution to the world economy is less than__ __Switzerland____'s. In military affairs, no regional state, save perhaps__ __South Africa____, has the capacity to conduct overseas combat operations, and indeed sub-Saharan African governments are primarily preoccupied with local troubles. The states of the region are thus not well positioned to influence events much beyond their own borders__ under any circumstances, good or ill - and the cruel consequence is that the world pays them little attention.n163 Ostergard similarly argued: The end of the global ideological tug-of-war between the USA and former Soviet Union marginalised Africa in US foreign policy and in the international community and consequently marginalized Africa's social problems, not least of which was the growing HIV/AIDS epidemic. The spread of HIV/AIDS in Africa was not a direct security threat to the West in any sense of the word.n164 The Group of Eight (G-8) countries' response at their 2002 summit in Canada to pleas for help and partnership from African leaders illustrates the ambivalence of the hegemons toward Africa's plight with HIV/AIDS. While the G-8 countries pledged $20 billion for reducing the threat to their security of weapons and materials of mass destruction,n165 they offered no new money for the fight against HIV/AIDS in sub-Saharan Africa.n166 This result is consistent with a realist perspective on national security: __the threat from weapons of mass destruction,__ including biological weapons, __constitutes a graver concern for the great powers than HIV/AIDS in Africa__. n167 __Even though September 11th may have taught the lesson that "failed states are a national security problem__," n168 __realists would see a myriad of "internal" factors that contribute to "state failure" in sub-Saharan Africa, which limits the credibility of elevating infectious disease over other causal factors, such as poverty, civil war, or ethnic hatred__.
 * 19)** **SSA has no influence outside its borders- disease spread provides no threat to US**
 * __Fidler 03__** (David P, Professor of Law, Indiana University School of Law**,** George Washington International Law Review, 35 Geo. Wash. Int'l L. Rev. 787, p. 818-9)

20) Multiple alternate causalities to disease
Jennifer **__Brower__****,** science/technology policy analyst, and Peter Chalk, political scientist, Summer **__2003,__** Rand Review, Vol. 27, No. 2, “Vectors Without Borders,” http://www.rand.org/publications/randreview/issues/summer2003/vectors.html This year's outbreak of severe acute respiratory syndrome (SARS) in Beijing, Hong Kong, Taipei, and Toronto is only one of the more recent examples of the challenge posed by infectious diseases. Highly resilient varieties of age-old ailments— as well as virulent emerging pathogens—are now prevalent throughout the world. These illnesses include cholera, pneumonia, malaria, and dysentery in the former case and Legionnaires' disease, acquired immune deficiency syndrome (AIDS), Ebola, and SARS in the latter. In the United States, West Nile virus entered New York in 2000 and then spread to 44 states by 2002, and monkey pox struck the Midwest this June. __In the latter half of the 20th century, almost 30 new human diseases were identified. The spread of several of them has been expedited by the growth of antibiotic and drug resistance. Globalization, modern medical practices, urbanization, climate change, sexual promiscuity, intravenous drug use, and acts of bioterrorism further increase the likelihood that people will come into contact with potentially fatal diseases__.