U.S. Department of State 95/08/07 Briefing: T. Wirth on Infectious Diseases Office of the Spokesman [Excerpt from Daily Press Briefing of August 8, 1995] BRIEFING ON GLOBAL INFECTIOUS DISEASE BY TIMOTHY WIRTH UNDER SECRETARY FOR GLOBAL AFFAIRS OFFICE OF THE SPOKESMAN MONDAY, AUGUST 7, 1995 MR. JOHNSON: Good afternoon. I'm pleased to introduce to you, to begin our briefing today, Under Secretary of State Tim Wirth, our Under Secretary for Global Affairs. He has responsibilities for such issues in the Department as drug-trafficking, population, refugees, human rights, the environment, health, and international science and technology. Today Under Secretary Wirth is going to describe two reports that speak to the implications for the United States of global infectious disease. One of the reports on emerging and re-emerging infectious diseases was unveiled on July 25; the second one on AIDS just an hour ago. He will be making a short opening statement and be pleased to take your questions for a few minutes. Under Secretary Wirth. UNDER SECRETARY WIRTH: Thank you, very much, and it's a pleasure to be back with you again. On previous visits we focused on various aspects of our broadened definition of national security. As the Cold War is over, clearly this Administration is working very hard to broaden the agenda beyond traditional foreign policy concerns, to focus on a whole new set of issues. In previous sessions here, we have talked about population stabilization, climate change, human rights, narcotics, persistent organic pollutants and biodiversity. And today I would like to just describe very briefly to you some of the work on a major health and science problem, infectious diseases. Ten days ago, at a major non-governmental organization event here in the Department, we released the report on emerging and re-emerging infectious diseases. I think these are available somewhere, these two reports -- have they been handed out -- on emerging and re-emerging infection diseases. That report came out of a joint effort coordinated by the President's Science Advisory Committee, which I co-chaired with Jane Wales, the number two person at the President's Science Advisory Committee, and was put together by the State Department and the Centers for Disease Control. And today, we are just back from an AID HIV/AIDS conference at which we released and will discuss with them tomorrow, the U.S. strategy on AIDS, which I will share with you today, as well. That was put together by State, AID, the Department of Defense and the Centers for Disease Control. Both reports lay out the urgency of the issue of infectious diseases. Tuberculosis, polio, diphtheria, malaria, cholera, Legionnaires' disease, hantavirus, Lyme disease, HIV/AIDS, and the Ebola virus, "Dustin Hoffman outbreak.". You are familiar with the galaxy of problems that we face; probably less familiar with where we are in terms of national and international action on these issues. Most infectious diseases have been pretty well controlled. Measles and smallpox are practically eliminated. Polio is effectively eliminated in the Western Hemisphere, and we are working very diligently with the Japanese to try to eliminate polio by the end of the century in the Pacific. Childhood diseases like whooping cough and diphtheria are sharply on the wane. And as these diseases have declined, there has emerged a complacency about infectious diseases, an assumption that all is well in the world of infectious diseases and we don't have to worry about them. And as that complacency has set in, unfortunately we in the United States and nations all over the world have let down our guard -- have let down our guard in terms of our surveillance, in terms of the overall measuring of infectious diseases, and in terms of our capability of reacting to infectious diseases. There are a lot of reasons for the decline of attention. One is this kind of complacency. A second is the fact that antibiotics, which have become so much a part of the global battle on infectious diseases, have in many cases been ill-used, and in many cases the microbes involved have developed a resistance to these antibiotics. Another reason is populations have grown around the world, moved into areas where they had not lived before, and populations have become increasingly mobile, moving around the world and thus carrying these infectious diseases with them. New viruses have emerged, and we have all become familiar, for example, with Legionnaires' disease, which hit this country about twelve years ago; Lyme disease, discovered first emerging in Connecticut; the Hantavirus, emerging in the southwest. This year's stories have been perhaps overwhelmed, above anything else, by the ebola virus outbreak in Central Africa, and very importantly, the persistent and very difficult issue of HIV/AIDS. These issues are of scientific and medical attention, but also of great urgency to this Administration and to the United States of America. Obviously, the great suffering involved is enormously important. The loss of life, a tragic and an extraordinary waste. The people who are hit in particular by these diseases tend to be those who are less able to deal with those diseases: the poor; the poorest individuals, the most marginalized individuals, and this is especially true with HIV/AIDS. It is extremely costly. The expense of infectious diseases when they hit is extremely costly. And we have also very, very narrow -- as well as broad international -- security concerns; very narrow domestic concerns in our concern that these may hit us, impact us right here in the United States of America, as has happened with some of the viruses I have described. We have much to do around the world and here at home in prevention, detection and treatment. One of the key areas is the importance of giving it the highest level of political attention and leadership, which the United States is doing through these two very important reports. Today on HIV/AIDS, in particular, I don't have to remind all of you that this has now become the number one killer of 25 to 44 year olds in the United States of America. There are estimates of 40 to l00 million cases of HIV/AIDS by the year 2000 around the world, and unlike most infectious diseases, like cholera or the plague, or others, AIDS is not likely to run its course and to subside. Without better response strategies and without massive behavioral changes, we are going to continue to see a multiplication of AIDS infection, and we are seeing that around the world. There is no known candidate now for an HIV/AIDS vaccine, and, if one is found, it will probably be l5 or 20 years before that becomes very broadly used. So we are dependent upon a number of issues, a number of strategies. One, changing the behavior of individuals; second, developing non-vaccine technologies, particularly those necessary to allow women to protect themselves. There are some promising anti-viral therapies that are available now for expectant mothers, but we have a long way to go before a vaccine will be available, and therefore we have to work very much on technologies that may be found and could be useful very quickly. Major prevention programs could cut the infectious level by 50 percent, and that's the best estimate of most people around the world, and we have certainly found that to be true here in the United States of America. But in order to have this kind of prevention program work, you have to have strong political leadership, a strong recognition of the problem, and the willingness to admit that the problem exists, and a strong commitment to do something about it. The two reports that we have done were filled with recommendations about urgent action needed, especially at the international level, and those actions, like so many others, demand leadership from the United States of America: urging other governments to focus on these issues as legitimate and important issues of governments and of foreign policy; joining in various international and U.N. efforts; encouraging the non- governmental sector and the private sector to become more deeply involved in these; the importance of training our own people as they are moving around the world -- for example, elements that focus on disease have to be built into the training of Foreign Service officers, military officers, and are being done so; spreading examples of successful prevention programs. We have been also working very closely with the military. Militaries are uniquely sensitive to infectious diseases, and this is particularly true in many developing countries, where the cadre of individuals most likely to be impacted by AIDS is the very leadership that is necessary for the security and stabilization of those countries. And the Department of Defense, I would say, has been absolutely extraordinary in its commitment to helping to spread the word on this, to helping to develop training programs, and very, very broad cooperation in the United States and around the world. We are in need of continuing research on issues coming out of the NIH, the Centers for Disease Control, Food and Drug Administration; the need to focus on safeguarding blood supplies, the need to focus on reproductive health issues. Especially important is the need to focus on the status of women. The economics of who gets infected is, as I pointed out earlier, those who are least able to take care of themselves, those who most vulnerable and those tend to be more women and children. They need to focus very sharply on education programs. This is a very, very broad strategy that is necessary in both infectious diseases -- the Infectious Diseases Report of last week and HIV/AIDS. I wanted to spend a little bit of time with you today, pointing out that this is extremely high priority for us here. We have launched this major interagency effort and come out with two, I think, very, very good reports replete with long sets of recommendations. Now it's going to be our responsibility, obviously, to follow up on this, both within the interagency process, but more importantly, across the government, working with the private sector, working with non-governmental organizations, and working to promote U.S. leadership around the world on this very important set of questions on infectious diseases. These reports are available. So thank you all very much for your forbearance, and I guess they're available. Q Secretary Wirth, you say that to fight AIDS you have to have the political leadership and the commitment to do something about it. To what extent is that commitment and the ability to do something about it subject to the vagaries of Congress? For example, Senator Helms seems to think that AIDS is a result of disgusting personal behavior and has opposed any large-scale Federal funding for things like this. Is he or people who think like that -- are they in a position to stop what you consider to be such a priority battle? UNDER SECRETARY WIRTH: A significant majority in Congress reinforced our efforts and reinforced the need for this to continue to be a high priority domestically, with the Ryan White legislation reaffirmed by the Congress only last week. I think most Americans have come to an understanding now that this is an extremely important issue. Whereas ten years ago, when I was in the Congress, for example, and we were just beginning to discover AIDS, it was extremely difficult to even talk about it. Seven years ago, we distributed throughout -- eight years ago -- throughout the district that I represented a flyer on AIDS, and there was much less controversy. And by the time that we get to this day and age, most people are very aware of the fact that this has got to be discussed openly, honestly, and we have to continue to work on it. The cost of not doing so, as with other infectious diseases, is very high indeed. I think we have very strong support on the Hill for a focus on infectious diseases overall and for HIV/AIDS in particular. I think the NIH appropriation in the House received an increase, as you probably know, and there was a good deal of discussion about the need for the Centers for Disease Control and NIH overall to be focusing on infectious diseases in that appropriation. So we were very pleased with that. Q Could I just follow up. You say there is a significant majority, but Senator Helms is in a unique position where the forces of democracy may not work perfectly. In other words, he has some blocking power. Have you weighed in with him at all? Would he go along with this program? UNDER SECRETARY WIRTH: I don't know if he would go along with this program in particular. I think you're quite right in saying that Senator Helms is in a unique position and fills that position quite uniquely as well, and I think that that uniqueness is that he is not in a majority in the Congress in his view of the importance of our focusing on infectious diseases. Q Secretary Wirth, you mentioned that there was a multiplication of infection, I believe you meant, in some developed countries. I take it in some Central African countries. Is this accurate? UNDER SECRETARY WIRTH: We're seeing an increase as you have populations moving into areas where they've not been before; increasing transport of individuals through various communications routes in Africa, and I can see a very rapid spreading of HIV/AIDS in some parts of Africa in a very alarming way. Q My question would be on the other side what progress is reported in this HIV report with regard to stemming, remedying this spread of infection, and can you speak specifically to the United States? UNDER SECRETARY WIRTH: Broadly, the progress that's being made is the understanding that when prevention strategies are embraced by a national government from the top down -- in other words, saying that this is a legitimate issue to be discussed and worked on -- that country will tend to have a stronger program. When not only the prevention strategies get going but behavioral changes start to work through society, we see changes there as well. Some of the successes that our military has had, again working with other militaries in Central and West Africa, have been sharp, although in small countries, have been sharp, and we would like to try to build upon that model. A similar sort of thing here at home, I think, when we saw, starting 15 or 20 years ago, the first recognition of AIDS. Probably if we had had a better surveillance program, probably if we had had a better detection program, we would have caught AIDS earlier. That seems to be the consensus among the medical community. We would have caught that earlier and perhaps saved some of the early infection which, as you know, spiked out very sharply in the late 70s, early to mid-1980s. For the next ten years, we saw a real decline in infections, and we began to get a handle on that as a public health program. As I understand it -- and I am no expert on what's going on domestically -- we've seen now an increase again. We're very concerned here in the Department about an increased heroin epidemic and the transfer of needles and the transfer of the disease in that fashion coming from very cheap heroin coming in from Southeast Asia. That's very, very troubling. The behavior changes have not been -- apparently not as consistently permanent among some of the at-risk communities as we would like to see, and I know public health authorities are worried now that we may have again something of an increase in AIDS infections in the United States of America. Q Is there a particular program in any of the countries of the world where we are seeing a success, an attenuation, at present that would be a good model? UNDER SECRETARY WIRTH: I might ask some of my colleagues. I know in West Africa where our military has been working very closely with governments, but I'll get back to you with a couple of examples of where that would be, if I could do that. Q Secretary Wirth, to what extent has the research and recommendations included in these reports focused on the former Soviet Union, particularly the spread and in many cases reappearance of alarming diseases such as typhus, diphtheria, cholera, and so forth? UNDER SECRETARY WIRTH: This report is not focused country by country but rather on the steps the United States Government should be taking in these areas, both domestically and particularly internationally. But we have seen a very troubling collapse of the public health system in the former Soviet Union. That's very disturbing in many, many ways. Perhaps many people view this as a case study of what may happen with the collapse of public health and the collapse of environmental standards and the exposure of people to an enormous number of environmental variables, including infectious diseases, and the need for us to much better understand the very close relationship between the environment and human health. Maybe the route to increasing people's sense of urgency about environmental issues will be found in the nexus of health and environmental issues coming together. Q Would you like to take the last one. UNDER SECRETARY WIRTH: Sure. Q Thank you. Yes. Talking about a different issue now. Yesterday the Colombian Government arrest another Cali cartel trafficker. What he says is the Colombian President doesn't receive any money from the Colombian Cali cartel. What does the United States Government think about it, and do you believe there's any corruption in the Colombian Government now? UNDER SECRETARY WIRTH: I think any government anywhere in the world, including our own, faces the difficulties of corruption coming from narcotics and narcotics money. It's everywhere. One of the highest priorities of this Department and this Administration is to do everything we can to profile the very major set of problems that relate to narcotics. We see that in the Andean countries in particular, but we also see it in the states of the former Soviet Union. We see the corruption of drugs in Nigeria, increasingly in South Africa, in Southeast Asia. You know, it is everywhere. In many ways it's probably fair to say that James Bond was about right, but 20 years ahead of time, or truth is stranger than fiction. The same concentration of enormous amounts of money, private armies and access to weapons, plus the corruption of governments was something that was a construct of Ian Fleming but now is becoming a reality, and we're seeing that in many, many places. We are working very closely with the Government in Colombia. We applaud the efforts made by the authorities in Colombia, particularly the change of command in which the drug enforcement has been much more aggressively carried out, and we hope that this continues, and we will do everything we can to assist the authorities in Colombia to make sure that happens. Thank you. Q Thank you.