Joseph V. Micallef is a best-selling military history and world affairs author, and keynote speaker. Follow him on Twitter @JosephVMicallef.
Geopolitics refers to the study of how physical geography influences the political and economic landscape and, in turn, the national power and foreign policy of a state.
The concept isn't new. Aristotle wrote about geopolitics, as have a host of political theorists since then.
The subject was particularly in vogue at the beginning of the 20th century when strategists like Alfred Thayer Mahan and Halford Mackinder explored the consequences of new technologies on national power. Their conclusion was that, even in the age of railroads, the internal combustion engine and far-ranging ships, geography still mattered and still shaped national outlooks and state power.
Even today, in an age of intercontinental-range ballistic missiles, long-range bombers and remotely controlled drones, the conclusion remains the same: Geography still matters. Technology may shape how we interact with it, but geography still exerts a powerful influence on how national power is created, expressed and projected.
We don't normally think of disease as a matter of geopolitics. Medical technology and pharmaceuticals are ubiquitous and highly transportable. Other than for very remote locations or the absence of the appropriate infrastructure, medical services are not typically constrained by geography.
On the other hand, the extent that particular regions are more susceptible to outbreaks of disease, are more likely to be a source of transmission, or are more severely affected by its consequences makes, at least some diseases, a topic of geopolitical concern.
Globalism and Disease
Anytime different gene pools come into proximity with one another, there is a greater risk of a disease epidemic developing -- either because a particular population gets exposed to disease organisms they have no immunity to or because the exchange of genetic material creates new, virulent diseases.
The most spectacular example of this phenomenon is what historian Alfred Crosby termed the Columbian Exchange. The arrival of Europeans to the Americas represented the commingling of three distinct gene pools: Nordic/North European and Hispanic/Mediterranean with West African and Native American ones. That genetic exchange brought, among other things, corn, cacao and turkeys to the Old World and coffee, wheat and horses to the New World. It also brought yellow fever and malaria from Africa; smallpox, measles, diphtheria and influenza from Europe; and syphilis and polio from the Americas.
That exchange made the Caribbean, whose different range of climates created a genetic hot zone, a lethal, disease-prone environment. That 95% of native Americans succumbed to mistreatment and Old World pathogens is well-known, but 70% of Europeans and Africans also died within two to five years of arriving in the Americas. Moreover, since the European and African populations in the New World were predominantly young to middle-aged males, and did not have a large component of very young or old who were more susceptible to disease, the disease lethality between the different groups was actually much closer.
Nor was this phenomenon limited to the exploration of the New World. Throughout history, the commingling of disease organisms facilitated by long-distance exchanges has been associated with outbreaks of disease and, often, deadly pandemics. It is not a coincidence that the pandemic of plague that ended the Pax Augustana in the 2nd century AD, crippling Rome, occurred at a time when fleets of Roman ships were routinely traveling to Asia to trade, or that the recurring plagues that decimated Medieval Europe, especially the 14th century Black Death, occurred at a time when the Mongol conquest of central Asia made trade along the Silk Road trade routes between Asia and Europe more prevalent.
What today we term globalization is not the cause of disease, but it makes the consequences of disease outbreaks that much more far-reaching. In doing so, it creates a geopolitical dimension. The comparative advantage of global trade and cost-effective international supply chains is in part offset by the comparative disadvantage that outbreaks of new diseases can create around the globe and the consequences on both health and international trade.
The Coronavirus
Viruses are among the simplest of all organisms. Essentially, they are a strand of ribonucleic acid (RNA) surrounded by a coat of protein molecules. RNA is a primitive form of DNA. It consists of a single strand rather than the double helix of DNA. Its simple structure makes it prone to mutation, especially via the incorporation of other genetic material into the RNA strand.
Coronaviruses are a large family of viruses that cause respiratory illnesses ranging from the common cold to influenza. The physical structure of the virus resembles a crown, hence the term corona. In recent years, they have also been the cause of more severe respiratory diseases such as SARS (severe acute respiratory syndrome) or MERS (Middle East respiratory syndrome). In November 2019, reports emerged of a new coronavirus-induced disease in the Chinese city of Wuhan.
The Covid-19 virus has never been encountered before. Like other coronaviruses, it is a zoonotic disease: an infectious disease caused by bacteria, viruses and parasites that spread from non-human animals (usually vertebrates) to humans. Many of those initially infected either worked or frequently shopped in the Wuhan seafood wholesale market. The market also sells large quantities of wild animals. The origins of the virus are still disputed. The original case, termed patient 0, does not appear to have had any contact with the seafood market.
Those who have fallen ill report suffering coughs, fever and breathing difficulties. In some cases, it can lead to pneumonia and, in a small number of severe cases, to organ failure. As this disease is viral, antibiotics are of no use. Moreover, as it is genetically different from other coronaviruses, the existing antiviral drugs against flu/influenza will not work. Recovery depends on the strength of the patient's immune system. Many of those who have died were old or already in poor health.
As of Feb. 24, according to the World Health Organization (WHO), there had been a total of 77,042 confirmed cases in China, which had resulted in 2,445 deaths. An additional 1,769 cases had been reported across 28 other countries, which had resulted in 17 deaths. Six hundred and thirty-four of those cases, and two of those deaths, are associated with the cruise ship Diamond Princess currently docked in Japan; 602 cases are in the Republic of Korea; and 76 in Italy. The U.S. currently has 35 cases. There have been reports on social media of an outbreak in Iran, but Tehran has officially reported only 28 cases.
When developing models of disease outbreaks, epidemiologists focus on two principal factors: the transmission rate and lethality. The transmission rate refers to the number of additional people an infected person will transmit the disease to. Lethality refers to the number of patients that will die from the disease. These factors are expressed as R0 and R1.
Hemorrhagic fevers like Ebola, for example, have a very high lethality, as much as 90%, but have a low transmission rate -- partly because they require an exchange of body fluids to spread, cannot exist for very long outside the body, and because they are so fast acting and so deadly that carriers die before they have much opportunity to infect others.
Measles or the common cold, on the other hand, have a very high transmission rate because they can be spread by aerosols created when an infected person coughs or sneezes. Moreover, they can live outside the body for several hours, so it is possible to get infected even if you are nowhere near someone who is sick. The transmission rate for measles, for example, is R18. That means, on average, someone with the measles will infect another 18 people. That's why measles epidemics in schools, for example, can wreak such havoc. The R0 for influenza is 1.3, while Covid-19 is estimated at 2.2.
In the case of Covid-19, the lethality is 2%. Virtually everyone who comes down with the disease will recover, although those who come down with pneumonia will require extended medical treatment. To date, victims have mostly been the old or those whose immune system was already compromised in some way. Medical personnel involved with treatment can be particularly vulnerable, both because of the potential for repeated exposure and because many are working long hours with little sleep, a condition that can compromise the effectiveness of their immune systems.
SARS, in comparison, had a lethality of 10%. There is some question, however, on the reliability of the data that the Chinese government has released. In the case of SARS, it is quite likely that the number of reported cases was significantly underreported. The lethality of SARS was likely less than 10%. The Centers for Disease Control (CDC) in Atlanta, which is working closely with its counterparts in China to stem the outbreak, has expressed satisfaction with Beijing's current disclosure, but doubts persist.
The incubation period for Covid-19 is approximately two weeks. An infected person can transmit the disease over this period without showing any symptoms of being ill. How long the virus can exist outside the body is unclear. There have been reports that it can survive for up to 24 hours.
Not surprisingly, the outbreak of Covid-19 has given rise to no shortage of conspiracy theories that the virus is manmade. The presence of the Wuhan Institute of Virology at the epicenter of the outbreak, which is the only Level 4 facility in China and works with infectious diseases, has reinforced those theories. To be clear, there is no concrete evidence that the Covid-19 virus is manmade, or that the outbreak was caused by its "escape" from the Wuhan Institute of Virology. There is, however, some circumstantial evidence suggesting that possibility.
Zoonotic diseases are quite common. Disease pathogens jump from animals to humans all the time. In many cases, the consequences are minimal. On occasion, however, they can be far-reaching and deadly. The source of the SARS virus was civet cats. The source of the MERS virus was camels. A recent study identified more than 400 different coronaviruses carried by bats in China. What effect any of these viruses would have on humans is unknown. Moreover, it is not just the viruses themselves that are of concern. It is also how the genetic material they embody could get transferred into another coronavirus to create a new, deadly pathogen.
Take influenza, for example. Most years bring new, hitherto unseen influenza viruses. Many of these viruses incorporate genetic material from avian influenza viruses. In general, avian influenza does not affect humans and is not carried by them, limiting the opportunity for the transfer of genetic material. Pigs, however, can be a host for both avian and human influenza, even though neither virus affects them.
The proximity of both types of virus in pigs makes it more likely that genetic material will be exchanged and a new influenza virus capable of infecting humans will be created. Those parts of the world where fowl, pigs and humans live in proximity to one another are particularly prone to be the source of new influenza viruses. Precisely such conditions are found in many areas of rural east Asia, especially in China. That's why Asia has been the leading source of new influenza viruses in recent years.
Since 2010, according to the CDC, influenza has resulted in between nine million and 45 million illnesses; between 140,000 and 810,000 hospitalizations; and between 12,000 and 61,000 deaths annually. The hospitalization rate of the typical influenza epidemic is around one percent and its lethality is around .13%. So far, this season, there have been an estimated 29 million illnesses, 280,000 hospitalizations and 16,000 deaths from flu in the U.S.
To be clear, Covid-19 is just a particularly severe form of an influenza-like disease. The public panic surrounding Covid-19 would have been far worse had it been called the Wuhan flu. Calling it the coronavirus makes it seem different from the yearly flu epidemics, but it is caused by the same type of virus.
That doesn't mean that Covid-19 isn't dangerous. A 2% lethality rate still means that hundreds of thousands, if not millions, of people could die from a global pandemic. Moreover, there is always a risk that an outbreak could simply overwhelm existing medical facilities. Pneumonia doesn't typically lead to death, but if left untreated, as would happen if the medical system simply runs out of available beds (as has happened in Wuhan's hospitals), it can easily result in death, especially among the young and very old. The U.S. has around 900,000 hospital beds. With a population of 350 million people, it wouldn't take much to overwhelm hospitals.
The Geopolitics of Coronavirus
An increasingly interconnected world means that the global impact of what have historically been local disease outbreaks can have far-reaching political, social and economic consequences. East Asia's and, in particular, China's, increasing role in the world -- the prevalence of Asian tourists and Asian-based supply chains -- facilitates the spread of such diseases and makes it more likely they might mushroom into full-blown pandemics.
It's not that Asia is a particularly rich reservoir of disease organisms. Rural Africa or the Amazon basin is likely just as rich, maybe richer. Consider that the African hemorrhagic fevers are also zoonotic. But rural Africa or the Amazon basin do not attract a lot of visitors, nor are they a source of many tourists or the location of many international supply chains.
Does disease and, specifically coronavirus-linked influenzas, have a geopolitical consequence? The answer is yes. A variety of factors: rural farming practices in China and east Asia, local consumption of wild animal species, the number of visitors both to and from China, and the presence of global supply chains centered in east Asia all mean that the risk of local disease outbreaks morphing into global pandemics is higher in east Asia than elsewhere.
That's not a reason to abandon Asian supply chains or to stop going on Asian cruises. It is a reason, however, to acknowledge that the region poses a higher level of risk and to make sure that individuals, companies and governments have a fall-back plan should another Covid-19-like outbreak occur.
What the recent experience with the Covid-19 virus clearly demonstrates is that most companies do not have a Plan B for dealing with such outbreaks or the impacts on their supply chains and operations. There is insufficient coordination between different countries on how to respond and, notwithstanding the advisory role of the World Health Organization, WHO lacks authority to enforce its recommendations.
SARS was a warning, as was MERS, to the potentially devastating effects of an influenza-like/coronavirus pandemic. Covid-19 is another reminder.
-- The opinions expressed in this op-ed are those of the author and do not necessarily reflect the views of Military.com. If you would like to submit your own commentary, please send your article to opinions@military.com for consideration.
