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A LIKELY DEMOCRATIC HEALTH SECURITY POLICY

Looking forward, the growing linkage between health and national security reflected

both in the academic and political worlds is likely to persist with the debate limited more to

means over ends. Although a second Bush administration would likely adhere to the international

health policies set during its first term, a Kerry administration would face a variety

of challenges and choices as it contemplated its responses to the infectious disease threat.

First, a Democratic administration is more likely to incorporate the fight for better

health and against infectious diseases into a broader grand strategy that is more personal

security- than state security-centric. This may not translate into substantially more funds

than the considerable sum the Bush administration has committed, however, since it may

want to spend more on health for its gay and other marginalized domestic constituencies.

But it may well be more inclined to fund the program fully.

Second, a Democratic administration will want to burnish its more multilateral orientation

and credentials. Giving the U.S. effort against infectious diseases a more multilateral

cast would be a low-cost and efficacious way to do so, certainly lower than multilateral

initiatives on Iraq and other “hard” security issues. This may entail selecting a new global

AIDS coordinator not associated with the U.S. pharmaceutical industry (The current

coordinator, Randall Tobias, is a former executive officer of Eli Lilly); abandoning the

current policy of using only those anti-retroviral drugs approved by the Food and Drug

Administration in favor of accepting much cheaper generics approved by the World

Health Organization; and, most important, substantially increasing the proportion of U.S.

funds allocated to the Global Fund.

Third, a Democratic administration, like its predecessor, will want to maintain a balance

between prevention and treatment, but it almost certainly will purge the U.S. program

of all influences seen as originating in the Bush administration’s evangelical

support base. Specifically, the” abstinence” component of the U.S. program that currently

receives 33 percent of funding allocated for prevention efforts will be jettisoned

in favor of expanded condom and other programs that are seen as more demonstrably

effective — and moral in a non-religious sense. This also would appeal to the broader

Democratic constituency that supports family planning, choice regarding abortion, and

fewer restrictions on stem cell research aimed at finding cures for infectious and noninfectious

diseases.

A LIBERAL/CONSERVATIVE NEXUS

In sum, while much may divide liberals and conservatives — and neoconservatives —

as they try to gauge the dynamics of the new international system we are in, there is a

growing consensus that the concept of security must be expanded to include the types of

non-traditional challenges that fuel the despair, anger, and hatred that are at the core of the

terrorist and other 21st-century threats we confront. The growing health divide between

North and South that will determine who lives and who dies of AIDS and other diseases is

one such challenge.

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