Stabilization during Epidemics

3 April 2020

By Dr. Raymond A. Millen and the PKSOI Team

Peacekeeping and Stability Operations Institute.

Executive Summary

Since recorded history, disease has beleaguered mankind and at times precipitated epidemics and pandemics. As such, epidemics have ravaged dense population centers due to close communal association. Epidemics alone have never caused the demise of a great power, though disease did contribute to the failure of some military campaigns. While states have occasionally used disease to gain a tactical advantage, in no instance has any used epidemics as a grand strategy. In actuality, the international community of nations has frequently rendered assistance to countries afflicted by disease, epidemics and other disasters. From the late nineteenth century onwards, scientists and doctors have eradicated the great majority of diseases that once scourged mankind. Within the last fifty years, developed countries have established sophisticated medical services and public health sectors to withstand diseases and attenuate epidemics. Despite modern advances, disease and epidemics continue to cause calamity, so stabilization activities during such crises are imperative. To mitigate the effects of an epidemic, government authorities need to project optimism and confidence, as well as safeguarding the economy.

Introduction

While epidemics have been a recurring feature of civilization, the effects over time have lessened for developed countries. Throughout history the effects of plagues, famine, and war have weakened nations. In antiquity, great powers were hardest hit because their heavily populated urban centers were the most susceptible to epidemics. Over time, all countries with dense population centers also became susceptible to epidemics. Until the twentieth century, epidemics and endemic diseases diminished populations, disrupted essential services, undercut governance and civil control, and caused socio-economic change (e.g., accelerating the end of the feudal system in Europe). While epidemics certainly caused domestic adversity, the fate of great powers was decided by other factors, mostly strategic in nature. Minor attempts to exploit epidemics have likely occurred, but they were largely irrelevant. For example, at a recent press briefing, President Donald Trump warned of “malign actors” attempting to exploit Coronavirus epidemic for their own purposes, but he iterated that US vigilance remained undaunted. Historical footnotes are of little use to decision makers. This paper touches on the historical background of diseases/epidemics, the medical advances combating disease from the late nineteenth century onward, and stabilization actions a government should take during an epidemic.

Historical Background

The fate of the Roman Empire is instructive for modern states. Like Globalization, all roads led to Rome and along them came epidemics. Military campaigns, increased commerce, and imperial expansion exposed citizens to new diseases, many of which became epidemics. The most significant effect was on large population centers due to close communal association. Peripheral tribal societies lived in smaller, relatively isolated communities, so epidemics were less severe. However, whenever they mounted invasions against the Roman Empire, their massed armies were susceptible to disease and epidemics. Of note, Romans (as well as Greeks and Byzantines) practiced good personal hygiene and were keenly attentive to clean water, with the superb aqueduct system as a prime example. The early Romans had no medical profession in the modern sense. Instead, the patriarch was responsible for the care of ailing family members, using home remedies. While episodic epidemics wreaked havoc on population centers, the Romans always recovered—with the exception of malaria. From 1 BC to 400 AD, endemic malaria stunted population growth, diminished immunity systems, and created listlessness among the populace. More than any other disease, malaria weakened the Roman labor force, deprived the military of hale manpower, and fatally undermined the national will to resist invasions. The depletion of economic wealth, continual military campaigning and defeats, and unrelenting incursions of migratory tribes led to the collapse of the Roman Empire—but this took centuries. Incidentally, the destruction of the Roman aqueduct system in 541 AD dissociated the importance of clean water and personal hygiene with subsequent generations of Europeans, which led to centuries of squalor and impure water.

Although the temptation exists to attribute epidemics as the cause of a great power’s demise, disease is just one factor and by no means the deciding one. Ancient Athens experienced a plague in 430 BC, but military blunders during the Peloponnesian War (431-404 BC), such as the Sicilian Campaign, had a greater impact. The Byzantine Empire experienced Bubonic plague from 542 to 590 AD, but centuries more of warfare continued, with some spectacular military defeats, until the fall of Constantinople in 1453 AD. Hernando Cortez’s invasion of Mexico in 1518 introduced smallpox into the native population, but it took three additional years of fighting (and reinforcements) before Cortez conquered the Aztecs. Typhus fever ravaged Napoleon’s army during the invasion of Russia in 1812, but France recovered and fought for another two years against the Grand Alliance of powers. A more significant factor was the poor health of Napoleon, which left him lethargic and indisposed during the fateful battles of Borodino, Leipzig, and Waterloo. During the US Civil War, two-thirds of all deaths were attributed to disease and infections (around 450,000). However, a better strategy and hard fighting ultimately decided the Union victory.

There are a few instances of countries or armies making tactical use of pathogens against enemies during conflicts, but the results were inconclusive. Since endemic disease abounded already, it was difficult to determine whether such attacks triggered the intended epidemic or not. Imperial Japan, but not Nazi Germany, conducted research, testing, and some minor attacks with biological agents in China during World War II, but their use proved indecisive. The Soviet Union, and the United States did conduct extensive research, experimentation, and testing of biological weapons despite international conventions, but both discontinued the programs and entered into treaties. Nevertheless, if countries are determined to develop biological weapons programs, little can be done. Verifying such programs is difficult since disease prevention research and biological weapons research are practically indistinguishable.

Medical Advances

History reveals that warfare, trade, and exploration were responsible for the spread of disease, epidemics, and pandemics (i.e., global epidemics). Of interest, most epidemics died out with no apparent explanation. Viruses either mutated into a nonlethal form or became dormant, reemerging later in another, sometimes more virulent, form. Further, afflicted survivors became immune and checked the spread of the disease. The Black Death (1346-1361) and Black Plague (1665) are instructive examples. While doctors and scientists began experimenting with inoculations in the seventeenth and eighteenth centuries, it was not until the late nineteenth century that they understood the link among pathogens, vectors, and disease. They became fervent disease detectives, using both inductive and deductive reasoning. Basic personal hygiene, clean water and food, the cleansing of wounds, and sterilization of surgical equipment were remarkable breakthroughs. But it was not until the twentieth century that the targeting of vectors (e.g., mosquitoes, lice, tsetse flies, and fleas) and the provision of vaccinations and inoculations eradicated most diseases that plagued mankind. By World War II, the US military practiced disease prevention and possessed robust medical services. Additionally, the US military prevented the spread of disease in occupied territories. By the end of the twentieth century, developed countries possessed sophisticated medical services, infrastructure, and research. Further, they have devoted significant resources to the monitoring and study of diseases, notably the US Centers for Disease Control and Prevention (CDC). Lastly, the information age has increased awareness of outbreaks and preventative measures.

There is no historical instance of a state deliberately creating or exploiting an epidemic to weaken or attack another state prior to a conflict. Given the advances in medicine, research, and monitoring of diseases, potential aggressors would find little profit in such attempts. Disease does not recognize national borders, so starting an epidemic is akin to mutually assured destruction. Any attempt to wage biological warfare would require, beforehand, mass inoculations or immunizations, which are incredibly expensive, impossible to keep secret, and unlikely to immunize the entire domestic population. In view of UN prohibitions on biological weapons, any country using them would become a global pariah. Regardless, rational actors would balk at throwing the iron dice against a developed country with a robust health sector. However, underdeveloped countries remain vulnerable to epidemics and natural disasters. Aside from humanitarian reasons, the United States would need to assist affected countries which provide strategic resources or are of geostrategic value.

Minor attempts probably occurred, but their historical impact was negligible. For example, at his 1 April 2020 Coronavirus White House press briefing, President Trump mentioned that “cartels, criminals, terrorists and other malign actors will try to exploit the situation for their own gain, and we must not let that happen.” Since international and domestic criminal organizations never cease their activities (e.g., trafficking, cyberattacks, and smuggling), irrespective of disasters, the president was merely signaling US vigilance. Decision makers, like historians, must not be consumed by minor events when drawing on historical lessons learned.

Contrary to mankind’s affinity to warfare, epidemics and disasters (manmade or natural) bring out a humanity that transcends enmity. Global media swiftly alerts the world of disasters, and it is common for other nations and organizations to render humanitarian assistance and provide moral support to afflicted countries. A few examples underscore this point.

While Iran remains a demonstrable threat to the Middle East and is an intractable enemy to the United States, no country ever took advantage of the numerous earthquakes which have plagued Iran in the last thirty years: 1990 (50,000 killed), 2003 (26,000 killed), and 2017 (600 killed). In each instance, several countries (including the United States), international organizations, and NGOs dispatched aid personnel and humanitarian assistance. The 2020 COVID-19 epidemic is no exception, with the EU and international organizations dispatching medical experts, humanitarian assistance, and medical supplies to the stricken country.

Despite Cold War tensions, Europe and NATO did not take advantage of the Soviet Chernobyl nuclear power plant disaster in April 1986, which affected around 7 million people. Instead, international organizations responded with humanitarian assistance and emergency response personnel, evacuating millions from the radiation zone.

Countries of little geostrategic value vis-à-vis great powers have also received humanitarian assistance/disaster response in the aftermath of natural disasters or epidemics. The 2004 tsunami which struck Indonesia killed over 200,000 people; the 2010 earthquake which devastated Haiti killed over 200,000 people; and the 2014 Ebola epidemic in West Africa killed over 11,000 and threatened millions more. In each case, several countries, international organizations, and NGOs rendered immediate assistance, saving millions from starvation, incidental diseases, and the elements.

Stabilization Activities during Epidemics

During an epidemic, the government must safeguard government structures at all levels, essential services (i.e. energy, medical sanitation, water, and food), the economy, constitutional rule of law, police services, and the military. At the same time, the government must pay particular attention to psychological factors.

While the lethal impact of diseases and viruses today is demonstrably lower than historical antecedents, news and social media awareness is extraordinarily high. Increased awareness has a tendency to cause panic, which can cause instability. Fear of an epidemic can paralyze society, overwhelm medical services, and disrupt the economic vitality of a state. Accordingly, senior policy makers must analyze nascent epidemics/pandemics without succumbing to false analogies. Richard Neustadt’s Thinking in Time provides a practical analytical framework for assessing the similarities and differences between a current crisis and a past, analogous crisis, as well as conducting a trend analysis leading up to a current crisis. Of note, Neustadt discusses the Carter administration’s overreaction to the Swine Flu virus in 1977 due to faulty analysis of the 1919 Spanish Flu. Early analysis provides a plan of action before a crisis becomes acute.

National counter-epidemic plans should be measured and graduated. Authorities at all levels should have systems in place to prevent the paralysis of medical services and infrastructure. Accordingly, both federal and state governments should identify the most vulnerable people and advise them to self-quarantine. Local governments should establish several small inspection stations (e.g., clinics, shelters, and tents) to check people for viral symptoms. The issuance of self-testing kits will further ameliorate strains on medical services. Only those people testing positive should enter hospitals or other designated facilities for care and quarantine. Graduated military support (i.e., Reserves, National Guard, and Active Duty) should respond to most affected areas as back-up. As a general observation, people who are the least vulnerable to the virus should continue daily activities. Experience suggests that exposure to a virus creates immunity, thereby checking the spread of the disease.

Police services are the first responders for civil order. Community oriented policing strives to inform and calm local communities. The local government and police should remain vigilant to the hoarding of commodities in order to prevent black market activities. Anti-hoarding placards and policies at stores will deter most citizens, but information gleaned from community oriented policing will uncover hoarding, price gouging, and black market gangs. Governors and mayors should only implement curfews and more stringent measures in communities where the breakdown of civil order is imminent.

The US president’s use of the bully pulpit is a powerful instrument of power. Projecting optimism and confidence has a remarkable calming effect on a nation under stress. Reminding the country of robust medical capabilities, vaccine research and testing, and preventive measures sustains confidence. While a presidential administration should encourage similar assurances from congressional representatives, governors, and the media at large, the president’s use of departments/agency officials, news conferences, interviews, and public addresses is the most effective form of national communication. Nonetheless, government officials should avoid speculations on infection rates, particularly mortality, since such talk only heightens uncertainty. Lastly, encouraging the assistance of the private sector creates a sense of national community and innovative solutions to epidemics.

Since economic vitality is largely psychological, an administration must take measures to stimulate employment and wealth creation in the private sector. As President Dwight Eisenhower once observed, a bankrupt country is a defenseless country, so economic vitality and national security are intimately linked. A robust economy is fundamental to stability and hence national security. Without it, people lose hope in the political-economic system, and national will falters.

Federal and state governments must avoid the development of a siege mentality due to irrational fears of epidemics. National security should never equate to complete assurance against potential epidemics. Such an attempt will eventually erode democratic institutions, the free market economy, and the national spirit. The most damaging development is the creation of a police state in pursuit of absolute security. While a degree of social distancing may be necessary, the government must establish a definitive timeline for its termination. The preservation of civil rights and free enterprise is the principle mandate of a democracy. Without it, the national will to resist national security threats will erode.

Conclusion

Disease and epidemics are common occurrences and need no sinister actor to propagate. No historical evidence exists in which a state has used an epidemic to pursue a foreign policy objective. In reality, countries and aid organizations have not hesitated to render assistance to afflicted states, even when they are adversaries. Except in the realm of fiction, scientists and medical professionals have been successful in mitigating the deleterious effects of disease. Fear of the unknown can paralyze a country, and the media will always engage in speculation and rumors. Since democracies treasure freedom of expression among all others, government leaders can most effectively counter unwarranted fears with optimism and confidence. The greatest danger to stability is economic depression, with untold calamity. If economic vitality is eviscerated, an epidemic will be the least of a country’s woes.

Recommended Reading

Centers for Disease Control and Prevention, https://www.cdc.gov/.

Edmond Hooker, “Biological Warfare,” eMedicineHealth (October 2019), https://www.emedicinehealth.com/pictures_slideshow_cold_and_flu_13_germiest_places/article_em.htm.

Frederick F. Cartwright, Disease and History (New York: Dorset Press, 1972).

Friedrich Frischknecht, “The History of Biological Warfare,” EMBO Reports, no. 4 (June 2003), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1326439/.

Jared Diamond, Guns, Germs, and Steel (New York: W. W. Norton & Company, 1999).

John M. Barry, The Great Influenza: The Epic Story of the Deadliest Plague in History (New York: Penguin Books, 2005).

Richard A. Muller, Physics for Future Presidents (New York: W. W. Norton & Company, reprint, September 21, 2009).

Richard Neustadt and Ernst May, Thinking in Time: The Uses of History for Decision Makers (New York: Schuster & Schuster, Inc., 1986).