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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.
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