Public Health Engagement Aff

Notes
Hello!
This is the Public Health Engagement Aff and Neg.

*~Basic Introduction~*
Public health in China is a really big problem and spans a variety of issues, including disease, public
health education, healthcare, counterfeit drugs, etc. The thesis of the affirmative is basically that the
public health system in China has proven to be very inefficient and not capable of combatting
diseases ever since the SARS outbreak in 2003. The plan contributes U.S. aid to reform the public
health system in some way, specifically through China’s pandemic control (which can encapsulate a
lot of the issues noted above). Although the solvency cards are really great in talking about how the
U.S. and China need to work with each other to build public health infrastructure and reform the
system, it’s really difficult to find a solvency advocate that says that we should specifically work on
one single thing with China. That’s why the plan text only says aid—there are a couple of benefits:
firstly, it allows the affirmative to not have to specify what specifically they do (it could be training,
expertise, resources diverted to local governments, research and development, sharing of disease
technology, etc); secondly, it means that because we don’t specify what we do, the affirmative can
argue that they leave it up to China as a way of drawing back and working as equal partners rather
than telling China what to do—this can be a good way to frame the aff when answering kritiks;
lastly, it’s easier to win a spillover of how public health measures can spillover to other social issues
in China if the targeted problem area overlaps.

There are three main advantages: disease control, the economy, and soft power. Disease is pretty
self-explanatory: the plan stops diseases from coming that would risk extinction if a pandemic
broke out. Although it may seem like a weakness at first, one of the great parts of this aff is that it’s
not specified which specific disease is coming because it’s impossible to predict zoonotic diseases,
which this aff is centered around. Zoonotic diseases are uniquely lethal because 1) they mutate
easily and can transfer from animal to human, and 2) they travel extremely fast—it can cover the
continents in 15 hours before anybody detects something. China is uniquely likely because of things
like its dense population and constant movement of people and animals—I highly recommend
reading all of the Sparrow evidence from the 1AC to get a better understanding of the likelihood of
disease breaking out.

The economy scenario is just that a pandemic would destroy the economy, and not only through
dead people, but also through changed behavior of survivors—reference the Begley evidence.

Lastly, there’s a very unique scenario in soft power: the argument is that public health diplomacy is
much more effective as leverage in international affairs, more than cooperation over things like
counter-terrorism or political alliances. The plan increases public diplomacy, which is the
cornerstone of soft power. If the U.S. has more soft power, they will be able to foster more
cooperation on other issues when that goodwill spills over.

*~Strengths and Weaknesses~*

The main strength in this affirmative lies in the fact that I just think this affirmative is true (public
health is such a big problem everywhere), and since the overarching theme is disease, it’s pretty
hard to win an impact turn to disease. However, it’s a lot harder to win the nuances than the thesis
of the aff: the internal links are susceptible to examination, especially the internal link to extinction.
AFF:
Because the thesis of this aff is pretty true, a lot of arguments you need to make against neg case
arguments are just intuitive and analytical common sense (i.e. China is uniquely key because their
population is one of the largest in the world, they interact heavily with domesticated animals,
there’s no access in rural areas to health care, etc.) Long and Erickson are two major authors on this
topic and a lot of cards are written by them, especially on the solvency level—read them carefully!

Because the aff claims to solve for a laundry list of impacts, you can isolate any one of them and go
for them as individual extinction scenarios in the 1AR or 2AR if they win impact defense to the
general claim but you find a reason why their reasons don’t apply to a specific scenario.

You should alter your strategy depending on whether you are hitting a team that is more policy-
oriented or more kritikal. If you are hitting an extinction-claims team, you should defend the wall.
However, if you are hitting a more kritikal team, you can always kick the extinction claim and go for
structural violence impacts from the aff and how disease affects marginalized communities. The
economy scenario is useful here because you don’t have to win it causes extinction; it’s just an
internal link from disease that has a lot of structural damage. A lot of potential answers to things
like kritiks of apocalyptic rhetoric or disease representations can be found elsewhere—I’ve tailored
the answers to be responsive to the other popular files at this camp.

NEG:
I think that in order to win on a straight policy strategy you absolutely have to win lots of impact
defense to the aff. There are a lot of impact d and impact turn files that you can draw from outside
of this file, so I didn't put a lot of answers that I thought you wouldn’t be able to find elsewhere.

On case, I’d suggest developing multiple alt cause arguments in the block, and find an off-case
argument that can turn disease fairly obviously. For example, there are many other drivers of soft
power, and it’s also a viable impact turn to go for—the same goes for the environment. I strongly
recommend against going for topicality—on face-value it may seem that pandemic control does not
seem like economic or diplomatic engagement, but public health diplomacy is a real thing and the
cards about its importance to foreign policy are really good.

Finally, if you choose to use this file during the year, there are a couple of things you should watch
out for and update often:
1) The U.S. and China have already been working together on scientific/medical research
together; pandemic control has not been done yet (thus is the beauty of not specifying). If
they do end up doing some kind of cooperation in the future, you will probably need to
change the plan text to make it a bit more specific to limit out what’s already been done
2) Soft power uniqueness—the current card is from 2015, and America’s status in the
international community may change more throughout this year, especially given the
upcoming election 
3) There are a lot of small diseases breaking out in conflict areas in the status quo—if they
begin to spread you can make new, more specific scenarios out of them.

Cheers!
Christina Li / Interlake High School ’17 / RKS Lab 2016
christina.li2017@gmail.com
AFF
 1AC
“The Trend Towards Establishing Vertical, Disease Specific Global Health Programs May Be At The
Cost Of Strengthening Basic Public Health Infrastructure And Development In The Long Term”
 1AC Pandemic Control Advantage
Scenario 1 is Disease

Current Chinese systems in place for pandemic control is insufficient—they lack

training and the resources for research
Wang et. al '08 (Langde Wang, Yu Wang, Shuigao Jin, Zunyou Wu, Daniel P Chin, Jeffrey P
Koplan, Mary Elizabeth Wilson, researchers of the WHO, "Health system reform in China 2:
Emergence and control of infectious diseases in China", World Health Organization, published
October 20, p. 40, www.who.int/management/district/2%20Infectious%20Diseases.pdf, CL)
As China looks ahead to deal with existing and new infectious diseases, it is also important to address the
challenges and weaknesses in the present infectious disease control efforts. We now have new and different challenges in this
millennium. Continuation in the use of the old methods, even if they have been successful, will not be sufficient.
Public-health and hospital systems: The public-health workforce in many areas remains poorly trained and unmotivated .
Incentives for community-based health workers to undertake disease control activities is insufficient. A
substantial amount of time will be needed to train a workforce capable of further controlling existing infectious diseases and dealing with
new infectious diseases. This drawback is especially serious in the poor parts of China where the burden of infectious disease is the
greatest. Hospital
staff have an insufficient understanding of the role they should have in disease control. They need to be
better trained and motivated to participate in proper diagnosis, reporting, and management of
infectious diseases. Hospitals should become part of the network to control and prevent
epidemics of infectious diseases. An increased sense of professionalism and the idea and practice of life-long learning needs
to be developed and inculcated in hospital staff. Development of education programmes to change the present treatment-focused
mindset of hospital personnel will take time and creativity. Strengthen
collaboration between and within
governmental sectors: As in many countries, responsibilities for health issues in China are separated into several different
ministries and levels of government. The Chinese Government can clearly respond effectively and efficiently when confronted with a
crisis (eg, SARS). The state council has the authority to enforce collaboration between ministries and between different levels of
government.
An improved leadership by the state council is needed to address infectious disease
control through multisectoral involvement as part of routine work instead of as a part of crisis management.
Population mobility: More than 10% of China’s population has moved away from their original residence, mainly from poor rural areas to
urban centres in search of better economic opportunities. Migration promotes transmission of infectious diseases and creates major
challenges for detection and control of epidemics of infectious diseases. The diagnosis and treatment of some
infectious diseases like tuberculosis are already free for migrants in some areas; however, much more
assistance is needed. Inadequate access to health services: The high cost of health care severely restricts access to
health-care services in China. In some of the poor rural areas, this difficulty is magnified by the absence of basic health-
care coverage. Patients with infectious diseases who delay or do not seek treatment because of the
cost or difficulty of accessing services will be at increased risk of developing more severe and chronic
forms of the disease and will be much more likely to infect other people. Health-system and health-financing
reforms are discussed in this Series.47 These issues are an essential component of the effort to control
infectious diseases in China.

Another pandemic is imminent and easily spreads—also causes a positive feedback

loop and increases risk of other diseases emerging again
Sparrow '16 (Annie Sparrow, a medical doctor and Assistant Professor at the Arnhold Global
Health Institute at the Icahn School of Medicine at Mount Sinai Hospital in New York, "The Awful
Diseases on the Way", The New York Review of Books, June 9,
www.nybooks.com/articles/2016/06/09/the-awful-diseases-on-the-way/, CL)
Pandemics—the uncontrolled spread of highly contagious diseases across countries and continents—are a modern phenomenon. The word itself, a
neologism from Greek words for “all” and “people,” has been used only since the mid-nineteenth century. Epidemics—localized outbreaks of diseases—have
always been part of human history, but pandemics require a minimum density of population and an effective
means of transport. Since “Spanish” flu burst from the trenches of World War I in 1918, infecting 20 percent of the world’s
population and killing upward of 50 million people, fears of a similar pandemic have preoccupied public health practitioners,
politicians, and philanthropists. World War II, in which the German army deliberately caused malaria epidemics and the Japanese experimented with
anthrax and plague as biological weapons, created new fears. In response, the US Centers for Disease Control (CDC), founded in 1946 to control
malaria domestically, launched its Epidemic Intelligence Service in 1951 to defend against possible biological warfare, an odd emphasis given the
uncontrolled polio epidemics raging in the 1940s and 1950s in the United States and Europe. But in
the world of public health, the
latest threat often takes precedence over the most prevalent. According to the doctor, writer, and philanthropist Larry
Brilliant, “outbreaks are inevitable, pandemics are optional .” Brilliant, a well-known expert on global
health, ought to know, since he has had much to do with smallpox eradication . Smallpox, arguably the worst
disease in human history, caused half a billion deaths during the twentieth century alone. The strain called Variola major—the most lethal cause—killed one
third of all infected and permanently scarred all survivors. In 1975, Rahima Banu, a two-year-old Bangladeshi girl, became the last case of V. major smallpox.
Two years later, Ali, a twenty-three-year-old hospital cook in Somalia, became the last case of V. minor. Rahima and Ali survived. Smallpox did not.

Forty years later, smallpox is still the only disease affecting humans ever to have been eradicated. (Rinderpest, a virus affecting cows—
literally “cattle plague”—was eradicated in 2011.) There is optimism that polio and guinea worm may soon follow. Meanwhile, dozens
of new infectious diseases have emerged, including the pathogens behind the twenty-first-century
“pan-epidemics”—a term coined by Dr. Daniel Lucey to describe SARS, avian flu, swine flu, MERS, Ebola, and now Zika. The fear,
fascination, and financial incentives that these new diseases create divert attention and resources
from ancient diseases like cholera, malaria, and tuberculosis, which infect and kill far more people.
Ebola has caused relatively few deaths, while TB infects 9.6 million people each year and kills 1.5 million, and malaria infects more than
200 million, killing nearly half a million. (Ali, smallpox’s last survivor, later succumbed to malaria.) Zika virus was first discovered in
1947 in Uganda in monkeys bitten by forest mosquitoes. In recent years, monkeys have sought food outside the forests, and Zika virus
has diversified: its carriers now include Aedes aegypti, a tough mosquito with a preference for human blood and urban environments,
and it has spread to the Americas. A. aegypti also carries dengue, yellow fever, and West Nile virus, but it is the evolving pan-epidemic of
catastrophic birth defects that makes Zika particularly terrifying. In Brazil there have been 1,271 confirmed cases of microcephaly—
babies born with severely stunted brains, blindness, and other congenital defects. Cases identified in Colombia, French Polynesia,
Panama, Martinique, and Cabo Verde provide advance notice of the likely scale of the damage being wreaked. Zika provides a devastating
backdrop for Sonia Shah’s Pandemic: Tracking Contagions from Cholera to Ebola and Beyond. But far from opportunism, the book
represents six years’ work and considerable prescience on Shah’s part. A science writer and investigative journalist, she has a history of
taking the long view. Her last book, The Fever, describes how malaria, an ancient parasite acquired from apes, has affected humans for
half a million years, becoming a dominant influence on the success or failure of human efforts such as the colonization of North America.
The success of the slave trade, for example, depended on the malaria resistance developed over centuries in Africa.

As a doctor of pediatrics and public health, I have treated several hundred malaria patients on three continents during two decades,
managed UNICEF’s malaria program in Somalia for the Global Fund to Fight AIDS, Tuberculosis and Malaria, and even contracted malaria
myself. I wasn’t convinced I would learn much from Shah, nor did I have time for extraneous reading. Then last year, I found myself on
Idjwi, a remote island in the Democratic Republic of Congo, treating scores of seriously ill children with malaria. Lacking electricity for
lights, I read The Fever in the last hours of daylight after the clinic had closed. Shah’s synthesis of public health and politics, science and
social behavior, provided new insight into malaria’s systematic contagion of mankind. When light faded each evening I dodged
mosquitoes to take a brief bath in a lake infested with schistosomiasis, the second-most-common parasitic disease after malaria. Despite
Brilliant’s position that pandemics are optional ,
the prevailing view in global health is that pandemics are
inevitable. Shah’s thesis is that pandemics are the product of complex human behavior. In her view, development,
urbanization, and population growth transform harmless animal microbes into human pathogens .
Empire-building takes humans into animal habitats, while climate change caused by human
activity and deforestation forces animals into urban areas; industrial poultry, cattle, and pig
farms also bring humans into greater contact with animals . The “cholera paradigm” is a term coined by the
microbiologist Rita Colwell. It means that the environment—biological, social, political, and economic—is both the source and driver of
today’s emerging diseases in ways resembling the spread of cholera. Pandemics are caused by zoonoses—diseases
that “jump” from animals to humans. Historically, this was a slow process, requiring considerable personal contact.
Malaria took millennia to make the leap from primates to mankind. About ten thousand years ago, the dawn of agriculture
and the domestication of livestock led to new levels of intimacy between humans and animals,
which encouraged the emergence of our most familiar microbes. Cows gave us measles and TB;
pigs gave us pertussis; ducks gave us influenza. Shah notes that, like us, microbes undergo natural selection for survival.
Around the same time as the extinction of the smallpox virus, another virus was under threat. When the logging industry in Cameroon
reduced the chimp population, simian immunodeficiency virus jumped from chimps to humans —a consequential
choice since humans offered a host population of billions. When HIV appeared, rumors circulated of sexual congress between chimps and
people as the means of transmission. In fact, we have our most intimate contact with animals when we consume them. On this point,
Shah takes us to the wet markets of Guangzhou, China, where the SARS pandemic started in 2002. The markets flourished in the 1990s,
as the rising incomes among China’s
elite fed the demand for the wild game cuisine called yewei—including
swans, peacocks, snakes, and turtles. Animals that would never be seen next to one another in the wild were forced into
close proximity. Shah gets a good look at the scene in a market in Guangzhou—a turtle in a bucket
next to wild ducks and ferrets, snakes close to civets . This unnatural confinement and proximity
provides pathogens with the opportunities not only to mutate rapidly but also to jump species . The
virus causing SARS spread from horseshoe bats to raccoon dogs, snakes, and civets, mutating along
the way until it evolved sufficiently to infect humans. For centuries, cholera lived undisturbed in tiny crustaceans in
the Bay of Bengal, until the arrival of the East India Company in the 1760s. Fishermen and rice farmers colonized five hundred square
miles of wetlands, half-immersed in the natural habitat of the bacteria called Vibrio cholerae. Constant exposure to humans led to two
important mutations: first, Vibrio grew a long tail that allowed it to, in Shah’s words, “stick to the lining of the human gut like scum on a
shower curtain.” A second Vibrio mutation resulted in the toxin that causes massive diarrhea—and that makes cholera stool so
infectious.

In 1817, the first cholera pandemic started when Vibrio took advantage of the international traffic on the Spice Route. Since then, there have been seven
separate cholera pandemics and hundreds of millions of deaths. Cholera spreads twice as fast as Ebola and kills considerably more quickly. People without
detectable symptoms can carry the disease for several weeks, such as UN peacekeepers from Nepal who imported it into Haiti in 2010 with catastrophic and
ongoing consequences. Today, cholera infects roughly three million people each year and kills almost 100,000. The
seventh pandemic has
been underway since 1961 and shows no signs of abating. In less than two hundred years, cholera has
become the most successful and enduring of all pathogens . It is the ultimate traveler’s diarrhea. The cholera bacteria
colonized Europe during the second pandemic of 1829–1851. Europeans called it “Asiatic cholera,” assuming Western civilization would be immune. Echoes
of this complacency are seen in the modern response to Ebola, which was considered an African disease unworthy of investment until it arrived in Texas in
September 2014. Human arrogance was cholera’s advantage : Paris, for example, was completely unprepared for its arrival in March
1832. Bizarrely, in the evenings, the elite dressed up as corpses for “cholera balls,” the inspiration for Edgar Allan Poe’s “Masque of the Red Death.” Shah
writes that “cholera killed them so fast they went to their graves still clothed in their costumes”—a detail consistent with the typical onset of cholera’s
diarrhea after midnight, followed by massive dehydration and death within hours. By mid-April, cholera had killed more than seven thousand Parisians. Fifty
thousand fled, taking cholera with them. Thousands took advantage of the recently established transatlantic shipping service financed by the Bank of the
Manhattan Company, more familiar now as JPMorgan Chase. Many fled to Montreal. The Erie Canal, connecting the Hudson River to Lake Erie, had opened a
few years earlier, contributing to New York’s phenomenal commercial success. It also fast-tracked cholera’s journey from Montreal to Manhattan, where
conditions for its rapid spread were already in place. Shah describes those conditions in “Filth,” a chapter devoted to human excrement. She attributes the
decline in sanitation in the Middle Ages to the rise of Christianity. Hindus, Buddhists, Muslims, and Jews all have built hygiene into their daily rituals, but
Christianity is remarkable for its lack of prescribed sanitary practices. Jesus didn’t wash his hands before sitting down to the Last Supper, setting a bad
example for centuries of followers. Christians wrongly blamed plague on water, leading to bans on bathhouses and steam-rooms. Sharing homes with
livestock was normal and dung disposal a low priority. Toilets took the form of buckets or open defecation. The perfume industry, covering the stink, thrived.
During the seventeenth century, these medieval practices were exported to Manhattan, where wells for drinking water were only thirty feet deep, easily
contaminated by the nightly dump of human waste. Nineteenth-century New Yorkers tried to make their water palatable by boiling it into tea and coffee,
which killed cholera. But the arrival of tens of thousands of immigrants overwhelmed these weak defenses, and the city succumbed to two devastating
cholera epidemics. Corrupt economic gain, a recurrent theme in the history of cholera, is illustrated by the story of how a powerful Manhattan company—the
future JPMorgan again—was established by diverting money from public waterworks to 40 Wall Street. This resulted in half a century of unsafe drinking
water as the city abandoned plans to pump clean water from the Bronx and substituted well water from lower Manhattan slums. In a more recent case, the
2008 subprime mortgage collapse fostered by JPMorgan Chase and others in the banking industry left thousands of homes abandoned in South Florida. Their
swimming pools of stagnant water provided ideal breeding grounds when Aedes mosquitoes arrived in 2009 carrying dengue fever. In part as a result, this
tropical disease is now reestablished in Florida and Texas, transmitted by the same mosquito that carries yellow fever, West Nile, and Zika virus. Similarly
corrupt schemes by governments
have a long history of covering up infectious disease to avoid
interrupting trade or tourism. New York’s mayor and board of health denied there was a cholera epidemic in 1832. Italy hid the cholera
epidemic of 1911. Assad’s Syria concealed cholera outbreaks in 2008 and 2009. Mugabe’s Zimbabwe denied the 2008 cholera outbreak for months,
facilitating its spread to South Africa, Zambia, Mozambique, and Botswana. The Cuban government suppressed reports of its cholera outbreak in 2012.
While it is common knowledge that the Chinese government covered up initial reports of SARS in
2002, Shah reveals that the Saudi Arabian government tried to silence the doctor who reported mers, forcing him to resign and relocate to Egypt.
The structure of the World Health Organization (member states elect the same regional directors who must issue quarantines and
sanctions against them) lends itself to giving priority to governmental preferences over public health needs, illustrated by WHO’s
acquiescence to governmental cover-ups in reporting polio’s reemergence in Syria in 2013 and the Ebola outbreak in Guinea in 2014. The
cover-up in Zimbabwe was assisted by the United Nations, which has also consistently denied its role and responsibility in importing
cholera into Haiti. Shah’s book should be required reading for anyone working in global health. It should also alert a much wider
audience to the ways that many kinds of the microorganisms called pathogens have caused Western pandemics of chronic, or so-called
noncommunicable, diseases. Many of our most familiar diseases are set off or directly caused by
pathogens. Viruses lie behind at least 25 percent of all cancers. Cervical cancer, for example, the second-most-common cancer among
women worldwide, is caused by human papillomavirus (HPV). Infestation by the bacteria Helicobacter pylori is a common cause of
ulcers, but also causes gastric cancer and lymphoma. Epstein-Barr virus causes Burkitt’s lymphoma, leukemia, and gastric, breast, and
ovarian cancer. Hepatitis B and C cause liver cancer. Herpes virus can cause brain tumors and Kaposi’s sarcoma. Even psychiatric
diseases are linked to pathogens: a few years after influenza outbreaks, schizophrenia is more commonly diagnosed. Babies exposed to
flu and herpes in utero are at greater risk of autism. Lyme disease can cause depression and dementia. Moreover, the phenomenal
success of the HPV vaccine in protecting teenage girls from infection shows us that cervical cancer is a disease that can be prevented by
vaccine. H. pylori infestation is readily treated with two weeks of antibiotics and acid-blocking agents. The smallpox vaccine was
developed in 1796, but
it took 170 years and mandatory vaccination to eradicate this pox. Measles is
the most contagious disease on earth, and the measles vaccine the most cost-effective public
health intervention we have, but the false and financially motivated connection made in 1998
between the measles vaccine and autism has permanently damaged the eradication effort . The
consequence goes well beyond a global measles revival: several studies show that the measles vaccine, known as a live or attenuated
vaccine, also reduces child mortality from infectious diseases such as malaria, pneumonia, and pertussis by 30 to 80 percent. But that
effect lasts only until an inactivated vaccine is given—usually a diphtheria-pertussis-tetanus booster—at eighteen months. This suggests
that changing the childhood vaccination schedule could have deep effects. Universal measles vaccinations in adulthood might protect us
from Zika, future pathogens, even the viruses behind today’s cancer epidemics. It could also provide important protection for
populations in disaster and war, such as the millions in Syria, with immunity compromised by malnutrition, crowding, and contaminated
water.

Much of human history can be seen as a struggle for survival between humans and microbes. Pandemics are microbe
offensives; public health measures are human defenses. Water purification, sanitation, and vaccination are crucial to
our living longer, better, even taller lives. But these measures of mass salvation are not sexy. While we know prevention is
better and considerably cheaper than cure, there is little financial reward or glory in it.
Philanthropists prefer to build hospitals rather than pay community health workers. Pharmaceutical companies prefer the Western
market to the distant and poor Global South where people cannot afford to buy treatments. Education is a powerful social vaccine against
the ignorance that enables pathogens to flourish, but insufficient to overcome the corruption of public goods by private interests. The
current enthusiasm for detecting the next panic-inducing pathogen should not divert resources and research from the perennial threats
that we already have. We must resist the tendency of familiarity and past failures to encourage
contempt and indifference. The ideal in public health is to protect everyone. Shah explicates why as the rich get richer, the
poor get infectious diseases, and also reiterates that pathogens with the means to travel respect neither class nor
position. When it comes to susceptibility to new organisms and biological weapons, in a
hyperconnected world we are all vulnerable. The first case in a pandemic is most likely to emerge
from war and poverty. Current conflicts in the Middle East and Africa have created the biggest
population of refugees and displaced people since World War II—a flood of malnourished people
highly vulnerable to new and old pathogens. Investments in public health in those areas that are likely to be the source of
new pandemics will protect not only the 99 percent but also the one percent. Preventing pandemics requires pragmatic solutions—doing
what works—to protect people from infectious diseases. This means investing in a global supply of vaccines for cholera, hepatitis,
tuberculosis; funding local people to implement vaccination campaigns in the populations at risk; sterilizing mosquitoes, which would
help control not only Zika but also dengue, yellow fever, and malaria; and universal measles coverage. Such practical solutions are likely
to be cost-effective, as well as provide the broadest feasible protection against current and future pathogens.

U.S. aid towards China is key to fight pandemics on a large scale—the two countries
align in both their vulnerabilities and capabilities
Erickson '07 (Dr. Andrew S. Erickson, Assistant Professor in the Strategic Research
Department at the U.S. Naval War College in Newport, Rhode Island and a founding member of the
department’s China Maritime Studies Institute (CMSI). His research, which focuses on East Asian
defense, foreign policy, and technology issues, has been published in Comparative Strategy, Chinese
Military Update, Space Policy, Journal of Strategic Studies and Naval War College Review,
"Combating a Truly Collective Threat: Sino-American Military Cooperation against Avian Influenza",
Global Health Governance, published January 2007, ghgj.org/Erickson%20article.pdf, CL)
Avian influenza, poses a large and growing threat to international security. No nation is safe from the pandemic
influenza threat, and every nation is essential to defense efforts. In one indication of the importance of such efforts to international
economic stability, Robert R. Morse, Citicorp’s Asia-Pacific head, has stated, “ We do not view the possibility of avian flu
as an Asian issue, we view it as a global issue.” In response to this world-wide challenge, important progress has been
made already. At a major international conference to combat avian influenza, China’s Vice-Foreign Minister Qiao
Zonghuai noted that “…our destinies are interconnected. In the fight against avian influenza, no
country can stay safe by looking the other way .” Cooperation is vital to defend against pandemic
influenza. Robust partnerships involving the U.S., Japan, South Korea, Australia, New Zealand, ASEAN nations, other
Asia-Pacific allies, and nations around the world will be critical. Indeed, important progress has been made already. Several factors,
however, make China worthy of particular focus for U.S. policy makers and medical experts. China will
likely be at the center of a pandemic influenza crisis. It is home to some 800 million people who
live in close contact with over 15 billion poultry , and thus possesses a potential reservoir for the
incubation of avian influenza that is perhaps unequaled anywhere in the world. China also has “1,332
species of migratory birds, over 13 per cent of the world’s total.” The persistence of conditions analogous to those
detailed above over decades explains why “most flu pandemics in recorded history originated in
South China (e.g., 1918, 1957 and 1968).” China’s massive scale and vulnerable populations thus give it a unique importance in
disease control measures. Despite continuing challenges in relations between the United States and China,
therefore, no effort to stem the spread of infectious disease will be complete without cooperation
between what are respectively the world’s largest developed and developing nations . As two Asia-Pacific
nations potentially threatened by pandemic influenza, the United States and China have significant shared interests in the area of the
prevention of large-scale outbreaks of devastating infectious disease. The
two nations also share a strategic interest
in fighting other unconventional threats such as terrorism . Thanks to its largely apolitical and nonreligious
nature, the combating of pandemics, even more than counter-terrorism, offers common ground upon
which to build a basis for bilateral and multilateral cooperation. Given the important work that remains to be
done before effective cooperation between the United States and China can be fully realized, however, this essay will be devoted to
suggesting the extent to which the two great powers share an interest in combating avian influenza, and how robust collaboration
toward this end can more fully be realized.

Higher population movement and density makes the transfer of disease and the
emergence of pandemics increasingly lethal and uncheckable—goes global
Long ’11 (William Long, Professor and Chair at the Sam Nunn School of International Affairs
Georgia Institute of Technology, “Pandemics and Peace: Public Health Cooperation in Zones of
Conflict", published June 2011, CL)
The spread of avian influenza and other naturally occurring or man-made biological threats presents a
grave security and humanitarian threat regionally and globally ? Dramatic increases in the
worldwide movement of people, animals, and goods; growing population density; and uneven
public health systems worldwide are the driving forces behind heightened vulnerability to the
spread of both old and new infectious diseases.18 Since the global spread of the human immunodeficiency virus (HIV)
began in the early 1980s, twenty-nine new bacteria or viruses have been identified, many of which are capable of global reach.°
Commenting on this trend in 2007, the United Nations' World Health Organization warned, "Since the 1970s, newly
emerging
diseases have been identified at the unprecedented rate of one or more per year . . . . It would be
extremely naïve and complacent to assume that there will not be another disease like AIDS ,
another Ebola, or another SARS, sooner or later."" Senior World Health officials have noted that "inadequate
surveillance and response capacity in a single country can endanger national populations and
public health security of the entire world."2' With more than a million travelers flying across national boundaries every
day, it is not an exaggeration to say that a health problem in any part of the world can rapidly become a
health threat to many or 02—what one author calls the microbial unification of the world.23 The outbreak of severe
acute respiratory syndrome (SARS) in 2002 and 2003 demonstrated how a previously unknown but lethal virus could
spread by modern air transport, traveling from Hong Kong to Toronto in fifteen hours and
eventually reaching twenty-seven countries.24 The increased speed of transmission also means that contagion is
likely to be well established before governments and international organizations are aware of the
presence of the disease." SARS, in turn, focused attention on the ability of public health systems
worldwide to cope with an anticipated pandemic associated with the next major antigenic shift in the influenza A
virus. Although the influenza A virus mutates regularly (antigenic drift), every decade or so the virus undergoes a major change, or shift,
for which most people have little or no protection. The threat is magnified today by the ability of such diseases to spread worldwide very
rapidly." For example, since emerging in 1997, avian influenza—which to date has infected more than 400 people and killed more than
200—could create, if it becomes capable of human-to-human transmission as a new influenza. A virus, a global pandemic of
unprecedented lethality. Avian influenza could, if it becomes capable of human-to-human transmission as SARS did in 2002, kill
somewhere between 200,000 to 16 million Americans. Countries
with less robust public health systems would
lose an even larger percentage of their population to such a disease.27 The relatively benign H1N1, or swine
flu, outbreak provides a harbinger of this future danger.

Kills millions—it’s the biggest threat to humanity

Boseley '16 (Sarah Boseley, health editor of the Guardian and has won a number of awards for
her work on HIV/Aids in Africa, including the One World Media award and the European section of
the Lorenzo Natali prize, awarded by the European commission "Millions could die as world
unprepared for pandemics, says UN", The Guardian, February 8,
https://www.theguardian.com/society/2016/feb/08/millions-could-die-as-world-unprepared-for-
pandemics-says-un, CL)
A global epidemic far worse than the Ebola outbreak is a real possibility and could kill many
millions if the world does not become better prepared to deal with the sudden emergence and
transmission of disease, the UN has said in a hard-hitting report. The report has emerged in draft
form, as experts rally to deal with the rapid spread of the Zika virus across Latin America, which has
been linked to thousands of cases of brain damage in babies. Countries in the region have again
been caught off-guard because of the lack of scientific knowledge about the virus and the absence
of good data on microcephaly, a condition in which babies’ heads fail to grow properly in the womb.
The report comes from the high-level panel on the global response to health crises, set up by the UN
secretary general in April 2015, as the Ebola epidemic that killed more than 11,000 people finally
waned. Several other inquiries into what occurred, and the slow and inadequate response by the
World Health Organisation (WHO), have reported and fed into the UN panel’s conclusions. “The
high risk of major health crises is widely underestimated , and … the world’s preparedness and
capacity to respond is woefully insufficient. Future epidemics could far exceed the scale and
devastation of the west Africa Ebola outbreak,” says the panel’s chair, Jakaya Mrisho Kikwete from
Tanzania, outlining their findings in the preface.
“Too often, global panic about epidemics has been followed by complacency and inaction . For example,
the 2009 influenza pandemic prompted a similar review of global preparedness, but most of its recommendations were not addressed.
Had they been implemented, thousands of lives could have been saved in west Africa. We owe it to the victims to prevent a recurrence of
this tragedy.” The report, which has been posted online in advanced, unedited form in the UN’s Daily Journal, is not just about the
mishandling of Ebola, but about the crucial need for the world to put in place systems to detect and fight
new disease threats. “Notwithstanding its devastating impact in west Africa, the Ebola virus is not the most
virulent pathogen known to humanity,” says the report. “Mathematical modelling by the Bill and Melinda Gates
Foundation has shown that a virulent strain of an airborne influenza virus could spread to all major global
capitals within 60 days and kill more than 33 million people within 250 days .” Other diseases that have
recently caused widespread suffering include four major outbreaks of Middle East Respiratory Syndrome (Mers) in Saudi Arabia and the
Republic of Korea, the pandemics
of avian and swine flu and severe acute respiratory syndrome (Sars). “These all
serve as stark reminder of the threat to humanity posed by emerging communicable diseases ,”
says the report. The panel says surveillance and response to outbreaks must be led by the WHO, but the key role should be played by a
centre for emergency preparedness and response. The centre “must have real command and control capacity”, says the report, and it
should have the best technology available to identify, track and respond to an emerging threat. The report also says countries must
report on their state of compliance to WHO every year and must be regularly reviewed. All countries must give the WHO more money,
says the report – an increase of at least 10% in their funding. In addition, they must put $300m for a contingency fund for emergencies,
not $100m as recently set up. A further fund worth $1bn must be set up for the development of vaccines, drugs and testing equipment.
Prof Jeremy Farrar, director of the Wellcome Trust, said: “Epidemic and pandemic diseases are among the greatest
of all threats to human health and security, against which we have for too long done too little to
prepare. After four inquiries into the preventable tragedy of Ebola, there is now a strong consensus about what must be done. The
WHO’s leadership and member states must make 2016 the year of decision and act now to build a more resilient global health system.
“As the UN panel and the other inquiries recommend, the cornerstones of better health security must be a strong,
independent WHO centre to lead outbreak preparedness and response, new mechanisms and financing for developing vaccines, drugs
and diagnostics for potential epidemic threats, strong community engagement and investment in basic health
infrastructure in every country, not just those that can afford it.”

Extinction
Meyer 5/2 (Robinson Meyer, associate editor and writer for The Atlantic, "Human Extinction
Isn't That Unlikely", The Atlantic, May 2, readersupportednews.org/news-section2/318-66/36639-
human-extinction-isnt-that-unlikely, CL)
Yet natural pandemics may pose the most serious risks of all. In fact, in the past two millennia, the only
two events that experts can certify as global catastrophes of this scale were plagues. The Black
Death of the 1340s felled more than 10 percent of the world population. Eight centuries prior, another epidemic of the Yersinia pestis
bacterium—the “Great Plague of Justinian” in 541 and 542—killed between 25 and 33 million people, or between 13 and
17 percent of the global population at that time. No event approached these totals in the 20th century. The twin wars
did not come close: About 1 percent of the global population perished in the Great War, about 3 percent in World War II. Only the
Spanish flu epidemic of the late 1910s, which killed between 2.5 and 5 percent of the world’s people, approached the medieval plagues.
Farquhar said there’s some evidence that the First World War and Spanish influenza were the same catastrophic global event—but even
then, the death toll only came to about 6 percent of humanity. The report briefly explores other possible risks: a genetically engineered
pandemic, geo-engineering gone awry, an all-seeing artificial intelligence. Unlike nuclear war or global warming, though, the report
clarifies that these remain mostly notional threats, even as it cautions: [N]early
all of the most threatening global
catastrophic risks were unforeseeable a few decades before they became apparent. Forty years before
the discovery of the nuclear bomb, few could have predicted that nuclear weapons would come to be one of the leading global
catastrophic risks. Immediately after the Second World War, few could have known that catastrophic climate change, biotechnology, and
artificial intelligence would come to pose such a significant threat.

Scenario 2 is the Economy

Another pandemic will devastate the economy more than 50% of current growth—
it goes global and disproportionately affects impoverished populations and creates
lasting changes in human behavior which spillover to other impacts
Begley '13 (Sharon Begley, senior science writer at various news correspondences including
Reuters, Newsweek, The Daily Beast, The Wall Street Journal, and regular public speaker for science
writing, neuroplasticity, science literacy at Yale University, the Society for Neuroscience, the
American Association for the Advancement of Science, and the National Academy of Sciences, "Flu-
conomics: The next pandemic could trigger global recession", Reuters, Jan 21,
www.reuters.com/article/us-reutersmagazine-davos-flu-economy-idUSBRE90K0F820130121, CL)
A high body count is not the only meaningful number attached to a pandemic. The potential cost of a global outbreak of
the flu or some other highly contagious disease, however ghoulish to calculate, is
essential for government officials and
business leaders to know. Only by putting a price tag on such an occurrence can they hope to
establish what containing it is worth. The financial damage by itself can be devastating. The
expense of major epidemics is evident every time a health agency totes up the cost of treating
infected people — the outlays for drugs, doctors' visits, and hospitalizations . But that spending is only the most
obvious economic impact of an outbreak.
Consider the effect on international airlines. During
the 2003 SARS (severe acute respiratory syndrome), which began in
southern China and lasted about seven months, business and leisure travelers drastically cut back on flying. Asia-Pacific carriers
saw revenue plunge $6 billion and North American airlines lost another $1 billion. The tourism
industry also took a beating. The net revenue of Park Place Entertainment, owner of Caesar's Palace in Las Vegas and other gambling
and hotel complexes, plunged more than 50 percent in the second quarter of 2003 compared with the year before, mainly
because Asian high rollers hunkered down rather than risk infection while traveling. Fear even hurt
businesses dependent on sales calls. AIG, which pulled almost 30 percent of its revenue from Asia back then, was
hobbled when the epidemic kept its agents from visiting potential customers.

indirect costs pushed the total SARS bill much higher . "The biggest
That's just the easily measured stuff; the
driver of the economics of pandemics is not mortality or morbidity but risk aversion, as people change
their behavior to reduce their chance of exposure ," says Dr. Dennis Carroll, director of the U.S. Agency for International
Development's programs on new and emerging disease threats. "People don't go to their jobs, and they don't go to
shopping malls. There can be a huge decrease in consumer demand, and if (a pandemic) continues long
enough, it can affect manufacturing " as producers cut output to align supply with lower demand. If schools are
closed, healthy workers may have to stay home with their children. People afraid of becoming
infected are less likely to go out to stores, restaurants or movies .
Most of China was essentially on lockdown in the first half of 2003 as the government did everything in its considerable power to
minimize human-to-human contact and, hence, the spread of SARS. Beijing was shut down tighter than at any time since
martial law was declared during the 1989 Tiananmen Square protests. Discos, bars, shopping malls, indoor sports
facilities, and movie theaters were closed, and 80 percent of the capital's five-star hotel rooms were vacant. By May
2003, Singapore Airlines had cut capacity 71 percent and put its 6,600-member flight staff on unpaid leave. Tourism to Singapore fell 70
percent, and the country's gross domestic product took a $400 million hit that year. From Asia, where the disease was largely confined,
the ripples spread in all directions. Toronto recorded 361 SARS cases and 33 deaths, and the World Health Organization issued an
advisory against traveling there — surely a factor in the $5 billion loss Canada's GDP suffered in 2003.

It's not surprising that a pandemic hurts businesses dependent on employees or customers moving
from point a to point b (as AIG and the airlines learned), but SARS also set back transport companies such as
FedEx (closed airports; fewer people doing business), telecom equipment-makers such as Nortel (vendors and customers
staying home) and cable-TV-box maker Scientific-Atlanta (multiple parts made in Asia). It even cut deeply into
profits for Estee Lauder, which under normal circumstances sells a lot of cosmetics in Hong Kong, Singapore and China, and in
duty-free airport shops. In our interconnected world, a farmer running a fever in Southern China can reduce the income of a baggage
handler in Frankfurt, and hence all the businesses that worker patronizes. " Within
hours or days, an event that starts
on one side of the world can establish itself on the other ," says Carroll. Lufthansa saw demand for flights to and
from the Far East tumble 85 percent that year, and grounded a dozen planes. With planes grounded, oil demand fell by
300,000 barrels a day in Asia, dinging the revenues of oil companies from Kuwait to Venezuela .
A COST BEYOND MEASURE? The World Bank estimated China's SARS-related losses at $14.8 billion , and
although the United States and Europe were largely spared its ravages, the pandemic reduced the global GDP by $33
billion. And here's a scary thought: As health crises go, SARS wasn't that bad: It killed just 916 people and
lasted well under a year. The Department of Health & Human Services estimates that the ho-hum seasonal flu is responsible for 111
million lost workdays each year in the United States. That's $7 billion in sick days and lost productivity. A global pandemic that
lasted a year could trigger a "major global recession," warned a 2008 report from the World Bank. If a pandemic were on
the scale of the Hong Kong flu of 1968-69 in its transmissibility and severity, a yearlong outbreak could cause world GDP to fall 0.7
percent. If we get hit with something like the 1957 Asian flu, say goodbye to 2 percent of GDP. Something
as bad as the 1918-
19 Spanish flu would cut the world's economic output by 4.8 percent and cost more than $3 trillion .
"Generally speaking," the report added, "developing countries would be hardest hit, because higher population
densities and poverty accentuate the economic impacts ." The majority of the economic losses
would come not from sickness or death but from what the World Bank calls "efforts to avoid infection: reducing
air travel … avoiding travel to infected destinations, and reducing consumption of services such
as restaurant dining, tourism, mass transport, and nonessential retail shopping."
The really bad news is that we may not be hearing all the bad news. Economists who study pandemics worry they
may be underestimating the financial toll because they haven't been considering all the
ramifications. "Research to understand the indirect costs of an epidemic has been growing, focusing on how to accurately
incorporate productivity losses and effects on economic activity," says Bruce Lee of the University of Pittsburgh Medical Center, where he
is an associate professor, director of the Public Health Computational and Operations Research Group, and an expert in the economics of
infectious diseases. Take workplace vaccination. Public health officials recommend it, but does it help the bottom line? Would targeted
shots bring a higher return on investment? Should employers vaccinate only their older employees? Or just those, say, in the shipping
department? Lee and colleagues found that for the 22 main occupations defined by the U.S. Bureau of Labor Statistics (legal,
management, food preparation, education, and 18 more), when the employer footed the bill, "employee vaccination was cost-saving for
the median wage" if contagion was on the low side (one case producing 0.2 to 0.6 additional cases). It was almost cost-neutral for low-
paid occupations, and a clear benefit for high-paid ones. The biggest payoff is for older workers, since they are more likely to
become ill and miss work if infected. As a result, "employers could gain money" by underwriting flu shots, Lee says,
adding that "a flu virus does not have to hospitalize or kill a lot of people to have a large effect on
society." Analyses of epidemic-related school closings can also inform policy. In 2009, as the H1N1 influenza (swine flu) epidemic
gathered force, the U.S. Centers for Disease Control and Prevention (CDC) as well as state and local public health officials considered
closing schools in order to reduce transmission of the virus. Taiwan did so, closing schools for one week.

Lee and colleagues analyzed what closing schools in Pennsylvania would cost. Reducing transmission of a virus saves
healthcare expenditures, not surprisingly, and averts deaths. "But closing a school has a lot of ripple effects," Lee says. "You not only have
teachers and staff not working, and having to make up the lost time in July, but parents have to stay home with their kids." Bottom line: It
would cost as much as $51,000 to avert a single case of a very transmissible flu. As a result of the Taiwan
school closings for SARS, one study found, 27 percent of households reported workplace absenteeism and 18 percent suffered an average
wage loss of five days' pay. A 2009 study by economists at the Brookings Institution analyzed the direct economic impact of closing
schools during a flu pandemic. Since about one-quarter of civilian workers in the United States have a child under 16 and no stay-at-
home adult, closing
all the nation's K-12 schools for two weeks would result in between $5.2 billion
and $23.6 billion in lost economic activity; a four-week closing would cost up to $47.1 billion
dollars — 0.3 percent of GDP. "Those are only the first-order effects," says Ross Hammond, who led the Brookings study.
"There are also multiplier effects from a multibillion-dollar decline in economic output." He looked only
at lost wages, but people whose income falls because they don't work for several weeks don't spend as much, and the people who don't
receive that spending cut their own in turn. In addition, he said, "The
decrease in supply of some goods as factories
run at less than full capacity might lead to inflation." Also tricky is deciding how to account for outbreak-related
spending. For instance, Hong Kong spent $1.5 billion on a "We love HK" campaign to get residents out of their homes, facemasks in place.
Note that such economic activity counts toward GDP. Similarly, hospital charges, doctors' fees, medication, and other epidemic-related
costs add to GDP.

A pandemic causes economic decline and politically destabilizes countries—only

cross-country collaboration can solve
Long ’11 (William Long, Professor and Chair at the Sam Nunn School of International Affairs
Georgia Institute of Technology, “Pandemics and Peace: Public Health Cooperation in Zones of
Conflict", published June 2011, CL)
Global economic and political stability could fall victim to a pandemic too. Today, nations must
provide for their citizens' health and well-being and protect them from disease. Health provision has
become a primary public good and part of the social contract between a people and its government."
Accelerating transnational flows, especially pathogens, can stress and could overwhelm a state's capacity to
meet this essential function. Weak states could fail economically or politically, thereby creating regional instability and a
breeding ground for terrorism or human rights violations." Statistical studies reveal that declining public health
substantially increases the probability of state failure, 30 and historical examples of the correlation
between disease outbreak and political instability and violence extend from the fall of ancient
Athens to recent violence in Zimbabwe. Even in the strongest states, leaders must be prepared, in an integrated
way, to respond to the full spectrum of biological threats that could impede essential social functions such
as food supply, transportation, education, and workforce operation and result in huge economic
costs.31 Reducing the danger of influenza or other infectious diseases requires a focus on preparedness and monitoring. Rapidly
identifying the problem, sharing information, and coordinating response are each critical to limiting the perils of pathogenic threats.
Although the peril is great, so too is the promise of building cooperation through regional
disease surveillance, detection, and response. Here is the positive potential of globalization: it can
facilitate the rapid response to health challenges by quickly mobilizing health professionals,
medicines, and supplies, and by deploying information technology for disease surveillance and
sharing best health practices across nations .32 These exchanges, between neighboring states and even between
traditional adversaries, could contribute to reducing disparities in health and help improve regional relations. Armed with a theoretical
understanding of the basis for such cooperation, the regional and international practitioner and policy communities can respond more
effectively to this critical transnational security and humanitarian concern.

Economic decline causes nuclear war and extinction

Kemp ’10 [Geoffrey Kemp, Director of Regional Strategic Programs at The Nixon Center, served
in the White House under Ronald Reagan, special assistant to the president for national security
affairs and senior director for Near East and South Asian affairs on the National Security Council
Staff, Former Director, Middle East Arms Control Project at the Carnegie Endowment for
International Peace, 2010, “The East Moves West: India, China, and Asia’s Growing Presence in the
Middle East”, p. 233-4, CL)
The second scenario, called Mayhem and Chaos, is the opposite of the first scenario; everything
that can go wrong does go
wrong. The world economic situation weakens rather than strengthens, and India, China, and Japan suffer a major
reduction in their growth rates, further weakening the global economy. As a result, energy demand falls
and the price of fossil fuels plummets, leading to a financial crisis for the energy-producing
states, which are forced to cut back dramatically on expansion programs and social welfare. That in
turn leads to political unrest: and nurtures different radical groups , including, but not limited to, Islamic
extremists. The internal stability of some countries is challenged , and there are more “failed states.”
Most serious is the collapse of the democratic government in Pakistan and its takeover by Muslim extremists, who then
take possession of a large number of nuclear weapons . The danger of war between India and Pakistan increases
significantly. Iran, always worried about an extremist Pakistan, expands and weaponizes its nuclear program. That further enhances
nuclear proliferation in the Middle East, with Saudi Arabia, Turkey, and Egypt joining Israel and Iran as nuclear states. Under
these circumstances, the potential for nuclear terrorism increases, and the possibility of a nuclear
terrorist attack in either the Western world or in the oil-producing states may lead to a further
devastating collapse of the world economic market, with a tsunami-like impact on stability. In this scenario, major
disruptions can be expected, with dire consequences for two-thirds of the planet’s population.
 1AC Soft Power Advantage
U.S. soft power needs help now but not yet collapsing
Gasana '15 (Parfait Gasana, assistant director of the Center for Peace, Democracy, and
Development at the University of Massachusetts Boston's McCormack Graduate School of Policy
and Global Studies, co-founder and board president of the Kigali Reading Center, "The Decline of
America’s Soft Power", CPDD, December 24, blogs.umb.edu/paxblog/2015/12/24/the-decline-of-
americas-soft-power/, CL)
Joseph Nye, distinguished professor of service and former dean of the Harvard Kennedy School of Government, famously said the
following: “Soft power is the ability to affect others to obtain the outcome you want” (Nye). In a world that
is experiencing a spike in terrorist activities with spectacular displays of cruelty, soft power is politically harder to sustain but even more
essential for effective governance. For the U.S., recent rhetoric on the campaign trail (Donald Trump suggested that all Muslims be
banned from entering the U.S., or Ted Cruz who suggested that they carpet bomb areas that pose a threat to the U.S.) threaten more than
just America’s loss of leadership in rallying the world in the fight against terrorism. Politics like this will alienate Arab countries; without
whom the war on terror is already lost. There is no doubt that America maintains an edge over all other countries in
the world in
terms of military might. The U.S. Defense budget is estimated at $585.2 Billion for fiscal year 2016, while that of
Russia is estimated to be at $50 Billion in 2016.
However, American leadership is only effective when the U.S.
successfully deploys both military and diplomatic tools at its disposal. Failure to strategically
deploy these tools undermines U.S leadership and prevents it from building bridges of trust. This is
even more important after America’s military involvement in Iraq, Afghanistan, Libya and other Muslim countries. The toxic and
inflammatory rhetoric seen recently on the campaign trail threatens America’s ability to gain a diplomatic upper hand. The
U.S.
should be doing more to boost its public diplomacy efforts, not undermine them . This is important because
as Nye states, “soft power is a staple of daily democratic politics ” (Nye). With more than 9000 air strikes in Syria and
Iraq since the campaign against ISIL begun, coupled with ISIL’s ability to still recruit, gain sympathizers in Western capitals, loosing the
public diplomacy battle is a strategic blunder that should not be allowed to happen. Yet, this is exactly what the crop of republican
candidates have offered in their language on the fight against terrorism. One of the central components of soft power, according to Nye, is
its foreign policy (Nye). America’s
foreign policy as it currently stands has indisputably challenged its
diplomatic leverage. In many countries, the U.S. has lost its “legitimate… moral authority” (Nye). Perceptions matter and
how one is perceived can be the deciding factor in politics . Those who witnessed the debate between Kennedy
and Nixon would remember his perspiring face next to the calm and well-controlled Kennedy. Kennedy was perceived by many to be
ready and charismatic, while Nixon looked uncomfortable and unprepared. With the rising threat of lone wolves, the ability of non-state
actors including terrorists groups to use social media to recruit in the West, how can the U.S. build its soft power to counter the message
of hate and terror? The divisive rhetoric and at times outright racist comments made by some republican candidates for the White House
can only contribute to a decline in America’s soft power, and, by extension, a less safe world. It would be wise for the likes of Donald
Trump, Ted Cruz, Carly Fiorina, and others to think beyond the primaries, and even the general election to what kind of a world they
would face on day one after taking office should they be elected. Would it be a world ready to welcome and partner with the new U.S
leadership, or one that sees the U.S as seeking to antagonize them? The
complexity of current global governance
issues require consensus building, and the broadening of coalitions as the Paris Climate talks demonstrated.
As we push deep into the 21st century, successful leaders are going to be those who can appreciate
international trends such as the increasing power of social media and non-state actors, and the challenges these pose to
traditional governing bodies. In such a world, a wise leader would pay just as much attention to the power and
effectiveness of public diplomacy, as they would that of military capabilities.

U.S. soft power key to solve multiple scenarios for extinction

Hamre ‘07 (John Hamre, specialist in international studies, a former Washington government
official and President and CEO of the Center for Strategic and International Studies, “Restoring
America’s Inspirational Leadership.” Forward, CSIS Commission on Smart Power, Center for
Strategic and International Studies,
http://csis.org/files/media/csis/pubs/071106_csissmartpowerreport.pdf, CL)
There is a moment of opportunity today for our political leaders to strike off on a big idea that balances a wiser internationalism with the
Americans are unified in wanting to
desire for protection at home. Washington may be increasingly divided, but
improve their country’s image in the world and their own potential for good. We see the same hunger in
other countries for a more balanced American approach and revitalized American interest in a broader range of issues than just
terrorism. And we hear everywhere that any serious problem in the world demands U.S.
involvement. Of course, we all know the challenges before us. The center of gravity in world affairs is shifting to Asia. The threat
America faces from nuclear proliferation, terrorist organizations with global reach, and weak and
reckless states cannot be easily contained and is unlikely to diminish in our lifetime. As the only
global superpower, we must manage multiple crises simultaneously while regional competitors
can focus their attention and efforts. A globalized world means that vectors of prosperity can quickly become vectors of
insecurity. These challenges put a premium on strengthening capable states, alliances, partnerships,
and institutions. In this complex and dynamic world of changing demands, we greatly benefit
from having help in managing problems. But we can no longer afford to see the world through only a state’s narrow
perspective. Statehood can be a fiction that hides dangers lurking beneath. We need new strategies that allow us to
contend with non-state actors and new capabilities to address faceless threats—like energy insecurity, global
financial instability, climate change, pandemic disease —that know no borders. We need methods and
institutions that can adapt to new sources of power and grievance almost certain to arise. Military power is typically the
bedrock of a nation’s power. It is understandable that during a time of war we place primary emphasis on military might.
But we have learned during the past five years that this is an inadequate basis for sustaining
American power over time. America’s power draws just as much from the size of its population
and the strength of its economy as from the vitality of our civic culture and the excellence of our
ideas. These other attributes of power become the more important dimensions. A year ago, we
approached two of our trustees—Joe Nye and Rich Armitage—to chair a CSIS Commission on Smart Power, with the goal of issuing a
report one year before the 2008 elections. We imposed the deadline for two reasons. First, we still have a year with the Bush presidency
wherein these important initiatives can be furthered. Second, looking ahead to the next presidency, we sought to place before candidates
of both parties a set of ideas that would strengthen America’s international standing. This excellent commission has combined that
essential American attribute—outlining a truly big idea and identifying practical, tangible actions that would help implement the idea.
How does America become the welcomed world leader for a constructive international agenda for the twenty-first century? How do we
restore the full spectrum of our national power? How do we become a smart power? This report identifies a series of specific actions we
recommend to set us on that path. CSIS’s strength has always been its deep roots in Washington’s defense and security establishment.
The nature of security today is that we need to conceive of it more broadly than at any time
before. As the commission’s report rightly states, “Today’s central question is not simply whether we are capturing or killing more
terrorists than are being recruited and trained, but whether we are providing more opportunities than our enemies can destroy and
whether we are addressing more grievances than they can record.” There is nothing weak about this approach. It is pragmatic, optimistic,
and quite frankly, American. We were twice victims on 9/11. Initially we were victimized by the terrorists who flew airplanes into
buildings and killed American citizens and foreigners resident in this country. But we victimized ourselves the second time by losing our
national confidence and optimism. The
values inherent in our Constitution, educational institutions,
economic system, and role as respected leader on the world stage are too widely admired for
emerging leaders abroad to turn away for good. By becoming a smarter power, we could bring
them back sooner. What is required, though, is not only leadership that will keep Americans safe
from another attack, but leadership that can communicate to Americans and the world that the
safety and prosperity of others matters to the United States. The Commission on Smart Power members have
spoken to such a confident, inspiring, and practical vision. I am sure they will not be the last.

Public health diplomacy has become an important driver for soft power
Brown et al. 13 (Matthew Brown, Bryan A. Liang, Braden Hale, and Thomas Novotny, Senior
Advisor at Office of Global Affairs, US Department of Health and Human Services - US Department of
Health and Human Services, “China's Role in Global Health Diplomacy: Designing Expanded U.S.
Partnership for Health System Strengthening in Africa”, Global Health Governance, Volume 6, No. 2,
CL)
First, it
is important to understand how geopolitical relations among nations now involve critical
multi-sectoral actions in health and foreign policy. This may be thought of as ‘global health diplomacy’.
Global health diplomacy, as characterized by Adams and Novotny in 2007, refers to “tools of diplomats and statecraft
[that] can be employed for the dual purposes of improving health and relations among nations .”28
Jones later described this concept as a useful perspective for diplomats in the U.S. Department of State,29 and by Fidler who suggested
that mapping relations among state and international actors can help identify areas of shared
interest and assist in forming plans for collective action in global public health .30 The July 2012 U.S.
Department of State (DOS) announcement of the formation of an S/GHD, at the same time announcing the closure of the coordinating
office for President Obama’s Global Health Initiative (GHI), launched in May 2009, illustrates the importance the U.S. government places
on this perspective.31 According to the announcement, the new S/GHD will champion the original GHI principles, programs, and
interagency coordination activities, but will focus this health activity within the diplomatic sector.32 While the office has yet to publish a
plan of action, it has identified priorities and actions, and its establishment in the DOS under Ambassador Eric Goosby (Global AIDS
Coordinator) is unique and notable. Diplomats
represent the policy interests of their government to other
foreign governments and multi-national organizations and have not traditionally been given a
mandate to address public health issues. According to requirements set forth in the 1961 Vienna Convention on
Diplomatic Relations, the cornerstone of modern international relations guiding diplomatic interaction among the 193 member states of
the United Nations (UN),33 the United States regularly publishes a list of accredited foreign diplomats (the ‘Diplomatic List’).34 A review
of the Diplomatic List for Winter 2012 shows that only seven of the more than 180 countries accredited to the United States have
diplomats with the word “health” in their title.35 No other country has established an entity similar to the S/GHD which will, according
to its founding principles, champion global health in the diplomatic arena.36 The
establishment of S/GHD itself
presents new opportunities in strategic health cooperation among donor nations.

Pandemic control is the cornerstone for diplomacy and is the most effective starting
point
Long ’11 (William Long, Professor and Chair at the Sam Nunn School of International Affairs
Georgia Institute of Technology, “Pandemics and Peace: Public Health Cooperation in Zones of
Conflict", published June 2011, CL)
As noted, the
fight against infectious disease spread occurs on many levels: global, pan-regional,
subregional, and national and these initiatives are interdependent. Chapter 2 introduces the global and pan-
regional frameworks for fighting infectious disease and analyzes in-depth the working of three intriguing subregional infectious disease
control networks. National
policies are also critical in infectious disease control and, as discussed at length in
chapter 5, no nation is more important than the United States in this respect. The
United States, as a leader in both
medical and information technology, is well situated to strengthen public health systems abroad
and indirectly support regional health cooperation as a peaceful and positive dimension of its
global health diplomacy and a frontline defense of its own population from the threat of infectious
diseases, outbreaks of which typically begin in the developing world. Beyond terrorism, disease
surveillance and response provides the United States an opportunity to address a critical
national and transnational problem. Indeed, because it is largely apolitical and nonreligious, combating
pandemics, more than counterterrorism, may offer a basis on which to build better bilateral
relations and lay a foundation for regional cooperation . The U.S. government could, by helping prevent the political
and social discord and the personal suffering wrought by pandemic disease, win the good will of both foreign governments and peoples.
To date, some domestic actors—notably the U.S. Centers for Disease Control and Prevention (CDC), the U.S. Department of Defense
(DOD), and the United States Agency for International Development (USAID)—have participated indirectly in support of some of these
subregional networks by their assistance to infectious disease surveillance and response capacity abroad. Chapter 5 analyses in detail the
programs of the U.S. government explicitly designed to bolster foreign capacity in infectious disease control within the larger context of
America's global health diplomacy. It asks whether the policies and the institutional arrangements of the U.S. government are enough to
fully meet the challenge that infectious disease spread poses to national and international security and whether the United States is doing
all it should to maximize the potential diplomatic benefits to be had from its policies.

Public health cooperation can spillover to sociopolitical cooperation in a multiplicity

of other global issues—solves terrorism, environmental challenges, resource
scarcity, human rights, and economic stability
Pierannunzi and Sturma '11 (Meg Pierannunzi and Allison Sturma, writers and primary
contacts at the USIP, "Global Health Diplomacy Can Foster International Cooperation", United States
Institute of Peace, June 1, www.usip.org/publications/global-health-diplomacy-can-foster-
international-cooperation, CL)
(Washington) – The United States Institute of Peace releases Pandemics and Peace: Public Health Cooperation in Zones
of Conflict, a new study revealing lessons in infectious disease control and international health cooperation. Identifying infectious disease
as a first-order problem affecting the security and welfare of the international system, author William J. Long explores
the extent
to which public health cooperation can lead to new and improved forms of transnational political
cooperation in a host of important areas, such as counterterrorism, environmental challenges,
resource management, human rights protection, and economic assistance . Long focuses on three unexpected
cases of cooperation to prevent such diseases as bird flu and swine flu among countries with historic or present antipathies and in
resource-constrained environments: the Mekong Basin, Middle East, and East Africa. He demonstrates how interests,
institutions, and ideas can align to allow interstate cooperation even in unfavorable
environments. He provides analytical frameworks for practitioners grappling with transnational problems and generates working
propositions on what makes new forms of public-private governance effective and legitimate. U.S. policies in the area of
infectious disease control are little known, and this book outlines the key players, policy initiatives,
and their impacts. Long contends that the United States, a leader in both medical and information
technology, is well situated to strengthen public health systems abroad and indirectly support
regional health cooperation as a peaceful and positive dimension of its global health diplomacy
and as a frontline defense of its own population from the threat of infectious diseases. As such,
the United States has an unparalleled opportunity to address a critical national and
transnational problem, deepen bilateral ties, foster regional and global cooperation and stability,
and burnish America’s image globally. Long calls for an expansion—both in actual resources and
in interagency coordination—of U.S. global health policy in infectious disease control. “At their
current levels, U.S. support for foreign capacity in infectious disease control is shortchanging
American interests. Given the seriousness of the threat posed by the spread of infectious disease
and the vast potential for goodwill to be had from U.S. support for overseas surveillance and
response capacity, this policy area requires greater U.S. commitment of funds and expertise .” said
Long. “This study recommends a significant increase in the size of U.S. programs devoted to this
challenge. This is a particularly daunting goal in light of an extremely difficult budget climate, but it
is a critical step for U.S. security. In the context of overall U.S. global health expenditures, even an
increased expenditure on foreign capacity for infectious disease control would be only a small
fraction of America’s international public health budget but deliver significant security and
diplomatic returns on the investment.”
 1AC Plan
The United States Federal Government should offer to provide economic aid for pandemic control
with the People’s Republic of China.
 1AC Solvency
The United States and China need to develop the infrastructure together to combat
pandemic outbreaks—there are no costs and only a risk lack of action escalates
Erickson et. al ’10 (Andrew S. Erickson, Lyle J. Goldstein, Nan Li, “China, the United States,
and 21st Century Sea Power: Defining a Maritime Security Partnership”, p. 342-343, CL)
These significant challenges should not distract us from the larger issues at stake: that a significant
threat to humanity can be, and must be, averted. This collective responsibility requires
cooperation across national boundaries regardless of political differences. A sense of humility and
respect is vital for effective cooperation to be realized in practice, however. AS Dr. Liu observes,
Both China and [the] U.S. have the capacity to play leadership roles in the response to pandemic
outbreak. The U.S. and China need to build infrastructure for cooperation and coordination if joint
leadership and response is needed. At present, there are lots of exchanges; avian influenza experts
in the West already collaborate with their Chinese counterparts, and vice versa. But it needs to be
broadened and deepened. Again, if joint leadership and response is expected, ongoing scientific
collaboration needs to be applied to policy and command structures. A superiority complex on the
part of any country could jeopardize effectiveness when it comes to working together. Under time
pressure, the negative effects of such an attitude would be intensified. In this spirit, though
translation and analysis of Chinese sources, I have endeavored to increase awareness among
Western scholars, analysts, and policymakers of important Chinese developments and their
potential relevance to Sino-American cooperation against avian influenza. The bottom line is that
differences in other national interests should not prevent the United States and China—or, for
that matter, all other nations—from recognizing their growing collective interests in combating
emerging threats such as that of pandemic influenza. As Admiral Michael Mullen stated in 2005 as
U.S. Chief of Naval Operations, “in today’s interconnected world, acting in the global interest is
likely to mean acting in one’s national interest as well. In other words, exercising sovereignty and
contributing to global security are no longer mutually exclusive events.” And as a Chinese proverb
cautions, “disasters know no boundaries”

Public health policies are key to fighting pandemics –the U.S. is in a prime position
internationally to exercise “smart power” to improves relations and foster regional
stability, but it must be in the form of material assistance or training
Long ’11 (William Long, Professor and Chair at the Sam Nunn School of International Affairs
Georgia Institute of Technology, “Pandemics and Peace: Public Health Cooperation in Zones of
Conflict", published June 2011, CL)
In addition to the emerging subregional networks of cooperation focused on in earlier chapters and the pan-regional and global
organizations noted in chapter 2, the public health policies of states also play a critical role in the fight
against pandemics. This chapter examines in detail the policy of a key national actor, the United States, in the fight against
infectious disease spread. From the perspective of the United States, old and new infectious diseases present a major
danger to the health and welfare of its citizens and to its interests worldwide . By the same token, the
control of infectious disease also presents an unparalleled opportunity for U.S. leadership in global
public health that could deepen bilateral ties, foster regional cooperation and stability, and burnish
the U.S. image globally through the effective exercise of "smart power."' As a frontrunner in
health and information technology and the largest single contributor to global public health , the
United States can both enhance its national and international security and economic interests and
demonstrate its commitment to improving human welfare through the promotion of infectious
disease control systems abroad. Its record of successful participation in campaigns against infectious disease, such as
eradicating smallpox, reinforces its legitimacy in this domain.2 Rhetorically, protecting domestic and foreign populations from infectious
diseases has become a national priority, and the need to develop foreign capabilities in infectious disease detection and response has
received explicit presidential endorsement. In 1996, President Clinton's Decision Directive NSTC-7 "established a national policy to
address the threat of emerging infectious diseases through improved domestic and international surveillance, prevention, and response
measures."3 In introducing the new national policy to the public, then vice president Al Gore underscored that the
directive
instructs the U.S. government, particularly CDC, USAID, and DOD, to work with other nations
and international organizations to establish a global infectious disease surveillance and response system, based on regional hubs and
linked by modern communications technologies .4 Shortly after taking office, President Obama
announced a new global
health initiative that would adopt an integrated approach to fight the spread of infectious diseases while
addressing other global health challenges.' The president emphasized America's military leaders have echoed these
sentiments. In November 2009, the National Security Council document "National Strategy for Countering Biological Threats" reinforced
the importance of strengthening foreign capacity in detecting and responding to infectious disease outbreaks, because this capacity is of
equal importance in combating naturally occurring or man-made biological threats. President Obama noted that addressing the challenge
"requires a comprehensive approach that recognizes the importance of reducing threats from outbreaks of infectious disease whether
natural, accidental, or deliberate in nature."' Recognizing
multilateral partnerships to improve international
preparedness by helping countries establish "effective and sustainable systems for disease
surveillance, detection, diagnosis, and reporting." Despite consensus on the importance of the
issue and clear recognition that combating the threat of infectious diseases requires support for
public health systems abroad, U.S. policies designed to bolster foreign capacity in infectious disease
control have not kept pace with America's burgeoning global public health expenditures .
With regard to the finely wrought cooperative regional networks de-scribed in chapter 2 and analyzed in chapters 3 and 4 of this book,
the U.S. government role has been, and should remain, indirect . For example, U.S. governmental
material assistance and training has contributed to the development of substantial epidemiological capacity in
Thailand, which in turn is a locus of expertise for the Mekong Basin Disease Surveillance Network. Even though the role of U.S.
policy is most appropriately an indirect one of technical assistance and capacity building, this chapter
questions whether U.S. policies that indirectly foster regional cooperation and global capacity are enough to meet the challenge to its
interests and the opportunity for enhanced cooperation posed by the emergence and potential global spread of old and new infectious
diseases. If not, what changes in terms of policies, purse, or bureaucratic organization and coordination might better secure these
interests and opportunities? To explore these questions, this chapter identifies and describes four federal programs designed exclusively
to strengthen foreign capacity in infectious disease surveillance and response, considers their interagency and international
partnerships, and recommends ways to expand U.S. support for infectious disease control abroad.

The U.S. and China need to work together to build public health infrastructure in
order to avoid extinction level impacts
Erickson '07 (Dr. Andrew S. Erickson, Assistant Professor in the Strategic Research
Department at the U.S. Naval War College in Newport, Rhode Island and a founding member of the
department’s China Maritime Studies Institute (CMSI). His research, which focuses on East Asian
defense, foreign policy, and technology issues, has been published in Comparative Strategy, Chinese
Military Update, Space Policy, Journal of Strategic Studies and Naval War College Review,
"Combating a Truly Collective Threat: Sino-American Military Cooperation against Avian Influenza",
Global Health Governance, published January 2007, ghgj.org/Erickson%20article.pdf, CL)
These significant challenges should not distract us from the larger issues at stake: that a significant
threat to humanity can be and must be averted. This collective responsibility requires cooperation
across national boundaries regardless of political differences. A sense of humility and respect is
vital for effective cooperation to be realized in practice, however. As Dr. Liu observes. Both China
and [the] U.S. have the capacity to play leadership roles in the response to pandemic outbreak. The
U.S. and China need to build infrastructure for cooperation and coordination if joint leadership and
response is needed. At present, there are lots of exchanges: avian influenza experts in the West
already collaborate with their Chinese counterparts, and vice versa. But it needs to be broadened
and deepened. Again, if joint leadership and response is expected, ongoing scientific collaboration
needs to be applied to policy and command structures. A superiority complex on the part of any
country could jeopardize effectiveness when it comes to working together. Under time pressure,
the negative eiTects of such an attitude would be intensified.** In this spirit, through translation
and analysis of Chinese sources. I have endeavored to increase awareness among Western scholars,
analysts, and policymakers of important Chinese developments and their potential relevance to
Sino-American cooperation against avian influenza. The bottom line is that differences in other
national interests should not prevent the United States and China—or. for that matter, all other
nations—from recognizing their growing collective interests in combating emerging threats such as
that of pandemic influenza. As Admiral Michael Mullen stated in 2005 as U.S. Chief of Naval
Operations, "in today's interconnected world, acting in the global interest is likely to mean acting in
one's national interest as well. In other words, exercising sovereignty and contributing to global
security are no longer mutually exclusive events.”8 And as a Chinese proverb cautions, “disasters
know no boundaries".

The plan improves a global pandemic response and symbolizes a commitment to

collaboration
Erickson '07 (Dr. Andrew S. Erickson, Assistant Professor in the Strategic Research
Department at the U.S. Naval War College in Newport, Rhode Island and a founding member of the
department’s China Maritime Studies Institute (CMSI). His research, which focuses on East Asian
defense, foreign policy, and technology issues, has been published in Comparative Strategy, Chinese
Military Update, Space Policy, Journal of Strategic Studies and Naval War College Review,
"Combating a Truly Collective Threat: Sino-American Military Cooperation against Avian Influenza",
Global Health Governance, published January 2007, ghgj.org/Erickson%20article.pdf, CL)
In domestic, bilateral and international forums, the U.S. and China have already made
considerable, if preliminary, progress in combating avian influenza. In October 2005, for instance, Chinese
Minister of Health Gao Qiang signed an agreement with the U.S. Department of Health and Human Services to enhance cooperation on
avian influenza and other infectious diseases. On November 19, 2005, the United States and China announced a
“Joint Initiative on Avian Influenza,” through which the countries’ respective ministries of Health and Agriculture will
“strengthen cooperation” concerning vaccines, detection, and planning. Such bilateral measures could offer a model for
U.S. cooperation with other nations. At the January 2006 “Ministerial Pledging Conference for Avian Influenza,” attended by
700 representatives of over 100 nations, including the U.S., Chinese Premier Wen Jiabao stated that “China will continue to actively
participate in international cooperation in avian influenza prevention and control, share our experience with related countries and help
them fight avian influenza.” Paul Wolfowitz, president of the World Bank, emphasized, “By hosting this event in Beijing, the Chinese
Government is sending a powerful message … that we
urgently need a global commitment to share information
quickly and openly, and to find ways to work together effectively .” Such information exchange has already
been facilitated by a draft agreement signed on December 20, 2005, affirming China’s intention to share “virus samples isolated from
human H5N1 cases” with the WHO. At the end of the conference, representatives matched their words with substantive actions. The
World Bank agreed to contribute $500 million, the Asian Development Bank, $470 million, the U.S. $334 million and China $10 million. As
of October 2006, virtually all the $1.9 billion granted at the Pledging Conference had been committed. Other
examples of Sino-
American cooperation regarding pandemic preparedness include the Joint Science Academies’
Statement on avian influenza and infectious diseases, whose signatories include Lu Yongxiang of the Chinese
Academy of Sciences and Ralph Cicerone of the U.S. National Academy of Sciences. Noting that SARS caused as much as $30 billion in
economic damage, and affirming the accomplishments of the Beijing ministerial pledging conference, the
statement calls for
“coordinated actions on a global scale by a whole spectrum of stakeholders including
governments, scientists, public health experts, veterinary health experts, economists,
representatives of the business community, and the general public .” In order to ensure that these
recommendations are carried out, however, it is necessary to explore in depth the potential roles of
the U.S. and Chinese militaries in combating avian influenza. No pandemic disease prevention efforts will be
complete without the robust involvement of these two powerful and influential organizations. Given the U.S.
military’s strong presence throughout the Asia-Pacific region, as well as the abundance of relevant information thanks to its relative
transparency, its potential role in such efforts will now be examined in detail.

SQ can’t solve—the U.S. needs to reorient its approach towards health infrastructure
—we need to shift from symptom based approaches to tackling the root cause of the
problem
Long ’11 (William Long, Professor and Chair at the Sam Nunn School of International Affairs
Georgia Institute of Technology, “Pandemics and Peace: Public Health Cooperation in Zones of
Conflict", published June 2011, CL)
U.S. disease-specific support in the case of pandemic influenza, illustrates a second problem
with the focus of U.S. funding: the tendency to spend funds overwhelmingly on domestic
preparedness, rather than creating a front line of defense by detecting and controlling infectious
disease outbreaks at the source, that is to say primarily in Africa and Asia is as reflected in figure 7. When the United States
responded to the swine flu outbreak with a supplemental appropriation of more than $6.5 billion in 2009, for example, only $190 million
of that amount went to global measures, the balance spent largely on domestic defensive countermeasures.
Of course, domestic programs such as a vaccine stockpiling are essential to protect Americans, but
the issue is whether an
ounce of protection achieved by putting a higher priority on global overseas surveillance and
response capacity is worth a pound of domestically medical cure . In considering that question, a recent study by
the Center for Strategic and International Studies concluded that efforts to support overseas capacity in infectious
disease surveillance and response “will likely benefit U.S. national security more than U.S.-based
countermeasure efforts have to date while also working to improve health during times of peace.” Long-term
investments in support of surveillance programs overseas is an efficient way to support resource-poor countries as
they develop their national surveillance and overall public health infrastructure and to enhance
transnational capacity for disease control.
2AC’s
Case
Disease EXT
 SQ Insufficient
Despite efforts, countries aren’t prepared enough to combat the next
pandemic
Economist '13 (Economist, world news and issues, "Pandemic Preparedness: Coming, ready
or not", The Economist, April 20, www.economist.com/news/leaders/21576390-despite-progress-
world-still-unprepared-new-pandemic-disease-coming-ready-or-not, CL)
Despite progress, the world is still unprepared for a new pandemic disease . THE threat of a global pandemic
is rising again. In China an influenza virus never before seen in people had, as The Economist went to press, infected at least 82 and killed
17. Meanwhile a new type of coronavirus, the family that brought severe acute respiratory syndrome (SARS), is festering in the Middle
East. The risk of such an outbreak turning into a pandemic is low, but the danger, if it does, is huge: in 1918 50m-100m people were
killed by Spanish flu, compared with 16m in the first world war and 30m so far from AIDS. Fortunately, the world is better prepared for
an outbreak than ever before (see article). SARS in 2003, the H5N1 bird flu of 2005 and the H1N1 swine flu of 2009 have prompted
action. By 2011, 158 countries had pandemic-preparedness plans. America has poured money into the development
of new vaccines and antiviral drugs. Researchers have a better understanding of influenza and other risky pathogens.
Rapid amplification of DNA segments helps scientists identify viruses quickly. Full genomic sequencing allows them to explore worrying
strains. Mathematical models predict where a new disease might emerge and how it might spread. Going viral: Yet
all this may not
be enough. No one has yet managed to predict an influenza outbreak . H1N1 exposed many problems, from
the slow deployment of vaccines to simple breakdowns in communication. Thankfully that virus was not especially deadly. But an
independent commission, charged with reviewing the response of the World Health Organisation (WHO), issued a bleak assessment:
“The unavoidable reality is that tens of millions of people would be at risk of dying in a severe
pandemic.” Reducing that risk means, among other things, more government spending—an unwelcome prescription at a time of
austerity, but a necessary one, for protection against pandemics is a valuable public good . First, governments and
companies should continue to expand the availability of vaccines. America’s Biomedical Advanced Research and Development Authority
deserves praise for working with Novartis, GlaxoSmithKline and other drug firms to create new vaccines and faster ways of making them.
Such contracts often guarantee the American government a share of production. Some vaccines are donated to other countries. But poor
countries, in particular, need reliable access to vaccines. GlaxoSmithKline has signed a deal with the WHO to donate 7.5% of its vaccine
production to poor countries, in the event of a pandemic. More firms should follow suit. Second, governments
should
encourage more basic research on dangerous pathogens. In 2011 studies of mutations that might make H5N1
more contagious inspired global controversy—critics feared the papers would provide a cookbook for a biological attack. America
suspended funding of such projects, a moratorium that dragged on foolishly. Now officials are implementing new ways to
oversee research of dangerous viruses. Concern over security must not slow urgent work. Studying a deadly virus is risky.
Not studying it is riskier. Third, patent laws for viruses need reform. Last year a scientist in Saudi Arabia sent a sample of the coronavirus
to Ron Fouchier, a prominent academic in the Netherlands. Dr Fouchier then patented his sequencing of the virus’s genome. Saudi
officials, who did not authorise the shipment, were furious. America’s Supreme Court is currently hearing a case involving genome
patents (see article). A good starting-point would be that natural DNA cannot be patented, but therapies exploiting the discovery of
specific genes can be. Faced
with a distant but deadly threat, the world is not doing badly. But it needs
to be better prepared still, because viruses move a lot faster than governments do.
 Pandemic Coming
Pandemics are inevitable—our ignorance fuels its deadliness
Quammen '13 (David Quammen, writer, analyst and science researcher, "The Next Pandemic:
Not if, but When", New York Times, May 10, www.nytimes.com/2013/05/10/opinion/the-next-
pandemic-is-closer-than-you-think.html?_r=0, CL)
TERRIBLE new forms of infectious disease make headlines, but not at the start. Every pandemic begins small. Early
indicators can be subtle and ambiguous. When the Next Big One arrives, spreading across oceans and
continents like the sweep of nightfall, causing illness and fear, killing thousands or maybe
millions of people, it will be signaled first by quiet, puzzling reports from faraway places — reports
to which disease scientists and public health officials, but few of the rest of us, pay close attention . Such reports have
been coming in recent months from two countries, China and Saudi Arabia. You may have seen the news about H7N9, a new strain of
avian flu claiming victims in Shanghai and other Chinese locales. Influenzas always draw notice, and always deserve it, because of their
great potential to catch hold, spread fast, circle the world and kill lots of people. But even if you’ve been tracking that bird-flu story, you
may not have noticed the little items about a“novel coronavirus” on the Arabian Peninsula. This came into view last September,
when the Saudi Ministry of Health announced that such a virus — new to science and medicine — had been detected in three
patients, two of whom had already died. By the end of the year, a total of nine cases had been confirmed, with five fatalities. As of
Thursday, there have been 18 deaths, 33 cases total, including one patient now hospitalized in France after a trip to the
United Arab Emirates. Those numbers are tiny by the standards of global pandemics, but here’s one that’s
huge: the case fatality rate is 55 percent. The thing seems to be almost as lethal as Ebola.
Coronaviruses are a genus of bugs that cause respiratory and gastrointestinal infections , sometimes
mild and sometimes fierce, in humans, other mammals and birds. They became infamous by association in 2003 because the agent
for severe acute respiratory syndrome, or SARS, is a coronavirus. That one emerged suddenly in southern China, passed from
person to person and from Guangzhou to Hong Kong, then went swiftly onward by airplane to Toronto, Singapore and elsewhere.
Eventually it sickened about 8,000 people, of whom nearly 10 percent died. If not for fast scientific work to identify the virus and
rigorous public health measures to contain it, the total case count and death toll could have been much higher. One authority at the
Centers for Disease Control and Prevention, an expert on nasty viruses, told me that the SARS outbreak was the scariest
such episode he’d ever seen. That cautionary experience is one reason this novel coronavirus in the Middle East has attracted such
concern. Another reason is that coronaviruses as a group are very changeable , very protean, because of their
high rates of mutation and their proclivity for recombination: when the viruses replicate, their genetic material is
continually being inaccurately copied — and when two virus strains infect a single host cell, it is often intermixed. Such rich genetic
variation gives them what one expert has called an “intrinsic evolvability,” a capacity to adapt quickly to new
circumstances within new hosts. But hold on. I said that the SARS virus “emerged” in southern China, and that raises the
question: emerged from where? Every new disease outbreak starts as a mystery, and among the first things to be solved is the question
of source.

In most cases, the answer is wildlife. Sixty percent of our infectious diseases fall within this category,
caused by viruses or other microbes known as zoonoses. A zoonosis is an animal infection transmissible to
humans. Another bit of special lingo: reservoir host. That’s the animal species in which the zoonotic bug resides
endemically, inconspicuously, over time. Some unsuspecting person comes in contact with an infected monkey, ape,
rodent or wild goose — or maybe just with a domestic duck that has fed around the same pond as the wild goose — and a virus
achieves transcendence, passing from one species of host into another . The disease experts call that event a
spillover. Researchers have established that the SARS virus emerged from a bat. The virus may have passed through an intermediate
species — another animal, perhaps infected by cage-to-cage contact in one of the crowded live-animal markets of the region — before
getting into a person. And while SARS hasn’t recurred, we can assume that the virus still abides in southern China within its reservoir
hosts: one or more kinds of bat. Bats, though wondrous and necessary animals, do seem to be disproportionately implicated as reservoir
hosts of new zoonotic viruses: Marburg, Hendra, Nipah, Menangle and others. Bats gather in huge, sociable aggregations and have long
life spans, circumstances that may be especially hospitable to viruses. And they fly. Traveling nightly to feed, shifting occasionally from
one communal roost to another, they carry their infections widely and spread them to one another. As for the novel coronavirus in Saudi
Arabia, its reservoir host is still undiscovered. But you can be confident that scientific sleuths are on the case and that they will look
closely at Arabian bats, including those that visit the productive date-palm groves at the oases of Al Ahsa, near the Persian Gulf. What can
we do? The first obligation is informed awareness . Early reports arrive from afar, seeming exotic and peripheral, but
don’t be fooled. One emergent virus, sooner or later, will be the Next Big One. It may show up first in China, in Congo or Bangladesh, or
maybe on the Arabian Peninsula; but it will globalize. Most people on earth nowadays live within 24 hours’ travel time of Saudi Arabia.
And in October, when millions of people journey to Mecca for the hajj, the Muslim pilgrimage, the lines of connections among humans
everywhere will be that much shorter. We
can’t detach ourselves from emerging pathogens either by distance
or lack of interest. The planet is too small. We’re like the light heavyweight boxer Billy Conn, stepping into the ring with
Joe Louis in 1946: we can run, but we can’t hide.

Our relationship with disease depends on our response now

NPR '16 (NPR, top reporter on world news, "'Pandemic' Asks: Is A Disease That Will Kill Tens Of
Millions Coming?", NPR, February 22, www.npr.org/sections/health-
shots/2016/02/22/467637849/pandemic-asks-is-a-disease-that-will-kill-tens-of-millions-coming,
CL)
As public health officials struggle to contain the Zika virus, science writer Sonia Shah tells Fresh Air's Dave Davies that
epidemiologists are bracing themselves for what has been called the next "Big One" — a disease that
could kill tens of millions of people in the coming years . Citing a 2006 survey, Shah says, "the majority of ...
pandemic experts of all kinds, felt that a pandemic that would sicken a billion people, kill 165 million people
and cost the global economy about $3 trillion would occur sometime in the next two generations." In
her new book, Pandemic: Tracking Contagions from Cholera to Ebola and Beyond, Shah discusses the history and science of contagious
diseases. She notes that humans put themselves at risk by encroaching on wildlife habitats . "About 60
percent of our new pathogens come from the bodies of animals," she says. Shah adds that international travel is also a
factor in the spread of disease. "Air travel shapes our epidemics in such a powerful way that scientists can actually predict where and
when an epidemic will strike next just by measuring the number of direct flights between infected and uninfected cities," she says.
Looking toward the future, Shah says that epidemiologists
can do more to identify potential outbreaks before
they happen. But eliminating them altogether is another matter . "Our relationship to disease and
pandemics is really ... part of our relationship to the natural world," she says. "It's a risk we have to live
with."
On our first response to new pathogens: A lot of times when we talk about being more prepared in preventing pathogens from spreading
or preventing pandemics, what we're really talking about is first response, stepping up our first response, so that when we have
outbreaks of disease that our
hospitals are prepared and we have vaccines stockpiled and we are able to fly our experts around
really quickly to get to the scene of the outbreak, and things like that. But that's not
actually preventing these pathogens
from emerging and from causing outbreaks. That's kind of after the fire has started, then we rush
in with our fire extinguishers. But to really prevent them would mean stepping it way farther
back, and that is possible now, because ... we know there's certain places that have higher risk of
pathogens emerging, and we can do kind of active surveillance in those places by mapping the microbes that are there, by
surveilling people or animals who are more likely to spread or to have spill-overs of microbes into their bodies. ... We have more
advanced detection capacity now with genetic analysis and other kinds of ways that we can see where these invisible microbes are
spreading and changing. On how most of our pathogens come from animals: From bats, we got Ebola; from monkeys we got HIV, malaria,
most likely Zika, as well; from birds we got avian influenzas, all other influenzas as well, West Nile virus, etc. So it's when we invade
wildlife habitat or when we disrupt it in ways that brings people and animals into close contact, that their microbes start to spill over and
adapt to our bodies.

On the evolution of antibiotic-resistant bacteria: We've known since antibiotics were first developed that if we use them in ways that
were not medically necessary that it would lead to the evolution of resistant bacteria. And yet, in this country, 80
percent of our
antibiotic consumption is not medically necessary, it's done for commercial reasons. When we have livestock
farmers giving antibiotics in low doses to their animals because it fattens them, it helps them gain weight faster and that gets them to
market faster, so this is a commercial use. And that's the vast majority of the antibiotics that are consumed in this country are for that
reason. We've known this for years and we do have
an increasing problem with antibiotic-resistant
pathogens, which is a very serious problem where we're running out of these drugs to treat these
runaway infections, and we're on the cusp of entering an era when we have no more antibiotics that work for some of these bugs.
We need to use antibiotics more rationally. We don't do that now. That's sort of the hardest part of it that we need to do. But the other
part of it is we also need
to develop new antibiotics to keep up — these pathogens are always going to
evolve resistance eventually, so we always need to come up with new weapons to fight them.
On why incidents of Lyme disease are increasing: Lyme disease is caused by a bacteria that lives in rodents and is spread by ticks. Now in
the intact northeastern forest where Lyme disease first emerged, there used to be a diversity of different woodland animals there, like
chipmunks and opossums as well as deer and mice and other things, but as we spread our suburbs into the northeastern forest and we
kind of broke up that forest into little patchworks, we got rid of a lot of that diversity. We lost chipmunks, we lost opossums, and it turns
out that those animals actually control tick populations. The typical opossum destroys about 6,000 ticks a week through grooming, but
the typical white-footed mouse, which is what we do have left in those patchwork forests, a typical mouse destroys maybe 50 ticks a
week. So the fewer opossums you have and the more mice you have, the more ticks you have and the more likely it becomes that this
tick-borne pathogen will spill over into humans. And that's exactly what happened with Lyme disease and now with many other tick-
borne illnesses as well. On what scares virologists most: Novel
forms of influenza are what really keeps most
virologists up at night, because we are so good at spreading those around quickly, and it happens every year. We have a flu
pandemic every year, and now we're hatching all kinds of new kinds of flu viruses, mostly in Asia, and then they're spreading
across the globe, and we don't have immunity to some of those. Right now, a typical flu virus, the seasonal flu, will still kill a lot of people
every year and it's a real drain on our global economy. But we kind of put up with that, so if you had a new flu virus that even had a
slightly higher mortality rate, you could see a lot more death and destruction because so many people get the flu. Think about the 1918
flu, which killed maybe 100 million people, maybe more, estimates vary, but certainly huge numbers of people died from that flu .
The
mortality rate was like 1 percent, which isn't huge. It sounds like a small number, but when you think
about how many people get the flu, that adds up to a huge number of deaths. So these new kinds of
influenza, I think, are what virologists are most fearful of.
 Spreads Quickly
A modern outbreak spreads across the continents within a few days
Jha '13 (Alok Jha, Guardian reporter and science correspondent for ITV News and the author of
The Water Book: the Extraordinary Story of Our Most Ordinary Substance"A deadly disease could
travel at jet speed around the world. How do we stop it in time?", The Guardian, November 12,
https://www.theguardian.com/science/2013/nov/12/deadly-disease-modern-global-epidemic,
CL)
Walk past the endless rows of vegetables, past the dozens of stalls selling every possible part of a pig and, at
the centre of Cao Lanh city's market, a woman is doing a brisk trade in selling rats for food. Two cages swarm with them on
a table next to her. Live frogs are available too, and, on the floor near her stall is a box of sluggish snakes.
Chickens and ducks cluck and quack nearby. A faint smell of urine thickens air that is already
heavy from the previous night's rains. Rats are a staple source of meat in Vietnam, farmed and
sold much like any other livestock. The stallholder butchers the animals to order. Reaching into the cage she will grab an
animal by its tail, hit its head across a large stone, chop off its feet and head with a large pair of scissors, skin it, cut it into pieces and
the animal's blood ends up on her hands. Scores of
place everything into a small yellow plastic bag. Inevitably,
people are selling and butchering live animals, breathing the same air and in constant contact with the animals'
blood, urine and feces. This woman, and many others like her who work in the farms and abattoirs deep in southern Vietnam's
Mekong delta, are doing what they have done for generations. And now they are in the front line in a new scientific race to predict the
next pandemic. Of the roughly 400
emerging infectious diseases that have been identified since 1940, more
than 60% are zoonotic ie they came from animals. Throughout history this has been common. HIV originated in
monkeys, ebola in bats, influenza in pigs and birds. The rate at which new pathogens are emerging is on the rise, even
taking into account the increase in awareness and surveillance. Which pathogens will cross the species barrier next, and which one is the
greatest potential public health concern, is a subject of intense interest. A
modern outbreak, caused by a previously
unknown virus, could travel at jet-speed around the world, spreading across the continents in just
a few days, causing illness, panic and death.
Pathogens have transferred from animals to people for as long as we have had contact. The
ancient domestication of
livestock led to the emergence of measles, and further intensification of farming in recent decades has caused problems
such as the brain-wasting Creutzfeldt-Jakob disease, the human form of BSE. Expanding trade routes in the 14th century spread the rat-
borne Black Death across Europe and smallpox to the Americas in the 16th century. Today's
tightly connected world has
seen the spread of swine flu, Sars, West Nile virus and H5N1 bird flu. The biggest pandemic on record was
the 1918 Spanish influenza, which killed 50 million people at a time when the fastest way to travel the globe was by ship. In 2009
swine flu was the most recent pandemic that got public health officials concerned; first detected in April of that year in
Mexico, it turned up in London within a week. One of the most worrying recent outbreaks for scientists was the re-
emergence of the H5N1 bird flu virus in 2005. Jeremy Farrar, a professor of tropical medicine and global health at Oxford University and,
young girl came into the
until recently head of the university's clinical research unit in Vietnam, says he remembers the night a
children's hospital in Ho Chi Minh City with a serious lung infection . Initially, he thought that it might have
been Sars – a coronavirus that had first been identified in China in late 2002 and had spread rapidly to Canada among other places –
making its comeback. That was until he heard the girl's story from a colleague. "This is years ago and I remember the story as if it was
yesterday," he says. "She
had been playing with her duck, arguing with her brother. They had buried it when it
died and she had dug it up later to re-bury it somewhere she wanted to bury it ." The duck was the crucial
part of the evidence in determining that this was a new outbreak and Farrar says that for the next few hours, no one knew how bad it
would get. Would the girl's family come in during the night with infections? Would the nurses and doctors be affected? H5N1 did not
become the next Sars and was contained, although 98 people were infected and 43 died in 2005. It has not gone away, says Farrar, and is
still circulating in poultry and ducks in almost the whole of Asia, remaining a major concern for human cases, given how virulent it is
when people get infected.

A successful zoonotic pathogen manages to jump from an animal to a person, invades their cells,
replicates and then finds a way to transmit to other people . Working out which pathogens will make the leap – a
process called "spillover" – is not easy. A pathogen from a primate, for example, is more likely to spill over to humans than a pathogen
from a rat, which is more likely to do so than something from a bird. Frequency of contact is also important; someone working on a live
bird farm is more likely to be exposed to a multitude of animal viruses than someone living in a city who only sees a monkey in a zoo.
"The truth is, we really don't know how much of this happens," says Derek Smith, a professor of infectious disease informatics at the
University of Cambridge. "Much more is noticed today than was noticed 50 years ago and was noticed 50 years before that. There are
reasons to think this might be because we disrupt habitats and come into contact with animals we haven't been in contact with before.
We have different things that we do socially, perhaps, than we did in the past. But we also look harder." Viruses
and other
pathogens continually flow between species, often with no effects, sometimes mutating, once in
a while causing illness. This mixing is known as " viral chatter" and the more different species
come into regular close contact, the higher the chances of a spillover event occurring. "This is how
viruses have always worked, the big change is us," says Mark Woolhouse, a professor of infectious disease epidemiology at the University
of Edinburgh. "The big change happened probably several thousands of years ago when we became a crowd species and that gave these
viruses new opportunities which they hadn't had before in humans. Ever since then, from time to time a new virus has come along to
take advantage of this new, very densely populated, crowded species – humans – that it can now spread between much more easily. That
process is still happening; the viruses are still discovering us. We
like to think we discover viruses, but it's also the
viruses discovering us." Tracking what is moving between which species is the task of Stephen Baker's team, based at the Oxford
University clinical research unit in Ho Chi Minh City. Baker is an infectious disease biologist who co-ordinates the Vizions project and I
met him at his lab while I was making a Radio 4 documentary about the scientific hunt for the next big pandemic. His sampling teams
visit farms, markets and abattoirs across Vietnam to take regular blood from people at high risk of being subject to a spillover event. This
high-risk cohort, which will eventually number 1,000 people, will be monitored every six months and, if they ever turn up sick at a
hospital, Baker's team will get an alert. The sampling teams also take blood and faecal swabs from pigs, chickens, dogs, cats and rats and
anything else living nearby. During a trip to a smallholding near the Cao Lanh food market, Baker explains that it is at places like this,
where people are in regular and close contact with animals , that scientists will be able to get their first
hints of any spillovers that might become a bigger threat. The farm, which is typical of Vietnam and other parts of
south-east Asia, has a range of animals – pigs, ducks and free-range chickens. They are in close exposure to each other and any
farmworkers, too. The farms next door are only separated by lines of trees or small fences. As well as the farm animals, Baker's team also
do their best to sample wild animals in the vicinity, including civets, rats and bats, that can easily transport pathogens across wide
distances.
 Can’t Adapt
A pandemic is such a large shock that our systems can’t adapt fast enough to
prevent its spread
Jha '13 (Alok Jha, Guardian reporter and science correspondent for ITV News and the author of
The Water Book: the Extraordinary Story of Our Most Ordinary Substance"A deadly disease could
travel at jet speed around the world. How do we stop it in time?", The Guardian, November 12,
https://www.theguardian.com/science/2013/nov/12/deadly-disease-modern-global-epidemic,
CL)
As the scientific effort to build a front-line defence against pandemics gathers pace, authorities need protocols to handle and make
decisions on the information coming in. The detection of a potential pandemic virus needs scientific boots on the ground for surveillance,
but what happens if they spot something they think is dangerous? A decade ago, when Sars was breaking out in China, the country
restricted information and some people think this led to the outbreak lasting longer than it should have done. Things are different now,
says Farrar, who took up his new post as the director of the Wellcome Trust in October. "It really has changed out of all recognition in
that 10 years and large areas of the response mode is now reasonable, we've made progress. Sars was in Asia and Canada; coming
through to H5N1 we had learned a little bit and improved but there were still gaps; coming through to H7N9, which is another new virus
emerging which humans do not have any immunity to in China this year, the Chinese response has been exemplary. As soon as it
emerged, it was picked up, the information was communicated both privately and publicly to everybody who needed to know about it.
They should be applauded, they did do a great job." This does not mean public health cannot be improved to deal with
potential new threats. The World Health Organisation is nominally in charge when a pandemic is looming and Farrar says its
greatest strength is that it represents so many states. But that could also be its greatest weakness: " Because it always has to
reach a compromise everybody can sign up to. We now have the international health regulations where it's mandatory
that countries report new events. My view is that those regulations were, in the end, a compromise that didn't go as far as anybody,
including the WHO, would want in terms of what must be reported." We
are in a better position to detect a potential
problem than we have ever been, but all the surveillance does not mean scientists will not be
caught out by something that is sitting in an animal to which nobody happens to be paying attention. Woolhouse says there
is always the potential for something to come out of left-field, something that surprises us. And how should anyone making policy
prioritise preparing for the next pandemic with more urgent concerns? Many public health officials might point out
that emerging infectious diseases are a potential future threat but we also need to deal with real,
major threats now such as malaria, TB or HIV. Woolhouse says the counter argument is that, although the toll of current diseases is
huge and dealing with them is important, public health services have learned to accommodate them. Emerging infections such as
influenza or Sars or the next pandemic would create a shock with the potential not only to overburden
health systems but to shut down travel networks, close down work. "The concern is that these things
present such a huge shock that the global system is not really able to cope ," he says. "That's why, despite
the somewhat forward-looking aspect of this, we think they are, and should remain, a priority. The costs of
an H1N1 or Sars pandemic is in the billions to hundreds of billions – substantial costs we could do well without." Persuading members of
the public or governments to keep the surveillance networks strong is an ongoing and crucial task, Woolhouse says: "This is one of those
investments that, if it's working, no one notices."
 Kills Everyone/Extinction
Rapid growth and complacency make disease an overarching threat to the survival
of all of humanity
Lederberg ’92 (Joshua Lederberg, an American molecular biologist known for his work in
microbial genetics, artificial intelligence, won the Nobel Prize in Physiology or Medicine in 1958, “In
Time of Plague: The History and Social Consequences of Lethal Epidemic Disease”, NYU Press, Jun 1,
https://books.google.com/books?
id=LAkUCgAAQBAJ&printsec=frontcover#v=onepage&q&f=false, CL)
Darwin had placed Homo sapiens at the pinnacle of the evolutionary process, but with as much emphasis on pinnacle as on evolution. He
never quite rectified the view that man has a privileged place in mature. Man’s intelligence, his culture, his technology has of course left
all other plant and animal species out of the competition. Darwin was oblivious about microbes as our competitors of last resort. In
experimental science, the Darwinian and Pasteurian perspectives are at last fully integrated. The study of mechanisms of virulence is a
top priority in research laboratories applying the most advanced techniques of molecular genetics. Since Theobald Smith in the 1934,
F.M. Burnet and R. Dubos have offered us broad perspectives of the natural history of infectious disease—perspectives that leave no
illusions about the feasibility of eradicating our scourges, of the ongoing struggle. For a period, the works of Paul de Kruif dramatized the
efforts of the “microbe-hunters.” But one legacy of the “miracle drugs”, the antibiotics of the 1940s, has been an
extraordinary complacency on the part of the broader culture. Most people today are grossly overoptimistic
with respect to the means we have available to forfend global epidemics comparable to the Black Death of
the fourteen century (or, on a lesser scale, the influenza of 1918), which took a toll of millions of lives . We have no guarantee
that the natural evolutionary competition of viruses with the human species will always find
ourselves the winner. I would ask the professional cultural historians for their comment; but it appears that our half-century has
turned away from external culture and to the self-depreciation of human nature, or of human organizations, as the central target of fear
and struggle. Not that we have to quarrel over pride of place between virus infection and nuclear doomsday. The countercultural protest
against technology posits a benign nature, whose balance we now disturb with diabolical modernities. But man himself is a fairly recent
emergent on the planet; the
sheer growth of our species since the Paleolithic is the major source of
disturbances to that hypothetical balance. Man as a creature of culture is a man-made species; for better or worse, the only
planet we know is a Promethean artifact. Genesis mandates: “be fruitful and multiple!” After sampling the tree of knowledge, and
acquiring the means, we could return to Eden only by reducing the human population to about 1% of its current density. We are
complacent to trust that nature is benign; we are arrogant to assert that we have the means to except ourselves from the competition.
But ourprincipal competitors for dominion, outside our own species, are the microbes: the viruses,
bacteria, and parasites. They remain an interminable threat to our survival.

Disease is the most plausible for human extinction—it has the highest risk of killing
us all as our systems weaken
Lederberg ’92 (Joshua Lederberg, an American molecular biologist known for his work in
microbial genetics, artificial intelligence, won the Nobel Prize in Physiology or Medicine in 1958, “In
Time of Plague: The History and Social Consequences of Lethal Epidemic Disease”, NYU Press, Jun 1,
https://books.google.com/books?
id=LAkUCgAAQBAJ&printsec=frontcover#v=onepage&q&f=false, CL)
As crowded as we are, humans are more dispersed over the planetary surface than are the "bugs" in a glass tube, and we have somewhat
fewer opportunities to infect one another, jet airplanes notwithstanding. The culture medium in the test tube offers fewer chemical and
physical barriers to virus transmission than the space between people—but you will understand why so many diseases are sexually
transmitted. The ozone shield still lets through enough solar ultraviolet light to make aerosol transmission less hospitable; and most
viruses are fairly vulnerable to desiccation in dry air. The unbroken skin is an excellent barrier to infection; the mucous membranes of
die respiratory tract much less so. And we have evolved immune defenses, a wonderfully intricate machinery for producing a panoply of
antibodies, each specifically attuned to the chemical makeup of a particular invading parasite. In the normal, immune-competent
individual, each incipient infection is a mortal race: between the penetration and proliferation of the virus within the body, and the
development of antibodies that will dampen or extinguish the infection. If we have been vaccinated or infected before
with a virus related to the current infection, we can mobilize an early immune response. But this
in turn provides selective pressure on the virus populations, encouraging the emergence of antigenic
variants. We see this most dramatically in the influenza pandemics; and every few years we need
to disseminate fresh vaccines to cope with the current generation of the flu virus. 10 Many quantitative
mitigations of the pandemic viral threat are then inherent in our evolved biological capabilities of coping with these competitors.
Mitigation is also built into the evolution of the virus: it is a pyrrhic victory for a virus to eradicate its host! This may
have happened historically, but then both that vanquished host and the victorious parasite will have disappeared. Even the death of the
single infected individual is relatively disadvantageous, in the long run, to the virus—compared to a sustained infection leaving a carrier
free to spread the virus to as many contacts as possible. From the virus's perspective, its ideal would be a
virtually symptomless infection, in which the host is quite oblivious of providing shelter and nourishment for the indefinite
propagation of the virus's genes. Our own genome probably carries hundreds of thousands of such
stowaways. The boundary between them and the "normal genome" is quite blurred; intrinsic to our
own ancestry and nature are not only Adam and Eve, but any number of invisible germs that have crept into our chromosomes.
Some confer incidental and mutual benefit. Others of these symbiotic viruses (or "plasmids"11) have
reemerged as oncogenes, with the potential of mutating to a state that we recognize as the
dysregulated cell growth of a cancer. As much as 95 percent of our DNA may be "selfish," parasitic in origin. At
evolutionary equilibrium, we would continue to share the planet with our parasites , paying some
tribute but deriving some protection from them against more violent aggression. Such an equilibrium is unlikely on
terms we would voluntarily welcome: at the margin, the comfort and precariousness of life would be evenly shared. No
theory lets us calculate the details; we can hardly be sure that such an equilibrium for earth even includes
the human species. Many prophets have foreseen the contrary, given our propensity for technological sophistication harnessed to
intraspecies competition. In Fact, innumerable perturbations remind us that we cannot rely on
"equilibrium"—each individual death of an infected person is a counterexample. Our defense mechanisms do not
always work; viruses are not always as benign as would be predicted to serve their long-term
advantage. The historic plagues, the Black Death of the fourteenth century, the recurrences of cholera, the 1918 swine influenza
should be constant reminders of nature's sword over our head. They have been very much on my mind for the past two decades.
However, when I have voiced such fears, they have been mollified by the expectation that modern hygiene and medicine would contain
any such outbreaks. There is, of course, much merit in those expectations: the plague bacillus is susceptible to antibiotics, and we
understand its transmission by rat-borne fleas. Cholera can be treated fairly successfully with simple regimens like oral rehydration
(salted water with a touch of sugar). Influenza in 1918 was undoubtedly complicated by bacterial infections that could now be treated
with antibiotics; and if we can mobilize them in time, vaccines can help prevent the global spread of a new flu. On the other hand, the role
of secondary bacterial infection in 1918 may well be overstated: it is entirely possible that the virus itself was extraordinarily lethal. The
retrospective scoffing at the federal campaign against the swine flu of 1976 is a cheap shot on the part of critics who have no burden of
responsibility for a wrong guess. It underrates health officials* legitimate anxiety that we might have been seeing a recurrence of 1918
13—and underscores the political difficulty of undertaking the measures that might be needed in the face of a truly species-threatening
pandemic. This so-called fiasco in fact mitigated an epidemic that happily proved to be of a less lethal virus strain. The few cases of side-
effects attributed to the (polyvalent) vaccine are undoubtedly less than would have appeared from the flu infections avoided by the
vaccination program. However, the incentives to attach fault for damages from a positive intervention have predictable consequences in
litigation, not to be confused with the balance of social costs and benefits of the program as a whole. Many
outbreaks of viral
or bacterial infections have destroyed large herds of animals, of various species, usually leaving a few
immune survivors. With all the discussion of faunal extinctions, nothing has been said about infectious disease. It would
be impossible to verify this from the fossil record, but disease is the most plausible mechanism of episodic shifts in
populations. Incontrovertible examples of species wipeouts are seen with fungi in the plant world:
Dutch elm disease and the American chestnut blight. Yes, it can happen.

Even if a pandemic doesn’t kill everyone, governments or non-state actors can take
advantage to manipulate the strain to be strong enough to kill everyone
Sandberg '14 (Anders Sandberg, a Jam Martin Research Fellow at the University of Oxford,
"The five biggest threats to human existence", The Washington Post, June 11,
https://www.washingtonpost.com/posteverything/wp/2014/06/11/the-five-biggest-threats-to-
human-existence/, CL)
Natural pandemics have killed more people than wars . However, natural pandemics are unlikely to be existential
threats: There are usually people resistant to the pathogen, and the offspring of survivors would be more resistant. Evolution also does
not favor parasites that wipe out their hosts, which is why syphilis went from a virulent killer to a chronic disease as it spread in Europe.
Unfortunately, we can now make disease nastier . One of the more famous examples is how the introduction
of an extra gene in mousepox – the mouse version of smallpox – made it far more lethal and able to infect
vaccinated individuals. Recent work on bird flu has demonstrated that the contagiousness of a
disease can be deliberately boosted . Right now, the risk of somebody deliberately releasing something devastating is low.
But as biotechnology gets better and cheaper , more groups will be able to make diseases worse.
Most work on bioweapons have been done by governments looking for something controllable, because wiping out humanity is not
militarily useful. But there
are always some people who might want to do things because they can . Others
have “higher” purposes. For instance, the
Aum Shinrikyo cult tried to hasten the apocalypse using
bioweapons beside their more successful nerve gas attack. Some people think the Earth would
be better off without humans, and so on. The number of fatalities from bioweapons and epidemic
outbreaks looks like it has a power-law distribution – most attacks have few victims, but a few kill many.
Given current numbers, the risk of a global pandemic from bioterrorism seems very small. But that is just bioterrorism: Governments
have killed far more people than terrorists with bioweapons (as many as 400,000 may have died from the WWII Japanese biowar
program). And as technology gets more powerful, nastier pathogens become easier to design .
 Plan Solves
Disease research and control is important to prevent pandemics
McCarthy '15 (Matt McCarthy, assistant professor of medicine at Cornell and a staff physician
at Weill Cornell Medical Center, "The Next Ebolas: Three factors predict whether a new virus will
cause a human pandemic.", Slate, January 9,
www.slate.com/articles/health_and_science/medical_examiner/2015/01/preparing_for_pandemic
s_what_diseases_will_be_the_next_ebolas.html, CL)
Peter Daszak has spent the past three decades attempting to predict global pandemics. He leads a group of international investigators
who try to anticipate when and where outbreaks will happen and how far they will travel. “Pandemic prediction is a bit like earthquake
prediction,” Daszak recently told me from his office in Manhattan. “There are lots of tremors, and occasionally you get a big one. Ebola
was the big one.” The Ebola outbreak caught us all off guard. As an infectious-disease physician who practices in Manhattan, I readily
answered basic questions about the virus, but I got uncomfortable as soon as things got nuanced. Could it go airborne? I didn’t think so,
but I wasn’t sure. And that’s because I wasn’t prepared for it. None of us was. Any
new health threat comes with
uncertainties, which can be twisted into the suggestion that experts don’t really know what
they’re doing. In the worst cases, this leads to panic or suspicion of medical advice. Part of preventing that
scenario has to do with better communication and public relations. But a much larger part involves knowledge. Infectious-disease
discovery must become a public health priority . We need to know what diseases are out there and which ones are
coming for us; we need to be prepared. Scientists estimate that between 1940 and 2004, 335 new infectious diseases appeared in
humans. This number includes pathogens that likely entered our species for the first time, such as HIV, and newly evolved strains of
familiar organisms, such as multidrug-resistant tuberculosis. The majority of these diseases—about 60
percent—were caused
by zoonotic pathogens, meaning they were transmitted to humans from animals. And of those, about 70 percent were from
animals that typically live in the wild. (Two of the last global pandemics—SARS and Ebola—were caused by viruses that appear to live in
bats.) Interestingly, the percentage of human diseases coming from wild animals seems to be rising—and quickly. But why? And more
importantly, what can we do about it?

Daszak is trying to give us answers. As president of the EcoHealth Alliance, he leads a team that has analyzed hundreds of new infectious
agents, trying to determine the factors that allow a disease to make the leap from animal to human. His group does this by traveling to
biodiversity hot spots—Bangladesh, Malaysia, Brazil—to sample wildlife known to harbor unstudied viruses. When team members
discover one, they enlist mathematicians to run computer models to predict the likelihood of human transmission. This type of
investigation, referred to as mathematical epidemiology, has long been the basis for our understanding of how most pathogens emerge,
evolve, and spread. But the nature of outbreak prediction is becoming more sophisticated, as Daszak and others have increasingly
incorporated insights from behavioral economics to improve the quality of outbreak prediction and prevention. Economic behavior plays
a vital role in disease transmission. Trade affects the number of humans exposed to a pathogen, which means it’s possible to model a
potential outbreak as a function of commerce. This approach, referred to as economic epidemiology, has recently opened up a new set of
prediction tools and prevention strategies. “We’ll tell a local government that there’s a market selling bats and we found a lethal virus in
those bats,” Daszak told me. “You can shut down that market. There’s a rat breeder I know in Guilin, China, who sells them for food. We
test his rats to make sure they’re safe to eat.” Daszak’s team has identified three factors that help a virus take hold in people: human
population density, wildlife diversity, and changes in land use. “The worst thing you can have,” he told me, “is a place where you have
rapidly growing human population—West Africa, China, or India—in a place with a lot of wildlife diversity, like near a rain forest. It
creates a pathway for a virus to go directly from animal to humans.” There are believed to be about 320,000 viruses in the world that
infect mammals (some estimates push that number even higher), and it’s been projected that it could cost about $6 billion to discover
and characterize them. “In the next 20 years, we’ll find all of them,” Daszak said. “Then we’ll figure out which ones are the most likely to
emerge as a global pandemic.” Given viruses’ high mutation rates and abilities to colonize new hosts, thenext pandemic will
likely be caused by a virus. Recently, two candidates have emerged: Nipah virus and Rift Valley
fever. Nipah was identified in 1999 after a cluster of Malaysian pig farmers developed encephalitis. (The virus is named after a village
where an infected patient lived.) Farmers were developing a sudden onset of fever, headache, vomiting, and diffuse muscle aches; 60
percent were in a coma within one week of becoming infected and more than 70 percent died .
Infection occurred through direct contact with respiratory secretions and urine from infected pigs. More troublingly, there was also
evidence that Nipah may have been transmitted from person to person—a Malaysian nurse who cared for infected patients was found to
have the hallmark blood and brain abnormalities of the disease, despite the fact that she had no exposure to infected animals. The disease
has spread from Malaysia since then. “Every year, we see an outbreak of Nipah virus in Bangladesh,” Daszak said. “[ Outbreaks
are]
small right now, but they’re extremely lethal. More lethal than Ebola, but less transmittable. But viruses evolve
… they’re supreme evolutionary machines.”
The other candidate for a pandemic among humans, Rift Valley fever, was identified in 1931 during an epidemic among sheep on a farm
in the Rift Valley of Kenya. Transmission to humans occurs via bites from infected mosquitoes or through close contact with infected
mammals. Symptoms are similar to those of Ebola, including the acute onset of fever and headache, and hemorrhage from the
gastrointestinal tract. The largest human outbreak of Rift Valley fever occurred during the rainy season in Kenya in 1997–1998, when
nearly 90,000 people were infected and 478 died. Although not as lethal as Ebola or Nipah, it still worries epidemiologists. “Rift Valley
fever is transmitted by mosquitoes,” Daszak said, “which means it can get on a plane—there’s an average of 1.2 mosquitoes on every
flight—and that means it could spread quickly.” The Ebola epidemic in West Africa isn’t over, but as it recedes from the headlines, it’s
time to consider what’s coming for us next. Pandemicprediction isn’t cheap, but waiting for an outbreak to
happen can be even more costly. Economic losses due to SARS were estimated to be anywhere
from $15 billion to more than $50 billion; the cost of the Ebola outbreak will almost certainly
exceed that figure. By contrast, Daszak estimates that it would cost a total of $6.3 billion to discover all of the viruses that infect
mammals—a fraction of the cost required to respond to a global pandemic like Ebola or SARS—and that information will ultimately lead
to better disease monitoring, treatment, and preventative measures at the cusp of the next outbreak. It’s a massive endeavor, but a
necessary one. Once we know what’s out there, we’ll be able to figure out what’s coming for us.

New collaborative regulations are necessary to effectively prevent the international

spread of diseases
Fidler '03 (David P. Fidler, professor of Law and Ira C. Batman Faculty Fellow at Indiana
University School of Law, Bloomington, "SARS and International Law", The American Society of
International Law, April 5, Volume 8, Issue 7,
https://www.asil.org/insights/volume/8/issue/7/sars-and-international-law, CL)
WHO's International Health Regulations: The SARS outbreak implicates the International Health
Regulations (IHR). The IHR were promulgated by WHO under Article 21 of its Constitution in 1951 and, according to WHO,
constitute the "only international health agreement on communicable diseases that is binding on [WHO] Member States." [6] The
purpose of the IHR "is to ensure the maximum security against the international spread of
diseases with a minimum interference with world traffic." [7] To achieve maximum security against
the international spread of diseases, the IHR establish a global surveillance system for diseases subject to
the IHR, [8] require certain types of health-related capabilities at ports and airports, [9] and set out disease specific
provisions for the covered diseases. [10] To achieve minimum interference with world trade and travel, the IHR, among
other things, set out the most restrictive health measures that a WHO member state may take to protect its territory against the diseases
subject to the IHR. [11] WHO officials and public health experts acknowledge that the
IHR have historically failed to
ensure the maximum security against the international spread of diseases with minimum
interference with world traffic. [12] One of the leading reasons for the failure of the IHR is that the Regulations only apply to
a small number of diseases. Since the eradication of smallpox at the end of the 1970s, the IHR have applied to only three infectious
diseases-cholera, plague, and yellow fever. [13] The
IHR do not apply to new infectious diseases that have
emerged, such as HIV/AIDS, or are now emerging, such as SARS. WHO member states have no international
legal obligation under the IHR to report SARS cases to WHO or to refrain from certain trade and travel restricting measures aimed at
stopping the spread of SARS. Thus, the
only international agreement on infectious diseases binding on
WHO member states has been irrelevant to the SARS outbreak. In the mid-1990s, WHO began
the process of revising the IHR to address, among other things, the narrow disease-specific scope of the Regulations. WHO's
objective is to make the IHR more relevant for the infectious disease threats faced by its member
states in the 21st [14] Although the final structure and substance of the revised IHR have not been determined, [15] the SARS
epidemic may encourage WHO member states to accept a more robust international legal
framework for global infectious disease control than has existed historically. century.
Public Health Measures to Stop the Spread of SARS and Infringements on Civil and Political Rights: A number of countries affected by
the SARS epidemics have resorted to voluntary and compulsory isolation and quarantine measures as
part of the effort to stop the spread of SARS. According to the CDC, isolation and quarantine "are common practices in public health and
both aim to control exposure to infected or potentially infected individuals. . . . The
two strategies differ in that isolation
applies to people who are known to have an illness and quarantine applies to those who have
been exposed to an illness but who may or may not become infected ." [16] Isolation and
quarantine infringe, however, on civil and political rights recognized in international law, such as freedom
of movement and the right to liberty. International law on human rights has long recognized that governments may infringe on civil and
political rights for public health purposes. [17] The use of isolation and quarantine by governments to stop the spread of SARS is not,
therefore, illegal per se under international human rights law. Governments must, however, fulfill certain conditions before interference
Public health measures that
with a civil or political right on public health grounds survives scrutiny under international law.
infringe on civil and political rights must (1) be prescribed by law; (2) be applied in a non-
discriminatory manner; (3) relate to a compelling public interest in the form of a significant
infectious disease risk to the public's health; and (4) be necessary to achieve the protection of
the public, meaning that the measure must be (a) based on scientific and public health information and principles; (b) proportional
in its impact on individual rights to the infectious disease threat posed; and (c) the least restrictive measure possible to achieve
protection against the infectious disease risk. [18] Most
national governments have enacted public health
statutes that authorize isolation and quarantine as measures to control infectious diseases, even if
many of these statutes are quite old and have not been widely used in recent decades. Because public health experts believe SARS is
contagious and can be transmitted through the air from person to person, isolation and quarantine measures appear to (i) relate to a
significant infectious disease threat; (ii) be based on the best available scientific and public health information; and (iii) be proportional
in impact on individual rights to the serious public health threat SARS and its unchecked spread poses. Further, the
lack of
effective diagnostic technologies, treatment options for infected persons, or vaccine for prevention
purposes suggests that isolation and quarantine measures may be the least restrictive measures currently possible to achieve
protection against the spread of SARS. Not all isolation and quarantine measures enacted, or that could be enacted, to deal with SARS are
necessarily permissible under international human rights law. The
main point is that responses to SARS should be
reviewed under international human rights law, especially the obligation not to discriminate on
any grounds in the application of SARS control measures.

Public health systems have a direct correlation with health outcomes

Woolf and Aron '13 (Steven H. Woolf and Laudon Aron, Editors on the Committee on
Population for the National Research Council and U.S. Institute of Medicine, "U.S. Health in
International Perspective: Shorter Lives, Poorer Health", National Research Council and Institute of
Medicine, www.ncbi.nlm.nih.gov/books/NBK154484/, CL)
As other chapters in this report emphasize, population health is shaped by factors other than health care, but it is clear
that
health systems—both those responsible for public health services and medical care—are instrumental in both the
prevention of disease and in optimizing outcomes when illness occurs. The importance of
population-based services is marked by the signature accomplishments of public health, such as the
control of vaccine-preventable diseases, lead abatement, tobacco control, motor vehicle
occupant restraints, and water fluoridation to prevent dental caries (Centers for Disease Control and
Prevention, 1999, 2011b). Public health efforts are credited with much of the gains in life expectancy that high-
income countries experienced in the 20th century (Cutler and Miller, 2005; Foege, 2004). The effectiveness of a core set of clinical
preventive services (e.g., cancer screening tests) is well documented in randomized controlled trials (U.S. Preventive Services Task Force,
2012), as are a host of effective medical treatments for acute and chronic illness care (Cochrane Library, 2012). For
example,
gains in cardiovascular health have occurred with the adoption of evidence-based interventions
including antiplatelet therapy, beta-blockers, and reperfusion therapy (Khush et al., 2005; Kociol et al.,
2012). Although some authors have questioned the impact of medical care on health (McKeown, 1976; McKinlay and McKinlay, 1977),
others estimate that between 10-15 percent (McGinnis et al., 2002) to 50 percent (Bunker, 2001; Cutler et al., 2006b) of U.S.
deaths that would otherwise have occurred are averted by medical care. Across various countries,
medical care is credited with 23-47 percent 3 of the decline in coronary artery disease mortality that
occurred between 1970 and 2000 (Bots and Grobbee, 1996; Capewell et al., 1999, 2000; Ford and Capewell, 2011; Ford et
al., 2007; Goldman and Cook, 1984; Hunink et al., 1997; Laatikainen et al., 2005; Unal et al., 2005; Young et al., 2010). Barriers to health
care also influence health outcomes. Inadequate health insurance coverage is associated with inferior health care and health status and
with premature death (Freeman et al., 2008; Hadley, 2003; Institute of Medicine, 2003b, 2009a; Wilper et al., 2009). Conversely,
universal coverage has been associated with improved health, both in U.S. states (Courtemanche and Zapata, 2012) and in other
countries (Hanratty, 1996). Two other barriers, inadequate
numbers of physicians and a weak primary care
system, are associated with higher all-cause mortality , all-cause premature mortality, and cause-specific
premature mortality (Chang et al., 2011; Macinko et al., 2003, 2007; Or et al., 2005; Phillips and Bazemore, 2010; Starfield, 1996;
Starfield et al., 2005).
 Quarantine Fails
Quarantine fails—increases the likelihood of spreading disease
Hull '14 (Harry F. Hull, trained in epidemiology at the U.S. Centers for Disease Control and
Prevention and an adjunct professor of pediatric infectious diseases and infectious disease
epidemiology at the School of Public Health., "Why quarantines won’t stop Ebola from spreading in
the U.S.", The Washington Post, October 3,
https://www.washingtonpost.com/posteverything/wp/2014/10/03/why-quarantines-wont-stop-
ebola-from-spreading-in-the-u-s/, CL)
The United States’ first Ebola patient was identified this week in Texas. He probably won’t be the last. Ebola is contagious and highly
lethal. With no demonstrably effective vaccine available, isolation and quarantine are invaluable tools. Is it enough to stop Ebola here?
Although used interchangeably, isolation differs from quarantine in a couple of key ways. Isolation refers to placing an ill and contagious
person in a controlled environment to prevent transmission. Quarantine, on the other hand, means restricting the
movements and contacts of healthy people exposed or potentially exposed who may become
contagious. Isolation is commonly used in hospitals for many diseases. Quarantine is rarely employed because it
may unnecessarily restrict liberty and may spread disease to quarantined persons who were not
actually exposed. Calls for quarantine to control AIDS in the 1980s were counterproductive.
Quarantine of passengers arriving from Ireland in the 1800s on typhus ships condemned many to death.
Quarantining crowded slums in Liberia may have increased the spread of Ebola as people fled.
Mass quarantine efforts in the United States would likely be similarly ineffective as people seek to
escape perceived death traps. Closing borders to healthy travelers from Africa would be
ineffective. People would simply lie, forge documents or carry more than one passport. An
inability to return if exposed would deter skilled health workers from supporting control efforts in
Africa. Except for extremely high risk or uncooperative persons, quarantine has been replaced by identification and monitoring of at-
risk people.

Quarantines are too outdated to work today

Werner '14 (Erica Werner, Associated Press, "Do quarantines actually work? Experts question
effectiveness", PBSNews, October 30, www.pbs.org/newshour/rundown/quarantines-rarely-used-
effectiveness-questioned/, CL)
Large-scale quarantines were used frequently during disease outbreaks in the 19th and early 20th
centuries, including the influenza pandemic in 1918. Experts say it’s not clear such quarantines were very
effective. In some cases, entire populations were isolated , such as a quarantine of Chinatown in San Francisco in
1900 in response to the bubonic plague. The quarantine order was struck down by a court after an outcry by residents. Such large-
scale quarantines have largely fallen into disuse with the rise of modern medicine, vaccines and
antibiotics. More recently, the spread of tuberculosis led authorities to quarantine individuals to make sure they were taking their
medicine and following other protocols. More than 100 TB patients were detained in New York City between 1993 and 1995. What about
elsewhere? TheSARS epidemic led to large-scale quarantines in Asia and Canada in 2003, including around
30,000 people quarantined in Toronto, mostly at home. There’s disagreement about whether the
quarantine in Toronto was effective. Some believe it did limit the spread of the outbreak, while others say it was
ineffective and inefficient and noncompliance was a problem. What are experts’ concerns about quarantine for
Ebola? Experts note that unlike SARS and the flu, Ebola is not easily spread to others by coughing or sneezing. Instead it requires direct
contact with a sick person’s bodily fluids while they are showing symptoms of the disease. So they question
the need to
quarantine people who are not showing symptoms. Health officials also agree that the best way to protect the U.S.
from the disease is to end the outbreak in West Africa. Doctors, nurses and other health workers are badly needed there, and experts
worry that imposing quarantines here at home could discourage those volunteers. “Being overboard, being
draconian is not necessarily the best way to keep us safe,” said Wendy Parmet, a health policy expert at
Northeastern University School of Law.

Even if they work, overuse risks disaster and more suffering—doesn’t assume mass
spread
Hill-Cawthorne '14 (Grant hill-Cawthorne, lecturer in Communicable Disease Epidemiology
at the University of Sydney, "Quarantine works against Ebola but over-use risks disaster", The
Conversation, October 1, theconversation.com/quarantine-works-against-ebola-but-over-use-risks-
disaster-32112, CL)
While quarantine is an important weapon in our arsenal against Ebola, indiscriminate isolation
is counterproductive. The World Health Organisation has warned that closing country borders and
banning the movement of people is detrimental to the affected countries, pushing them closer to
an impending humanitarian catastrophe. Stopping international flights to the affected countries ,
for instance, has led to a shortage of essential medical supplies. Still, this didn’t stop Sierra Leone from imposing a
stay-at-home curfew for all of its 6.2 million citizens for three days from September 19 to 21. Results from this unprecedented lockdown
are unverified, with reports of between 130 and 350 new suspect cases being identified and 265 corpses found. But in
a country
where the majority of people live from hand to mouth with no reserves of food, the true hardship
of the measure is difficult to quantify. In addition to the three-day lockdown, two eastern districts have been in indefinite
quarantine since the beginning of August. On September 26, Sierra Leone’s president, Ernest Bai Koroma, announced that the two
northern districts of Port Loko and Bombali, together with the southern district of Moyamba, will also be sealed off. This means more
than a third of the country’s population will be unable to move at will. Sierra Leone’s excessive
quarantine measures are
having a significant impact on the movement of food and other resources around the country, as
well as on mining operations in Port Loko that are critical for the economy. The country had one of Africa’s fastest-
growing economies before the outbreak, with the IMF predicting growth of 14%. The World Bank estimates the outbreak will cost 3.3%
of its GDP this year, with an additional loss of 1.2% to 8.9% next year. Rice and maize harvests are due to take place between October and
December. There’s a significant risk that the ongoing
quarantines will have a significant impact on food
production. Quarantine is an excellent measure for containing infectious disease outbreaks but its
indiscriminate and widespread use will compound this epidemic with another humanitarian
disaster.
 U.S.-China Framework
U.S. Chinese public health collaboration spans research, fighting disease, sharing
info, and tobacco control
Brown et al. 13 (Matthew Brown, Bryan A. Liang, Braden Hale, and Thomas Novotny, Senior
Advisor at Office of Global Affairs, US Department of Health and Human Services - US Department of
Health and Human Services, “China's Role in Global Health Diplomacy: Designing Expanded U.S.
Partnership for Health System Strengthening in Africa”, Global Health Governance, Volume 6, No. 2,
CL)
To understand where opportunities to capitalize on existing U.S.-China collaborations to work in Africa, it is useful to describe the
organization of the Chinese health system as well as how U.S.
and Chinese public health agencies work together,
sharing nearly two decades of various collaborations in public health . China has a single party political system,
governed by the Communist Party of China. While this is in stark contrast to the United States and many other countries that maintain a
multiparty system of democracy, this centralized system has unique characteristics that need to inform any foreign collaboration. China
has 34 province-level administrative units, similar to U.S. states, including four municipalities, 22 provinces, five autonomous regions,
two special districts, and Taiwan, a province handled by a separate Taiwan Affairs Office within the State Council.61 One critical
characteristic of China’s intricate bureaucratic structure is a consistent separation of political authority from implementation functions.
The Chinese Ministry of Health (MOH) preserves this same separation within the Chinese public health system.62 The
highest
level of administrative authority is the Chinese State Council. The State Council supervises the
MOH, which consists of approximately 100 technical leaders who set policy and which serve as the
main authority for the national public health system.63 Additionally, the MOH supervises the multiple
technical implementing agencies including provincial health bureaus . The provincial health bureaus
supervise the prefectures health units. This pattern continues down the administrative chain to counties, townships, and village health
centers (Figure 2).64 One
technical implementing agency overseen by the MOH is the Chinese Centers
for Disease Control (China CDC), which has also served successfully as the Principal recipient of over U.S.
$825 million for the Global Fund to Fight Tuberculosis, Malaria, and HIV/AIDS.65 With authority and purview over the public health
component of the Chinese health system, China CDC is the lead technical implementing agency for disease control and prevention at the
national level. China CDC has its own counterpart CDC entities at the provincial, prefecture and county levels (Figure 3). This network of
authority, supervision, and implementation, yields a health system of more than 2,200 provincial and county CDCs.66

COLLABORATIONS BETWEEN U.S. AND CHINESE PUBLIC HEALTH AGENCIES

Due to these characteristics and differences in governmental structure ,
U.S. governmental counterparts do not align
perfectly with Chinese governmental units. Unless the Chinese implementing institution has the appropriate delegated
authority from their supervising institution, that institution or agency may find it difficult to engage with a
foreign institution on a global health project. This can create significant barriers to
collaboration.67 Despite these barriers, bridging the U.S. and Chinese health agencies are multiple
Memoranda of Understandings (MOUs) between the Chinese MOH, the China CDC, and the U.S. Department of Health and
Human Services (HHS), CDC, and the National Institutes of Health (NIH), dating from 1979 . These address HIV/AIDS,
influenza, emergency preparedness, health communications, emerging and reemerging
infectious diseases, and most recently, chronic and non-communicable diseases and tobacco
control.68 U.S.-Chinese partnerships in public health illustrate how arrangements in other
countries where these nations share similar health development agendas.
 AT: Ebola Didn’t Spread
Ebola got out of control very quickly—7 reasons
Belluz '14 (Julia Belluz, senior health correspondent, "Seven reasons why this Ebola epidemic
spun out of control", Vox, September 4, www.vox.com/2014/9/4/6103039/Seven-reasons-why-
this-ebola-virus-outbreak-epidemic-out-of-control, CL)
If you'd asked public-health experts a year ago whether an Ebola outbreak could turn into an
epidemic spread across borders, they probably would have confidently told you that there was no
way: the virus isn't transmitted very easily, and people usually get so sick and die so quickly, it has little opportunity to infect a new
host. Then came 2014, the year that is rewriting the Ebola rulebook. More people have died from the virus in the last nine months
than the total number of deaths since the first recorded outbreak in 1976. The virus has also popped up in enough
countries — first Guinea, then Liberia, Sierra Leone, Nigeria, and now Senegal — that the cases
add up to the world's first Ebola epidemic. How did Ebola spiral so badly out of control? There are a few obvious
features that have made this outbreak different and more violent: the virus hit unprepared countries in West Africa that
had no previous experience with Ebola, and it quickly moved to densely populated urban hot
spots (as opposed to isolated, rural areas where the virus typically popped up in Central and East Africa). But there are other more
subtle factors that are helping Ebola survive today for the first ever Ebola epidemic. They hold lessons for public health
responses of the future on how to better contain such a deadly disease.
1) Public-health campaigns started too late and didn't reach enough people: In Uganda, as soon as an
Ebola case is identified, public health officials overwhelm all streams of media with messages about how to stay safe. People won't leave
their houses out of fear of infection, and they immediately report suspected cases to surveillance officials. It's one of the reasons Uganda
has successfully stamped out four Ebola outbreaks, even ones that have turned up in urban areas. Dr. Anthony Mbonye, Uganda's director
of health services, said this aggressive public-health awareness campaigning didn't start soon enough in the current West African
outbreak. "They responded too slowly to make the community aware of the disease ," he told Vox. Ishmeal
Alfred Charles, who has been working on the Ebola front-line in Freetown, Sierra Leone, said there was little awareness
about Ebola until late July, about four months after the first suspected cases emerged in the
country. "It only got serious when we lost Dr. Sheik Umar Khan," he said of the prominent local Ebola physician whose July 29 death
made international headlines. "That's when the political wheels (started turning) and the government started putting resources together
to help." Charles also noticed that, in the initial periods of the outbreak, most of the public-health messaging about Ebola was
concentrated on mainstream media, including TV and radio, so it was mainly reaching the middle- and upper-classes of the country. "Not
a lot of people have access. We're talking about people who are living in very poor communities so they basically have little or no
Internet or TV or to radio." For this reason, by the summer, Charles — who works as a program manager with the Catholic aid agency
Caritas — took to the streets to spread the word. "We get people out into small communities to talk to people (about Ebola)," he said.
"We gave megaphones to our community volunteers and told them to go public places, to markets, to houses." Of course, the
message came too late and Ebola has now reached almost every district in Sierra Leone.
2) The countries affected by Ebola have some of the world's lowest literacy rates: Health campaigning
and raising health literacy is not easy in places where people can't read. As you can see in the map below, the countries that are now most
affected by Ebola — Guinea, Liberia, and Sierra Leone, circled in green — are also the ones with the lowest literacy rates in the world.

3) There's a strong Ebola rumor mill: The low levels of literacy, poor access to health
information, and delayed public-health campaigning only fueled the Ebola rumor mill. There's no
proven treatment for Ebola but lies about supposed cures have spread fast. One persistent myth has been that hot water
and salt can stop Ebola. Others suggest faith healing or hot chocolate, coffee and raw onions will stamp out the virus. Homeopathy has
also emerged as a supposed Ebola crusher. In the US, the the FDA has warned consumers to watch out for Ebola quackery, while African
public health officials are getting creative to debunk the lies. The electro-beat song 'Ebola in Town' was created to set the record straight
about how to avoid the illness. "Ebola, Ebola in town. Don't touch your friend! No kissing, no eating something. It's dangerous!" In Lagos,
Nigeria, the local government resorted to hiring a "rumor manager" to help wage a war on the misinformation that is swirling about.
"The rumors themselves can actually cause a lot of damage ," Lagos state Commissioner for Health Jide Idris told
reporters. And he has reason to be worried. If this disease starts to take off in Lagos - Africa's largest city, population 22 million - some
say this could "instantly transform this situation into a worldwide crisis."
4) Sierra Leone, Liberia, and Guinea are some of the poorest countries in Africa with fragile health systems: Before
the Ebola outbreak, the three countries hardest hit this year had very weak health systems and little money to
spend on health care. Less than $100 is invested per person per year on health in most of West Africa and these countries record
some of the worst maternal and child mortality rates on the planet. So resources were already extremely constrained when Ebola hit.
Daniel Bausch, associate professor at the Tulane University School of Public Health and Tropical Medicine, who is working with the WHO
and MSF on the outbreak put it this way: "If you're in a hospital in Sierra Leone or Guinea, it
might not be unusual to say, 'I
need gloves to examine this patient,' and have someone tell you, 'We don't have gloves in the
hospital today,' or 'We're out of clean needles,' - all the sorts of things you need to protect
against Ebola." In these situations, local health-care workers — the ones most impacted by the disease — start to get scared and
walk off the job. And the situation worsens. In Liberia, nurses have gone on strike because of Ebola. When Bausch was in Sierra Leone in
July, he and other doctors were left scrambling during a nurse strike, too. "There were 55 people in the Ebola ward," he said, "and myself
and one other doctor." He'd walk into the hospital in the morning and find patients on the floor in pools of vomit, blood, and stool. They
had fallen out of their beds during the night, and they were delirious. "What should happen is that a nursing staff or sanitation officer
would come and decontaminate the area," he said. "But when you don't have that support, obviously it gets more
dangerous." So the disease spread.
5) These countries have spotty disease surveillance networks: These countries also had spotty disease surveillance
networks. "We're dealing with countries with very poor health systems to start with ," said Estrella Lasry, the tropical
medicines adviser for MSF. "That goes from setting up surveillance systems through setting up networks of community health workers." By contrast, places
that have been able to fight off the virus in the past — like Uganda — have robust disease surveillance systems, said Lasry. That means that suspect cases
can be tested and reported on quickly, and that information can spread through the surveillance network in the country as fast as possible so that prevention
measures and public-health campaigns are implemented right away. While there's no
way to completely prevent another outbreak
from happening, she said, "We can prevent spread by putting the appropriate measures in place so
we can identify Ebola and stopping transmission as quickly as possible."
6) The international community responded painfully slowly : "Ebola is a very preventable disease," said
Lawrence Gostin, a health law professor at Georgetown University. "We've had over 20 previous outbreaks and we managed to contain
all of them." But this time, the international response just wasn't there. "There was no mobilization ," Gostin
said. "The World Health Organization didn't call a public health emergency until August — five months after the first international
spread." Part of the reason for the slow response can be attributed to cuts at the WHO that have left the agency understaffed and under-
resourced. But Gostin said this epidemic
has also revealed how poorly designed and unready our global
systems seem to be for epidemics. In an article published today in the Lancet, he offered this wake-up call for future
outbreaks: "How could this Ebola outbreak have been averted and what could states and the international community do to prevent the
next epidemic?
The answer is not untested drugs, mass quarantines, or even humanitarian relief. If
the real reasons the outbreak turned into a tragedy of these proportions are human resource
shortages and fragile health systems, the solution is to fix these inherent structural deficiencies."
7) The countries most affected — and our world — is increasingly interconnected : The most worrying
vector of spread in any epidemic or pandemic is the traveler. And in this outbreak, the three worst-hit countries shared very porous
borders, where the disease could easily hop across in people moving around for work or to go to the
market. But Dr. Bausch said this West African outbreak should also serve as a reminder that we live in an increasingly interconnected
planet. "Even from the most remote areas of our world, people are getting more and more connected," he said, "sometimes nationally,
sometimes internationally." This is the new normal, he said, and it should rewrite how public health officials think about Ebola going
forward. "The various different features of this outbreak —where we
have an outbreak cutting across international
boundaries, involving urban areas — we can think of this as the new norm and we have to be
concerned this can happen every time because of the connectivity of places."
 AT: Nanotech
Nanotech may sound good but fail to manifest in real life
Koshy and Sethi '13 (Jacob P. Koshy is a deputy science editor at The Hindu and business
editor at The Huffington Post and Neha Sethi is the principal correspondent for the Economic Times
News Network in Noida, India and previously been a reporter and editor for the Hindustan Times,
"Nanotech research speeds up, but applications fail to materialize", Live Mint, April 22,
www.livemint.com/Specials/j8UZSy0iiA8kRpgtjwxioM/Research-speeds-up-but-applications-fail-
to-materialize.html, CL)
Slightly more than a decade after India officially embarked on a concerted Rs.1,000 crore effort to accelerate
nanoscience and build an industrial base reliant on nanotechnology applications, it has doubled
its share of research publications in the sector in that period. On the other hand, it has barely made a dent
in being able to translate this research into usable products , says a just published report on nanotechnology in
India. “There is a long way for promising research leading to applications and only a few organizations have
been able to translate some of their research to applications,” according to the study, Knowledge Creation and Innovation in
Nanotechnology, prepared by the National Institute of Science Technology and Development Studies (NISTADS). More worryingly, key
elements that are necessary to accelerate industrial applications, such as specifying manufacturing standards and a clear policy on
addressing the potential health risks posed by nanotechnology, are only “at preliminary stages” and lag behind those of China and South
Korea even though these countries began concentrating resources on nanotechnolgy around the same time as India.
Nanotechnology is the science of creating and manipulating particles that are a thousand times
thinner than human hair. At those dimensions, many common materials behave unexpectedly .
Highly water absorbent materials become water repellent. Gold for example melts at much
lower temperatures and silicon absorbs a higher amount of solar energy, leading to more efficient solar
cells. Sujit Bhattacharya, a professor at NISTADS and key author of the report, said that while several government departments and top-
flight research institutions were investing in nanotechnology, the surprise was that consumer goods companies—even in India—were
incorporating nanotechnolgy in their products. Thus companies such as Arvind Mills Ltd offer a range of fabrics that use nanomaterials,
and Tata Chemical’s Tata Swach and Hindustan Unilever’s Pureit water filters have employed indigenously developed nanotechnology
applications to make water filters.

At the other end, according to the report, the bulk of forthcoming products that employ nanotechnology applications were from the
pharmaceutical sectors—Shasun Pharmaceuticals and Dabur Pharma Ltd have nano-particle based drugs for cancer in development.
Early entrepreneurs in India’s nanotechnology scene maintain that it made sense for them to offer low-cost materials using
nanotechnology and then move up to more complex products. Arup Chatterjee, chief executive officer (CEO) of Kolkata-based I-CAnNano,
which makes nanoparticle-based cleaning agents, was among a group of early adopters that used nanomaterials to develop a new class of
adhesives which could be used in a wide range of articles from windshields to paint. “It was a big leap as nanocomposites (a mixture of
nanomaterials) are sensitive to temperature during manufacture,” Chatterjee said in an earlier interview to Mint. “ Making
nanoparticles is only the beginning. Handling and using them practically is substantially difficult .”
His company has now forged tie-ups with academia to develop more complex materials and products, he said. A hurdle in the way of
India’s nanotechnology industry was a general aversion to risk and the unwillingness to explore beyond low-hanging fruit, said Rudra
Pratap, chairperson of the Indian Institute of Science (IISc) Centre for Nanoscience and Engineering. Most investors in nanotechnology
based products looked for “quick returns”, and were unwilling to stay the long haul for investing in genuinely inventive products, said
Pratap, who’s led his own nanotechnology start-up. “Things like nanomaterials and paints are the easy bits and they are all done,” said
Pratap. “To get beyond that you have to commit funds at an early stage for a long time.” His company, i2n Technologies, makes scanning
tunnelling microscopes that are frequently used in research labs to take atom-level snapshots of surfaces. Though his entry-level
products cost two-thirds of what similar devices are priced at, Pratap said that he typically runs into demands such as “give me
references from three customers who’ve used your product”. “Such obstacles reflect a lack of an entrepreneurial
mindset. More than money or institutional support, it’s this mindset that must change to foster
acceptance for nanotechnology products,” he added. Then there’s the problem with the health aspects of nanotechnology. A
recent US study published in Proceedings of the National Academy of Sciences indicated that nanomaterials potentially
posed unknown health hazards. Given their small size, they could easily be absorbed via the skin or orally
and lodge themselves within several organs and pose a variety of risks. These risks were relevant to India too,
according to Alok Adholeya, director of the biotechnology and bioresources division at The Energy Resources Institute. “ One is
occupational hazard— we have to in-build policies to ensure that (nano) science is done in a safe
manner, which is not there as of now and the second is future risk,” said Adholeya. “Even though currently
India doesn’t use much of nano for consumer materials, things may change.” Adholeya, who’s in the process of preparing a study to
ascertain the risks associated with nanotechnology with the Department of Biotechnology, added that currently, the use of nanoparticles
in the agricultural sector was predominantly in the form of nano-fungicides and nano-fertilizers but other sectors getting involved would
“rise in the future”.
 AT: Trust Alt Cause
Increasing trust now—recent rural health care financing proves; concerns are
resolved by the plan
Hu et al. '16 (Rong Hu, Chunli Shen, Heng-fu Zou, East China Normal University, "Health Care
System Reform in China: Issues, Challenges and Options",
down.aefweb.net/WorkingPapers/w517.pdf, July 16, date is date accessed, CL)
The financing mechanisms in community should follow at least three principles: equity, openness,
and be in accordance with economic status (Liu 2006). The rural people should enjoy the equal
right in term of health care as the urban people and the government needs to pave the road. In
terms of insurance spending, the administration should attempt to make the whole process open
and accessible to all the insured people and actively accept the supervision from them. This activity
will enhance people’s trust in the new CHCS and attract more people to participate in its system.
Inevitably, there have been a lot of various difficulties in financing rural health care. Income instability of peasants, the lack of suited
legislation and high administration cost are barriers on financing schemes (MOH 2004). The current policy in the poor region is to insure
as many people as possible with basic medical care. However, patients with a severe illness face the risk of bankruptcy. Besides, the
competition between public and private medical institutions has negative impact on the peasants’ enthusiasm in participating in the
insurance system. In
the framework of the new policy, the peasants generally need to pay the cash
first and then apply for reimbursement. The prices of drug and health service in public hospitals
are higher than that of private clinics in most cases. As a result, people prefer go to private
sector, which is included in the new CHCS. Financing methods should be more flexible in order to attract more people
to join the cooperative medical system. Considering that peasants have less cash, the local governments in some areas (Henan province)
have ever tried to replace the cash premium with farm products. (Liu 2006) It has been demonstrated that the
peasant
welcomes this policy, and the administration cost is lower . However, it takes a long time to sell
the products and get cash for the new CHCS funding. Meanwhile, many other factors such as product price, would
influence the operation of the system. The “compulsory participation”, where the governments pay the premium for the farmers using
the tax money, was was adopted in some places so as to improve the coverage of the cooperative medical scheme. However the peasants
indirectly bear the burden because the local government usually has to exert more tax on them. In many cases, the
peasants’
resist to insurance medical system did not result from the financing mechanisms themselves,
but something else, e.g. low quality of health care service in town hospitals. The simultaneous
improvement of health care service in rural areas can encourage the peasants’ participation in
the new CHCS.

The majority of the Chinese have more trust in the central government, who would
do the plan—a better economy would also increase trust
Huang '14 (Hsin-hao Huang, Department of Anesthesiology, National Taiwan University
Hospital and National Taiwan University College of Medicine, Taiwan, Republic of China.,
"Explaining Hierarchical Government Trust in China:The Perspectives of Institutional Shaping and
Perceived Performance", Taiwanese Journal of Political Science, March Volume (Vo. 59),
politics.ntu.edu.tw/psr/?post_type=english&p=3115, CL)
“Hierarchical government trust” indicates that political trust varies according to the level of government. Many scholars have argued that
within Chinese society, trust in the central government is higher than trust in local governments. However, the literature is
primarily focused on specific groups, and still needs to be verified with more representative surveys. Using comprehensive survey data
from the 2012 World Values Survey in China, this article demonstrates that Chinese citizens have varying levels of political trust
according to the level of government. The results show that approximately 75
percent of respondents had higher trust
in the central government than in local governments, demonstrating that “hierarchical
government trust” is prevalent in Chinese society. Second, this article uses the perspectives of institutional shaping
and perceived performance as a starting point to explain hierarchical trust in government in China. Through empirical analysis , this
article identifies the petitioning system and political mobilization as two contextual factors
shaping institutions. Perceived performance (central and local government performance and assessment of family
economic condition) has a mediating effect on the higher trust in central government. Finally, the article
argues that hierarchical government trust is a more suitable approach for understanding the nature of public opinion in China, and
identifying its political implications.
 AT: Warming Alt Cause
Warming doesn’t cause disease
Moore '16 (Thomas Gale Moore, Senior Fellow at the Hoover Institution at Stanford University,
"Why Global Warming Doesn't Cause Disease",
web.stanford.edu/~moore/WarmingandDisease.html, July 15, date is date accessed, CL)
Threats of global warming are bringing on a plague. Some will tell you it's a plague spread by the mosquitoes that
thrive in a hotter climate. But we know differently . In fact, infestation we speak of is a plague of misinformation ,
infecting the public consciousness and blurring the issue of the effects of climate change on human
health in a swarm of anxiety and confusion . This plague feasts not on blood but on fear: Officials at
the very highest levels of government are doing all they can to scare us, even though some of us know
better, and they probably know better themselves. Both the President and the Vice President continue to emphasize the health hazards of
climate change. In setting his goals for Kyoto, President Clinton asserted that "temperatures will rise and will disrupt the climate Disease-
bearing insects are moving to areas that used to be too cold for them." In his sermon to the congregation of environmental ministers
praying together in Kyoto, Vice President Gore spoke of "disease and pests spreading to new areas." (Like Washington, D.C.?)

Oh, the tangled Website they weave...In keeping with these high-tech times, the White House's home page also trumpets this theme:
Americans better watch out-global warming will make them sick. Going to extremes, the President's Website extrapolates CO2
concentrations to a quadrupled level of 1100 ppm-a scary prophecy-which they claim would boost the average July heat index
(combination of humidity and temperature) for Washington, D.C., to 110 degrees! (Some of us have difficulty suppressing the thought
that such a climate might provide a great boon: The federal government would shut down during the hot summer months, as it used to
do before air-conditioning. Ah, the beauty of human adaptation to climate.) In truth, promoting such a scenario on the official White
House Website constitutes terror-hawking. No one-on either side of this issue-is predicting such a high concentration of greenhouse
gases for any time during the next century, or even during the first part of the hundred years to follow. Forecasts for the late
21st century can only come under the heading of "science fiction." And those for the 22nd century are "pulp
fiction." No one knows which types of energy humans will be using, or what technology will be available to them. Remember, in the
late 19th century, waistcoated forward-thinkers predicted America's major cities would be knee-
deep in horse manure by 1920 unless we "did something" like institute a big horse tax . We
cannot predict the climate's future. What we can predict, however, is that people will be richer, have more and better
technology, and will be living longer. They will be better equipped to deal with any climate change than are
people today. Moreover, the warmer climate predicted for the next century is unlikely to bring a rise in heat-related deaths. As a
recent article in Science magazine points out, "People adapt. One doesn't see large numbers of cases of heat stroke in New Orleans or
Phoenix, even though they are much warmer than Chicago." Even so, the Presidential Website goes on to warn that "Diseases that thrive
in warmer climates, such as malaria, dengue and yellow fevers, encephalitis, and cholera are likely to spread."

Unfounded, exaggerated, misleading: Even if the White House ignores WCR's frequent, informative messages on global warming and
health, these officials should pay attention to the experts on disease. Both the scientific community and the medical establishment say the
frightful forecasts are unfounded, exaggerated, or misleading. Further, and more important for policy-makers to note, these
rumors
of an upsurge in disease and early mortality stemming from climate change do not require
action to reduce greenhouse gas emissions. As Science reports: "Predictions that global warming will
spark epidemics have little basis, say infectious-disease specialists , who argue that public health
measures will inevitably outweigh effects of climate ." The article adds: "Many of the researchers behind the dire
predictions concede that the scenarios are speculative." The director of the division of vector-borne infectious diseases at the Centers for
Disease Control and Prevention (CDC), Duane Gubler, calls those prophecies "'gloom and doom' based on 'soft data.'" Others attribute
them to "simplistic thinking." These experts agree that "breakdowns
in public health rather than climate shifts are
to blame for the recent disease outbreaks." Even El Nino, our most recent climate scapegoat, cannot take the blame for
recent epidemics. The claim that dengue fever epidemics in Latin America in1994 and 1995 were due in part to El Nino is simply wrong.
Science quotes dengue experts at the Pan American Health Organization: "The epidemics resulted from the breakdown of eradication
programs aimed at Aedes aegypti in the 1970s and the subsequent return of the mosquito. Once the mosquito was back the
 AT: Won’t Spread
Their defense is descriptive, not prescriptive—today’s diseases are much faster,
more lethal, and easier to spread due to dense populations, lack of attention, and
mutation abilities
Richardson ’16 (Robert Richardson, founder and editor of OFFGRID Survival, "PANDEMICS –
How likely are we to see a Major Pandemic?", Offgrid Survival, July 6,
offgridsurvival.com/globalpandemic/, *date is date accessed, no date available, CL)
I am a microbiologist with over 25 years of experience in various areas of microbiology and human health research. I am currently the
coordinator for two research centres at the University of Ottawa, the Emerging Pathogens Research Centre (EPRC) and the Centre for
Research on Environmental Microbiology (CREM). I’m also known as the “Germ Guy” and a promoter of global health and hygiene. At
Ottawa, our work focuses on the nature of pathogens both in the environment and in the host, their evolution, their spread and how best
to prevent and control them. With respect to pandemics, we have published peer-reviewed articles on the evolution of SARS (the
pandemic that never was) and the infamous H5N1, more specifically, why it may never end up causing a pandemic. I’ve also co-authored
a chapter on the environmental survival of SARS and how to effectively control its spread. How likely are we to see a major pandemic in
the near future? By its definition, a
pandemic is major however in the context here, I believe that the world is becoming
increasingly more likely to see a major event. It’s a process that is highly predictable. It starts with migration
of agriculture and urban environments into more rural and remote area s, increasing the likelihood
that a potential pandemic strain of a pathogen will come into contact with humans increases .
Then, thanks to the rise in densification of both animal and human populations , these pathogens can
spread in a localized environment and evolve to cause greater problems. Finally, with travel
from the localized area, the pathogen can then move worldwide. This fact is particularly important when one
thinks that almost 100 years ago, when we had the 1918 pandemic, it could take months to circumnavigate
the globe. Today, it can be accomplished in a day. Moreover, with more individuals traveling than ever before (some
1.4 billion air travelers per year), the opportunity for a pandemic strain to spread is greater than it has ever been.

What are the biggest threats that you see on the horizon? T he majority of pandemics have been due to the
evolution of an animal pathogen to a human pathogen. So, the real threat that faces humanity is the
continued sharing of spaces between animals who carry these viruses , such as chickens and pigs, and
humans. In the case of several near-pandemic pathogens, like H5N1 influenza and the H1N1 pandemic, cases were almost always
associated with close contact with a carrier animal. Then, through a process of evolution, the pathogen can ‘adapt’ to the
human host and then be able to spread without the need of an anima l. The H5N1 has yet to accomplish this
adaptation whereas the H1N1 successfully made the transition and led to the pandemic. If a major pandemic does hit what will it look
like? I guess if one looks back over the last decade, there are two possible streams for a pandemic. The first, represented by H1N1, may
lead to a high number of infections with a slightly higher or equal rate of mortalities. Normally, influenza has a mortality rate of about
0.1% . The mortality from the H1N1 pandemic virus was similar, if not lower. By the time the pandemic was over, there was some impact
on the global scale but for the most part, the world was able to move forward. The second, represented by SARS, would be much worse.
With a mortality upwards of 15-20%, the virus would not only spread like wildfire, but also kills in high numbers. In affected regions,
which included Toronto here in Canada, hospital intensive care units would be filled to capacity and many of them would be essentially
locked down. Away from the health impact, travel to these cities would plummet and economies would suffer for years afterwards. As a
result of a rapid global effort, SARS
was effectively stopped before it could go global, however, the impact
could be extrapolated to give an idea of what might happen in the event of a pandemic following
this path.
Can you give us some realistic contagion timelines? To be honest, no. While it’s easy for Hollywood to come up with potential timelines
for a pandemic, the reality is that several
factors have to be taken into consideration before making a guess
as to the speed that a pandemic might travel. These factors include: The ability of the strain to infect,
How lethal the strain is to humans, The ability of the strain to spread, How easy it is to kill the strain ,
The likelihood that people will listen to warnings and advisories in order to prevent a pandemic from taking
hold. For example, almost everyone believes that Ebola virus would make a great pandemic. It infects rapidly and it quite lethal.
However, it’s fairly easy to kill and it’s not easy to pick up the virus unless you are relatively close to an infected individual. Also, because
it’s so lethal, when infection is found, people tend to ‘run for the hills’ and would easily take to any recommendations to prevent spread .
So, in that sense, it’s not a particularly good candidate for a pandemic and it’s timeline would be rather short. As we saw with the H1N1
pandemic, the virus infected with relative ease although it wasn’t quite lethal. It spread between humans effectively although it was
simple to kill. The real reason
the pandemic took hold was that people simply didn’t listen to the
warnings and advisories and acted as if nothing was wrong. It wasn’t until a few key deaths occurred in October
of 2009 that suddenly the world took notice. By that point, the virus had spread worldwide and simply had to peter out, which took at
least another 10 months. So, I guess the simplest way to estimate a timeline is a comparison between the lethality of the virus and the
ability of humans to react to the news of the virus. I’m sure that there’s
a ‘happy medium’ that could lead to the worst
case scenario, significant lethality and a lack of attention leading to a sustained timeline, but I haven’t
seen anything that could qualify…yet.
 AT: No Incentive
The benefits of controlling infectious disease outbreak are both internal and
external to a country
Long ’11 (William Long, Professor and Chair at the Sam Nunn School of International Affairs
Georgia Institute of Technology, “Pandemics and Peace: Public Health Cooperation in Zones of
Conflict", published June 2011, CL)
Why Cooperation: Securing Common Interests in a Transnational Public Good
Absent the prospect for meaningful new gains, states and their private and public collaborators have
limited motivation to overcome the challenges to cooperation. States participate in transnational initiatives to obtain
interests they could not otherwise secure, and it is the overlapping of interests among states and nonstate
actors that can be seen as the central or necessary condition for transnational cooperative
efforts.' A transnational initiative must have the potential to create a collaborative advantage, that is, some significant welfare
enhancing benefit that could not be achieved without the collaboration. Furthermore , the value created must flow to all
core members. Preventing and controlling infectious disease outbreak and the health benefits
related to doing so are a shared interest in a public good best se cured regionally or transnationally .
In general, securing public goods is difficult and capturing the benefits of transnational public goods
even more problematic. Public goods are those that yield benefits that are non-rival in consumption (can be enjoyed
simultaneously by all in a specific community) and non-excludable (from which no one in the community can be kept from consuming).3
At a local level, for example, a public good could be the enjoyment of a city park, or at a national level, the sense of security from foreign
invasion provided to all citizens by the existence of a national army or militia. The
paradox of public goods, of course, is
that they tend to be underprovided. Because they are non-excludable, a price cannot be enforced
and thus no private incentive exists to produce them .4 The paradox can be overcome at the local and national level to
the extent that the government can enforce production, such as by taxing citizens for the provision of a city park or by conscripting
soldiers for an army: For
global and regional transnational public goods, however, the problem is more
difficult because (as realists rightly underscore) no global or regional government finances and
enforces public goods production . Absent a formal government with such powers , the multilateral actors
involved in providing a regional or global public good must rely on recognizing their enlightened
self-interest. Enlightened self-interest is composed of self-interest, shared interest, and altruism (other-interest) that together
enhance one's well-being.' As all theoretical perspectives can agree, recognizing and acting collectively on one's enlightened self-interest
is rare in international relations; it does not happen just because one believes it should happen from an ethical or logical standpoint.
Cooperation is particularly vexatious when it touches on the security of the state and the states
in question, as here, have little or no history of cooperatio n. Why are MBDS, MECIDS, and, for a time, EAIDSNet,
exceptional in their ability to overcome the barriers to the production of a sensitive trans-national public good, especially
when the organizations' membership in-dudes countries without a strong history of cooperation ? I suggest three
reasons. First, it is in the clear self-interest of each member to control trans-boundary
communicable diseases. As noted in chapter 1, it is increasingly the responsibility of states to provide for the health of their
populations. Second, infectious disease control is a public good that is, preventing or treating an
infectious disease not only benefits the patient, but also benefits others by reducing their risk of
infection. Likewise, the control of a communicable disease in a given country reduces the likelihood of an outbreak in an adjacent
country if the two countries share common food, air, and water or other vectors of interdependence. If each country receives
substantial consumption externalities from another's control of infectious disease, then both are
more likely to appreciate and act on their shared interest in disease control . Furthermore, because of their
physical interdependence, the mutual benefit arising from infectious disease control is readily apparent
and the consequences of failing to cooperate are equally clear to all . In this sense, vulnerability to infectious
disease outbreak and spread is a classic and compelling superordinate problem because infectious disease affects each member, is
shared by all, and cannot be resolved without joint action. As one author suggests, "the vicious threat posed by diseases and pathogenic
microbes . . . is predicated on . . . the mutuality of vulnerability."' Because of their proximity, network participants are keenly and directly
aware of their mutual vulnerability and that national efforts alone will not protect their populations. Third,
their shared
vulnerability both underscores the benefits of securing mutual interests and infuses an element
of altruism into state calculations. Public health officials, by virtue of their training and current responsibilities, are
particularly sensitive to the indivisible nature of their shared vulnerability. MBDS actors, for example, expressed empathetic
understanding of the problem their cohorts in other member states faced and showed no interest in blaming each other for past
outbreaks. They stressed that the dangers in this area of public health are serious, and, as scientists, recognized that infectious
disease could arise in any part of the region at any time .’ Taken together, states can more readily appreciate and act
on their en-lightened self-interest in providing a regional public good when interdependence (both positive and negative) is acute and
where positive externalities exist. Recent pandemic scares such as SARS and avian flu added a sense of urgency to national efforts.
With regard to infectious disease control, the six countries of the MBDS system, the three political entities of
MECIDS, and the three founding countries of the EAIDSNet each faced a problem with a clear and compelling win-
win-win-win solution, not just win-win: by cooperating on infectious disease control, I benefit, you
benefit, I benefit by you benefiting, and vice versa. As one MECIDS principal explained, in infectious disease protection,
"You are only as strong as your neighbor."' Also, each actor can take credit for any successful results from cooperation because this
benefit is also nonrival and nonexclusive. This latter feature helps to ensure political support from participating countries' health
ministers.
Economy EXT
 U.S. aid solves
US aid to China on public health helps economy
Hickey '14 (Christopher Hickey, Ph.D. Countr Director for the People's Republic of China,
"China's Healthcare Sector, Drug Safety, and the U.S.-China Trade in Medical Products", U.S. Food
and Drug Administration, www.fda.gov/NewsEvents/Testimony/ucm391480.htm, CL)
FDA is addressing the challenges outlined above in several different ways. We currently have 13 staff in China, posted in Beijing,
Shanghai, and Guangzhou. This includes eight U.S. civil servants and five Chinese staff. Using funding Congress provided in 2013, FDA is
The mission of FDA’s China Office is to
currently working to increase to 27 the number of U.S. officers it posts in China.
strengthen the safety, quality, and effectiveness of FDA-regulated products produced in China
for export to the United States. FDA’s China Office works to fulfill this mission through: Collaborating, capacity-building, and
confidence-building with Chinese regulatory counterparts at central, provincial, and municipal levels; Conducting outreach to regulated
Chinese firms that wish to export their products to the United States to enhance understanding of—and compliance with— FDA
requirements; Monitoring and reporting on conditions, trends, and events that could affect the safety and effectiveness of FDA-regulated
products exported to the United States; Conducting
inspections at facilities that manufacture FDA-regulated
goods; and Working closely with other key government and non-government stakeholders who
work to strengthen the safety of FDA-regulated products manufactured in China. In addition to other
budget requests that focus on imports from China, the Agency’s FY 2015 budget has requested $10 million in funding specifically for
continuing the China Initiative. These new resources will strengthen the protection of American patients in the following ways:
Strengthening FDA’s inspectional and analytical capabilities by adding nine drug inspectors to FDA’s China Office. The United States and
China were able to address problems associated with visas for these staff during the visit of Vice President Biden to Beijing in December
2013, and FDA anticipates posting these new staff in country in Fiscal Years 2014 and 2015. This will allow more rapid access to Chinese
facilities and will help to increase the number of FDA inspectors who have in-depth knowledge and expertise about current challenges
that Chinese industry faces.

Broadening the range of inspections FDA performs in China. In addition to inspecting Chinese facilities that manufacture food and
medical products for export to the United States, FDA will increase the number of sites it inspects that conduct clinical
trials pursuant to investigational new drug (IND) applications , and will also perform follow-up inspections to
ensure that firms continue to produce and manufacture food and medical products under safe conditions. Increasing
opportunities for engagement with Chinese regulatory counterparts . Direct observation of FDA inspections
can bolster Chinese regulators’ understanding of FDA’s requirements and processes and strengthen China’s inspectional capacity.
Enhancing Chinese regulators’ knowledge of U.S. safety standards through participation in
workshops and seminars, such as the International Conference on Harmonisation and the International Pharmaceutical
Regulators Forum. These opportunities help facilitate dialogue and encourage scientific exchange on the
critical role inspections play in improving the safety and quality of food and medical products.
Strengthening FDA’s ability to use informatics tools, such as trend analysis, predictive modeling, and geospatial mapping. These tools
will help to sharpen FDA’s understanding of potential public-health risks. Increased use of data will help FDA strengthen its systems in
several key areas, including the implementation of science-based, harmonized standards .
The ultimate goal is to detect
and address risks through preventive, risk-based approaches before those risks result in harm to
U.S. consumers.
Soft Power EXT
 Decline Now
U.S. soft power has been continuously declining since 2001
Shuja '07 (Sharif Shuja, lecturer and coordinator of Issues in Contemporary Asia subjects at
Victoria University, "Has the US forgotten the importance of soft power?", Newsweekly, October 27,
newsweekly.com.au/article.php?id=3206, CL)
As the world's sole superpower with unrivalled economic and military dominance, the United States must make critical
choices about the forms of power it employs to achieve its foreign policy objectives. In contrast to hard
power that rests on coercion and is derived from military and economic might, soft power rests, not on coercion, but on
the ability of a nation to co-opt others to follow its will through the attractiveness of its culture,
values, ideas and institutions. When a state can persuade and influence others to aspire to share such values, it can lead by
example and foster cooperation. Joseph Nye first coined the term "soft power" in a 1990 essay, Bound to Lead: The Changing Nature of
American Power, and further developed the concept in a 2004 book, Soft Power: The Means to Success in World Politics. Up until 2000,
American soft power was strong. The attractiveness of its society and institutions was conveyed by economic power, the domination of
US businesses, American television, film and music, soaring immigration and the international appeal of its democratic culture and
institutions. During that period, US foreign policy involved the use of both hard power and soft power.

Controversial: However, since September 11, 2001, US soft power has declined sharply due to the controversial
policies of the current Bush Administration, which has relied excessively on coercive diplomacy and military
power and a unilateralist approach. It has also neglected public diplomacy and cultural exchange programs, and failed to
promote the attractiveness of American society to the rest of the world. Since 2001, US foreign policy, especially in the Iraq
War, has become increasingly unpopular, strengthening anti-American sentiment and seeing a
further decline of American soft power. It is argued that both hard and soft power are important in US
foreign policy and in the fight against terrorism. However, America's neglect of soft power is undermining its
ability to persuade and influence others. In comparison, the soft power capabilities of others such as the European
Community and China have grown. Soft power has always been an important element of leadership. For example, the Cold War was won
with a strategy of containment that used soft power along with hard power. However, in the global information age, we are seeing an
increase in the importance of soft power. Communications technology is shrinking the world and creating ideal conditions for projecting
soft power through the control of information. Polls taken around the world show strong evidence of America's declining popularity. A
2005 poll by the Lowy Institute reported that just over half of Australians polled had a positive view of the US, but, paradoxically, that
around the same number saw the foreign policies of the US as a potential threat - equivalent to the same number of Australians who
worried about the threat of Islamic fundamentalism. Polls taken in other nations suggest similar anti-American sentiment. A poll by the
Pew Charitable Trust reported that the attractiveness of the US decreased significantly between 2001 and 2003 in 19 of 27 countries
sampled. Gallup International polls report that, for the majority of people in 29 countries, US policies have had a negative impact on their
opinion of the US. It is argued that the Bush Administration has neglected its soft power capabilities. The US State Department's public
diplomacy initiatives, such as educational and cultural exchange programs, help to project the more non-commercial aspects of American
values and culture, and influence public opinion overseas. These were once a linchpin of American foreign policy. Similarly, US
government overseas broadcasting that is open, unbiased and informative helps to improve American credibility. However, funding has
been slashed, and the efforts of the current administration to boost State Department's public diplomacy and international broadcasting
have been limited. Arguably, there is currently no coherent public diplomacy strategy to communicate American values and mould public
opinion worldwide. According to Joseph Nye, the US spends billions of dollars on defence and only one-quarter of one per cent of this on
public diplomacy. One element of American society that tends to decrease its attractiveness abroad is its lack of knowledge and interest
in the rest of the world. America's soft power capabilities are built on the style and substance of its foreign policy. J. Kurlantzeck, in an
article in Current History (December 2005) said: "T he
Clinton Administration did not always use its political
leverage to promote multilateral institutions, but it at least openly praised multilateralism while
trying to publicly soothe fears of American unilateralism . The Bush Administration does not even offer such
praise or reassurance." Events such as the abuse of prisoners in Abu Ghraib and Guantanamo Bay have undermined the attractiveness of
American values, since that is based in part on international perceptions of the US as a humane and law-abiding nation. America's
declining soft power capabilities mean it is losing its persuasive power . In its attempt to persuade
North Korea to give up its weapons of mass destruction, the US has had to let China play a major role.
While the US continues to rely on hard power, other nations have successfully used soft power
to improve their global position. Polls taken in 2005 report that a large majority of nations
believe Europe and China play more positive roles in the world than does America.
China: As its economy has rapidly grown over the last decade, China has sought to develop its soft power
capabilities. It has sought to influence other countries using regional aid, public diplomacy, interaction with multilateral institutions
and the embracing of free trade. Its appeal threatens to outstrip that of the United States and cast it as the primary regional power,
presenting a potential danger to US influence and interests in the region. Some proponents of hard power argue that the US is so strong
that it can do as it wishes without approval. According to former US Secretary of Defence Donald Rumsfeld, "The world's only
superpower does not need permanent allies; the issues should determine the coalitions, not vice versa." I believe both hard and soft
power are important in US foreign policy - the right balance of hard coercive power and soft co-optive power.
 Health Diplomacy Key
Cooperation on pandemics spillovers to other international issues—decreases the
risk of miscalculation and solves first impending extinction
Erickson '07 (Dr. Andrew S. Erickson, Assistant Professor in the Strategic Research
Department at the U.S. Naval War College in Newport, Rhode Island and a founding member of the
department’s China Maritime Studies Institute (CMSI). His research, which focuses on East Asian
defense, foreign policy, and technology issues, has been published in Comparative Strategy, Chinese
Military Update, Space Policy, Journal of Strategic Studies and Naval War College Review,
"Combating a Truly Collective Threat: Sino-American Military Cooperation against Avian Influenza",
Global Health Governance, published January 2007, ghgj.org/Erickson%20article.pdf, CL)
Cooperation against the threat of avian influenza could build mutual confidence and generate
momentum for initiatives in other areas. In addition to enhancing communication, the building of bilateral contacts could
give both sides a healthy respect for each other’s capabilities, thereby reducing the chance of dangerous miscalculations. Ongoing
tensions in U.S.-China relations are based in part upon differences in national interests that are likely to endure. A
positive
bilateral military relationship will not in and of itself resolve those tensions. But such a
relationship could offer realistic first steps that might serve to outline and safeguard mutual
interests and thereby provide incentives to avoid unnecessary escalation and avert serious crises
as the two nations seek to realize stable if competitive coexistence. China, situated at the potential epicenter of an avian
influenza outbreak, has a particularly vital role to play in infectious disease control. China’s efforts in this regard are apparently growing,
and seem to be increasingly impressive. Already, according to Dr. David Nabarro, Asia as a whole has made substantial progress in
preparation for an influenza pandemic.

One way to increase mutual understanding and goodwill would be for Chinese and U.S. researchers to translate unclassified Chinese
documents—starting with those concerning avian influenza and related public health threats—into English and to facilitate their wider
distribution among Western experts. Such dissemination could increase Western knowledge of Chinese advances in disease
prevention and control, which are reportedly numerous and rapid— particularly in specific technological areas. This might help to set
the stage for follow-on medical research—perhaps with an innovative combination of government and private sector funding— that
could exploit the synergy between U.S. technology and analysis and Chinese ability to conduct
large scale experiments and biotechnological production in a cost effective manner. Moreover,
Western analysts and scholars could use knowledge of China’s disease prevention efforts and security challenges to augment their
analysis and understanding of China from a broader perspective. Here it must be emphasized that a more robust and nuanced spectrum
of U.S. analyses of China, such as could be facilitated by greater transparency concerning Chinese military medical progress, is in China’s
own national interest. After all, like its foreign counterparts, the U.S. military is duty bound to anticipate and prepare for worst case
scenarios. But more optimistic projections and positive-sum
suggestions produced by other analysts who are free from such
responsibilities are extremely important as well. Such analyses could
further elucidate the great benefits that the
U.S. and China might derive from effective cooperation in a wide range of areas. Otherwise,
exclusive focus on the possibility of conflict could negatively influence U.S.- China relations by
overshadowing these other vital areas.
At very least, the origins and purposes of military medical and other analyses should be made transparent where possible by their
authors and kept in proper perspective by those who consume them. This can be facilitated by efforts on both sides of the Pacific, even in
the absence of explicit inter-governmental cooperation. There is substantial room for improvement in both nations. American analysts
would do well to understand important nuances of increasingly robust (though often still somewhat opaque) Chinese policy debates in
order to differentiate between official government policy and opinionated reports from China’s ever livelier media. This effort would be
greatly facilitated if more Americans would develop their often inadequate language skills—Beijing can be surprisingly transparent in
Chinese. Chinese analysts, who already tend to be quite sophisticated both linguistically and in their ability to trace political debates,
would do well to document their assertions with ample specific references, such as footnotes, to where they obtained their information.
While slowly improving, and already achieved by some highly advanced journals such as the Chinese Academy of Social Sciences’
American Studies, the overall dearth of such citations in both Chinese scholarship and official government reports makes it extremely
difficult even for foreigners fluent in Chinese to assess the quality of data being presented. This is particularly true in the exacting fields
of science and medicine, where a vaccine’s efficacy must be proven in a manner that is replicable by experts around the world, not simply
announced without supporting evidence.
These significant challenges should
not distract us from the larger issues at stake: a significant threat to
humanity can and must be averted. This collective responsibility requires cooperation across national boundaries
regardless of political differences. In this spirit, through translation and analysis of Chinese sources, I have endeavored to increase
awareness among Western scholars, analysts, and policy makers of important Chinese developments and their potential relevance to
Sino-American cooperation against avian influenza. The bottom line is that differences
in other national interests should
not prevent the United States and China—or, for that matter, all other nations—from recognizing their growing
collective interests in combating emerging threats such as that of pandemic influenza. As a Chinese proverb cautions,
“disasters know no boundaries ” (shuihuo wuqing).

Health and disease cooperation is an optimal way to foster international relations

and increase governmental stability --accounts for realism
Long ’11 (William Long, Professor and Chair at the Sam Nunn School of International Affairs
Georgia Institute of Technology, “Pandemics and Peace: Public Health Cooperation in Zones of
Conflict", published June 2011, CL)
Because states remain indispensable actors in these cases, international relations theory is a useful framework for
thinking about international and transnational cooperation in public health and disease
surveillance and response.34 This literature is vast. In a nutshell, though political realism in its many forms
emphasizes the enduring propensity for conflict among self-interested states seeking their
security in an anarchic environment, that is, one where there is no central authority to protect states from each other or to guarantee
their security. Hence international cooperation is thought to be rare, fleeting, and tenuous—limited, by enforcement
problems and each state's preferences for relative gains in their relationships because of their systemic vulnerability." Liberal
approaches are particularly interested in identifying several ways to mitigate the conflictive
tendencies of international relations, particularly through shared economic interests and norms and
institutions (e.g., democracy). Liberals argue that these factors can help ameliorate the enforcement problem in
anarchy and permit states to focus more on mutual gain defined in absolute rather than relative terms." More recently, constructivist
approaches emphasize that nonmaterial, ideational factors, not just state interests and national and international institutions, are critical
to understanding the formation of interests and the possibility of cooperation. As the name implies, for constructivists, the interests and
identities of states are highly malleable and context-specific and the anarchic structure of the international system does not, in itself,
dictate that conflict is the norm and cooperation the exception. Rather, the process of interaction
between and among
actors shapes how political actors (not just states) define themselves and their interests: "self-
help and power politics do not follow logically or causally from anarchy . . . . Anarchy is what states make of
it."37 Because identities and interests are not dictated by structure, a state's purely egoistic interests can be transformed under anarchy
to create collective identities and interests by intentional efforts and positive interaction. Moving away from concerns about whether
theory should focus primarily on interests, institutions, or ideas as the key causal variable in understanding cooperation (or the lack
thereof), the theory of cooperation that emerges in chapter 3 blends elements of these and other approaches, often cast as alternatives,
to demonstrate precisely the processes by which interests, institutions, and ideas (particularly about identity) can combine to shape
cooperation in this, and arguably other, areas of international relations. In so doing, it demonstrates the organic interrelationship among
the causal forces of cooperation and specifies the characteristics and dimensions of interests, institutions, and ideas about identity that
facilitate cooperation.38 Most
explanations for international cooperation in the area of public health
come from practitioners, policymakers, and analysts, not international relations scholars ." To
account for cooperation in matters of international public health, the practitioner and analyst literature offers several contending, but
largely untested, proto-hypotheses that draw from various social science approaches: An interest-based argument derived from the
forces of globalization and the social nature of the problem, that the global benefits from controlling the transnational spread of disease
necessitate cooperation and that "enlightened self-interest and altruism will converge in the increasingly interdependent world being
shaped by the process of globalization." Infectious diseases know no physical borders and present particularly compelling superordinate
problems that transcend the interests of contending parties, are shared by all of them, and require joint efforts for effective response. 41
This explanation identifies the potential basis for interest-based cooperation in infectious
disease surveillance and response, but fails to address how the difficulties inherent in providing an international public
good such as disease control are overcome. A psychosocial, identity hypothesis that health initiatives promote an environment that
emphasizes human well-being. The
aim of reducing pain and disease is relatively undisputed. Health
initiatives thus help overcome other, more divisive sources of identity by shifting the focus away
from questions of national or ethnic security to human security , and allowing for an evocation and extension of
altruism.42 How such identities are formed and reformed is not addressed, however. A domestic politics, rational choice* hypothesis that
health cooperation provides an essential national public good 46 (physical security) that redounds to a
participating government's credit, thus enhancing state capacity and legitimacy and improving
regional stability. This approach highlights the domestic, state-level, variables that might help account for cooperation.
Furthermore, positive results in health can be observed and measured by epidemiological statistics on
mortality and morbidity, have powerful impacts on citizens, and thus are attractive investments for
governmental and nongovernmental actors.47 A negotiation and signaling hypothesis that health initiatives, as
voluntary; novel, and consequential projects, are reliable signals for improving communication, reducing threats, and breaking patterns
of conflict among traditional rivals or antagonists.48 For example, Thomas Novotny and Vincanne Adams maintain that " health
and
scientific interactions can serve as core diplomatic gestures to improve communication, reduce
mutual or bilateral threats, and address health problems of mutual importance." This observation suggests
that health initiatives can be a top-down strategy as part of national statecraft.
 U.S. Key
The United States is the expected leader of public health diplomacy engagement
Brown et al. 13 (Matthew Brown, Bryan A. Liang, Braden Hale, and Thomas Novotny, Senior
Advisor at Office of Global Affairs, US Department of Health and Human Services - US Department of
Health and Human Services, “China's Role in Global Health Diplomacy: Designing Expanded U.S.
Partnership for Health System Strengthening in Africa”, Global Health Governance, Volume 6, No. 2,
CL)
Why would the U.S. government explore expanded public health collaborations with China in Africa? It is important to note that these
two nations already have a shared history of public health collaboration. The
United States and China have collaborated
for more than two decades on infectious diseases (HIV/AIDS, influenza, and emerging
infections), cancer, and other non-communicable diseases .37 These collaborations share common goals for
improving the practice of public health as well as strengthening public health institutions in detecting and responding to public health
problems in the United States and China. Additionally, improving medical infrastructure and health systems are shared global health
objectives and stated priorities of African leaders, and such activities may also facilitate economic development and commerce among
these partner nations.38-39 Despite common goals, strategic cooperation in health development activities on the continent of Africa
between the United States and China remains limited. From the early 2000s, the United States has focused on single disease approaches
in Africa. For example, the United States has supported a series of large global health initiatives on HIV/AIDS;
in fact, the President’s Emergency Plan for AIDS Relief (PEPFAR) represents the largest amount of funding pledged by any nation to a
single disease.40-41 However, PEPFAR’s single-disease approach also supported the development of public health institutions that can
tackle additional public health problems that plague African nations.42 This was the objective behind the creation of the GHI in 2009,
capitalizing on the infrastructure of PEPFAR to tackle other diseases of public health significance.43 For
the United States, the
next phase of global health investment also coordinated by the DOS includes strengthening health
systems.44 Drawing upon lessons learned from U.S.-China collaborations and employing
leadership of the S/GHD to explore and map potential collective action with the Chinese
government presents an opportunity to amplify the public health impact of development
assistance by both nations. It also provides the basis to respond to African leaders’ call for stronger coordination among donor
nations. characteristic of this evolution is the critical role U. S. Ambassadors now play in allocating and
directing public health resources. As the U.S. President’s representative to a foreign country, Ambassadors negotiated
PEPFAR expansion and Partnership Frameworks directly with leaders of host governments. While the implementing agencies were still
responsible for the funds appropriated for their programs, U.S. Ambassadors were held accountable for the overall success or failure of
the PEPFAR country program. Authority to make funding recommendations rested with the Ambassador and PEPFAR performance
elements were integrated into U.S. Mission Strategic Plans in each target country. This escalation and expansion of public health
management accountability to the diplomatic sector was unprecedented and helped engender stronger foreign policy attention overall to
global health in embassies abroad and, to some extent, in the DOS as a whole. For example, both the Global AIDS Coordinator and the
deputy head of the Office of Global Health Diplomacy routinely attend the Secretary’s weekly staff meeting of all the bureau heads.
 Yes Spillover
Foreign aid towards public health systems strengthens U.S. credibility in negotiating
other issues—spills over to long term diplomatic, economic, and security
agreements
Institute of Medicine Committee ’09 (Institute of Medicine (U.S.) Committee on the
U.S. Commitment to Global Health, a subpart of a branch of the National Institutes of Health, “The
US Commitment to Global Health: Recommendations for the New Administration”, National Center
for Biotechnology Information, http://www.ncbi.nlm.nih.gov/books/NBK32621/, CL)
Given the importance of health in building stable and prosperous communities , the committee
encourages the new President to make a bold public statement that global health is an essential component
of U.S. foreign policy. This could be confirmed by a major speech early in his tenure to pledge support to the United States’
successful investments in this arena and propose new means for pursuing global health objectives in a committed, cooperative, and
nonpartisan manner. In a public address, the President should declare that the dominant rationale for U.S. government investments in
global health is that the
United States has both the responsibility as a global citizen, and an
opportunity as a global leader, to contribute to improved health around the world. The U.S.
government should act in the global interest, recognizing that long-term diplomatic, economic, and
security benefits for the United States will follow. Priorities should be established on the basis of achieving sustained health
gains most effectively, rather than on short-term strategic or tactical U.S. interests. Government efforts should focus on reducing deaths
and disabilities among the most vulnerable and marginalized populations in regions with the greatest need, in countries that possess the
capacity to effectively use financial and technical resources. Equally important, health resources should not be withheld from people in
countries where the United States takes an unfavorable view of the governing regime. TheU.S. offer of cyclone assistance
to Myanmar in February 2008 was a good example of placing priority on humanitarian needs
over politics. In developing sanctions at the UN and elsewhere, food, medicine, and other health necessities should not be included
among the areas of denied trade or assistance.

U.S.-China cooperation creates dialogue and new areas of multilateralism in global

health security
Huang ’16 (Yanzhong Huang, Senior Fellow for Global Health, Council on Foreign Relations, and
professor of Diplomacy and International Relations at Seton Hall University, “China’s Healthcare
Sector and U.S.-China Health Cooperation”, April 16, Council on Foreign Relations, CL)
U.S-China cooperation in addressing other health challenges
U.S.-China cooperation, of course, is not confined in R&D for new drugs, vaccines and therapies .
They have cooperated in other areas of global health security. The U.S. and China were two of
the first countries to respond to the Ebola outbreak in Western Africa . Unlike the United States, China has
not publically framed the Ebola outbreak as an international security threat or deployed a large number of military personnel to the
affected countries. Its dispatch of elite PLA units to the affected countries nevertheless suggests that it did view the outbreak as an
existential security threat that required a response out of the normal political boundaries. Beijing’swillingness to implicitly
securitize trans-border disease outbreaks has opened a new area for future collaboration between
China and other countries (e.g., the U.S.) under the Global Health Security Agenda. Indeed, during the crisis Chinese
military personnel trained a Liberian engineering company so that the latter could play an instrumental
role in helping the U. S. Army to construct its treatment center in the country. Similarly, the U.S. Air Force provided
large forklifts to help unload the supplies that China brought to Liberia. On June 24th, 2015, US Secretary of Health and
Human Services Sylvia Mathews Burwell, Chinese Vice Premier Liu Yandong and Minister Li Bin of China’s National
Health and Family Planning Commission, met to recommit to that partnership in addressing public health
emergencies by renewing a Memorandum of Understanding for the next five years on cooperation to address
emerging and re-emerging infectious diseases.
In addition, both governments have established partnerships over basic medical research . In
2008, National Cancer Institute (NCI) launched a research partnership with China and established NCI Office of
China Cancer Programs. This is followed by the launch of US-China Program for Biomedical Research
Cooperation in 2011, by NIH and National Science Foundation of China. Non-governmental organizations are also involved in
establishing partnership with China. In August 2014, Massachusetts General Hospital was reported to be in early discussions with two
partners to build a full-service hospital with 500 to 1,000 beds in China. Mass. General also signed a “framework agreement’’ with a
Chinese hospital specializing in traditional medicine and a Chinese investment firm, allowing the three parties to exchange financial
information and work on developing a definitive agreement to open a facility in an island city close to Hong Kong. In late November 2015,
the U.S.-China Joint Commission on Commerce and Trade (JCCT) was held in Guangzhou, China. Secretary of Commerce Penny Pritzker
and U.S. Trade Representative Michael Froman co-led a high-level U.S. government delegation to the high-level dialogue. The Chinese
delegation was led by Vice Premier Wang Yang. For the first time in JCCT’s 26 years of history, t he
dialogue featured a one-
day healthcare event attended by senior government officials and business leaders from the
healthcare industry in both countries.
Solvency EXT
 Generic
China holds valuable expertise in combatting pandemics and can use a multilayered
approach in cooperation
Erickson '07 (Dr. Andrew S. Erickson, Assistant Professor in the Strategic Research
Department at the U.S. Naval War College in Newport, Rhode Island and a founding member of the
department’s China Maritime Studies Institute (CMSI). His research, which focuses on East Asian
defense, foreign policy, and technology issues, has been published in Comparative Strategy, Chinese
Military Update, Space Policy, Journal of Strategic Studies and Naval War College Review,
"Combating a Truly Collective Threat: Sino-American Military Cooperation against Avian Influenza",
Global Health Governance, published January 2007, ghgj.org/Erickson%20article.pdf, CL)
China has already allocated $246.6 million for domestic measures to control avian influenza. These include building a network of
monitoring stations to track transmission of avian influenza by migratory birds and its infection of humans. Chinese
officials are
simultaneously working to raise awareness, coordinate domestic efforts, and build a more efficient
reporting system between provinces. The last is an attempt to address the fact that, particularly in recent years, inter-
province coordination has posed a particular challenge for Beijing. China has been similarly proactive in the
international arena. In April 2006, Dr. David Nabarro, U.N. System Coordinator for Influenza, met with Chinese officials “to
discuss China’s role in the international control of avian influenza and preparation for dealing with any possible influenza pandemic.”
During that same month, China hosted the “Asia-Pacific Economic Cooperation Symposium on Emerging Infectious Diseases.” Chinese
universities, government research institutions and corporations have responded to the growing
challenge of avian influenza by conducting what official Chinese media sources report to be cutting-edge research in
the prevention and treatment of infectious diseases. A wide variety of research is being conducted by students and
faculty members at academic institutions all over China, apparently with particularly prolific contributions from the Chinese Academy of
Agricultural Sciences, China Agricultural University, Shandong Agricultural University, and Yangzhou University. Academic conferences
have been held periodically in China to disseminate research results. In December 2005, China’s Ministry of Agriculture announced that
Harbin Veterinary Research Institute had developed the “world’s first live vaccine against bird flu.” “A major advantage of China’s
research into the bird flu virus is our technical reserve and capacity to meet emergencies,” Vice-Science Minister Liu Yanhua concludes.
“They are powerful resources.” Having
played a significant role in the handling of the 2003 Sever Acute
Respiratory Syndrome (SARS) crisis, China’s People’s Liberation Army (PLA) can claim valuable experience with
regard to infectious disease control measures. In 2004, the PLA published a practical pamphlet on techniques for
dealing with avian influenza. In fact, due to its large network of high-level hospitals and research facilities, the PLA holds jurisdiction over
a crucial element of China’s disease prevention responsibility and expertise. Academy of Military Medical Sciences researcher Li Song
recently reported that his team had “completed clinical experiments” concerning a new Chinese drug similar to Tamiflu “and find it is
more effective on humans than Tamiflu.” While little data is available in the West concerning the specifics of such achievements, the
PLA is so central to China’s medical infrastructure that it would probably be difficult to engage
more deeply with China in the prevention of avian influenza without also engaging with elements of
the PLA.

Empirics prove that cooperation between the U.S. and China can improve China’s
public health system
Huang ’16 (Yanzhong Huang, Senior Fellow for Global Health, Council on Foreign Relations, and
professor of Diplomacy and International Relations at Seton Hall University, “China’s Healthcare
Sector and U.S.-China Health Cooperation”, April 16, Council on Foreign Relations, CL)
In January 2011, the U.S. Department of Health and Human Services (HHS) and other federal agencies
announced a new public-private healthcare partnership between the U.S. and China. The initiative is
aimed at fostering cooperation in research, training and regulation . The initial U.S. participants include Pfizer,
Medtronic, Abbott Laboratories and Johnson & Johnson, as well as trade groups AdvaMed, which represents medical device makers, and
the Pharmaceutical Research and Manufacturers of America, which represents drug makers. In the meantime, we
have seen
private foundations and international NGOs forge partnerships with Chinese state-owned
enterprises in R&D. Through a generous grant from the Bill & Melinda Gates Foundation, for example, an international non-
nonprofit organization called PATH in 2009 signed a collaboration agreement with the government-owned Chengdu Institute of
Biological Products (CDIBP) to develop a vaccine for Japan Encephalitis (JE). PATH provided technical and financial support so that
CDIBP could meet the strict standards required for prequalification by the World Health Organization. Three years later, the vaccine
became the first single-dose JE vaccine that the WHO has approved for use on children. By 2017, the JE vaccine is anticipated to reach
nearly 290 million people in Asia.

The U.S. and China are invested in collaborating on fighting infectious disease and
global public health
KFF ‘09 (Kaiser Family Foundation, U.S. non-profit focused on providing n-depth information on
key health policy issues including Medicaid, Medicare, health reform, global health, "U.S.-China
Talks Expected To Include Collaboration On Fighting Infectious Disease", The Henry J. Kaiser Family
Foundation, July 29, kff.org/news-summary/u-s-china-talks-expected-to-include-collaboration-on-
fighting-infectious-disease/, CL)
China’s Deputy Health Minister Yin Li on Tuesday said that public health cooperation between
China and the U.S. can improve the health of both countries and be strategically significant to
world peace and development, Xinhua/China View reports (7/29). His remarks come after Secretary of State Hillary
Clinton said that she expects the second day of talks with Chinese officials to examine ways to work
together to combat infectious disease, according to VOA News. HHS Secretary Kathleen Sebelius will attend the session,
VOA News reports (7/28). According to Xinhua/China View, Yin said economic globalization fosters the spread of
diseases across borders and that every country is facing challenges and threats posed by
emerging and traditional epidemics, as well as chronic non-contagious diseases. “Therefore , both countries
believe that it is of great significance to expand China-U.S. research and cooperation on disease
issues, especially those concerning global public health,” Yin said. The deputy health minister praised two decades of
public health cooperation between the U.S. and China, including current efforts to control the H1N1 flu spread. Yin said China has
outlined proposals for future collaboration, including plans “to boost the bilateral cooperation on
global health and promote the establishment of a transparent mechanism of information
exchange and cooperation under the framework of international health regulations,” Xinhua/China View writes (7/29).
 China says yes
China says yes
Huang ’16 (Yanzhong Huang, Senior Fellow for Global Health, Council on Foreign Relations, and
professor of Diplomacy and International Relations at Seton Hall University, “China’s Healthcare
Sector and U.S.-China Health Cooperation”, April 16, Council on Foreign Relations, CL)
Unlike security-related issue areas, the dynamic of U.S.-China health cooperation is largely
insulated from the fluctuations of domestic politics and strategic foundations. Indeed, even in the post-Cold
War era, U.S.-China health cooperation continues to grow in breadth and depth. In part, this is because
health is a politically less sensitive area where each side feels strongly about. Shared health concerns
challenge the two countries to promote jointly the welfare of their people. Already, we have seen effective
bilateral cooperation under way in HIV/AIDS prevention and control, in food and drugs safety, and in
addressing international public health emergencies.

U.S. and China have a vested interest in working together on global health
Liu et. al ’14 (Peilong Liu, programme officer in the Department of International Cooperation
in the Ministry of Health, China and Masters of Public Health at John Hopkins University, “China’s
distinctive engagement in global health”, The Lancet, August 30, Volume 384 No. 9945,
http://thelancet.com/journals/lancet/article/PIIS0140-6736(14)60725-X/fulltext, CL)
Because there is no universal consensus for the definition of global health, some approaches focus on transnational health risks, which lie
beyond the reach of national governments, whereas other approaches stress the global commitment and
responsibility to address health inequities and to support health.13 We have adopted a framework of
global health as characterised by health and related transnational flows of diseases, people,
money, knowledge, technologies, and ethical values.14–16 Four domains capture these globalisation processes
(figure 1). First, health aid aims to advance global health equity . It is the traditional area of official development
assistance (ODA) coordinated by organisation for economic cooperation and development (OECD) countries. Second, global
health security should be ensured by management of interdependence in global health and mutual
protection against shared and transferred risks, such as epidemic diseases. Third, health
governance is needed for global stewardship to set ground rules as mediated by health diplomacy. Fourth,
knowledge exchange is needed, which includes the sharing of lessons and knowledge production, ownership, and
application worldwide. Knowledge centrally affects all four pillars of global health and global health
governance is recognised to be central to all four domains (figure 1).

China is interested in investing more in public health diplomacy since the 2003
SARS outbreak
Brown et al. 13 (Matthew Brown, Bryan A. Liang, Braden Hale, and Thomas Novotny, Senior
Advisor at Office of Global Affairs, US Department of Health and Human Services - US Department of
Health and Human Services, “China's Role in Global Health Diplomacy: Designing Expanded U.S.
Partnership for Health System Strengthening in Africa”, Global Health Governance, Volume 6, No. 2,
CL)
How did SARS change China’s global health engagement? The SARS epidemic exposed serious weaknesses with
China’s lack of transparency related to public health issues.80 The first SARS case in China appeared in November 2002.81 The WHO’s
Global Outbreak and Alert Response Network (GOARN) received reports of a “flu like outbreak” in China through Internet monitoring.82
WHO requested information from the Chinese government regarding the outbreak on December 5 and 11, 2002.83 However, according
to CNN news reports and several journal reports, Chinese
government officials did not inform WHO of the
outbreak until February 2003.84-85 This initial lack of transparency about the epidemic delayed the
global community’s response to a novel and highly dangerous infectious disease agent.86-87 It
brought economic and political pressure on China’s government for lack of transparency and
limited cooperation. China later apologized for the initial delay during the outbreak of the SARS epidemic, confirming the
importance of timely reporting and engagement in the response to emergent global health issues.88 China’s official report of SARS in
February 2003 and apology for delaying international notification demonstrates the newfound Chinese governmental authorities’
recognition of the importance of cooperation with WHO and other member states.89 International officials largely credit the increase in
communication with the international community to the leadership of the then new President Hu Jintao and Prime Minister Wen
Jiabao.90 SARS
also marked an increase in cooperation among Chinese scientists, WHO
epidemiologists, and U.S. CDC scientists, although there continue to be criticisms of China’s global public health
efforts.91 Discussions held during the SARS outbreak led to the HHS’s Health Attaché based at the U.S. Embassy in Beijing and the
Chinese MOH’s Division of International Cooperation, America’s Division, to initiate a joint project on emerging infections.92 In October
2005, the Chinese MOH and the U.S. Secretary of HHS met to sign an MOU, the U.S.-China Collaboration of Emerging and Reemerging
Infections (EID).93 The EID collaboration has produced dozens of peer-reviewed original research papers and maintains a biennial
meeting between the HHS Secretary and the Chinese MOH.94 Also as
a result of SARS, the Chinese CDC developed a
real-time Internet-based disease surveillance system to help increase monitoring and reporting
on adverse health events.95 This electronic disease reporting tool is linked to nearly every health institution in the country
and is used to allocate resources, characterize threats, and monitor disease patterns. This system is additional evidence of China’s
increased transparency around public health events of national and international importance.96 SARS was a watershed
event for the Chinese health system and its governmental authorities.97-99 It jumpstarted the development
of China’s modern health system by illuminating the critical need to detect and respond to public health threats of international
importance in a timely and coordinated manner with the global community.100 China’s rapid growth in public health
systems and disease reporting infrastructure post-SARS could provide valuable insights, lessons ,
and practices for both African and American diplomats.101 Additionally , using the lens of global heath diplomacy,
examining these lessons and practices can join nations around shared needs of greater health
impact and security.

Spending has increased, but China still lacks the resources necessary to adequately
address healthcare issues
Huang ’16 (Yanzhong Huang, Senior Fellow for Global Health, Council on Foreign Relations, and
professor of Diplomacy and International Relations at Seton Hall University, “China’s Healthcare
Sector and U.S.-China Health Cooperation”, April 16, Council on Foreign Relations, CL)
Healthcare demands are hard to measure. For a country of nearly 1.4 billion people, the challenge of financing healthcare
is overwhelmingly mounted. It is estimated that diabetes alone may consume more than half of China’s annual health budget if
routine, state-funded care is extended to all the diabetes sufferers. Compared to many countries, share of healthcare
expenditure in total GDP remained relative low in China. In 2013, China spent 5.6% of its GDP
on healthcare, which accounted for only 3% of the global healthcare spending (compared to 17% in the
U.S.). In other words, China addresses healthcare needs of 22% of the world’s population with only
3% of the world’s healthcare resources.
In the 1980s, driven by market-oriented economic reform, government spending as a percentage of total health expenditures dropped
precipitously—from 40 percent in 1982 to 15 percent in 1999. China’s economic take-off and the implementation of the tax-
sharing reform in 1994 nevertheless carved out more fiscal space for healthcare spending. In the 2000s, two
developments boosted government incentives to invest in the health sector. The first was the 2002-03 SARS crisis, which
uncovered the vulnerabilities in China’s healthcare system and the drawbacks in the government’s single-minded pursuit of economic
growth. The second was the 2008 global financial crisis, which made it imperative to construct a social
safety net to encourage domestic consumption. Between 2009 and 2013, government spending on healthcare has grown 20 percent
annually. Consequently, government spending in total health expenditure increased from 15% in 1999 to
30% in 2013, and out of pocket spending dropped from 60% to 34%. Still, compared with OECD countries the share
of government health spending in total fiscal expenditure remains relatively small . Even using the
government adjusted figure (12.5% in 2013), China’s share is still lower than that of the US (21%), UK (16%), and Japan (17%), although
it might be higher than other BRICS countries.
 U.S. Tech = Most Advanced
U.S. scientific dominance is by no means being threatened
Herper '11 (Matthew Herper, covers science and medicine for Forbes from the Human Genome
Project, "The Most Innovative Countries In Biology And Medicine", Forbes, March 23,
www.forbes.com/sites/matthewherper/2011/03/23/the-most-innovative-countries-in-biology-
and-medicine/2/#2c0d63796b13, CL)
It’s a threat deeply rooted in the American psyche, placed there sometime between Thomas Edison and Sputnik:
the idea that we’re losing our scientific and technological edge over the rest of the world . Intel
founder Andy Grove said it in 2003; Time Magazine said it in 2006; former Lockheed Martin chief executive Norm Augustine said it this
year. Hardly a month goes by that we don’t hear that we’re losing this edge or that, falling behind in one way or another. Is it true? And if
it is, why haven’t we fallen behind yet? To delve into this a little bit, I decided to go to SciVal Analytics, a consulting group at the giant
publisher Elsevier that has access to a database called Scopus, which contains more than 18,000 scientific journals — just about the
entire scientific publishing universe. They ran three analyses for me: which countries produce the most publications in biology and
medicine, which are tops in information technology, and which do the most in clean technology. I’m publishing the biology and medicine
data today. Come back tomorrow for a look information tech, and Friday for clean tech. I’ll also wrap up what I’ve learned from the data
dump. Of almost 3,000 articles published in biomedical research in 2009, 1,169, or 40%, came from
the United States. As the line graph below demonstrates (that’s the number of publications on the Y axis, and the year of
publication on the X axis), the output of every other single country in the world is dwarfed by what
America produces. The closest contender is Great Britain , which comes in at about 300 articles. But
aren’t the other countries catching up? Actually, the number of publications from the U.S. is grew about 7% between 2005 and 2009,
which is a little above average. It’s true that countries like South Korea (annualized growth: 32%), China (26%), and Ireland (22%) are
growing a lot faster, but they are also starting from a smaller base. It’s
certainly possible that the U.S. is publishing
entirely low quality data, but another data point, the citation score, seems to indicate that isn’t true.
The citation score is the number of times an average paper was referenced by other scientific
papers. In the graph below, the Y axis is the citation score and the X axis is the number of publications in total. The U.S. doesn’t come
through with flying colors – Switzerland and the Netherlands score higher on citation score – but that’s probably partly because it
publishes so much more than other countries, with volume tending to bring down the average. Another interesting stat: not
only is
the U.S. producing more research, it is producing a greater share of those publications with
other countries. The bar chart below shows how many of the total papers produced over a five-year period involved co-authorship
between different countries (for instance, between the U.S. and China , or Japan and Germany). Papers published
by U.S. researchers were much more likely to have had foreign co-authors , which the SciVal analysts think
means that the U.S. is more collaborative as well as being a bigger research force. So when it comes to
biology and medicine, U.S. researchers are publishing more than those in other countries . And this
probably shouldn’t come as much of a shock. You can see the effect of the U.S. dominance in biology and
medicine in the behavior of big drug companies. Novartis, a Basel, Switzerland-based drug giant, nonetheless chose
to place its research headquarters in Cambridge, Mass., near Harvard and MIT, and to put a Harvard doctor and biologist, Mark Fishman,
in charge of R&D. Sanofi-Aventis gives nearness to the U.S. research hubs as one of the reasons behind its pending purchase of Genzyme,
the U.S. biotechnology giant. And pushes
to establish other countries as research challengers to the U.S. in
medicine have often proceeded with fits and starts. For a while, it appeared that South Korea
was making a go of it when it came to stem cells and cloning, but then it turned out that one of its
leading researchers, Hwang Woo Suk, had faked results. There is a big movement to move some drug research to China —
Pfizer just moved its antibiotic research to Shanghai — but the bulk of the work is still very much U.S.-centered. There may be threats to
America’s position in biomedicine, but at best they are hoof beats in the distance, not imminent dangers.
The U.S. is the number one advanced country in medicine
Jevtic '15 (Aleksandar Jevtic, Institut de Robòtica i Informàtica industrial, 10 Most Advanced
Countries in Medicine", Insider Monkey, August 20, www.insidermonkey.com/blog/10-most-
advanced-countries-in-medicine-364917/, CL)
3. Germany: The first winner of Nobel Prize for medicine was a German, Emil Adolf von Behring in 1901. He got it for his work on a
serum against diphtheria. Ever since then Germany has been one of the forerunners in the field of medical research. 2. England: The
UK health care system is divided territorially, with England, Scotland, Wales and Northern Ireland each having their separate systems. In
terms of research and advancement, England is leading the way. 1.The United States of America: Despite all the
bashing America receives every time someone mentions medical care, it remains the most advanced country in
medicine. The sheer number of research papers published every year is higher than the next 5 countries on our list combined.
America’s medical scientists are also first in number of researchers that have foreign
collaborators, illustrating their willingness for cooperation with their colleagues from around the globe, which is a contributing
factor to their overall success.
 No Tradeoff
No trade-off between welfare and economic development
Wong et al. ’05 (Chack-kie Wong, professor of the Social Work Department at the Chinese
University of Hong Kong, “China's Urban Health Care Reform: From State Protection to Individual
Responsibility, Lexington Books, November 22, https://books.google.com/books?
id=hee1AQAAQBAJ&pg=PA100&lpg=PA100&dq=china+health+care+tradeoff+with+economy&
source=bl&ots=XyPweyWVgD&sig=uOCf-
BTJ4FZAgydPYLBZ9_WAD1o&hl=en&sa=X&ved=0ahUKEwjGvdrFifvNAhWHVz4KHREtDcIQ6AEIV
zAG#v=onepage&q=trade-off&f=false, CL)
The Perception of the Relationship Between Economic Development and Health Care:
We not consider whether the findings of the two social surveys support any linkage between
health care protection and the need for economic development. The first statement in table 5.9 suggests that
an overwhelming majority of the respondents from both groups disagree that “the primary role of the
government is economic development and not welfare improvement”—84.6 percent of the employed group
and 85.7 percent of the patient group; there is no difference in terms of statistical significant between the two groups . In order
words, the respondents do not see a trade-off between economic development and welfare
development. Welfare development has a life of its own. Does this response pattern reflect an endorsement of social
developmentalism? The following survey findings might provide us with some pointers. It can be assumed that if there is a
fine balance between economic growth and health care protection, respondents will be inclined
to agree more with statements about the affordability of medical treatments. This is not the case in the
response patterns for the following two statements. Nearly three quarters of respondents from both groups agree, to different extents,
that “medical expenses exceed what our country can afford under the current economic condition” (table 5.9, statement 2). No statistical
significant between the two groups is detected. Implicitly, from the perceptions of the respondents, medical expenses are costly in
relation to China’s level of economic prosperity. In a related question, somewhat more respondents from both groups, 86.1 percent of the
employee respondents and 84.7 percent of the patient respondents, agree that “the current medical examination and treatment expenses
exceed what the general public can afford” (table 5.9, statement 3). Here also, there is no statistical significant between the two groups.
Taking all of these responses together as evidence, there has not been an appropriate balance, in the perceptions of the respondents,
between economic growth and healthcare protection. The findings do not tell us where the right balance lies; however, it is clear that, at
present, affordability is a critical and major issue in the perception of the respondents. ON the basis of this discussion ,
it can be
inferred that the respondents generally endorse the principal tenet of social developmentalism
and that the state has a role in harmonizing social and economic development . They think that
the present model for the funding of medical services is not right because it exceeds what the
economy and the general public can afford.
 Awareness Solves
Even if the plan doesn’t significantly solve, mobilization and awareness alone
significantly reduces risks of pandemics
Hughes and Wilson '10 (James M. Hughes is Professor of Medicine and Public Health with
joint appointments in the School of Medicine (Infectious Diseases) and the Rollins School of Public
Health (Global Health) at Emory University and Co-Director of the Emory Antibiotic Resistance
Center, and Mary E. Wilson is Adjunct Professor of Global Health and Population at Harvard
University, "The Origin and Prevention of Pandemics", Clinical Infectious Disease, Volume 50 Issue
12, p. 1636-1640, cid.oxfordjournals.org/content/50/12/1636.full, CL)
Current global disease control focuses almost exclusively on responding to pandemics after they
have already spread globally [23]. Nevertheless, dramatic failures in pandemic control, such as the ongoing lack of success
in HIV vaccine development 25 years into the pandemic , have shown that this wait-and-respond approach is not sufficient and

that the development of systems to prevent novel pandemics before they are established should be

considered imperative to human health. Had we had such mature systems in place, we may have
averted the H1N1 influenza pandemic that is currently unfolding. The early detection of emergent threats to human health is all the more important
given the speed with which disease causing agents are now capable of being distributed around the globe through air travel [24] and the global trade of animals as potential reservoirs

our ability to
of disease [25]. Because the success of a pathogen depends on its ability to spread from human to human and on the number of susceptible humans,

cross continents in a single day poses a unique new challenge to emerging infectious disease
control. Past studies have highlighted the importance of global travel to the spread of pandemic disease [26–28], and the recent emergence and subsequent global spread of
H1N1 influenza virus eloquently illustrates how our global interconnectedness can affect the worldwide distribution of

a new virus, one that may otherwise have remained a regional phenomena in an era before global transit. The Committee on Achieving Sustainable Global Capacity for
Surveillance and Response to Emerging Diseases of Zoonotic Origin was convened by the Institute of Medicine and the National Research Council to assess the feasibility, needs, and
challenges of developing a future and sustainable global disease surveillance program [29]. As the committee's report comprehensively expresses, our current disease surveillance
system and our ability to identify emergent diseases early are inadequate. Implementing all of the committee's recommendations would represent a significant step forward in

. Given the fact that more than one-half

achieving a well-integrated zoonotic disease surveillance system, but we are still far from realizing this goal

of emerging infectious diseases have resulted from zoonotic transmission [1] and that the
human-animal interface is so pivotal to the process of disease emergence , it stands to reason that the most
effective strategy in terms of early detection of an emergent pathogenic threat would focus on conducting
surveillance of humans highly exposed to animals and within the animal populations to which
they are routinely exposed. Despite this, there exists no systematic global effort to monitor for pathogens emerging from animals to humans in “at-risk”
populations, and we are probably years from having such a system in place. Although a global surveillance system for pandemic prevention is still far from reality, there may be

more immediate, interim measures that may be taken to mitigate the risk of zoonotic transmission , even in the
absence of a global surveillance effort. In situations where humans and animals are in close contact, behavioral change approaches may be a preventative step to reducing the risk of
zoonotic transmission. Behavioral modification campaigns have previously been used in combating outbreaks of known infectious diseases [30–32]. For instance, a behavioral
modification campaign was launched in Sierra Leone to reduce cases of Lassa fever [32]. The intervention involved incidence mapping, contact tracing to warn relatives of the dangers

of secondary infection, and education to exposed populations in methods of avoiding exposure to rodents, the reservoir of the disease. Prevention
, and
posters included graphic depictions to instruct villagers in techniques for protecting food from rodents, trapping rodents, dealing safely with carcasses of dead rats symptom
recognition. As part of the campaign, local musicians were even commissioned to write and perform songs about routes of transmission of Lassa fever and preventative measures.

outreach activities were an attempt to increase awareness of the disease and to promote behavior
These

change aimed at reducing incident cases of Lassa fever through reducing the risk of exposure to animals, in this case rodents.
 Increases Access to Marginalized Communities
Measures enabled by the plan would improve basic health standards for
marginalized communities who didn’t have access before
Institute of Medicine '07 (Institute of Medicine Forum on Microbial Threats, "Ethical and
Legal Considerations in Mitigating Pandemic Disease: Workshop Summary.", National Academies
Press, www.ncbi.nlm.nih.gov/books/NBK54163/, CL)
Hygienic measures to prevent the spread of respiratory infections are broadly accepted and have
been widely used in both influenza pandemics (APHA, 1918) and also, although with uncertain benefits, the SARS
outbreaks (WHO, 2003; CDC, 2005a). These hygienic methods include hand-washing, disinfection, the use of
personal protective equipment (PPE) such as masks, gloves, gowns, and eye protection, and respiratory hygiene,
such as the use of proper etiquette for coughs, sneezes, and spitting. It is important that the public be informed of
the need for hygienic measures, and that accurate information, including the uncertainty of the effectiveness of the
recommended interventions, be provided. In past epidemics misinformation has been rampant , and this has led
to substantial public anxiety, to reliance on word of mouth for knowledge, and to the purchase of
ineffective and expensive products (Rosling and Rosling, 2003). The situation raises issues of distributive justice because
ineffective or inaccurate communications have the greatest effects on marginalized members of
society, as they are the least likely to have access to alternative credible sources of information
and are the people for whom wasting resources would have the greatest adverse effects (Gostin and
Powers, 2006). Furthermore, a consideration for personal dignity implies that individuals should be provided with adequate information
to make informed decisions about their own health. Public education campaigns should be grounded in the science of risk
communication, as the acceptability of health measures is vital to community adherence. The information disseminated through public
education campaigns should be accurate, clear, uncomplicated, not sensationalistic or alarmist, and as reassuring as possible (SARS
Commission, 2006).7

Pandemic control measures like increased access to vaccinations benefit children,

elders, and pregnant women the most—empirics prove that they become a focus
Reintjes et. al '16 (Ralf Reintjes is a Professor of Epidemiology and Surveillance - Hamburg
University of Applied Sciences, “Pandemic Public Health Paradox”: Time Series Analysis of the
2009/10 Influenza A / H1N1 Epidemiology, Media Attention, Risk Perception and Public Reactions
in 5 European Countries", National Center for Biotechnology Information, March 16,
www.ncbi.nlm.nih.gov/pmc/articles/PMC4794201/, CL)
Widespread viral activity within the country, led UK to move from containment to treatment phase on 2nd July 2009. Laboratory testing was no longer
required for all cases and case-tracing was stopped. Further, antiviral treatment was only offered to clinical cases [33]. To relieve some of the pressures on
the health system, the National Pandemic Flu Service was launched in England on 23rd July. This was an online and telephone self-care service that allowed
people outside the “at-risk” groups to be assessed for pandemic flu, and if required, to get access to antiviral treatment without the need to consult a
physician [33]. Denmark moved to a mitigation strategy on 7th July. The focus was on preventive treatment of persons at
risk. Only risk group patients or persons with close contact to a risk group patient needed to be swabbed. Further , antiviral treatment was
administered to risk group persons only, and prophylactic antiviral treatment was given to contacts of laboratory-confirmed
cases only if the contact belonged to a risk group. This included persons with chronic pulmonary conditions,
cardiovascular diseases, diabetes, immunodeficiency, HIV-Infection and pregnant women (2nd and 3rd
Trimester). Furthermore, it was recommended that pregnant women in their 1st trimester, children < 5 years and
severely obese patients should be closely monitored [34, 35]. On 27th July, Spain officially moved from containment to
mitigation, although response measures had already changed towards mitigation in late June, i.e. contact tracing was ceased. Case-based reporting in the
community was stopped, and antivirals were only given to cases requiring hospitalization and to those at risk of complications [36, 37]. From early August
2009, Germany applied a mitigation strategy, which predominantly focused on risk groups. In this strategy, contact-tracing was stopped. Isolation was
recommended for cases with contact to vulnerable persons only. Antivirals were only given to cases in at-risk groups with signs of developing severe illness
and case-based reporting requirements were relaxed [27]. Czech Republic started with a mitigation strategy on 9th July [38]. Further details of the strategy
could not be retrieved. Vaccination In late September 2009 (week 40), the European Commission granted approval for two influenza A H1N1 vaccines,
Focetria® (Novartis) and Pandemrix® (GlaxoSmithKline), in all EU Member States as well as Iceland, Liechtenstein and Norway [39]. The third vaccine for
influenza A H1N1, Celvapan® (Baxter), was approved in early October 2009 [40]. All five study countries implemented a vaccination program around the
time of the second wave (starting between week 40 to 44; week 48 in CZ) [Table 2] [4, 41–45] initially focusing on priority groups which in many cases was
extended to the general public. Media attention In all researched countries media attention, defined as the number of published news reports on influenza A
H1N1, was highest in week 18 [Table 2], when the WHO declared pandemic phase 4 and shortly thereafter, pandemic phase 5. Media attention rapidly
waned in all countries and was followed only by smaller peaks in news coverage over the remaining course of the pandemic Figs Figs11–5. Media attention
curves differed among countries. Germany: News reporting showed a small surge in media attention in week 24 coinciding with the WHO’s official pandemic
declaration, and another peak in week 30 contemporaneous with the first wave of influenza A H1N1 transmission. The start of a third surge in attention
corresponded with the official German definition of vaccine priority groups; its peak in week 43–45 paralleled with the start of the mass vaccination
program. United Kingdom: In week 28, after the first and largest wave of transmission, a second surge in media attention began peaking in week 30. Other
smaller peaks coincide with the introduction of pandemic control measures (mitigation strategy; introduction of vaccination). Denmark: After the first large
peak in media attention, three smaller peaks could be observed. The first occurred in week 31–32 concurrent with the first wave of transmission, the second
in week 37 following the first fatality abroad from Danish origin, and the third coinciding with the first national fatal case and the start of the mass
vaccination program. Spain: Following the initial peak, media attention was substantially lower over the remaining pandemic course than in the other
countries. A smaller surge in media attention, coinciding with the agreement of priority groups for vaccination, began in week 33, peaking during weeks 35
to 36. It is notable that the peak began the week before the agreement, and ceased at approximately the time of agreement. In week 45 another peak
emerged, which corresponded with a second wave in influenza A H1N1 transmission and the start of the national vaccination campaign. Czech Republic:
Media attention remained low until week 42, when two contiguous media attention peaks emerged. The first one, peaking in week 45, coincided with the
first fatal case although not entirely triggered by it. The second one, peaking in week 48, corresponded with the start of the national mass vaccination
program. During the second wave of the epidemic, when most influenza-related deaths occurred, relatively little media attention was seen in all five study
countries. Inlate November 2009, the Gallup Organization conducted a survey named Flash Eurobarometer in 30
European countries to assess public opinion about influenza and pandemic influenza A H1N1. In this survey, 69% of the German (N = 1001),
61% of the Czech (N = 1002), 58% of the Danish (N = 1008), and 49% of the UK participants (N = 1000) believed it was not at all likely or rather unlikely
that they would personally catch the A/H1N1 influenza. The majority of the participants from ES (66%), DE (62%) and DK (60%) also stated that is
was not likely or not at all likely that they would get vaccinated against the pandemic A/H1N1 virus. This proportion
was considerably lower in the UK (37% of the participants) and the CZ (47% of the Czech interviewees) [Table 2] [25]. For the included countries, the
vaccination coverage of persons with underlying diseases as well as the overall uptake, if available [4], is shown in the green hexagon in Figs Figs11–5. In the
UK, the vaccine uptake in clinical risk groups was assessed using data collected from a sentinel group of GP practices in England. The vaccination uptake
among the “under 65” clinical risk groups is reflected in the green curve in Fig 2. In this group as well as in the over 65 years age group (curve not shown),
the vaccine uptake increased steadily until week 4/2010. Overall, the national vaccine uptake in
patients in clinical risk groups aged under 65 years was 35.4%, this included pregnant women. It
was 40.4% in those aged 65 years and over. Another survey assessed the vaccine uptake among healthcare workers in all 389 NHS
Trusts in England on a weekly basis from 8th November 2009 to 4th April 2010 . The vaccine uptake among healthcare workers
increased sharply in the first weeks after the vaccine was available and leveled out at
approximately 40% from week 4 of 2010 [46].
Add-Ons
 ASEAN add-on
Combatting diseases ensures ASEAN stability and improves U.S.-China relations and
relations with the rest of Southeast Asia
Meacham '09 (Karen Meacham, CSIS Smart Power Initiative case scenario, "Hu et al. ' ("Health
Care System Reform in China: Issues, Challenges and Options",
down.aefweb.net/WorkingPapers/w517.pdf", Center for Strategic and International Studies, March
report, www.voltairenet.org/IMG/pdf/Chinese_Soft_Power.pdf, CL)
The global outbreak of severe acute respiratory syndrome (SARS) in 2002-2003 prompted a turning point in China’s
approach to multilateralism, transparency on public health issues, and its relationship with
ASEAN. Eventual Chinese cooperating with ASEAN on SARS control and surveillance bolstered its image as a participating member of
the regional community and demonstrated a new willingness to act constructively with its neighbors in response to a regional public
health crisis. The SARS
pandemic is considered a key factor in strengthening nonmilitary cooperation
between China and ASEAN contributing to China’s improved relations in the region. China-ASEAN
relations were at a low point in the mid-1990s when it was discovered that the People’s Liberation Army had erected concrete structures
in the resource-rich and border-disputes Spratly Islands in the South China Sea. The perceived militarization of a
long-standing
territorial dispute among China, Vietnam, the Philippines, Brunei, Malaysia, and Taiwan resulted in regional mistrust
of China and increased solidarity among non-China countries . Compounded by weakened Sino-U.S. relations,
China was pressured to reconsider its approach or face estrangement and a potential containment strategy from the United States and its
allies. Although the territorial dispute was largely restrained from the 2002 signing of the Declaration on the Conduct of Parties in the
South China Sea, in 2003 Chinese leader were still searching for ways to increase cooperation with ASEAN .
SARS emerged as a
transnational, organic threat with the potential to gravely affect the health and economy of all of
Southeast Asia. Although China initially attempted to conceal the SARS outbreak within its borders, international and
domestic pressures led leaders to ultimately adopt a more open and transparent approach to both
the SARS crisis and future public health concerns. Over the course of only a few months in 2003, China and ASEAN
held four special meetings over SARS outbreak that yielded a series of agreements. following the first ASEAN + 3 Ministers of Health
Special meeting on SARS in Kuala Lumpur in April 2003, China, Japan, and Korea committed to actions to be taken for the prevention of
further SARS infections. Other meetings followed that year in Cambodia and Thailand, at which many ASEAN member countries made a
point of commending China’s handling of SARS. At the June 10-11 + 3 (to include Japan and South Korea) health ministers meeting, the
ministers “congratulated China for its very strong political commitment in containing SARS and its utmost efforts to improve the quality
and timeline of surveillance.” In
October 2003, ASEAN and China signed the Joint Declaration of the
PRC and ASEAN State Leaders: A Strategic Partnership for Peace and Prosperity, a declaration
that called for the respect of territory and member sovereignty , China-ASEAN free trade initiatives, and
cooperation on issues of regional security. This series of meetings was an early sign that China was willing to work with ASEAN in a
serious and meaningful way—a significant advancement from the strained relationship of the late 1990s. China’s
cooperation
was not lost on the wider public health community,, evidenced by a World Health organization statement in April
2003 commending China and ASEAN on their cooperation. The positive response to China’s handling of the SARS outbreak from
neighboring countries and the international community may have contributed to China’s shift to a more soft-power
approach to global public health. Whether or not this evolution of events was intentional, it became clear to the Chinese
leaders that “enhancing mutual interests and interdependence [was] the best way to erode ASEAN
states’ perception of the “China threat” Multilateral collaboration and goodwill around public
health remains relevant as a number of Southeast Asian countries continue to express concern over
communicable diseases such as avian influenza. If the public commitment to a regional balance of power and security
is any indication of future Chinese foreign policy, we may see continued transparency in public health-related
issues as part of broader diplomatic strategy.
ASEAN has transformed to become more centralized and enhanced its credibility—
assumes past structural problems defense
Yong '09 (Ong Keng Yong, Singapore diplomat and Secretary General of of the Association of
South East Asian Nations, "In Defence of ASEAN", The Diplomat, December 17,
thediplomat.com/2009/12/in-defence-of-asean/1/, CL)
The strategic geography of the Association of Southeast Asian Nations–wedged between China and India and
straddling key trade and transportation networks–has enabled it to play a prominent role in
managing stakeholders’ interests in Southeast Asia and the surrounding neighbourhood . The
customised mechanisms put in place by ASEAN have helped to institutionalise habits of consultation and
cooperation among regional countries and their partners, while the prestige and recognition accorded to ASEAN
have increased a sense of belonging to a region. However, the ‘evolutionary’ approach to leadership
has raised doubts about ASEAN’s effectiveness in a rapidly changing world . Slow compliance and
decision-making combined with weak institutions and a lack of action in some cases have prompted criticism over
ASEAN’s ability to manage regional and international affairs. Yet, ASEAN member states’ leaders have
accepted that their respective societies need time and space to connect with outsiders and work
with them in mutually beneficial ventures. ASEAN’s mantra of ‘moving step by step, at a pace comfortable to all,’ is
therefore rooted in the realities of the diverse cultural, economic, political and social order in Southeast Asia. This time-tested philosophy
is not, as some would suggest, a wishy-washy approach. Instead it reflects the thorough preparation of the issues to be discussed and
reconciled–policy options and alternatives are considered, discussed and weighed up carefully by all parties with a stake in the outcome.
Relying on cooperation, dialogue and political convergence, ASEAN is still very much an inter-
governmental body. Although this has led to slow, sometimes tedious progress, it still requires
good conciliatory and political judgements– leaders need to think carefully about key issues and
decide the best moment to join a consensus based upon their own circumstances. Unfortunately, this
consensual method of regional cooperation is not fully understood or widely appreciated. Indeed , the ‘ASEAN way’ has been
maligned and dismissed by those in a hurry to achieve their own particular goals. But ASEAN is
not alone in adopting this consensual approach–such decision-making processes are the mainstay
of every effective, collective discourse. While more established international organisations have formalised precedents
and specific rules for reaching a quick decision, ASEAN has just institutionalised this process with the coming-into-force of the ASEAN
Charter on December 15, 2008 and the promulgation of blueprints on the building of the ASEAN Community by 2015, based on three
pillars-political and security cooperation, economic integration and socio-cultural cooperation. With the coming-into-force of the ASEAN
Charter, ASEAN has become a rules-based regime with a legal personality. Coupled with
the increase in resources
allocated to the ASEAN Secretariat, the establishment of the ASEAN Intergovernmental Commission on
Human Rights and several other processes aimed at improving efficiency and effectiveness, ASEAN
has indicated its commitment to the transformation of the loose informal grouping into a formal
body. The changes should allow ASEAN to become stronger and more able to promote solidarity and cooperation on the regional stage.
Maintaining a cohesive Southeast Asian region will ensure peace, security and stability and cooperation in solving common problems,
and expanding regional economic integration will also follow. The blueprints laid out for the establishment of the ASEAN Community,
meanwhile, will provide timelines and a roadmap (with scorecards) to help ensure the implementation of ASEAN’s intentions and plans.
By becoming more predictable and accountable, ASEAN
has enhanced its standing and attractiveness as a
reliable partner with those wishing to invest in the peace and prosperity of Southeast Asia. It would
also be simplistic to accept the conventional argument about the diversity of ASEAN member states and how mutual jealousy and
suspicion hampers the implementation of ASEAN accords. In reality, the national ego of bigger countries in ASEAN will be a major factor
in keeping ASEAN coherent and cohesive. Historically,
ASEAN is most successful when both the small and
big countries in the organisation rally around a specific cause, especially if there’s a perceived
common external threat, such as during the Cambodian Crisis of the late 1970s to early 1990s, the 1997-1998 Asian
financial crisis and the SARS crisis in 2003.
The U.S. and China working together on transnational issues through political
changes stabilizes ASEAN
Yong '09 (Ong Keng Yong, Singapore diplomat and Secretary General of of the Association of
South East Asian Nations, "In Defence of ASEAN", The Diplomat, December 17,
thediplomat.com/2009/12/in-defence-of-asean/1/, CL)
So far, therise of China and India has been positive for ASEAN and the regional interests of China and
India intersect with those of the United States, Europe, Japan and Russia. ASEAN has rich experience of
managing such stakeholders’ interests and the ‘ASEAN Plus’ processes such as ASEAN Plus Three (the ten ASEAN countries, China, Japan
and the Republic of Korea) and the East Asia Summit (ASEAN, China, Japan, the Republic of Korea, India, Australia and New Zealand)
have engaged these stakeholders in orderly and mutually rewarding exchanges and transactions. Consequently, ASEAN’s role is
recognised as ‘central’ and ASEAN is also acknowledged to be ‘the primary driver’ of regional architecture development. However, if
ASEAN wants to ensure its strategic usefulness is maximised it will have to make full use of its persuasive powers. The longer it takes for
decisions to be made, the lower the level of efficiency. Some ASEAN member states yearn for faster processes and want to see immediate
results, but by its nature ASEAN relies on individual countries finding common interests and working
together. This is, of course, time consuming and an issue that will need to be addressed going forward if the rest of the world is to
continue to engage productively with ASEAN. Individual member states of ASEAN will also need to have the
political will to support the processes and procedures laid down . This key factor will determine
the future success of ASEAN and push its ten member states into solidifying its plans for the building of an ASEAN Community.
The centrality of ASEAN in regional architecture has placed it in the midst of different proposals for either an East Asia community or an
Asia Pacific community, and with a number of countries wanting to take the steering wheel, there’s no certainty of success. The current
lack of clarity and consensus on how to move forward, with various countries involved wanting to ensure that their own interests are
well served, means a careful step-by-step process that balances national sensitivities must be undertaken. Ultimately,
ASEAN
must gain from such moves or risk irrelevance. The fumbling and quarrelling that sometimes occurs within ASEAN must not
distract from the fact that four decades of skilled management has reaped dividends. The ingenuity of ASEAN has been its
skilful use of its strategic geography and engagements with those who matter for the region. This
skill has fostered confidence among outside powers who now trust that ASEAN can deliver relevant
initiatives in tune with their own interests.

Strong ASEAN key to US influence and trade in Asia, solves pandemics, Korean war,
climate change, energy security, and terrorism
THE NATION 11-15-2009 (“US backs central role for Asean,”
http://www.nationmultimedia.com/home/2009/11/15/regional/US-backs-central-role-for-Asean-30116623.html)

the centrality of Asean in new regional community building

US President Barack Obama will today endorse
and an expansive role for it in global issues, at the inaugural Asean-US Leaders' Meeting in Singapore. Obama, who
is scheduled to hold a 90-minute meeting this afternoon with the 10 Asean leaders, will also pronounce the policy of engagement
with Asean as a key partner in promoting peace, stability and prosperity in the region. The historic
meeting, which is being co-chaired by Prime Minister Abhisit Vejjajiva, marks the first meeting between the leaders of the two sides.
It will also be the first time in 43 years that a Burmese prime minister has met a US leader. The draft joint statement, seen by The
Nation on Sunday, touches on the whole gamut of Asean and US relations in the past 32 years related to political/security,
economic/investment and social development issues. The draft also included Abhisit's proposal of Asean connectivity, which aims at
promoting infrastructure and communication links within Asean, including people-to-people contacts. Obama will reaffirm the
importance of Asean's centrality in building regional architecture, which must be inclusive, promote shared values and norms and
respect the diversity within the region. This is in line with his Tokyo speech on Asia yesterday, when he said: " Asean
will
remain a catalyst for Southeast Asian dialogue, cooperation and security ." The US will also express
support for the Asean Inter-government Commission for Human Rights, including the track-two initiatives. Washington will invite
members of the AICHR to the US to meet their counterparts. Leaders of Asean and the US are expected to
discuss regional and international issues. Topping the agenda will be the situation in Burma - particularly Aung San Suu Kyi's
freedom - and North Korea. Various efforts related to transnational issues, such as climate change,
energy security, terrorism, pandemics and disaster management , will also be discussed. The outcome
of a recent visit to Burma by two senior US officials will be discussed. On Burma, the leaders will stress that the US approach will
"contribute to broad political and economic reforms and the process will be enhanced in the future". Obama yesterday called for the
release of Suu Kyi ahead of the leaders' meeting. The leaders of Asean and the US will jointly urge the Burmese government to hold
free, fair, fully inclusive and transparent elections next year, including a dialogue with all stakeholders. The Asean leaders are
expected to support the US call for a nuclear-free world. Together, they will call for North Korea to return to the six-party talks.
Despite the US reluctance to call its first meeting with Asean a summit, both sides have agreed to meet next year. At the meeting
today, Obama is expected to invite all the Asean leaders to the US next year. US-Asean relations have been bolstered following the
new US policy towards Asia. In August, Washington signed the Treaty of Amity and Cooperation, which further strengthened the
three-decade relationship. According to the draft statement, both sides have agreed to set up a joint Asean-US Eminent Persons
Group to address regional and global issues. This group can work on issues tasked by their leaders, such as the Asean-US Free Trade
Agreement. The US has yet to agree to Asean requests on the regular participation of the Asean chair at G-20 summits and
Washington's support for non-Apec Asean members. Former US president George W Bush met Asean leaders three times - in
October 2002 in Los Cabos, Mexico; in December 2005, in Busan, South Korea; and in September 2007, in Sydney. These meetings
were on the sidelines of the Apec leaders' meetings and were limited to seven Asean members. Cambodia, Laos and Burma are not
members of the Apec forum. The US plans to open a permanent office in Jakarta with an Asean ambassador before the end of the
year. China stated last month it would do the same soon. Before he meets Asean leaders, Obama will hold a separate summit with
Indonesian President Susilo Bambang Yudhoyono. Obama, who skipped Indonesia this year, plans to go there next summer with his
family. He spent four and half years of his childhood in the country. Last year, bilateral
Asean-US trade reached
US$178 billion (Bt5.9 trillion), while US investment in Asean amounted to $153 billion . Other key
dialogue partners such as China, Japan, South Korea and India have an annual summit with Asean leaders. Russia is planning a
second summit next year in Hanoi under the new Asean chair, Vietnam.
 CCP Collapse Add-On
Economic decline causes CCP instability
Symonds '15 (Peter Symonds, Asia specialist for the global economy, "China’s Economic
Downturn Raises Concerns about Political Instability", Global Research,
www.globalresearch.ca/chinas-economic-downturn-raises-concerns-about-political-
instability/5472407, CL)
Amid continuing global share market volatility, the financial elites around the world have been intently focussed on the movement of
Chinese stock markets and more broadly on the state of the Chinese economy. Yesterday’s rise of the benchmark Shanghai Composite
Index, after falls in six successive trading sessions, produced an almost audible sigh of relief as share prices responded by rising on major
markets internationally. The deluge of media commentary on the
Chinese economy reflects the degree to which the
world economy as a whole is dependent on continued growth in China. Speaking on the Australian
Broadcasting Corporation’s “Lateline” program last night, Ken Courtis, chairman of Starfort Holdings, pointed out that “this year we’re
expecting 35 to 40 percent of all the world’s growth to come from China.” If that did not happen, “then we have a real problem.” Concerns
in ruling circles that China’s economic slowdown will lead to political instability were evident in an article
published in the Financial Times (FT) on Tuesday entitled, “Questions over Li Keqiang’s future amid China market turmoil.” Analysts and
party insiders who spoke to the FT suggested that the Chinese premier was “fighting for his political future” after the Shanghai
Composite Index plunged by 8.5 percent on Monday—its largest decline since early 2007. Analyst Willy Lam from the Chinese University
of Hong Kong told the newspaper: “Premier Li’s position has certainly become more precarious as a result
of the current crisis. If the situation worsens and if there comes a point where [President Xi Jinping] really needs a scapegoat, then Li fits
the bill.” Li and Vice Premier Ma Kai were closely associated with efforts in early July to stem the falling share markets, including a ban on
short selling and new stock offerings and share sales by large investors. According to the FT, state-owned
institutions
pumped an estimated $200 billion into the share market, only to see it plummet over the past
week. The Chinese leadership is more broadly under fire. A lengthy article in the New York Times last weekend
reported that Xi had been told by powerful party elders to focus more on restoring economic growth and less on his anti-corruption
drive. Xi, however, has exploited high-profile anti-corruption cases to consolidate his grip on power, jail potential rivals or challengers,
and intimidate factions critical of his government’s accelerating pro-market reform and further opening up to investment. A
shrinking economy will only fuel tensions within the isolated and sclerotic Chinese Communist
Party (CCP) regime and open up the prospect of renewed factional infighting. Having all but abandoned
its socialistic posturing, the CCP leadership has depended for its legitimacy on continued high levels of
economic growth. The fear in Beijing and major financial centres around the globe is that rising unemployment and
deepening social inequality will lead to social unrest, particularly in the working class, which is
now estimated to number 400 million. The official growth figures have fallen this year to 7 percent—well below the 8
percent level that the CCP long regarded as the minimum required for social stability. Many analysts, however, regard even 7 percent as
significantly overstating actual growth. A recent Bloomberg survey of 11 economists put the median estimate of Chinese growth at 6.3
percent. Others put the figure far lower. Analyst Gordon Chang told the Diplomatwebsite that “influential people in Beijing” were
“privately saying that the Chinese economy was growing at a 2.2 percent rate.” He pointed to other
indicators of declining
economic activity: rail freight (down 10.1 percent in the first two quarters of 2015), trade volume (down 6.9 percent),
construction starts by area (down 15.8 percent) and electricity usage (up by just 1.3 percent). While the Beijing
leadership is under pressure to boost the economy, the slowdown in China is bound up with the broader global crisis of capitalism. The
restoration of capitalism in China over the past three decades has transformed the country into a vast cheap labour manufacturing
platform that is heavily reliant on exports to the major economies. In highlighting China’s contribution to world growth, Ken Courtis
noted on “Lateline” yesterday that “Japan is contracting or in great difficulty still, the US is growing at 2, 2.5 percent, [and] Europe is
slugging around at 1.5, 1 percent.” These economies, however, are precisely the markets on which China depends. The latest figures for
July showed that exports slumped by 8.3 percent year-on-year, with exports to Europe and Japan down 4 percent, partially compensated
by a rise of 7 percent to the US. Following the 2008 global financial crisis, the CCP leadership only maintained economic growth through
a massive stimulus package and the expansion of credit. However, with exports and industrial production stagnating, the money flowed
into infrastructure spending, property speculation and, more recently, stock market speculation. Notwithstanding occasional rallies in
response to government measures to ease credit, falling property prices over the past year, and now plunging share prices, underscore
the fact that these speculative bubbles are unsustainable. The Chinese regime is under international pressure to
accelerate its pro-market reform agenda, including privatisation of state-owned enterprises (SOEs) and the further
liberalisation of the financial sector to open up new profit opportunities for foreign investors. Such measures, however, will
only heighten the social gulf between rich and poor and provoke wider social unrest . The last round of
privatisations in China resulted in the destruction of tens of millions of jobs. The Beijing regime, which represents the interests of the tiny
layer of Chinese millionaires and billionaires, is deeply fearful of the emergence of a movement of the working class. The
fact that
questions are being raised about the future of Prime Minister Li Keqiang is an indicator of the
existing sharp tensions that will only intensify as financial and economic turmoil worsens and
impacts on the lives of hundreds of millions of people.

Reduced legitimacy causes the CCP to embrace nationalism---that causes existing

territorial disputes to escalate to armed conflict
McKnight ‘13 (Tyler McKnight, M.A. student in International Relations at the University of San
Diego, B.A. in Political Science from Villanova University, “Regime Legitimacy and the CCP,” Fall
2013, http://www.sandiego.edu/cas/documents/polisci/TylerMcKnightPaper.pdf, CL)
Perhaps the most reasonable and likely path the CCP will pursue to shore up its legitimacy is by
embracing nationalism. There is a lot for the Chinese to be proud of these days. They are a country that has risen from the
ashes of the Cultural Revolution to become the second largest economy in the world. Most of the people of China no longer live a life of
subsistence, but one of material wealth. Many Chinese can now afford things that were once considered luxury items such as televisions
and cars. China has firmly established itself as an economic power. China is now not only economically strong, but also politically and
militarily strong on the international stage. After
many years of subjugation, exploitation, and humiliation at
the hands of foreign powers China is now a strong nation. China is powerful enough now to
defend its borders against any potential threat. Increasingly, China is also able to flex its muscles
beyond its own borders and territorial waters as exemplified by China’s recent establishment of an Air Defense Identification
Zone (ADIZ) over the disputed Senkaku/Diaoyu islands in the East China Sea. China’s ability to project power is quickly catching up with
potential rivals such as Japan and the United States. ¶ The use of nationalism to support regime legitimacy is not
a new concept for the CCP. Since the late 1970s the CCP have been cultivating nationalism as a way to compensate for the
weaknesses of communist ideology. After the turmoil of the Cultural Revolution and the “sanxin weiji” (three spiritual crises) the CCP
started using nationalism as a way to establish a hegemonic order of political values and as a way to rally popular support behind a less
popular regime and its policies by creating a sense of community .
The CCP double downed on using nationalism as
a way to unite the country and reinforce its legitimacy after the Tiananmen Square protests in
the spring of 1989. Nationalism was viewed as a way to counter Western liberal ideas and calls for democracy. As the CCP did
after the protest of 1989 and continues to do today, the party continues to sell itself as the protector of the Chinese people against foreign
aggression.
If the CCP were to allow weakness, disunity, and disorder at home it would open a
Pandora’s box. Such chaos would weaken China and give foreign aggressors the chance to reassert
themselves. With China’s history of foreign exploitation, such an argument can carry a lot of
weight in China. China is once again a strong country and it does not want to fall back into a role
of subjugation.xxiii¶ The problem with nationalism is it is a fickle beast. If the CCP were to strongly embrace and
stoke nationalism, it would be hard to contain it. If the CCP were to define itself as the guardians of Chinese
nationalism it would have to work hard to ensure it appeases the concerns of nationalist. China continues to have a number of festering
territory disputes with its neighbors: the continued de facto independence of Taiwan, its border with India, and the Senkaku/Diaoyu
islands in the East China Sea to name a few. With its history of foreign exploitation, China is acutely sensitive to any territory dispute. The
CCP would have a very hard time maintaining its nationalist credentials if it were to allow other countries to assert control over any of
the disputed areas. The Chinese leaders ran into this problem in the late 1990s when there was a distinct rise in nationalism in China.
The authors of the popular nationalist book The China That Can Say No were openly critical of the Chinese government for taking a
stance they viewed as too soft towards the United States and Japan. They endorsed taking action to annex Taiwan at any cost and open
confrontation with Japan and the United States. A move such as this would at best be risky considering China was, and still is, dependent
on Japan and the United States to ensure its continued economic growth.xxiv ¶ As a result of China’s history of humiliation and the CCP’s
need to strengthen its nationalist credentials, China
is more likely than other countries to use strong-arm tactics
or force to assert itself. Such moves are a double-edged sword for the CCP . They could help the CCP to
maintain its credentials as the guardians of the Chinese people, but this would be at the expense of hurting its standing in the
international community, or worse, sending China on path towards armed conflict. When military units of opposing countries are in close
proximity to each other and tensions run high, it can be very difficult to prevent acts of aggression from spilling over into armed conflict.
Posturing on one side can be viewed as an imminent intent to attack on the other. China will have to balance a fine line to ensure their
actions are not viewed as too soft at home or overly aggressive by the international community. If the CCP relies heavily on nationalism
to strengthen its legitimacy and it is viewed too soft at home, it will hurt the staying power of the regime. If China is viewed as too
aggressive by its neighbors, it could face reduced foreign investment, sanctions

xt Economic growth and performative legitimacy is key in a world where many

Chinese no longer believe in Communism
The Politic '13 (The Politic, "Performance Legitimacy: An Unstable Model for Sustaining
Power", The Politic, January 10, thepolitic.org/performance-legitimacy-an-unstable-model-for-
sustaining-power/, CL)
Surely, the
CCP’s hold on power for the past three decades suggests that performance legitimacy is
a workable model for justifying rule. However, China’s economic growth of the past 30 years was
unprecedented in magnitude and duration, as the country averaged 10% growth annually.[8] Thus, the
effectiveness of China’s performance legitimacy model was perhaps augmented in ways that normal economic growth would not make
possible. Therefore, looking into a future in which China expects high, but more ordinary growth rates, performance legitimacy will
inherently be a less effective method of justifying power. Moreover, accustomed to rapid economic progress, Chinese
citizens
will take growth for granted, reducing the effectiveness of performance legitimacy and elevating
the importance of alternative justifications of power. Performance-based legitimation is also unstable because the
government must reach ever-higher benchmarks of performance to maintain its rule. Improvements in official accountability, a key tenet
of performance legitimacy, can actually make future legitimacy harder to achieve.[9] Specifically, by increasing transparency and
accountability, the Chinese government makes its mistakes more noticeable to the Chinese citizenry. Thus, China’s
achievements are increasingly at risk of being overshadowed by even minor missteps. [10] In this
way, as transparency is increased, China’s achievements produce “diminishing marginal gains” to its
performance legitimacy. In other words, over time it becomes increasingly difficult to sustain
performance legitimacy. The Chinese government must constantly re-legitimate its rule, as achievements and setbacks keep its
performance legitimacy in fluctuation. Therefore, sole reliance on performance legitimacy is unstable because it progressively becomes a
less effective method of maintaining power. Overreliance
on performance legitimacy is also unstable because
when a government fails to deliver on its promises, it loses its only source of legitimacy . As
University of Chicago Professor of Sociology, Dingxin Zhao, writes, performance legitimacy is “intrinsically unstable because it carries
concrete promises and therefore will trigger immediate political crisis when the promises are unfulfilled.”[11] As mentioned, by
improving the quality of life of its citizens through rapid economic growth, the Chinese government demonstrated to its people that it is
fit to lead.If China’s economic miracle were to suddenly end, its performance legitimacy would be
undermined, and the country could find itself in a legitimacy crisis . Although it would be unfair to say that
China is solely reliant on performance legitimacy, the country stands on shaky ideological footing, as most
citizens no longer believe in Communism.[12] Moreover, the government possesses weak moral grounds to rule, as
corruption is rampant and Chinese citizens are well aware of it (recent revelations of the immense wealth of Premier Wen Jiabao’s family
Thus, if China’s economic growth were to cease, the country would lack other
is a prime example).[13]
forms of political justification to compensate for a decline in performance legitimacy. As a result,
Chinese citizens might withdraw support of such a government lacking ideological and moral
grounds to rule. Some may argue that performance legitimacy alone has enabled the CCP to
maintain its rule for the past thirty years; improvements to governing accountability bolstered China’s performance
legitimacy and allowed it to sustain power. Surely, the Chinese government has made great strides toward comprehensive governing
However, a
accountability, as bureaucratic administration has become more “institutionalized, regulated, and disciplined.”[14]
system that lacks moral grounds to rule inherently can never fully deliver on governing
accountability. Thus, a government cannot maximize its performance legitimacy unless it
possesses a moral justification to rule. For example, China’s government is not morally justifiable because corruption is
rampant and even shows signs of worsening.[15] If a government were held fully accountable for its actions, its officials could not get
away with actions such as misusing public funds and amassing vast private wealth. However, as corruption is rampant in China, the
government obviously does not possess governing accountability. Thus, a
lack of moral justification to rule indirectly
weakens a government’s performance legitimacy by undermining its governing accountability . By
contrast, moral legitimacy is a prerequisite of full governing accountability. Therefore, a regime that intertwines both moral and
performance legitimacy is inherently more stable than one that is not morally justified. Moreover, a lack of ideological agreement
between citizen and state necessarily reduces one’s quality of life. Since people naturally favor a system in which their quality of life is
maximized, a
system that relies on performance legitimacy and neglects moral and ideological
legitimacy is not as stable as one that intertwines both forms of legitimacy . Performance legitimacy takes
into account some aspects of quality of life: economic well-being, social stability, governing competence, and accountability. However,
quality of life also intrinsically entails concomitant ideology, ethics, and morality . For example,
Chinese citizens do not possess freedom of expression, and the government censors material that could subvert the Communist regime.
When I was in China, many of my college friends openly criticized the CCP’s censorship of the Internet. Others were less vocal, but
nonetheless shared a desire to be able to freely express themselves, both in person and online. Forbidding freedom of expression
reduces one’s quality of life because by restricting expression, the government takes something of value from its citizens. Similar
arguments could be extended to a just legal system, or an upright leadership. Thus, a
regime that possesses performance
legitimacy in addition to moral and ideological legitimacy is more stable than one that is solely
reliant on consistent performance.
 U.S. Economy Add-On
Independently, U.S. public health depends on public health engagement with China
Hickey '14 (Christopher Hickey, Ph.D. Countr Director for the People's Republic of China,
"China's Healthcare Sector, Drug Safety, and the U.S.-China Trade in Medical Products", U.S. Food
and Drug Administration, www.fda.gov/NewsEvents/Testimony/ucm391480.htm, CL)
This rapid globalization of commerce poses challenges. For example, drugs and medical device
manufacturers have the responsibility for the safety and quality of the drugs and devices they
produce. Some countries do not have strong regulatory system oversight to ensure industry is
meeting the standards required for safety and quality of these products. Increased numbers of
suppliers, more complex products, and intricate multinational supply chains can introduce risks to
product safety and quality. Unfortunately, these factors also mean that consumers can more easily
be exposed to risks, including those from intentional or unintentional adulteration, as well as those
that come from exposure to contaminated products. Below, I will discuss FDA’s implementation
of its comprehensive strategy to use strong global partnerships to enhance the safety of imported
products. Many of the challenges associated with globalization manifest themselves in China ;
however, challenges we see in China mirror challenges we see in other countries with developing
regulatory systems. In recent years, FDA has faced several public health threats related to imports
from China. The members of this Commission will recall the threats to the safety of the country’s
heparin supply in 2007 and 2008, which emerged when Chinese suppliers of heparin (a critical
drug that helps to prevent blood clots) substituted a lower-cost, adulterated raw ingredient in their
shipments to U.S. drug makers. This substitution caused numerous deaths, as well as severe
allergic reactions. In 2007, FDA found shipments of toothpaste from China that contained
poisonous levels of diethylene glycol, a product used in antifreeze. And in China’s dmestic supply
chain in 2012, numerous companies used industrial-grade gelatin to make pharmaceutical-grade
gelatin capsules for drugs and dietary foods. This industrial-grade gelatin contained more
chromium than the edible gelatin that firms should have used. FDA’s success in protecting the
American public depends increasingly on the Agency’s ability to reach beyond U.S. borders and
engage with its regulatory counterparts in other countries. This collaboration encourages the
implementation of science-based standards to ensure the quality and safety of FDA-regulated
products manufactured overseas and imported into the United States. It is equally important for
FDA to partner with industry, and with regional and international organizations to accomplish this
goal. FDA works with numerous partners to enhance responsibility and oversight for safety and
quality throughout the supply chain.

Healthcare improvements in China causes economic growth for both countries

Huang ’16 (Yanzhong Huang, Senior Fellow for Global Health, Council on Foreign Relations, and
professor of Diplomacy and International Relations at Seton Hall University, “China’s Healthcare
Sector and U.S.-China Health Cooperation”, April 16, Council on Foreign Relations, CL)
Transformation in both countries’ healthcare sectors are generating extra business
opportunities. In the JCCT healthcare event, Dr. Michael Lu of U.S. Department of Health and Human Services identified five
changes in the U.S. healthcare system: improved access through the Affordable Care Act, payment
reforms, delivery systems transformation, health information technologies, and quality
improvement and innovation. Similar dynamics can be found in China. With the government
targeting healthcare as a social and strategic priority, the healthcare market is rapidly expanding. China
now trails the United States as the second largest market of health industry in the world. It is estimated that five years from
now the size of China’s health service industry—which covers medical care, pharmaceutical products, healthcare
products, medical devices, and health management—would reach $1.3 trillion, up from less than 1.7 trillion RMB in
2012. This would mean an annual growth rate of 21 percent between 2012 and 2020. But U.S.-China cooperation
in healthcare is not just about market opportunities. It is also about how to improve health and well-being of the people in both
countries. The two objectives are not necessarily mutually exclusive, but without proper regulation and balance of interests, single-
minded pursuit of business opportunities may exacerbate the problem of affordability, thereby defeating the very purpose of the
healthcare reform. Already, demographic and epidemiological transitions against the background of moving toward universal health
coverage have raised concerns regarding financing and cost control in both countries. The growing cost of healthcare highlights the
importance of cooperation in preventive care. Over
the past years, both countries have been collaborating
over tobacco control research and tobacco surveillance . But the areas of cooperation can be further
expanded to include health management, environmental health, healthy life style promotion, and
encouraging the private sector and social forces in health education and risk reduction. Meanwhile, in seeking
cooperation with China we have to keep in mind the inherent dilemmas and contraditions in China’s health policy processes. While the
13th Five Year Plan suggests that China is willing to allow the market to play a more decive role, it continues to rely on heavy-handed
industrial policy in pursuit of the growth of its healthcare and pharmaceutical industires. While
the government welcomes
the entry of foreign business and investment, it has increased information and ideological
control while sustaining its devotion to bolstering domestic industrial competiveness. Against this
background, the U.S. Congress is advised to work more deligently and closely with the executive branch to pressure Beijing to improve
the operating environment of U.S. businesses in China.

U.S. health is important to the U.S. economy

Blanding '12 (Michael Blanding, Boston-based journalist and author, "Public health and the
U.S. economy", Harvard School of Public Health, Fall 2012,
https://www.hsph.harvard.edu/news/magazine/public-health-economy-election/, CL)
How the next U.S. president can stack the deck in favor of people’s health and wealth in 2013 With
the November 2012 elections on the horizon, Americans surveyed in national polls consistently
rank the economy as their number one concern. Public health professionals can have a big impact
on this ballot-box issue. More than 17 percent of the U.S. Gross Domestic Product is spent on health
care—in many cases, for conditions that could be prevented or better managed with public health
interventions. Yet only 3 percent of the government’s health budget is spent on public health
measures. A 2012 study in Health Affairs notes that since 1960, U.S. health care spending has grown
five times faster than GDP. Why do these numbers matter? First, a healthier workforce is a more
productive workforce. According to an April 2012 report from the Institute of Medicine (IOM), the
indirect costs associated with preventable chronic diseases—costs related to worker productivity
as well as the resulting fiscal drag on the nation’s economic output—may exceed $1 trillion per
year. A 2007 study from the Milken Institute found that when unhealthy workers show up on the
job, as many must to survive financially, the effects of their lower productivity on the nation’s
economic health are immense: in dollar value, several times greater than the business losses
accrued when employees take actual sick days. Avoidable illness also diverts the economic
productivity of parents and other caregivers. Second, the costs of health care are built into the price
of every American-built product and service. And the per capita cost of health care in the U.S. is
higher than in any nation in the world. If the U.S. can reduce the costs of health care over the long
term—by preventing diseases that require costly medical procedures to treat and by making our
existing health systems more efficient—the costs of American products can become more
competitive in a global marketplace. Today, U.S. per capita health expenditures are more than twice
the average of other countries in the Organization of Economic Cooperation and Development. The
IOM estimates that cutting the prevalence of adult obesity by 50 percent—roughly the same
reduction across the population as was achieved through public health’s multipronged attack on
smoking in the late 20th century—could cut annual U.S. medical care expenditures by $58 billion.
 Topicality
Pandemic control is an emphasized focus in diplomatic engagement
CGHD ND (Center for Health and Diplomacy, where high level political figures, health care
workers and leaders in both the public and private sector can share and communicate their ideas,
www.cghd.org/index.php/global-health-partnerships-and-solutions/public-private-
partnerships/101-global-health-diplomacy-in-the-21st-century-private-sector-engagement-at-
johnson-johnson)
Over the past two decades, the
importance of global health, as an emphasis for diplomatic engagement, has
grown. The 1994 United Nations Human Development Report heralded the potential to advance human security with "first, safety
from such chronic threats of hunger, disease and repression." In 1996, following the first ever UN General Assembly focusing on a health
issue, the Joint United Nations Programme on HIV/AIDS (UNAIDS) was launched to strengthen the way in which the world was
responding to AIDS. And, just recently the second time the UN General Assembly convened on a health issue was in 2011 when a high
level meeting on NCDs led to targets to address the global threat. We
have also seen global health diplomatic
activities in such areas as the Framework Convention on Tobacco Control, response to pandemics, and in other
post conflict environments. Numerous countries have embraced health diplomacy. In Oslo in 2007,
Brazil, France, Indonesia, Norway, Senegal, South Africa, and Thailand made a joint Declaration
in which they declared global health to be a "pressing foreign policy issue of our time", and
committed to making health a "defining lens" for shaping foreign policy. Just last month, in December 2012, the US
announced an Office of Global Health Diplomacy with a mandate to influence global stakeholders, align donor investments with country
resources, and oversight, maintenance, and improvement of country-focused technical support that expands capacity for global health
priorities.

While much of this evolved in the traditional circles of diplomacy — namely state actors — as the world's largest
diversified health company, we believe that an approach to address the global health challenges requires private sector engagement. Our
commitment to advance global health success was amongst the first global companies to include global health diplomacy as a strategic
imperative in our Government Affairs and Policy department, a role which I have led since 2008. In 2010, I testified before a US
Congressional Committee on Achieving the United Nations Millennium Development Goals: Progress through Partnerships and presaged
the role that effective private sector engagement can offer: “We believe our efforts in global
health diplomacy drive new
ways of thinking that can help shape stronger, more sustainable approaches to benefit mothers and
fathers around the world.” We have been engaged in a number of global health diplomacy activities, pledging one of the first private
sector commitments to theMDGs that included contributions from our pharmaceutical sector increasing access for HIV and TB
medications. There are three examples that provide a glimpse into the promise of the novel global health approaches in this multipolar
world.

Health has empirically been a major area of collaboration in diplomatic engagement

KFF '12 (KFF, policy briefs on U.S. global health policy, "RAISING THE PROFILE OF DIPLOMACY
IN THE U.S. GLOBAL HEALTH RESPONSE: A BACKGROUNDER ON GLOBAL HEALTH DIPLOMACY",
Kaiser Family Foundation, September,
https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8360.pdf)
The U.S. government recently announced its intention to create a new “Office of Global Health
Diplomacy” at the State Department (S/GHD), elevating, at least structurally, the role of diplomacy in U.S. global
health efforts. As stated in the announcement, the creation of the office is a recognition of “the critical role of health
diplomacy to increase political will and resource commitments around global health among
partner countries and increase external coordination among donors and stakeholders.”1 It also appears to be part
of the “next phase” of the Global Health Initiative (GHI)* , the Administration’s effort to create a global health strategy for the U.S.
government, with the S/GHD office “champion[ing] the priorities and policies of the GHI in the diplomatic arena.”1 While the S/GHD
will be a new office, it joins a much longer history of diplomatic engagement on international health
issues by the U.S. and others. To help understand this broader context and history, this article provides an overview of global health
diplomacy as a concept, including how it has been defined and used, as well as the history of diplomatic engagement on health, both
globally and by the U.S., more specifically. Even as there remain a number of questions about the new S/GHD office, including exactly how
it will operationalize the principles of the GHI in diplomacy, now is an opportune time to examine and assess the state of understanding
in the emerging field of global health diplomacy.

U.S. policies have linked health and diplomacy together over time
KFF '12 (KFF, policy briefs on U.S. global health policy, "RAISING THE PROFILE OF DIPLOMACY
IN THE U.S. GLOBAL HEALTH RESPONSE: A BACKGROUNDER ON GLOBAL HEALTH DIPLOMACY",
Kaiser Family Foundation, September,
https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8360.pdf)
More recently, growing concern about the political and social impacts of HIV/AIDS and emerging
infectious diseases such as SARS and pandemic influenza have led policymakers to place greater
attention on health in the context of foreign policy and diplomatic activity. In response to the
growing political attention, a new United Nations agency (UNAIDS) was created in 1996 to serve a
center for multilateral policy negotiations on addressing HIV, and in 2000 the UN Security Council
declared HIV/AIDS a global security threat, the first time any disease had been singled out in this
way. International alarm about the spread of H5N1 avian influenza and the potential for an
influenza pandemic led UN Secretary General create a new UN System Influenza Coordinator office
in 2005 to help multilateral coordination.
The importance of global health as an emphasis for diplomatic engagement has continued to
grow. Over the past decade, proponents of global health have focused on how diplomacy and foreign
policy can be used to support global health goals. For example, the current WHO Executive Director opened a unit
dedicated to global health diplomacy,28 and heralded the burgeoning interest in diplomacy for health as a “new
era” for global health.29 The WHO served as the forum in which countries debated and came to agreement on the Framework
Convention on Tobacco Control, a global health treaty adopted by the WHA in 2003, and the negotiations leading up to the revision of the
International Health Regulations, which were approved by the WHA in 2005. As a further indication of the growing
international attention on the relationship between diplomacy and health , a diverse set of
countries (Brazil, France, Indonesia, Norway, Senegal, South Africa, and Thailand) made a joint declaration in 2007 known as the Oslo
Ministerial Declaration, in which they declared global health to be a “pressing foreign policy issue of our
time”, and committed to making health a “defining lens” for shaping foreign policy.30 Likewise, governments of Switzerland and
the United Kingdom have declared intentions to integrate health considerations into the development
of their foreign policy and diplomatic negotiations.
The U.S., too, has a long history of engagement in diplomacy on health issues. Early U.S. efforts stemmed as much from economic interests
as public health ones, as the government sought to promote international trade and travel while also protecting shipping ports and other
borders from external disease threats brought on by increased mobility. The U.S. participated in the International Sanitary Convention
negotiations in the 19th Century (its first active participation coming in 1866, at the 3rd Convention)33, promoted the founding of PAHO
and the creation of the WHO, and is an active a participant in the annual WHA meetings and related negotiations. Beyond the multilateral
dimension, there is also a long history of U.S. bilateral diplomacy on health issue s. For example, as early as
1929, the United States and Canada entered into a bilateral treaty requiring quarantine inspection of each country’s ships when entering
adjacent waters, to prevent the spread of disease between the two countries.34 Even before the creation of a formal U.S. foreign health
assistance apparatus, the
U.S. government was already involved in negotiating and overseeing the
disbursement of international health support to developing countries in the name of furthering
U.S. interests; this assistance had reached approximately $40 million in 1954.35 At the time of the creation of USAID in 1961,
President Kennedy clearly argued that by reaching out to other countries with assistance in health and other areas, the U.S. was
furthering its interests and supporting important foreign policy goals. Foreign assistance, Kennedy said in remarks to Congress that year,
could help prevent the “collapse of existing political and social structures” in developing countries that would “invite the advance of
totalitarianism into every weak and unstable area,” endangering U.S. security and prosperity.3

While health, foreign policy, and diplomacy , therefore, have been linked over time in U.S. policy , the
more contemporary and explicit use and application of “health diplomacy” as a concept and pursuit has its roots in the Carter
administration. In 1978, the administration released a landmark report on the role of international health in U.S. diplomacy titled New
Directions in International Health Cooperation. 37 At that time Peter Bourne, a special assistant to President Carter for health, wrote that
U.S.support for international health “can be a basis for establishing dialogue and bridging
diplomatic barriers”, and used the term “medical diplomacy” to describe such activities.38 The administration
advocated for greater U.S. engagement in this area, highlighting the contributions they could make to furthering U.S.
interests and achievement of foreign policy goals.

U.S. public health policies are inherently diplomatic engagement in practice in both
means and ends
KFF '12 (KFF, policy briefs on U.S. global health policy, "RAISING THE PROFILE OF DIPLOMACY
IN THE U.S. GLOBAL HEALTH RESPONSE: A BACKGROUNDER ON GLOBAL HEALTH DIPLOMACY",
Kaiser Family Foundation, September,
https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8360.pdf)
U.S. support for international health programs grew dramatically after 2000, through newly created international assistance
programs such as the multilateral Global Fund to Fight AIDS, Tuberculosis, and Malaria, which the U.S. helped to establish in 2002, the
U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), created in 2003, along with a new Office of the Global AIDS Coordinator
located within the State Department to oversee U.S. global AIDS efforts, and the U.S. President’s Malaria Initiative, launched in 2005. Such
efforts channeled significantly increased financial assistance into global health, described by
policymakers as important not only because they addressed pressing humanitarian needs
abroad, but also because they served U.S. national interests and foreign policy objectives in a
variety of ways (see Box 2, next page).44 Diplomatic engagement is an important component of putting
programs into practice, because they involve negotiation with recipient c ountry governments,
other donors, and additional partners. PEPFAR, in fact, engages in a formal process of negotiating annual Country
Operational Plans45 and five-year Partnership Frameworks with country recipients of assistance.

The U.S. has also engaged in global health diplomacy in response to crises or specific health-
related issues. For example, U.S. diplomats played an important role in the international effort mounted in response to the cessation
of polio vaccination in Northern Nigeria in 2003, a situation which placed the global campaign to eradicate polio in jeopardy.48 Likewise,
U.S.representatives were involved in the diplomatic effort to reach an agreement with Indonesia
regarding that country’s refusal to
share samples of H5N1 influenza starting in 2006.49 Current U.S. guidance
and strategy documents continue to emphasize the benefits of global health engagement and
global health diplomacy. The latest National Security Strategy declares the U.S. has a “moral and strategic interest” in advancing
global health. In the first ever “Quadrennial Diplomacy and Development Review” (QDDR, released in 2010), the State Department
provided a blueprint for “elevating American ‘civilian power’ to better advance U.S. national interests, focusing on the role of both
diplomats and development experts. Health is identified as one area that bridges both diplomacy and development. As stated in the
QDDR, “we invest in global health to strengthen fragile and failing states, to promote social and economic progress, to protect America’s
security, as tools of public diplomacy, and as an expression of our compassion.” A
key actor identified in the QDDR for carrying
out development and diplomacy is the U.S. Ambassador in country.

Global health policy has become a cornerstone in diplomatic U.S. efforts

Global Health Council ND (a United States-based non-profit networking organizing
linking "several hundred health non-governmental organizations, "U.S. GLOBAL HEALTH
DIPLOMACY AND THE ROLE OF AMBASSADORS", Global Health Council, globalhealth.org/event/u-
s-global-health-diplomacy-role-ambassadors/)
In recent years, the U.S. government has increasingly made global health issues a key element of its
diplomatic efforts – most notably in the creation of a new Office of Global Health Diplomacy at the
State Department in 2013, which includes a goal of supporting U.S. Ambassadors and embassies to
enhance the focus on global health as part of their diplomatic engagement. How does diplomacy
intersect with global health, and how is the new focus on global health diplomacy reshaping the
work of U.S. Ambassadors with partner countries? How does this new office relate to and
coordinate with other parts of the U.S. government’s global health architecture and foreign
policy?

Public health is an important discussion on the topic of foreign policy

Lim and Blazes '15 (Matthew Lim and David Blazes, Matthew Lim is an infectious diseases
physician who has been assigned to the U.S. Department of Defense’s HIV/AIDS Prevention
Program and served as a liaison officer working with the World Health Organization, David Blazes
is an infectious diseases physician who has been assigned to the USNS Comfort and the Navy
research laboratory in Peru and directed the U.S. Department of Defense’s Global Emerging
Infections Surveillance program, , “Collateral Duty Diplomacy”, U.S. Department of Defense and
Global Health Diplomacy, September 21, www.sciencediplomacy.org/article/2015/collateral-duty-
diplomacy)
In a world of increasingly diverse and complex actors, political forces, and transnational issues, global
health diplomacy is
emerging as an important arena of international relations across societal groups, including the education, policy,
research, operational, and response communities. In the past, health as a foreign policy matter was largely seen as a charitable
humanitarian concern or, in the case of infectious diseases, an issue primarily of quarantine laws and border inspections. By the turn of
the twenty-first century, however, improving
health at national and global levels increasingly became a
foreign policy goal in its own right, as well as a vehicle for other foreign policy interests. Various
trends contributed to this change: the globalization of travel and trade and the correspondingly increased risk of transnational
epidemics; the recognition of the importance of health as a driver of economic development; and the belief that health, as an agent of
“soft power,” was a means to affect political agendas. Health as a soft power tool seemed particularly attractive
and relevant in developing world settings where poor health and other fragile elements of human security might abet
the growth of violent extremism. Internationally, the significance of health as a foreign policy priority was
highlighted by events such as the Oslo Ministerial Declaration on health and foreign policy in
2007, signed by the ministers of foreign affairs of seven developed and developing countries, as well as real-world crises
such as the 2005 Boxing Day tsunami, the 2009 H1N1 influenza pandemic, and the thirty-year global
struggle against HIV/AIDS. In recent years the concept of “health security,” whether as an aspect of development, emergency
preparedness, or a distinct set of emerging threats and vulnerabilities, has
underscored the close linkage between
improved health and improved security at local, national, regional, and global levels . In 2014 the
Obama administration launched the Global Health Security Agenda, a partnership of more than forty nations committed to accelerating
progress in preventing, detecting, and responding to outbreaks of infectious disease of natural, accidental, or deliberate origin.

Engagement consists of health diplomacy interactions between governments

Lim and Blazes '15 (Matthew Lim and David Blazes, Matthew Lim is an infectious diseases
physician who has been assigned to the U.S. Department of Defense’s HIV/AIDS Prevention
Program and served as a liaison officer working with the World Health Organization, David Blazes
is an infectious diseases physician who has been assigned to the USNS Comfort and the Navy
research laboratory in Peru and directed the U.S. Department of Defense’s Global Emerging
Infections Surveillance program, , “Collateral Duty Diplomacy”, U.S. Department of Defense and
Global Health Diplomacy, September 21, www.sciencediplomacy.org/article/2015/collateral-duty-
diplomacy)
There is no single definition of “health diplomacy .” One commonly cited characterization is political action that
simultaneously advances public health as well as relations between states.2 Katz et al.3 propose three levels of health
diplomacy: “core” (interactions between governments); “multistakeholder” (interactions involving
governments and multilateral institutions, in support generally of transnational and “polylateral” agendas); and
“informal” (engagements at the technical or program level among actors in health). In this model, the DOD has no
specific mandate to engage in “core” or “multistakeholder” diplomacy by representing, per se, the U.S. government. However, its
extensive activities in “informal” diplomacy have ramifications across all three levels as well as
engagements beyond the health arena. This accords well with the DOD’s self-identification as a “supporting, not
supported” global health actor: the U.S. military’s global health engagements are not derived from the pursuit of global health as a good
endeavor in its own right, but as complementary to the primary purpose of defending U.S. national interests. As such, there is not an
overarching “health goal” that governs U.S. military health diplomacy efforts. Instead, each institution, program, or mission is justified
with reference to a U.S. military strategy or priority beyond the health domain.
Disads
India DA
 No Link
The U.S. has made it clear that they will not shirk India off
Mehta and Sidhu '15 (Vikram Singh Mehta currently serves as the executive chairman of
Brookings India and a senior fellow at the Brookings Institution, and Waheguru Pal Singh Sidhu is a
senior fellow with Brookings India and a senior fellow at New York University’s Center on
International Cooperation.,, "Introduction: Building Up the India-U.S. Relationship", Brookings,
January 2015, www.brookings.edu/research/opinions/2015/01/20-building-up-india-us-
partnership-mehta-sidhu)
When Prime Minister Narendra Modi and President Barack Obama met for their first summit in
September 2014 in Washington DC, they had a crowded and diverse agenda ranging from terrorism to
trade and a spate of other issues. This reflected the sheer breadth of the India-U.S. relationship ,
but the agenda also included many issues – such as the stalled civil nuclear deal – that remain unresolved and have become symptomatic
of the drift in the relationship. And the shadow of the past threatened to cloud the prospects for the future. The Modi-Obama Summit: A
Leadership Moment for India and the United States, a briefing book with memos by Brookings experts in New Delhi and Washington,
issued on the eve of the first summit, highlighted some of the challenges and opportunities for both leaders and offered ways to move
forward on a number of issues facing both countries. Both leaders did seize the leadership moment that the
first summit
provided to give momentum and outline the future contours of the India-U.S. relationship . This
was apparent in their joint Washington Post op-ed, “A Renewed U.S.-India Partnership for the 21st Century,” a
vision statement and the ambitious joint declaration, which called for consultations on global and regional issues,
as well as a bilateral focus on economic growth, energy and climate change, defense and
homeland security, and high technology, space and health cooperation. The New Delhi summit –
their second in less than six months – is an ideal opportunity to build on that joint vision. The India-U.S.
relationship is evolving against the backdrop of growing global disorder . A recalcitrant Russia, a resurgent
China and a fragile and vulnerable Afghanistan pose challenges to both India and the United States. Additionally a series of ‘black swan’
events – from the dramatic and brutal rise of Islamic State, to the precipitous fall in oil prices, and the inability to curtail the Ebola
outbreak – revealed how ill prepared nations, including India and the United States, are to deal with them. With the upheaval wrought by
state and non-state actors to its west and inter-state tensions to its east, India sits at the epicenter of the unfolding geopolitical
uncertainty; New Delhi might have no choice but to help manage the chaos and restore order regionally and globally for its own interest .
There is growing recognition in the Modi government that the United States is probably the best
partner to address these challenges and help India’s rise—despite the differences that persist between the two
countries and the questions about reliability. The Obama administration, on its part, has repeatedly stated that
even if India and the United States will not always be on the same page, India’s rise is in U.S.
interest—not least because a strong, prosperous, inclusive India could help manage global and regional disorder.

India doesn’t need aid anymore—the plan doesn’t trigger any resentment
Ramachandran '10 (Vijaya Ramachandran, a senior fellow at the Center for Global
Development, works on private-sector development, financial flows, food security, humanitarian
assistance, and development interventions in fragile states, "India Emerges as an Aid Donor",
Center for Global Development, October 5, www.cgdev.org/blog/india-emerges-aid-donor)
The Indian Express reported that India might not accept aid from the United Kingdom after April 2011. India has been the
largest single recipient of British aid, receiving more than €800m (about $1.25b) since 2008. Thisannouncement is perhaps
symbolic of the fine line that India is walking between being a “developed” and “developing”
country. It is the eleventh largest economy in the world, growing 8-9% annually. But it is also home to one-third of the world’s poor
—there are more poor people in India than in all of Sub-Saharan Africa. Nonetheless, over the past decade, India has
quietly transitioned to a donor country , emerging on the world stage as a significant provider of
development assistance. In the mid-1980s, India was the world’s largest recipient of foreign aid .
Today foreign aid is less than 0.3% of GDP. Seven years ago India announced that it would only accept bilateral
development assistance from five countries (Germany, Japan, Russia, the UK, and the United States) in addition to the EU. Now it appears
that the list is dwindling. India also declined international assistance after both the 2004 tsunami and the
2005 earthquake in Kashmir. Although there are no consolidated figures on the total foreign assistance that India provides, the estimates
are rising. India allocated approximately $547 million to aid-related activities in 2008 . It is now the fifth
largest donor to Afghanistan (with commitments over $1 billion since 2001) and is increasingly seeking out new recipients – India’s aid
India’s aid programs are
to Africa has grown at a compound annual growth rate of 22% over the past ten years.
increasingly including countries outside the immediate neighborhood of Afghanistan, Bhutan, and Nepal. These changes seem to
reflect fresh attention to aid as an instrument of foreign policy. India’s flagship aid initiative has been the Indian Technical and Economic
Cooperation (ITEC), which provides training and education to scholars and leaders from developing countries. There are more than
40,000 alumni of the ITEC program around the world; the hope is they have a friendly disposition to India that will be reflected in
policies and bilateral relationships. However, India is no longer containing itself to “soft power” influences. Driven by competition with
China and its own unprecedented growth, India
has begun to focus on not only diplomatic influence but also
on oil reserves and markets for goods, especially in Africa . During the April 2008 India-Africa Forum Summit,
India pledged $500 million in concessional credit facilities to eight resource rich West-African nations. Some observers argue that India
would do best not to completely abandon its “soft power” approach. Much of India’s success in its relations with the developing world
has been built through its traditional aid program and a shared colonial history with countries in Africa and elsewhere. India should
think twice before sacrificing this goodwill for mineral or other resources. More problematically, like China, India lacks an official
definition of what counts as development assistance. No official records of aid disbursements are kept, either by the Ministry of External
Affairs or the Ministry of Finance. Aid flows through various channels and various agencies in an ad hoc manner. And India has yet to
join the OECD’s Development Assistance Committee (DAC), which would require better record keeping and compliance with
international standard definitions. India’s foreign aid program will likely be more successful if it engages with other donors, provides
clear and transparent records of its activities, and participates as a full-fledged member of the global aid system, including joining the
OECD-DAC. Public information and records will not only allow India to receive due credit as an emerging player, but will also facilitate
cooperation with other donors. If India’s goal is to be recognized as a significant donor, it must start acting like one.

No link—India cares more about weapon and space tech development

Wortzel & Dillon '00 (Larry M. Wortzel is a fellow at the The Kathryn and Shelby Cullom
Davis Institute for National Security and Foreign Policy, Dana Robert Dillon is a senior policy
analyst at the Asian Studies Center, "Improving Relations with India Without Compromising U.S.
Security", Heritage, December 11, www.heritage.org/research/reports/2000/12/improving-
relations-with-india)
America and India share the distinction of being the world's largest democracies . Yet relations between
the two countries have been unsteady and will need executive attention if they are to improve. A major stumbling block to relations in
recent years has been India's testing of nuclear weapons and its missile development program, both of which threaten regional stability.
Now, aspart of a program to accelerate economic modernization, India is seeking U.S. assistance
to develop its commercial satellite and space launch capabilities. Although helping India to improve its
economy and increasing opportunities for U.S. businesses in India are good foreign policy objectives, history has shown that there are
limits to how far the United States should go in transferring sensitive technology that could be used in weapons development or ballistic
missile programs. Washington should not be swayed, either by rhetoric about India's democracy and its new nuclear power status or by
suggestions of increased trade, into placing India's interests before U.S. national security concerns. At the same time, the
United
States must recognize that India is a great emerging democracy that is redefining its identity and
future goals.1 A new strategy for improving relations with India should focus on how to improve regional
security by restraining nuclear proliferation and avoiding technology cooperation that could
advance ballistic missile programs, as well as on how to improve trade.
BALANCING TRADE ISSUES AND SECURITY CONCERNS
During a recent visit to Washington, Indian Prime Minister Atal Behari Vajpayee spoke before the U.S.-India Business Summit,
recognizing that "The United States is today India's largest trading partner. The US companies are
also the largest investors in India.... We would like to deepen this relationship ."2 Building on this theme
when he addressed a joint session of Congress, Vajpayee said that "In the years ahead, a strong, democratic and economically prosperous
India, standing at the crossroads of all the major cultural and economic zones of Asia, will be an indispensable factor of stability in the
region."3 Indian officials have asked for greater cooperation in the field of satellite technology and
space launches.4 Inherent in these remarks is India's desire to be seen today as strategically important to the United States. The
fact that visiting Indian officials urged their American counterparts to invest in India is not surprising. India's economy grew
slowly after the country gained its independence in 1947. Its formidable tariff regime and burdensome regulations stifled trade and
economic development. Then, in the 1980s and 1990s, the government began opening borders to trade and
emphasizing economic growth by increasing exports. India's economy began a steady and sustainable rise; however, it
remains constrained by an average tariff rate of 27.2 percent.
 Internal Link
India and China are working closely together economically
Gutpa and Wang '09 (Anil K. Gupta and Haiyan Wang, writers for the Magazing of U.S.-
China Business Council, "China and India: Greater Economic Integration", USCBC, September 1,
www.chinabusinessreview.com/china-and-india-greater-economic-integration/)
Rapidly expanding trade and nascent foreign investment promise stronger economic links between the world’s two fastest-growing and
most populous countries. Economic ties between China and India will play a large role in one of the most
important bilateral relationships in the world by 2020. Bilateral trade has already surged from
under $3 billion in 2000 to nearly $52 billion in 2008 (see Table 1). Though last year’s figure equals only one-
eighth of total US-China trade in 2008, China-India trade is growing at nearly three times the pace of US-China
trade, and rapid growth will likely continue. Even conservative estimates suggest that, by 2020, China-India trade could
surpass last year’s US-China total of $409.2 billion and more than half of total projected US-China trade in 2020. Such trade
expansion would affect every major world economy, including the United States. Though foreign direct investment (FDI) between China
and India trails trade growth, it too will likely surge in the years to come. Bilateral trade blossom: As neighbors and two of the world’s
oldest civilizations, China
and India have shared a long history of cultural, scientific, and economic
linkages. In modern times, economic ties between the two countries were almost completely severed from 1949 to 1978. Following a
brief border war in 1962, bilateral trade and investment came to a halt. Economic ties officially resumed when China embarked on
economic reforms but remained largely insignificant for the next two decades. The
last 10 years, however, have seen a
transformation of the economic relationship between China and India . Since the 1990s, both countries have
become increasingly outward-looking in their economic policies and have embraced deeper economic integration with the rest of the
world. China and India are also members of the World Trade Organization (WTO)—India as a founding member and China since 2001.
Indian Prime Minister Atal Behari Vajpayee’s visit to China in June 2003 accelerated the momentum for economic integration. The
visit led to a pragmatic decision by both countries’ political leaders to cultivate economic ties
without being constrained by unresolved border disputes. After this visit, the two sides set up a joint study group
to examine how China and India could expand trade and cooperation. The reduction and elimination of trade barriers has helped to
stimulate economic exchange. Since 2000, trade between China and India has grown nearly twice as fast as each country’s trade with the
rest of the world, and since 2001, China’s trade with India has grown more rapidly than its trade with any of its top 10 trade partners. In
2008, China surpassed the United States to become India’s largest trade partner. Last year, India was
China’s tenth-largest export market.

Drivers of bilateral trade: There

are two primary drivers of the burgeoning trade between China and
India: differing comparative advantages of the two countries and sustained, high growth rates in
both economies. The different comparative advantages of the two countries provide grounds for strong economic exchange.
Although China’s economy is three times as large as India’s, its manufacturing sector is five times that of India’s. Chinese exports to India
India has some of the
thus consist primarily of manufactured goods, especially various types of machinery. Conversely,
world’s largest reserves of iron ore, bauxite, and manganese, and its exports to China consist
primarily of raw materials to feed that country’s expanding steel and automotive sectors. Services trade
between China and India remains small. Though India has emerged as a global powerhouse in information technology (IT) and IT-
enabled services, language differences create natural barriers to the export of these services from India to China. Thus, many of India’s
larger IT companies invest directly in local operations within China. Rapid economic growth: The sheer size and growth rates of these
2008, China’s economy grew
economies have boosted bilateral trade, as bigger economies have more to buy and sell. In
9.0 percent and India’s grew 7.3 percent—both faster than any other major economy in the
world—and these countries will likely continue to grow faster than other major economies through 2010, according to International
Monetary Fund projections. The two countries could also remain the world’s two fastest-growing economies for the next two to three
decades. In this context, the prospects for continued strong growth in bilateral trade appear to be bright.
Imports of lower-priced capital goods from China, such as turbines for electric utilities, can help India address the infrastructure
bottlenecks—especially in roads, highways, ports, and electric power—that have appeared as India’s manufacturing revolution gets
under way. Because Chinese
capital goods are often much cheaper than those from Western or Japanese
manufacturers, such imports from China can keep costs low, allowing India to modernize and
upgrade its infrastructure more quickly. Emerging investment linkages: Unlike trade, levels of investment between China
and India remain relatively low. Though an estimated 100 companies from each country have offices in the other, cumulative bilateral
FDI is less than $500 million. Cross-border investment remains low because Chinese and Indian companies are still in the early stages of
learning how to operate and succeed in each other’s economies. FDI requires greater knowledge of and commitment to the host economy
than trade and often follows trade linkages. Recent developments, however, suggest that bilateral FDI will likely see a sharp upswing
over the next five years. Investment is rapidly entering a broader range of sectors, encompassing high-tech and low-tech industries, and
leading companies in both countries have their sights set on global expansion. Given the size and growth rates of the two economies,
corporate leaders from each country have realized that a leading market position in the other economy is critical to pursuing global
ambitions. Recent business developments also reflect this trend:

India can always just go to Russia

Wortzel & Dillon '00 (Larry M. Wortzel is a fellow at the The Kathryn and Shelby Cullom
Davis Institute for National Security and Foreign Policy, Dana Robert Dillon is a senior policy
analyst at the Asian Studies Center, "Improving Relations with India Without Compromising U.S.
Security", Heritage, December 11, www.heritage.org/research/reports/2000/12/improving-
relations-with-india)
INDIA'S CONTINUING ALLIANCE WITH RUSSIA
The only permanent member of the Security Council that supports India's accession is Russia,
India's one enduring security ally. This alliance was forged in 1950 when India signed the Soviet-Indian Treaty of Peace and
Friendship. It was reinforced when the two states signed a Treaty of Cooperation and Mutual
Friendship in 1971 and when India renewed that treaty with Russia in 1991. India's relations with the
Russian Federation continue to be based on this strategic partnership and oriented around the
complementary nature of their state-owned heavy industries and their arms trade . This long security
relationship means that the vast majority of India's weapons are either Russian-produced or Russian-designed. Moreover, India's
relationship with Russia is likely to continue under current economic conditions; India simply cannot
afford to make a major change in suppliers, and Moscow still produces generally high-quality weapons at low cost. The recent $3 billion
arms deal signed by Russian President Vladimir Putin during a visit in October demonstrates that New
Delhi will likely seek
Russia's assistance in developing nuclear weapons and missile capabilities, especially if the United States
prohibitively limits American commercial involvement in India's developing space program. India, however, has begun to move away
from a socialist, centrally planned economy to a more open market economy, and as it continues to do so, its foreign and defense policies
will change and links to the West will grow. India thus far has resisted Russia's calls to build a three-way alliance with China to offset
America's international power. India could move more toward the West as friction with China grows and economic ties to the United
States increase.
Elections
 Link Turn
Foreign aid may be unpopular, but public health efforts are uniquely popular
DiJulio, Norton, and Brodie '16 (Biana DiJulio is an Associate Director for the Public
Opinion and Survey Research Program, Mira Norton is a Survey Analyst for the Public Opinion
and Survey Research team, Mollyann Brodie is President of the American Association of Public
Opinion Research (AAPOR)., "Americans' Views on the U.S. Role in Global Health", Kaiser Family
Foundation, January 20, kff.org/global-health-policy/poll-finding/americans-views-on-the-u-s-
role-in-global-health/)
Broadly, the American public is largely supportive of the U.S. playing a large role in trying to solve
international problems. About two-thirds of Americans (65 percent) say that the U.S. should play at
least a major role in world affairs, including 18 percent who say the U.S. should take the leading role and
47 percent who say the U.S. should play a major role but not the leading one. Despite recent international events, including the
Ebola crisis in West Africa as well as the more recent terrorist attacks in Paris, these shares haven’t changed substantially since 2012. Majorities across
all parties say the U.S. should play a major or leading role, with Republicans more likely to say that the U.S. should play a
leading role compared to Democrats. When it comes to global health issues specifically, a slim majority of Americans (53
percent) say the U.S. government is doing enough to improve health for people in developing
countries, while four in ten (39 percent) say that it is not doing enough. In addition, half (51 percent) also say religious or faith-based organizations
are doing enough and a similar share (46 percent) say the same about international nonprofit organizations. Americans are split on their opinion of the
World Health Organization (WHO), the public health arm of the United Nations, with equal shares saying the WHO is doing enough and not doing enough (42
percent each). On the other hand, majorities say that large international businesses and corporations (64 percent), the United Nations (54 percent), and the
governments of other developed countries (51 percent) are not doing enough to improve health for people in developing countries .
 No Link
The only part of foreign policy voters care about this election season is combatting
terrorism
Saunders '16 (Elizabeth N. Saunders, assistant professor of political science and international
affairs at George Washington University, "Will foreign policy be a major issue in the 2016 election?
Here’s what we know.", The Washington Post, January 26,
https://www.washingtonpost.com/news/monkey-cage/wp/2016/01/26/will-foreign-policy-be-a-
major-issue-in-the-2016-election-heres-what-we-know/)
There is also the state-level evidence that casualties mattered in 2004 (and in Senate elections during Vietnam). Another recent study
also found that casualties can lead otherwise politically uninterested voters to turn out on election
day, although both supporters and opponents of the war appear to be equally mobilized. So how could foreign policy
matter in 2016? First, a significant terrorist attack on the scale of 9/11 could make foreign policy
central. So could a smaller event that happens after Labor Day, when voters are particularly tuned in. But that requires a rare
or precisely-timed event. Even major events can recede quickly. Just ask George H.W. Bush, who said this about
his reelection chances in March 1991, when his popularity after the Gulf War was at its height: “The common wisdom today is that I’ll win
in a runaway, but I don’t believe that. I think it’s going to be the economy.” Second, foreign policy might affect the primaries, as Drezner
has suggested. The potential nominee may have to pass the foreign policy “sniff test” (a problem Scott Walker and Ben Carson have
confronted). That’s a relatively low bar, however. This year the Republicans have no contender with significant foreign policy experience.
The Democrats have one, but that’s the exception for either party, not the rule. In general, we still know relatively little
about how foreign policy matters in primary elections. Third, foreign policy can affect a close
election. But that is very different from suggesting that foreign policy will be key for most voters . Is it
pointless to talk about foreign policy and elections, then? Not so fast. Although it is unlikely — — though not impossible — that
foreign policy will be a central factor in the 2016 election , campaign debates about foreign policy can affect
national debates and policymaking in other ways. For instance, Bethany Albertson and Shana Gadarian argue that anxiety can
affect politics, a relevant issue given recent terrorist attacks .

The general consensus is that public health collaboration can help the U.S.
DiJulio, Norton, and Brodie '16 (Biana DiJulio is an Associate Director for the Public
Opinion and Survey Research Program, Mira Norton is a Survey Analyst for the Public Opinion
and Survey Research team, Mollyann Brodie is President of the American Association of Public
Opinion Research (AAPOR)., "Americans' Views on the U.S. Role in Global Health", Kaiser Family
Foundation, January 20, kff.org/global-health-policy/poll-finding/americans-views-on-the-u-s-
role-in-global-health/)
While there is general skepticism about the effectiveness of global health spending, many Americans
believe there are a number of benefits to spending money to improve health in developing
countries. More than six in ten (63 percent) say that such spending helps protect the health of Americans
by preventing the spread of diseases like SARS, bird flu, swine flu, and Ebola and about half say it helps
make people and communities in developing countries more self-sufficient (53 percent) and helps improve
the U.S. image around the world (52 percent). Fewer Americans, however, say U.S. health spending in developing countries
benefits the U.S. economy (33 percent) or helps U.S. national security by lessening the threat of terrorism (31 percent), while about two-
thirds of the public thinks it does not have much impact in those areas. Democrats are generally more likely than Republicans and
independents to say that spending money on improving health in developing countries has such impacts, but still about six in ten
Republicans and independents say it helps protect Americans’ health (58 percent and 62 percent, respectively). lthough many
acknowledge there are domestic interests that could benefit from global health aid, nearly half of
Americans (46 percent) say that the most important reason that the U.S. spends money on improving health for
people in developing countries is because it’s the right thing to do. This ranks far above other reasons, such as
ensuring national security (14 percent), improving our diplomatic relationships (14 percent), helping the U.S. economy by creating new
markets for U.S. businesses (11 percent), or improving the U.S.’s image around the world (9 percent). Americans’ views of the
reasons for such spending do not vary by political party.

It’s a myth that Republicans hate foreign aid

Norris '11 (John Norris, the executive director of the sustainable security program at the Center
for American Progress, "Five myths about foreign aid", The Washington Post, April 28,
https://www.washingtonpost.com/opinions/five-myths-about-foreign-
aid/2011/04/25/AF00z05E_story.html)
What’s the point of U.S. foreign aid, and does it do any good? Let’s topple a few misconceptions and find out.
1. Republicans hate foreign aid. Former congressman Tom Delay (R-Tex.) once noted that it was difficult for lawmakers to
explain to their constituents why they were more interested in helping Ghana than Grandma.
Yet every Republican president since Dwight Eisenhower has been a staunch advocate for foreign aid
programs. In signing the Foreign Assistance Act of 1974, Gerald Ford resisted congressional restrictions on food aid. Ronald
Reagan launched the National Endowment for Democracy in 1983 to help “foster the infrastructure of
democracy — the system of a free press, unions, political parties, universities” around the globe, as he put it in a speech before the
British Parliament. Declaring that America needed to lead the fight against the HIV/AIDS pandemic,
George W. Bush established the President’s Emergency Plan for AIDS Relief in 2003. According to the Congressional
Research Service, this fund, along with money for Iraq reconstruction, was part of the largest appropriation for foreign aid in three
decades. When it came to opening the nation’s wallet to the world, these conservative commanders in chief weren’t very conservative.
“U.S. assistance is essential to express and achieve our national goals in the international community — a world order of peace and
justice.” Sound like Obama? Richard Nixon said it in 1969.

2. Foreign aid is a budget buster. In poll after poll, Americans

overwhelmingly say they believe that foreign aid
makes up a larger portion of the federal budget than defense spending, Social Security, Medicaid, Medicare, or
spending on roads and other infrastructure. In a November World Public Opinion poll, the average American believed that a whopping
25 percent of the federal budget goes to foreign aid. The average respondent also thought that the appropriate level of foreign aid would
be about 10 percent of the budget — 10 times the current level. Compared with our military and entitlement budgets, this is loose
change. Since the 1970s, aid spending has hovered around 1 percent of the federal budget.
International assistance programs were close to 5 percent of the budget under Lyndon B. Johnson during the war
in Vietnam, but have dropped since.
 AT: Libertarian Swing Voters
The plan doesn’t violate libertarian values
Friedman '16 (Mark Friedman, attorney from Georgetown Law J.D. and Harvard Business
School MBA, "A Libertarian Defense of Foreign Aid; No, Seriously", Natural Rights Libertarian,
March 3, naturalrightslibertarian.com/2016/03/a-libertarian-defense-of-foreign-aid-no-
seriously/)
U.S.economic and military assistance to foreign countries (“foreign aid”) is generally unpopular with
the electorate, but particularly distasteful to libertarians, as it is seen to violate non-
interventionism. Thus, the 2012 Libertarian Party Platform states: Our foreign policy should emphasize defense against attack
from abroad and enhance the likelihood of peace by avoiding foreign entanglements. We would end the current U.S. government policy of
foreign intervention, including military and economic aid (my emphasis). While
the logic of this stance is superficially
compelling, I do not believe it can justify a categorical ban on foreign aid . There are a variety of reasons why
libertarians almost universally condemn such assistance. Perhaps the most obvious is that it is the product of coercion. That is, the
money disbursed to foreign governments was not contributed by willing donors, but taken by force from the taxpayers. If individual
Americans wish to support (say) Egypt, Israel or Pakistan, let them write checks from their own accounts, according to this argument.
Moreover, given the generally ineptitude of our policymakers, aid will not be distributed wisely. It will likely end up in Swiss bank
accounts or be used to enrich the cronies of the recipients and for other dubious purposes. However, while persuasive on their own
terms, these arguments miss the big picture. The overridingissue is whether foreign aid can, in principle, be a
tool for advancing morally legitimate American interests , and I believe it can. From the perspective of minimal
state libertarianism, one of the central government’s essential functions is to protect the rights of its
citizens against predation by hostile nations, including the deterrence of and defense against
military aggression, and the vindication of our right to engage in travel and trade with citizens of other nations on a consensual
basis. I see no reason why we should rigidly reject international assistance as a means of inducing
foreign powers to respect these rights. Foreign aid is in many ways comparable to making
campaign contributions to our politicians , in that it attempts to trade money for influence. Of course, from the
libertarian perspective it is a tragedy that we live in a polity where the state is so powerful that citizens and groups must resort to this
tactic, but that’s the way it is. Under such circumstances, it
seems permissible for constituencies to make political
contributions in order to defend their rights. For example, I see nothing amiss in parents, interested citizens, and
private schools banding together to fund politicians who will promote school choice or for Uber and Lyft to do the same in order to
promote a regulatory scheme that does not arbitrarily favor the taxi industry. In short, such contributions
are morally
defensible if made to promote a just cause, and the same can be said about foreign aid. Using
Pakistan as an example, while there is no doubt that its government is horribly corrupt and no champion of individual rights, it possesses
many dozens of nuclear weapons, and has fought three wars with its neighbor India, another nuclear-armed state, since independence. A
nuclear war between these two nations would have potentially catastrophic negative externalities for the rest of the world, including US
citizens. Accordingly, if foreign
aid can, even slightly, influence Pakistan’s leaders to avoid aggressive
actions that might provoke India, it would be money well spent. A similar argument could be made in favor of
assistance to various Middle Eastern countries, in the hope of preventing a conflagration there. I note that the total amount of our foreign
aid represents a tiny fraction of our overall defense budget. It is entirely possible that this largess will not advance US interests, but
retard them. However, the same could well be said about our defense strategy at any given moment. And, while foreign aid is funded on a
non-consensual basis, so is the procurement of aircraft carriers, fighter squadrons, tank battalions, etc. My point is that it is
impossible to draw a principled distinction between the minimal state’s role in providing national
security, and the supply of foreign aid. The latter is simply one available means of promoting the former. I hope it is clear
that nothing said here should be taken as an endorsement of our existing aid program, including its roster of recipients, the amounts
given, the conditions attached, etc. The point here is, I think, a modest one, i.e. libertarian principles do not compel us to
renounce all foreign aid without a careful cost/benefit analysis.
Libertarians are swing voters, but they are increasingly swinging Democrat
Cato Institute '06 (Cato Institute, a nonpartisan public policy research foundation dedicated
to broadening policy debat, "Libertarians Will be Largest Swing Vote, Study Says", Cato Institute,
October 19, somd.com/news/headlines/2006/4633.shtml)
WASHINGTON – A dramatic shift in the voting patterns of the up to 21 percent of the voting-age public
identified as libertarian will likely tilt the balance of the 2006 midterm election, according to a new report.
Libertarians have traditionally voted for Republican candidates, and have voted overwhelmingly for almost
every Republican presidential candidate since at least 1972, according to the report. But the study’s authors, Cato Institute
Executive Vice President David Boaz and America’s Future Foundation Executive Director David Kirby, conclude that this group
of voters has suddenly – and silently – become the nation’s largest swing vote . Libertarians, the study
concludes, have become disillusioned with Republican overspending, social intolerance, civil liberties infringements, and the floundering
war in Iraq – and will likely abandon the GOP for the first time in generations. “Libertarians are, simply put, the most important swing
vote out there this year,” says Mr. Boaz. “Although the media will inevitably frame the debate in terms of liberal vs. conservative, Moore
vs. Coulter, this election will not be settled on blue vs. red. It will be settled on purple.” In
2002, just 15 percent of
libertarian voters supported a Democratic candidate for Senate. By 2004, fully 43 percent of all
libertarian voters did – a 287 percent increase in just two years. On the House side, only 23 percent of
libertarian voters supported a Democratic candidate in 2002 – but that number almost doubled to 44 percent by 2004. The same
trends are evident in presidential politics. Although Al Gore mustered just one in five libertarian votes in 2000, John
Kerry got almost two in five libertarian votes in 2004. According to a Gallup poll released last month, there are exactly as many
libertarians, 21 percent, as there are pure liberals. That number is just slightly lower than the number of pure conservatives found in the
poll of 25 percent.
Kritiks
 Feminist Killjoy
Economic decline furthers domestic abuse—the plan can prevent some forms of
structural violence
Huffington Post '12 (Huffington Post, American online news aggregator, "Poor Economy
Tied To Rise In Domestic Violence, Survey Finds", The Huffington Post, May 2,
www.huffingtonpost.com/entry/domestic-violence-economy-study-police_n_1467805, CL)
police departments across the
A new survey by the nonprofit Police Executive Research Forum (PERF) has found that
country are encountering more instances of domestic violence related to the poor economy , USA
Today reports. More than half of the 700 law enforcement agencies polled for the survey reported seeing a rise in “domestic conflicts”
related to the economy during 2011, according to USA Today. That’s a sharp increase from the numbers reported in a similar 2010
survey, when 40 percent of agencies reported seeing an increase in such cases. Scott Thompson, the Chief of Police in Camden,
N.J., spoke to the paper about the survey results and said that his city saw a 20 percent increase in domestic incidents and a 10 percent
increase in domestic-related aggravated assaults from 2010 to 2011. Thompson noted that the unemployment rate in the
city is currently 19 percent. “When stresses in the home increase because of unemployment and
other hardships, domestic violence increases,” Thomson told the paper. “We see it on the street.” In turn, the poor
economy has reduced the amount of resources available to victims of domestic violence , according to a
recent survey conducted by the Mary Kay Foundation. In a poll of 730 domestic violence shelters across the country, nearly 80 percent
reported seeing an increase in women seeking abuse at the same time funding for prevention and assistance programs had decreased.
Nearly three in every four domestic violence victims reported staying in an abusive relationship
because they could not afford to leave, according the survey. Rebecca White, president and CEO of the Houston Area
Women’s Center, said staffers have seen a sharp rise in calls from victims of domestic violence and that many say
economic woes have factored into their situations . “When there is less economic opportunity in
the community, it keeps that victim tethered basically to their abusers for financial dependence,”
White told KPRC Houston.

The perm solves better: women debating about policy is important to macro level
changes in the state—failure to engage with the state allows them to pass laws like
prohibiting abortions
Srivastava '09 (Meetika Srivastava, "Essay on Women Empowerment", SSRN, Social Science
Research Network, October 4, papers.ssrn.com/sol3/papers.cfm?abstract_id=1482560, CL)
Gender equality is, first and foremost, a human right. A woman is entitled to live in dignity and in freedom from want and from fear.
Empowering women is also an indispensable tool for advancing development and reducing
poverty. Empowered women contribute to the health and productivity of whole families and
communities and to improved prospects for the next generation. The importance of gender equality is underscored by its inclusion as
one of the eight Millennium Development Goals. Gender equality is acknowledged as being a key to achieving the other seven goals. Yet
discrimination against women and girls - including gender-based violence, economic discrimination, reproductive health inequities, and
harmful traditional practices - remains the most pervasive and persistent form of inequality. Women and girls bear enormous hardship
during and after humanitarian emergencies, especially armed conflicts. There have been several organisations and institutions
advocating for women, promoting legal and policy reforms and gender-sensitive data collection, and supporting projects that improve
women's health and expand their choices in life. Despite many international agreements affirming their human rights, women are still
much more likely than men to be poor and illiterate. They usually have less access than men to medical care ,
property ownership, credit, training and employment. They are far less likely than men to be politically active and far more likely to be
victims of domestic violence. The
ability of women to control their own fertility is absolutely fundamental
to women’s empowerment and equality. When a woman can plan her family, she can plan the rest of her life. When she is
healthy, she can be more productive. And when her reproductive rights — including the right to decide the number, timing and spacing
of her children, and to make decisions regarding reproduction free of discrimination, coercion and violence — are promoted and
protected, she has freedom to participate more fully and equally in society. Gender equality implies a society in which women and men
enjoy the same opportunities, outcomes, rights and obligations in all spheres of life. Equality between men and women exists when both
sexes are able to share equally in the distribution of power and influence; have equal opportunities for financial independence through
work or through setting up businesses; enjoy equal access to education and the opportunity to develop personal ambitions. A
critical
aspect of promoting gender equality is the empowerment of women, with a focus on identifying
and redressing power imbalances and giving women more autonomy to manage their own lives.
Women's empowerment is vital to sustainable development and the realization of human rights for all. Where women’s status is low,
family size tends to be large, which makes it more difficult for families to thrive. Population and development and reproductive health
programmes are more effective when they address the educational opportunities, status and empowerment of women. When women are
empowered, whole families benefit, and these benefits often have ripple effects to future generations. The roles that men and women
play in society are not biologically determined - they are socially determined, changing and changeable. Although they may be justified as
being required by culture or religion, these roles vary widely by locality and change over time. Key issues and linkages:
1)Reproductive health: Women, for both physiological and social reasons, are more vulnerable
than men to reproductive health problems. Reproductive health problems, including maternal mortality and morbidity,
represent a major - but preventable - cause of death and disability for women in developing countries. Failure to provide information,
services and conditions to help women protect their reproduction health therefore constitutes gender-based discrimination and a
violation of women’s rights to health and life. 2)
Stewardship of natural resources: Women in developing
nations are usually in charge of securing water, food and fuel and of overseeing family health
and diet. Therefore, they tend to put into immediate practice whatever they learn about nutrition and preserving the environment
and natural resources. Economic empowerment: More women than men live in poverty. Economic disparities
persist partly because much of the unpaid work within families and communities falls on the
shoulders of women and because they face discrimination in the economic sphere. Educational
empowerment: About two thirds of the illiterate adults in the world are female. Higher levels of women's
education are strongly associated with both lower infant mortality and lower fertility, as well as with higher levels of education and
economic opportunity for their children. Political empowerment: Social and legal institutions still do not guarantee women equality in
basic legal and human rights, in access to or control of land or other resources, in employment and earning, and social and political
participation. Laws against domestic violence are often not enforced on behalf of women. Experience
has shown that
addressing gender equality and women’s empowerment requires strategic interventions at all
levels of programming and policy-making. Women’s Work and Economic Empowerment: In nearly every country, women
work longer hours than men, but are usually paid less and are more likely to live in poverty. In subsistence economies, women spend
much of the day performing tasks to maintain the household, such as carrying water and collecting fuel wood. In many countries women
are also responsible for agricultural production and selling. Often they take on paid work or entrepreneurial enterprises as well. Unpaid
domestic work – from food preparation to care giving – directly affects the health and overall well being and quality of life of children and
other household members. The need for women’s unpaid labour often increases with economic shocks, such as those associated with the
Yet women's voices and lived experiences – whether as workers
AIDS pandemic or economic restructuring.
(paid and unpaid), citizens, or consumers – are still largely missing from debates on finance and
development. Poor women do more unpaid work, work longer hours and may accept degrading working conditions during times of
crisis, just to ensure that their families survive. Intergenerational gender gaps: The differences in the work patterns of men and women,
and the 'invisibility' of work that is not included in national accounts, lead to lower entitlements to women than to men. Women’s lower
access to resources and the lack
of attention to gender in macroeconomic policy adds to the inequity,
which, in turn, perpetuates gender gaps. For example, when girls reach adolescence they are typically expected to spend
more time in household activities, while boys spend more time on farming or wage work. By the time girls and boys become adults;
females generally work longer hours than males, have less experience in the labour force, earn less income and have less leisure,
recreation or rest time. This has implications for investments in the next generation. If parents view daughters as less likely to take paid
work or earn market wages, they may be less inclined to invest in their education, women's fastest route out of poverty. Empowering
Women through Education: "Education is one of the most important means of empowering women with the knowledge, skills and self-
confidence necessary to participate fully in the development process." (—ICPD Programme of Action, paragraph 4.2)
 Security Things
Securitization for pandemics can uniquely be good
Wishnick ’10 (Elizabeth Wishnick, Associate Professor of Political Science, Montclair State
University, “Dilemmas of securitization and health risk management in the People’s Republic of
China: the cases of SARS and avian influenza”, Oxford Journals,
http://heapol.oxfordjournals.org/content/25/6/454.full.pdf+html, CL)
Securitization of infectious disease in China has involved speech acts by outside actors (such as
international and regional organizations) and non-state actors (whistleblowers during both the SARS and avian influenza pandemics). In
the case of SARS, securitization by the Chinese leadership followed speech acts by the WHO and a domestic whistleblower. As a journalist
for the independent Hong Kong newspaper Apple Daily noted, officials throughout the Chinese political system
wait for the lead of the top leadership of the Chinese Communist Party to define an issue as a political
crisis and devote energy to address it. Once such a designation is made, other officials can hope to gain credit for their
efforts to resolve the problem in their own areas. This means that resources are not properly allocated to issues such
as public health until the leadership highlights an urgent problem (Apple Daily 2006). The avian influenza case
has shown that securitization involves more than speech, also including practices such as wide-scale culling of infected poultry.
Benefits of securitization include a mobilization of financial and public health resources, ending
practices than may spread disease (eating sick poultry etc.), promoting public awareness, improving
China’s international image and preventing panic and social instability . Although concern with China’s
international image often is seen as the driving force behind China’s more vigorous response to avian influenza, compared with SARS,
Chinese scholars tend to emphasize that China’s leaders
primarily were motivated by domestic concerns in
their efforts to improve governmental responses to epidemics. Many Chinese academics note that the
additional restrictions imposed by the authorities on the media during SARS were counterproductive, in that they led to rumours, panic
buying and social instability (Li 2004: 38; Li 2008: 23; Ma 2008: 562; Lu 2009: 96). Although some of the Western literature on
securitization contends that authoritarian governments securitize (and in the process, tighten controls over information) for the purpose
of enhancing regime legitimacy (Vuori 2008: 71), Chinese authors argue that, to the contrary, the greater
transparency in
reporting avian influenza and other emergencies in evidence after SARS improved the credibility of the
government domestically (Li 2008: 24; Lu 2009: 96).

Reactive security spurs action to respond to future crises

Wishnick ’10 (Elizabeth Wishnick, Associate Professor of Political Science, Montclair State
University, “Dilemmas of securitization and health risk management in the People’s Republic of
China: the cases of SARS and avian influenza”, Oxford Journals,
http://heapol.oxfordjournals.org/content/25/6/454.full.pdf+html, CL)
Restrictions on local and international dissemination of information and the spread of disease ,
typically occurring at the onset of an epidemic, can be seen as desecuritization if the purpose is to downplay the existence or
severity of the disease. Indeed the two case studies presented here interpreted efforts to restrict information on SARS and avian
influenza outbreaks as desecuritization. However, in both cases desecuritization also has taken place subsequently, either to
indicate progress in addressing a pandemic or as a result of efforts (which may or may not be warranted) by local officials
seeking to resist stigmatization of their areas as a result of a high incidence of disease . Until recently
Chinese policies have focused on reactive securitization of infectious diseases , rather than risk
management. The latter would include a sustained financial and political commitment to improving
public health, greater openness in reporting disease in the media, support for NGOs involved in
health, improved surveillance and training in infectious disease protocols, and expanded
multilateral cooperation. This would also require a broader spectrum of measures, linked to the degree of local and global
public health risk. Although flows of information on diseases and the work of NGOs continue to face major impediments, as discussed
earlier, in the past few years the Chinese government has committed to providing significantly more resources to health care and
ensuring more equitable access for all citizens. Considerable challenges remain before these pledges are fulfilled, however. Although
documents released in April 2009 called for an additional US$125 billion in national health
spending over the next 3 years, this amount was not reflected in the budget. Moreover, national
authorities were only supposed to cover 40% of the programme, leaving it partially dependent on provincial authorities to match
national contributions to the programme when they may have competing financial commitments (The Economist 2009). Reactive
securitization also has involved the elaboration of a multi-faceted emergency response framework
in the years following SARS (Information Office of the State Council of the PRC 2009). Nonetheless, Chinese experts have been
critical of these efforts for the continued ad hoc nature of financing, particularly on the provincial level (Shi 2008: 100; Tao 2009: 39),
inadequate inter-ministerial coordination (Gu et al. 2009: 15) and poor risk communication (Ma 2008: 564).

Failure to act right away urges more securitization

Wishnick ’10 (Elizabeth Wishnick, Associate Professor of Political Science, Montclair State
University, “Dilemmas of securitization and health risk management in the People’s Republic of
China: the cases of SARS and avian influenza”, Oxford Journals,
http://heapol.oxfordjournals.org/content/25/6/454.full.pdf+html, CL)
Some scholars have sought to identify areas of overlap between security and risk (Aradau et al. 2008: 149–52; Elbe 2008: 189–94). In
particular, The Paris School, involving sociologists inspired by Pierre Bourdieu and Michel Foucault, disputes the characterization of
securitization as a speech act responding to an emergency. Didier Bigo, who has played a key role in developing the Paris School’s
research agenda, views securitization of as a mode of governmentality, structured by ‘habitus’ of security professionals. In contrast to the
rule of princes in days past, Foucault saw present-day governmentality as embodying more than sovereignty over territory. In his view,
the modern state also embodied a security apparatus as well as an administrative capacity, which sought to ensure the welfare of the
population (Foucault 2007: 108). In Bigo’s understanding, securitization is not an exceptional speech act; rather it stems from a range of
routinized administrative practices such as population profiling, risk assessment, statistical analysis, secrecy and management of fear
(Bigo 2002: 73). Interestingly, Bigo argues that securitization does not just respond to threats; it creates unease and uncertainty itself,
for example, in the case of his work on migration, focusing fear on the presence of migrants (Bigo 2002: 78). The effort by the Paris
School to reframe securitization goes a long way to address some of the criticisms of the narrowness of the Copenhagen School’s
approach, but several contradictory elements remain nonetheless. One problem is that while, in Foucault’s terms,
governmentality is necessary to address the challenges of biopower, infectious diseases
themselves may undermine state capacity (Price-Smith 2002: 1; Price-Smith 2009: 204–6). Moreover, even when the
state has the capacity to address public health risks, a type of security dilemma may be created in that the
practices employed to ensure security and reassure the population (such as quarantines or wearing face
masks during a pandemic) may also create panic (C.A.S.E. Collective 2006: 461). Finally, using the language of risk
rather than security may not eliminate problems of stigmatization, as some groups are identified as ‘at risk’ or
presenting ‘risk factors’ (Elbe 2008: 190–3).

The critique of securitization from risk theorists and the Paris School thus provides an opportunity to
conceptualize responses to infectious diseases more broadly as practices and modes of
governmentality, rather than purely as speech acts (Elbe 2009). This critical approach to securitization also makes it possible to
delineate a risk spectrum ranging from an initial outbreak to a pandemic, with each stage requiring a different risk management
response. Results This section examines securitizing and desecuritizing moves in Chinese responses to SARS and avian influenza. Each
case study concludes with an assessment of the consequences for health risk management in China. Case 1: SARS SARS first appeared in
Guangdong province in southern China in November 2002, then spread to 28 countries, infecting 8096 people and resulting in 774
deaths, according to data from the World Health Organization (WHO). This case study raises interesting questions about securitizing
actors. Although SARS originated in China and disproportionately afflicted Chinese citizens (5327 infected and 349 dead), Chinese
authorities were not the first to securitize the disease; rather this role fell to WHO and a retired Chinese military
doctor who posted his concerns on the web. In fact Chinese leaders initially sought to desecuritize SARS.
Despite the tendency of the Copenhagen School to treat desecuritization as a desirable outcome,
indicating the end of extreme measures and their resulting negative impacts on social freedoms,
in the case of SARS, desecuritization actually led to further restrictions on freedom of expression .
NEG
Case Frontlines
Solvency
 Alt Causes
The U.S. should focus on improving its own public health systems first—they clearly
don’t have the knowledge or resources necessary to be expending to China
Woolf and Aron '13 (Steven H. Woolf and Laudon Aron, Editors on the Committee on
Population for the National Research Council and U.S. Institute of Medicine, "U.S. Health in
International Perspective: Shorter Lives, Poorer Health", National Research Council and Institute of
Medicine, www.ncbi.nlm.nih.gov/books/NBK154484/, CL)
One explanation for the health disadvantage of the United States relative to other high-income countries might be deficiencies in health
services. Although the United States is renowned for its leadership in biomedical research, its
cutting-edge medical technology, and its hospitals and specialists, problems with ensuring
Americans’ access to the system and providing quality care have been a long-standing concern of
policy makers and the public (Berwick et al., 2008; Brook, 2011b; Fineberg, 2012). Higher mortality rates from diseases, and
even from transportationrelated injuries and homicides, may be traceable in part to failings in the health care system. The United
States stands out from many other countries in not offering universal health insurance coverage.
In 2010, 50 million people (16 percent of the U.S. population) were uninsured (DeNavas-Walt et al., 2011). Access to health care services,
particularly in rural and frontier communities or disadvantaged urban centers, is often limited. The United States has a relatively weak
foundation for primary care and a shortage of family physicians (American Academy of Family Physicians, 2009; Grumbach et al., 2009;
Macinko et al., 2007; Sandy et al., 2009). Many Americans rely on emergency departments for acute, chronic, and even preventive care
(Institute of Medicine, 2007a; Schoen et al., 2009b, 2011). Cost
sharing is common in the United States, and high
out-of-pocket expenses make health care services, pharmaceuticals, and medical supplies
increasingly unaffordable (Commonwealth Fund Commission on a High Performance System, 2011; Karaca-Mandic et al.,
2012). In 2011, one-third of American households reported problems paying medical bills (Cohen et al., 2012), a problem that seems to
have worsened in recent years (Himmelstein et al., 2009). Health insurance premiums are consuming an increasing proportion of U.S.
household income (Commonwealth Fund Commission on a High Performance System, 2011 ).
Apart from challenges with
access, many Americans do not experience optimal quality when they do receive medical care
(Agency for Healthcare Research and Quality, 2012 ), a problem that health policy leaders, service providers,
and researchers have been trying to solve for many years (Brook, 2011a; Fineberg, 2012; Institute of Medicine,
2001). In the United States, health care delivery (and financing) is deeply fragmented across thousands of health systems and payers and
across government (e.g., Medicare and Medicaid) and the private sector, creating inefficiencies and coordination problems that may be
less prevalent in countries with more centralized national health systems. As a result, U.S. patients do not always receive the care they
need (and sometimes receive care they do not need): one study estimated that Americans
receive only 50 percent of
recommended health care services (McGlynn et al., 2003). Could some or all of these problems explain the U.S. health
disadvantage relative to other high-income countries? This chapter reviews this question: it explores whether systems of care are
associated with adverse health outcomes, whether there is evidence of inferior system characteristics in the United States relative to
other countries, and whether such deficiencies could explain the findings delineated in Part I of the report.

The panel defines “health systems” broadly, to encompass the full continuum between public health (population-based services) and
medical care (delivered to individual patients). As outlined in previous Institute of Medicine reports (e.g., 2011e), health systems involve
far more than hospitals and physicians, whose work often focuses on tertiary prevention (averting complications among patients with
known disease). Both
public health and clinical medicine are also concerned with primary and
secondary prevention.1 The health of a population also depends on other public health services and policies aimed at
safeguarding the public from health and injury risks (Institute of Medicine, 2011d, 2011e, 2012) and attending to the needs of people
with mental illness (Aron et al., 2009). There is mounting evidence that chronic
illness care requires better
integration of professions and institutions to help patients manage their conditions, and that
health care systems built on an acute, episodic model of care are ill equipped to meet the longer-
term and fluctuating needs of people with chronic illnesses. Wagner and colleagues (1996) were among the
first to document the importance of coordination in managing chronic illnesses. Many countries differ from the United States because
public health and medical care services are embedded in a centralized health system and social and health care policies are more
integrated than they are in the United States (Phillips, 2012). The panel believes that the totality of this system, not just the health care
component, must be examined to explore the reasons for differences in health status across populations. For example, a country may
excel at offering colonoscopy screening, but ancillary support systems may be lacking to inform patients of abnormal results or ensure
that they understand and know what to do next. Hospital care for a specific disease may be exemplary, but
discharged patients may experience delayed complications because they lack coverage, access to
facilities, transportation, or money for out-of-pocket expenses, and those with language or
cultural barriers may not understand the instructions. The health of a population is influenced
not only by health care providers and public health agencies but also by the larger public health system, broadly defined.2

No money
Woolf and Aron '13 (Steven H. Woolf and Laudon Aron, Editors on the Committee on
Population for the National Research Council and U.S. Institute of Medicine, "U.S. Health in
International Perspective: Shorter Lives, Poorer Health", National Research Council and Institute of
Medicine, www.ncbi.nlm.nih.gov/books/NBK154484/, CL)
The familiar adage to “follow the money” is a reminder that a society’s policy priorities are often
reflected in budget decisions. The panel’s review of data on the U.S. health disadvantage and its potential causes shows that
the United States often spends less per capita in many of the areas in which its performance is lagging, with the obvious exception of
health care. Levels
of spending should be interpreted with caution because they say little about the
efficiency or effectiveness of programs, but the spending patterns of the United States stand in contrast to those of other
high-income countries with better health outcomes. Examples include early childhood education, family and children’s services,
education, and public health. • Early childhood education: In 2007, the United States spent only 0.3 percent of its GDP on formal
preschool programs (for children aged 3-5 years), less than that of seven peer countries and even some emerging economies in Eastern
Europe (OECD, 2012i). • Family and children’s services: Totalpublic spending by the United States on services
for families and young children places the United States last among the 13 peer countries
studied. In 2004, the most recent year reported by the OECD, the United States devoted only 0.78 percent of
GDP to public services for families and young children , whereas Nordic countries spent approximately 4 percent
(OECD, 2006). Only Korea ranked lower than the United States on the proportion of its economy devoted to public services for families
and young children. • Public health: According to many analyses, public
health is systematically underfunded in the
United States (Institute of Medicine, 2012; Mays and Smith, 2011), for a variety of reasons (Hemenway, 2010), but valid data for
international comparisons are lacking. The OECD does measure the proportion of public expenditures devoted to health and to public
health, but classification schemes are too variable by country to draw meaningful inferences. • Social services: Compared with other
countries, theUnited States spends less on social programs, subsidies, and income transfers than
do other countries (see Figure 8-5). As noted above, U.S. spending on social services (13.3 percent of GDP) was
less than the OECD average (16.9 percent) and that of all 30 countries except Ireland, Korea,
Mexico, New Zealand, and the Slovak Republic (Bradley et al., 2011). A recent report found that the
United States spent less on public social protection (as a percentage of GDP) than any peer country but
Australia and less than some emerging economies, including Russia and Brazil (International Labour Office, 2011).
 Trade-Off
Trades off with efficiency—often comes at the expense of the people
Mankiw '10 (Greg Mankiw, Professor of Economics at Harvard University, "Healthcare,
Tradeoffs, and the Road Ahead", Greg Mankiw's Blog: Random Observations for Students of
Economics, March 22, gregmankiw.blogspot.com/2010/03/healthcare-tradeoffs-and-road-
ahead.html, CL)
Well, it appears certain that the healthcare reform bill will become law. One thing I have been struck by in watching this debate is how
strident it has been, among both proponents and opponents of the legislation. As a weak-willed eclectic, I can see arguments on both
sides. Life is full of tradeoffs, and so most issues strike me as involving shades of grey rather than being black and white. As a
result, I find it hard to envision the people I disagree with as demons. Arthur Okun said the
big tradeoff in economics is
between equality and efficiency. The health reform bill offers more equality (expanded insurance, more
redistribution) and less efficiency (higher marginal tax rates). Whether you think this is a good or bad choice to make,
it should not be hard to see the other point of view. I like to think of the big tradeoff as being between
community and liberty. From this perspective, the health reform bill offers more community (all Americans get
health insurance, regulated by a centralized authority) and less liberty (insurance mandates, higher taxes). Once again, regardless
of whether you are more communitarian or libertarian, a reasonable person should be able to understand the opposite vantagepoint. In
the end, while I understood the arguments in favor of the bill, I could not support it. In part, that is because I am generally more of a
libertarian than a communitarian. In addition, I could not help but fear that the
legislation will add to the fiscal burden
we are leaving to future generations. Some economists (such as my Harvard colleague David Cutler) think there are great
cost savings in the bill. I hope he is right, but I am skeptical. Some people say the Congressional Budget Office gave the legislation a clean
bill of health regarding its fiscal impact. I believe that is completely wrong, for several reasons (click here, here, and here). My judgment
is that this health bill adds significantly to our long-term fiscal problems. The Obama administration's political philosophy is more
egalitarian and more communitarian than mine. Their
spending programs require much higher taxes than we
have now and, indeed, much higher taxes than they have had the temerity to propose . Here is the
question I have been wondering about: How long can the President wait before he comes clean with the American
people and explains how high taxes needs to rise to pay for his vision of government ?
 Unsustainable
China’s health care system is overwhelmed and unsustainable
Wharton '13 (Knowledge at Wharton, "Ticking Time Bombs’: China’s Health Care System Faces
Issues of Access, Quality and Cost", University of Pennsylvania, June 26,
knowledge.wharton.upenn.edu/article/ticking-time-bombs-chinas-health-care-system-faces-
issues-of-access-quality-and-cost/, CL)
China’s health care system is ailing, and the prognosis for a cure in the near future is not good.
Wharton health care management professor Lawton R. Burns recently returned from Beijing, where he and Gordon G. Liu, professor of
economics at Peking University’s Guanghua School of Management, co-taught a four-day course on China’s health care system. The
course, attended by 20 Wharton students and 20 Peking University students, looked at such topics as quality and availability
of
care, the disparity between rural and urban health care, corruption in the delivery system,
medical training and the needs of a growing elderly population. Underlying some of China’s most basic health
care challenges is the “wide but shallow distribution of health insurance,” says Burns. Recent reforms have extended
health care to 95% of the population — most of whom have never had insurance before — a
development that has caused serious strains on the delivery system. Now that consumers have access,
“everyone wants to go to the major academic health centers, which means there are enormous lines starting early in the morning to get
in and see a specialist,” says Burns, who toured several health care facilities during his teaching week. Not everyone gets through the line,
however, and people who do get in don’t always get the results they want. “ People expect good care now, and when
they don’t receive it, they sometimes blame the doctors,” notes Burns, adding that there have been cases of
medical personnel physically attacked by dissatisfied patients. For the Chinese government, the issue is cost: How do you fund health
care for a new group of insured people, in both rural and urban areas, who had until recently been lacking coverage for even the most
basic health care needs? “There is always a trade-off between increasing access to health care, and
funding that access. It has to do with the ‘Iron Triangle,'” says Burns, referring to a phrase that describes the three main
cornerstones of health care: access, cost and quality. The difficulty comes when regulators try to improve all three, or even two, at once.
“If you increase access, you increase cost. So how do you balance the two,” especially when the expectations of newly insured consumers
are rising so quickly? More Money, More Prestige: The problem of access to quality care is especially acute in rural areas of China.
“Physicians find big disparities in terms of income, status and access to technology in the countryside versus the city,” says Burns, noting
that doctors naturally tend to gravitate to the research opportunities, higher salaries and clearer career paths offered by big urban
medical facilities. “Why would a doctor move from a class three urban hospital to the lower pay of a class one or two hospital in a rural
area? Doctors lose prestige and money by going outside the cities.” Indeed, with
so much investment and technology
targeted to urban medical centers — which then attract the best doctors and the highest-paying
patients — meaningful redistribution of physicians is difficult to bring about. Burns does suggest one option:
Provide incentives to medical students through a national rural health service program that
encourages them to practice in rural areas for the first two or three years after graduation . The
program could target new doctors who come from the countryside and might be more inclined to return there to work. China’s aging
population presents the health care system with another challenge, and one that is likely to get worse, as it will in many other countries
facing a similar demographic shift. According to figures from the United Nations, almost one third of China’s population, or 438 million,
will be over 60 by 2050, more than double the current number of 178 million. “In China, the percentage of the population that is really
elderly is 8% to 9%, but it is growing very quickly because of the one-child policy,” says Burns. Often referred to as “the 4-2-1 problem,”
the policy has meant that one child has to support two parents and four grandparents. Meanwhile,
no organized long-
term care or home health care systems exist despite the increasing number of people who will need these kinds of
services. While China’s aging problem is significant, France and Japan face an even bigger problem in this area because they have more
restrictive immigration policies, according to Burns. “In the U.S., what keeps our aging problem under control is the fact that we allow in
immigrants who work, pay taxes and support the elderly, thereby keeping our age-dependent ratio lower than that in more restrictive
countries.” While the U.S. has a positive and fairly high rate of immigration, China has a negative rate — meaning that more people leave
the country than enter. Another “ticking time bomb” in China is the middle-aged Chinese male who works long hours in often stressful
conditions, says Burns. “Many suffer from hypertension and diabetes, and 30% to 50% of them smoke .
All the Western diseases are showing up in China — the most popular Western restaurant now is Kentucky Fried Chicken — which
means thecountry will have a growing problem with early onsets of chronic illnesses, comparable
to the U.S.” Health care reform in China is further impeded by the fact that the heads of many Chinese medical centers tend to be
political appointees rather than professionally trained managers, Burns says, which results in serious performance and governance
issues. Nor does the country’s medical education system offer hospital administration programs. Add to that the existence of widespread
corruption. “The government controls the prices on low-cost items to make them widely accessible and available,” says Burns. “But
because that hurts the hospitals’ bottom line, the government lets the hospitals charge much higher prices on high-tech equipment and
offer more expensive drugs, devices and procedures.” Patients
end up paying the price. Indeed, a significant portion of
health care spending in China — 50% — is still out of pocket, Burns adds. Finally, there are kickbacks at various junctures in
the delivery process: Hospitals, for example, get kickbacks from drug and device companies, and hospital executives give a portion of
these kickbacks to their doctors. Burns acknowledges that the U.S. health care system is corrupt in some ways as well, “but not nearly to
the extent that it is in China. There
are conflicts of interest in the U.S., and there are hospital executives
giving kickbacks to doctors. But those people go to jail. There is nobody going to jail in China .”
Other parallels exist to varying degrees between China and the U.S. when it comes to the health care challenge. Even as the Chinese
government has expanded health care coverage, so has the Obama administration expanded coverage to an additional 30 million new
people, “many of whom will be hard pressed to find a primary care physician,” says Burns. Cost is an issue as well. If you “look at how
Obamacare was pitched, administration officials said part of it will be paid for by taxing the insurance and medical device industries and
reducing payments to providers,” says Burns. “Officials also said that some of the savings will come from employee wellness programs,
efficiencies in delivery and so forth. Yet there is little evidence that wellness programs and restructured delivery systems save money.”
Neither country has had success providing coordinated health care — such as pairing patients who have chronic diseases with nurses
and other care managers who can help these patients develop better health habits. “ Most
of the experiments in
coordinated care have not worked in the U.S., nor have they saved money,” says Burns. All these
challenges will cause problems for the provincial and central governments in China that must
foot the health care bill, Burns adds, noting that historically, China and also India — which both have much bigger populations
than the U.S. — have spent very little of their gross domestic product on these services. As for private health insurance, a number of
Western insurance companies have been in China for several years to study this option. But so far, “they have developed insurance only
for expats,” Burns says. “The
local population does not have much of a private health care insurance
industry.” Nor have the few private sector hospital chains in China proven very successful, “although the government is going to
encourage them because it needs more supply to meet demand.” Part of the problem is the lack of qualified doctors to treat the newly
insured. “There
is an insufficient supply of allopathic-trained physicians — those trained in the
Western model as opposed to the indigenous traditional medicine model,” says Burns. Both China and
India each have their traditional providers, “although there is no evidence they provide the same kind of care as allopathic doctors.”
Meanwhile, he adds, there is “a huge push to increase academic research and to institute higher and more uniform standards of training.”
The course co-taught by Burns and Liu took shape after Burns had offered a similar course on health care in India and realized it could be
duplicated in China. After further research and some negotiation, the two presented “China’s Healthcare System and Reform” for the first
time in May 2012 and then again last March. In addition, Burns has edited a book coming out this summer based on the course in India
and titled, India’s Healthcare Industry: Innovation in Delivery, Financing and Manufacturing. Several of the chapters were written by
course presenters, teaching assistants and enrolled students. Burns says he plans to edit a similar book based on the course in Beijing.
 Poor Framework
Institutional pluralism is the new framework for ensuring public health—aff is too
exclusive
Long ’11 (William Long, Professor and Chair at the Sam Nunn School of International Affairs
Georgia Institute of Technology, “Pandemics and Peace: Public Health Cooperation in Zones of
Conflict", published June 2011)
In health, power has shifted from vertically organized governments and international agencies to
horizontally linked coalitions or networks that also include private actors such as nongovernmental
organizations, businesses, and philanthropies; a process of institutional pluralism driven by changing
ideological and institutional preferences, technological advances, new sources of funding; and
lower barriers to entry.54 These new amalgamations have been labeled global health alliances, global health
partnerships, and global public-private partnerships." The three examples of public-private governance initiatives in
infectious disease control examined in this study provide a basis for systematically exploring key questions
regarding global health governance, and transnational problem-solving networks ." Specifically, we want to
know whether these experiments in transnational governance can collectively solve problems and effectively deliver the (public) goods.
If so, we need to identify the factors that either are necessary or facilitate effective governance. In addition, we want to use these cases
both to consider whether the authority wielded by these transnational networks is legitimate, defined in terms of democratic
accountability, and specify the factors that enhance or impede their legitimacy. Detailed comparative analysis of the
governance process in these three cases will generate useful insights for practitioners and researchable hypotheses for scholars.
For practitioners and policymakers, generic insights can be tailored to their specific circumstances. For scholars and students,
these cases may contribute to a better understanding of global governance, private-public partnerships, and
transnational problem-solving networks by generating plausible hypotheses about the effectiveness, legitimacy, and
origins of transnational networks for further inquiry.

Global public health policy needs to model a horizontal structure of aid—U.S.

doesn’t spend enough to help others
Long ’11 (William Long, Professor and Chair at the Sam Nunn School of International Affairs
Georgia Institute of Technology, “Pandemics and Peace: Public Health Cooperation in Zones of
Conflict", published June 2011)
U.S. Government Programs
American domestic public health initiatives date to the early years of the republic and the nation's involvement in international public
health began in the late 1800s with its participation in the first international sanitary conferences." During and soon after World War II,
U.S. military and civilian agencies were often called on to assist in identifying and eradicating disease and fortifying international public
health systems abroad. Support for over-seas public health systems has been part of the mission of the
U.S. Agency for International Development (USAID) since its inception in 1961, for example, and the Centers for Disease Control and
Prevention (CDC) has been active in the worldwide campaigns to eradicate infectious diseases, such as smallpox, since the 1960s.
Today, U.S. global public health policy is a sprawling and complex enterprise . As of 2008, federal
expenditures totaled about $9 billion allocated to eleven executive departments and agencies (plus five multiagency initiatives).12The
U.S. government has programs in more than 100 countries, and fifteen congressional committees oversee its efforts.13 Core support
for programs designed exclusively to strengthen international infectious disease surveillance and
response, less than $100 million, constitutes about 1 percent of all U.S. government global health
expenditures. This figure is inexact, however, because of the way American foreign assistance and global public health policies are
characterized and how programs are structured. First, American support for global public health programs are categorized as serving
several broad purposes.14 Because these purposes are complementary, it is not always clear which programs and expenditures fall in
which category.L5
A second and even larger problem for determining the scope of U.S. efforts stems from the
vertical rather than horizontal structure of America's global health policies . That is, American
programs and funding are directed overwhelmingly toward particular diseases or themes rather
than more general objectives such as strengthening overseas infectious disease control systems
and coordinating these programs regionally and globally . Initiatives directed at specific diseases
such as AIDS, malaria, tuberculosis, and influenza support some activities that improve infectious disease
detection and response abroad through interagency funds transferred to programs that pursue
this mission, and indirectly to the extent that their programs have system strengthening
dimension. The amount of related interagency transfers varies from program to program and from one year to the next, as do the
funds secured from private donors that augment U.S. infectious disease control programs abroad. Given these caveats, this chapter
focuses on four programs shared by three federal departments that are explicitly aimed at improving the infectious disease detection and
response capabilities of other nations and regions:" the Global Disease Detection Program operated by the CDC, which is part of the
Department of Health and Human Services (HHS); the Field Epidemiology and Laboratory Training Program administered by the CDC
with significant support from USAID;17 the Integrated Disease Surveillance and Response Program funded primarily by USAID and
administered through CDC; and the Global Emerging Infections Surveillance and Response System of the U.S. Department of Defense. In
addition to these four programs, USAID provides bilateral in-country support to public health programs in most of the more than 100
countries in which it operates, estimated at $14 million in 2006. These four programs, like U.S. support for global health programs
generally, have long pedigrees. Each of the three federal departments or agencies directly responsible for infectious disease surveillance
and response has supported foreign capacity building for many years. Within the last decade, however, these four programs have
emerged as distinct policy initiatives.

Current U.S. policy needs to be modified so that its goals are measurable, better
serves the target country, and are more long term
Long ’11 (William Long, Professor and Chair at the Sam Nunn School of International Affairs
Georgia Institute of Technology, “Pandemics and Peace: Public Health Cooperation in Zones of
Conflict", published June 2011, CL)
The failure to strengthen foreign capacity reflects a U.S. tendency to give money for treatment of
particular diseases rather than invest for the long-term in public health infrastructure abroad. This approach
persists despite the fact that viable health systems are key to curtailing the spread of infectious disease and
improving the overall health of the recipient country. Investment in foreign public health capacity is
limited for several reasons, but not particularly sound policy ones . First, demonstrating to appropriators and
their constituents the direct, quantifiable impact of bolstering overseas public health systems is difficult. Lives not lost to
disease, infections prevented by early detection, and pandemics avoided by rapid containment at
the source are not as easily calculated or as compelling as immediate, measurable effects of a
program that vaccinates or treats thousands or millions of patients for a particular illness. Secondly, system strengthening
takes time to realize and appreciate. One analyst recommends a time frame of ten to fifteen years for measuring systemic health impacts.
Policymakers in donor countries rarely think in terms beyond the current budget or electoral cycle,
however, and are unlikely to make such patient investments. Third, because funding for global health
primarily reflects the popular interests of the donor country (the United States) rather than the needs of the
recipient country, American expenditures do not always align with the recipient’s national health plans
or support the recipient’s overall public health and treatment infrastructure so as to maximize
long-run return on foreign investment through a true partnership between donor and recipient.
Finally, despite rhetoric to the contrary, U.S. policy still reflects too little appreciation of global
interconnectedness and that U.S. interests defined in security, welfare, diplomatic, and
humanitarian terms require significant investments abroad as well as at home. When it comes to
sustained support of foreign capacity in infectious disease surveillance and response, our
investment shortfalls leaves the United States and its global interests unnecessarily vulnerable and
the country’s positive diplomatic influence insufficiently realized .
Disease
 Disease Turns
Allowing a pandemic to erupt may deteriorate strength of similar disease strains
Canadian Press '09 (Associated Press, "Experts say pandemic could have a silver lining", CTV News,
December 22, www.ctvnews.ca/experts-say-pandemic-could-have-a-silver-lining-1.467208, CL)
TORONTO - When you think of a flu pandemic, the images that come to mind are of people sick and people dying. But influenza
experts quietly admit there may be a silver lining -- or several -- to the H1N1 pandemic that
erupted this year. Not just in the event itself, which was milder than feared, but also in the viral legacy it may leave. In the
wake of this pandemic, flu vaccine could be easier to make or could cover more targets. A tricky
problem of drug resistance could disappear. And the toll influenza takes on the elderly could conceivably ease, at least
for awhile. Before going too far down What-If Road, however, it's important to note that predicting influenza's path is a mug's game. The
longer people study it, the less likely they are to try to guess what influenza viruses may do. "I don't know - right now everything's a
possibility as far as I'm concerned," Dr. Michael Osterholm, director of the University of Minnesota's Center for Infectious Diseases
Research and Policy, cautions when asked about what the flu landscape might look like in the aftermath of this pandemic. Still, even
experts who share that understanding are thinking about some possibilities. Their
optimism is in large part fuelled by a
phenomenon known as viral replacement which has been seen in previous pandemics , or at least the
three that have been studied using modern laboratory techniques. In simple terms, during the pandemics of the 20th century - 1918,
1957 and 1968 - the new virus snuffed out its viral predecessor. If the same thing occurs as a result of the pandemic of 2009, the world
might actually one day look back fondly on the swine flu virus that caught us all by surprise last spring, some suggest. "If this pandemic
virus were to replace seasonal strains, either H3(N2) or H1(N1), that may be a blessing in disguise," says Dr. Danuta Skowronski, an
influenza epidemiologist at the British Columbia Centre for Disease Control. To grasp the significance of what might be afoot, it's helpful
to have some flu basics. Influenza viruses are divided into three large families, A, B and C, though C viruses
are thought to bit players when it comes to human illness . Pandemics can only be triggered by influenza A viruses.
And historically there was only ever one subtype of influenza A around at a time. But that changed in 1977 when H1N1 viruses, which
had stopped circulating 11 years earlier, mysteriously re-emerged. (It is widely believed the virus "escaped" from a Russian lab as a
result of a research accident.) Since then, there have been two flu A viruses circulating, seasonal H1N1 and H3N2. Annual flu shots target
both A viruses plus one of two families of influenza B viruses. Influenza B causes a fair amount of human illness. And earlier this year
there was some debate about making a four-component or quadrivalent vaccine to include both B families. But there has been hesitancy
because making the trivalent vaccine every year is challenging enough. If the pandemic H1N1 gets rid of both H3N2
and seasonal H1N1, vaccine manufacturers would only need to include one influenza A
component - the 2009 H1N1 - in seasonal flu shots. They could make a bivalent - two component
- vaccine, which would be easier to produce. Or they could stick with a trivalent shot, but have it cover one A and both
Bs, making the shot more protective. Getting rid of both of the previous seasonal A viruses also appeals from another point
of view. H3N2 is a nasty virus, one which takes a heavy toll on the elderly. No one in public health would miss H3N2 if
it disappeared. "It would be the most amazing thing," says Dr. Allison McGeer, a flu expert at Toronto's Mount Sinai Hospital.
"Because a the great majority of nursing home outbreaks are (caused by) H3N2. You get rid of 80 per cent of influenza outbreaks in
nursing homes - (it would) be brilliant." Dr. Anthony Mounts, a flu expert with the World Health Organization, says since this pandemic
started people have gone back and studied the patterns of H1N1 and H3N2 seasons. When H1N1 viruses predominate, younger people
are generally hit harder; during H3N2 seasons, as McGeer observes, the worst of the illness occurs in the elderly. "Why that is, I don't
think anybody really understands," he says. But children and adults respond better to flu vaccine than do seniors, whose immune
systems are breaking down with age. So if the burden of influenza shifts down the age spectrum, the primary tool available to
fight it - vaccine - could be targeted to people who get more benefit from it. And younger people are less
likely to die of flu than seniors, in whom a bout of flu can be the proverbial final straw. " That might be actually the silver
lining, is that this is something that's less deadly than H3 and maybe something that we can do more about," says
Mounts, who, like Osterholm, is quick to warn "it's all conjecture at this point." The WHO's top flu expert injects a note of caution of his
own. Dr. Keiji Fukuda points out the pandemic caused by H3N2 was the mildest of the three in the last century. Its behaviour as a
pandemic virus did not foreshadow what was to come. "Do we know that this H1N1 virus is going to always be like
it is now? The chances are: Probably not," Fukuda says. "I mean, it could stay mild all the time, but I think the lessons from H3N2 is
that something which starts out and looks relatively mild in fact can become something which becomes more severe over time." As it is,
many flu experts think we may be stuck with H3N2 for awhile yet. They are not convinced the
pandemic virus can oust it as well as seasonal H1N1. Dr. Arnold Monto, of the University of Michigan, notes H3N2
viruses are still circulating in pockets of Southeast Asia and in the tropics. He won't venture to guess whether they will die out there too,
or if those regions will serve as a reservoir for resurgent H3N2 activity. " Flu is un-pre-dict-able," he says, stringing out the word
for emphasis. Dr. Nancy Cox isn't convinced H3N2 is going away. But the head of the influenza division of the
U.S. Centers for
Disease Control would be happy with a one-for-one exchange, with the pandemic H1N1
replacing the seasonal virus of the same name. That's because seasonal H1N1 viruses are resistant to oseltamivir
(Tamiflu), the main drug used to fight flu. The pandemic H1N1 viruses are susceptible to Tamiflu, though they are resistant to two older
flu drugs, amantadine and rimantadine. Those two drugs aren't widely used anymore because resistance to them develops easily.
Swapping viruses that are immune to Tamiflu for ones the drug works against would be a bargain, Cox suggests. " Getting rid of
resistance in circulating H1N1 viruses would be a real silver lining ."

Disease results in a “survival of the fittest” type evolution that strengths our
populations
Pappas '14 (Stephanie Pappas, a science writer for LiveScience, where she focuses on
psychology and neuroscience, "Black Death Study Shows Europeans Lived Longer After 14th
Century Pandemic", The Huffington Post, May 12, www.huffingtonpost.com/2014/05/11/black-
death-europeans-pandemic_n_5289650.html, CL)
The Black Death, a plague that first devastated Europe in the 1300s, had a silver lining. After the ravages of the
disease, surviving Europeans lived longer, a new study finds. An analysis of bones in London cemeteries from before
and after the plague reveals that people had a lower risk of dying at any age after the first plague outbreak
compared with before. In the centuries before the Black Death, about 10 percent of people lived past age 70, said study researcher
Sharon DeWitte, a biological anthropologist at the University of South Carolina. In the centuries after, more than 20 percent of people
lived past that age. “It is definitely a signal of something very important happening with survivorship,” DeWitte told Live Science.
[Images: 14th-Century Black Death Graves] The plague years: The Black Death, caused by the Yersinia pestis bacterium, first exploded in
Europe between 1347 and 1351. The estimated number of deaths ranges from 75 million to 200 million, or between 30 percent and 50
percent of Europe’s population. Sufferers developed hugely swollen lymph nodes, fevers and rashes, and
vomited blood. The symptom that gave the disease its name was black spots on the skin where
the flesh had died. Scientists long believed that the Black Death killed indiscriminately. But DeWitte’s previous
research found the plague was like many sicknesses: It preferentially killed the very old and
those already in poor health. That discovery raised the question of whether the plague acted as a “force of
selection, by targeting frail people,” DeWitte said. If people’s susceptibility to the plague was somehow genetic — perhaps they had
weaker immune systems, or other health problems with a genetic basis — then those who survived might pass along
stronger genes to their children, resulting in a hardier post-plague population. In fact, research published in February in the
journal Proceedings of the National Academy of Sciences suggested that the plague did write itself into human genomes: The descendants
of plague-affected populations share certain changes in some immune genes. Post-plague comeback: To test the idea, DeWitte analyzed
bones from London cemeteries housed at the Museum of London’s Centre for Human Bioarchaeology. She studied 464 skeletons from
three burial grounds dating to the 11th and 12th centuries, before the plague. Another 133 skeletons came from a cemetery used after
the Black Death, from the 14th into the 16th century. These cemeteries provided a mix of people from different socioeconomic classes
and ages. The
longevity boost seen after the plague could have come as a result of the plague
weeding out the weak and frail, DeWitte said, or it could have been because of another plague side effect. With as much as
half of the population dead, survivors in the post-plague era had more resources available to them. Historical documentation records an
improvement in diet, especially among the poor, DeWitte said. “They were eating more meat and fish and better-
quality bread, and in greater quantities,” she said. Or the effect could be a combination of both
natural selection and improved diet, DeWitte said. She’s now starting a project to find out whether Europe’s population
was particularly unhealthy prior to the Black Death, and if health trends may have given the pestilence a foothold. The Black
Death was an emerging disease in the 14th century, DeWitte said, not unlike HIV or Ebola
today. Understanding how human populations responded gives us more knowledge about how
disease and humanity interact, she said. Y. pestis strains still cause bubonic plague today, though not at the pandemic levels
seen in the Middle Ages.
 Won’t Spread
Pandemics won’t spread—Ebola proves
Fox '14 (Maggie Fox, Senior writer for NBC News, "Don't Panic: Why Ebola Won't Become an
Epidemic in New York", NBC News, October 23, www.nbcnews.com/storyline/ebola-virus-
outbreak/dont-panic-why-ebola-wont-become-epidemic-new-york-n232826, CL)
A New York City doctor just back from volunteering in Africa with Doctors Without Borders has tested
positive for Ebola — a high price to pay for trying to help fight an epidemic that’s killed more than 4,500 people and threatens to
infect tens of thousands. The doctor, identified as Dr. Craig Spencer of Columbia University, correctly warned other experts before he was
taken to Bellevue Hospital, which has been gearing up to tackle Ebola cases. New York Presbyterian Hospital/Columbia Medical Center,
where he usually worked, says he stayed away during the virus’ 21-day incubation period. “He is a committed and responsible physician
who always puts his patients first. He has not been to work at our hospital and has not seen any patients at our hospital since his return
from overseas,” it said in a statement Thursday night. Ebola
only spreads via bodily fluids. Think wet and warm. The
virus lives in vomit, diarrhea, blood and sweat. Heat kills it, it doesn’t survive being dried out,
and it doesn’t travel through the air. It also doesn’t appear to stick to surfaces much, so unless Spencer threw up in a
public place, he would not have exposed the public to the virus. Even if he did, someone would have to touch it and then carry wet
particles to their eyes, nose or mouth to become infected. Ebola
patients cannot infect others before they are sick
themselves. No one has been documented to have spread the virus before showing symptoms
such as a high fever, vomiting and diarrhea . The virus builds up in the body as patients get sicker. In fact, people in the
early stages of Ebola infection often test negative for the virus, because there’s not very much in their blood. While the virus is found in
sweat and that might make people wary of public transport, what's meant by that is that it’s found in the profuse sweat of very ill
patients and unlikely to be in the normal perspiration of an otherwise asymptomatic person. The people most at risk of
Ebola are caregivers and health care workers, who are physically touching Ebola patients at their
sickest. In 40 years of studying Ebola outbreaks, no one has seen a mystery case. People are infected by direct contact with others —
not casual contact on buses, trains or in the street. Thomas Eric Duncan, the first person to die of Ebola in the United States, didn’t infect
his girlfriend or other people who were in an apartment with him after he became ill. Close to 50 people who had some sort of contact
with him all have passed the 21-day incubation period without disease. He did infect two nurses who had been intensively caring for him
when he was very ill. Ebola
has to get inside you to infect you. Unlike measles or tuberculosis, you can’t just breathe in
Ebola virus and get infected. For one thing, it
doesn't float in the air like those germs do. It must get into the
eyes, nose or mouth, or get past the very strong barrier that is human skin , carried by a needle or perhaps
through a fresh cut. Soap and water quickly removes Ebola virus and bleach or alcohol kills it quite effectively

Vaccines solve
NIH '08 (NIH Medline Plus, "Vaccines Stop Illness", National Institute of Health, Spring 2008,
https://medlineplus.gov/magazine/issues/spring08/articles/spring08pg6.html, CL)
To prevent the spread of disease, it is more important than ever to vaccinate your child. In the
United States, vaccines have reduced or eliminated many infectious diseases that once routinely
killed or harmed many infants, children, and adults . However, the viruses and bacteria that cause
vaccine-preventable disease and death still exist and can be passed on to people who are not protected by
vaccines. Vaccine-preventable diseases have many social and economic costs : sick children miss
school and can cause parents to lose time from work. These diseases also result in doctor's visits, hospitalizations,
and even premature deaths. Some diseases (like polio and diphtheria) are becoming very rare in the United States. Of course,
they are becoming rare largely because we have been vaccinating against them. Unless we can completely
eliminate the disease, it is important to keep immunizing. Even if there are only a few cases of disease today, if we take
away the protection given by vaccination, more and more people will be infected and will spread disease to others. We don't vaccinate
just to protect our children. We also vaccinate to protect our grandchildren and their grandchildren. With one disease, smallpox, we
eradicated the disease. Our children don't have to get smallpox shots anymore because the disease no longer exists. If we keep
vaccinating now, parents in the future may be able to trust that diseases like polio and
meningitis won't infect, cripple, or kill children.
 Quarantine Works
Quarantine methods in the SQ are the most effective
Hill-Cawthorne '14 (Grant hill-Cawthorne, lecturer in Communicable Disease Epidemiology
at the University of Sydney, "Quarantine works against Ebola but over-use risks disaster", The
Conversation, October 1, theconversation.com/quarantine-works-against-ebola-but-over-use-risks-
disaster-32112, CL)
A man in the United States has become the first known international traveller to be infected in the West Africa Ebola epidemic and carry
the virus abroad. He is thought to have been infected in Liberia and developed symptoms six or seven days after arriving in the United
States to visit family. He’s being treated in isolation in Dallas, Texas. Quarantine,
in the form of isolation, is an
important component of the response to Ebola infection. As people are infectious only once they develop
symptoms, isolating them and having health-care workers use personal protective equipment significantly reduces
the risk of onward transmission. The director of the US Centers for Disease Control and Prevention (CDC) says the man will
continue to be treated in isolation. In a process known as contact tracing, everyone he has come in contact with since he became
symptomatic on September 24 will be located and monitored for 21 days (the maximum incubation period of the virus). Anyone who
shows symptoms will also be isolated and treated. The
Ebola virus is unlikely to spread further in the United
States because these measures are known to be effective. Indeed, their absence has contributed
significantly to the spread of the virus in resource-poor nations of West Africa.
The benefits of quarantine: Countries have been practising this measure against infectious diseases well before we understood what
caused and transmitted infections. The earliest mention of isolating people in this way is in the books of the Old Testament, for leprosy
and other skin diseases. The word “quarantine” comes from the Italian “quaranta giorni” which simply means “40 days”. It refers to the
40-day isolation period imposed by the Great Council of the City of Ragusa (modern day Dubrovnik, Croatia) in 1377 on any visitors from
areas where the Black Death was endemic. In its most basic form, quarantine is the isolation of people with a disease from
unaffected people. The measure has
clear benefits; it was effective during the 2003 pandemic of SARS-
coronavirus when the isolation of cases and their contacts for ten days was arguably one of the most
significant interventions for containing the outbreak in only five months. And it has frequently been used to control
Ebola outbreaks. Since the virus' first and most severe outbreak in 2000, Uganda has used quarantine measures to good effect, isolating
contacts of cases for up to the 21 days of the viral incubation period. Surveillance, a more Ebola-educated populace and targeted
quarantine measures have meant Uganda had only 149 cases with 37 deaths, one case and death, and 31 cases with 21 deaths in
subsequent outbreaks in 2007, 2011 and 2012. Nigeria has also demonstrated the efficacy of a contact tracing and isolation approach.
Despite being one of the most populous countries in Africa and having cases introduced into Lagos, a city of 21 million people, its last
case was seen on September 5. Removing infected and potentially infectious people from the community
clearly helps reduce the spread of disease, but it still requires a place for people to be isolated
and treated. That’s what’s missing in countries still in the midst of the epidemic, and also what continues to drive it.

Quarantine empirically works at a high level

Nishiura et al. '09 (Hiroshi Nishiura, Nick Wilson, and Michael G Baker, Associate
Professor / MD, PhD at the University of Tokyo, "Quarantine for pandemic influenza control at the
borders of small island nations", BioMed Central, March 11,
bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-9-27, CL)
Background: Although border quarantine is included in many influenza pandemic plans, detailed guidelines have yet to be formulated,
including considerations for the optimal quarantine length. Motivated by the situation of small island nations, which will probably
experience the introduction of pandemic influenza via just one airport, we examined the potential effectiveness of quarantine as a border
control measure. Methods: Analysing the detailed epidemiologic characteristics of influenza, the effectiveness of quarantine
at the borders of islands was modelled as the relative reduction of the risk of releasing infectious
individuals into the community, explicitly accounting for the presence of asymptomatic infected
individuals. The potential benefit of adding the use of rapid diagnostic testing to the quarantine process was also considered.
Results: We predict that 95% and 99% effectiveness in preventing the release of infectious
individuals into the community could be achieved with quarantine periods of longer than 4.7 and 8.6 days, respectively. If
rapid diagnostic testing is combined with quarantine, the lengths of quarantine to achieve 95%
and 99% effectiveness could be shortened to 2.6 and 5.7 days, respectively. Sensitivity analysis revealed
that quarantine alone for 8.7 days or quarantine for 5.7 days combined with using rapid diagnostic testing could prevent
secondary transmissions caused by the released infectious individuals for a plausible range of
prevalence at the source country (up to 10%) and for a modest number of incoming travellers (up to 8000 individuals).
 No Extinction
Pandemics won’t kill everyone—extinction won’t happen
Adalja '16 (Amesh Adalja, an infectious-disease physician at the University of Pittsburgh, "Why
Hasn't Disease Wiped out the Human Race?", The Atlantic, June 17,
www.theatlantic.com/health/archive/2016/06/infectious-diseases-extinction/487514/)
“You’ll tell us when you’re worried, right?” That was the question posed to me countless times at the height of the 2014 West African Ebola outbreak. As an infectious disease physician, I was interviewed on outlets such

as CNN, NPR, and Fox News about the dangers of the virus, and the answer I gave was always the same: “ Ebola is a deadly, scary disease, but it is not that
contagious. It will not find the U.S. or other industrialized nations hospitable.” In other words, no, I wasn’t worried—and
not because I have a rosy outlook on infectious diseases. I’m well-aware of the damage these diseases are causing around the

world: HIV, malaria, tuberculosis; the influenza pandemic that took the world by surprise in 2009; the anti-vaccine movement bumping cases of measles to an all-time post-vaccine-era high; antibiotic-resistant
bacteria threatening to collapse the entire structure of modern medicine—all these, like Ebola, are continuously placing an enormous number of lives at risk. But when people ask me if

I’m worried about infectious diseases, they’re often not asking about the threat to human lives;
they’re asking about the threat to human life. With each outbreak of a headline-grabbing emerging infectious disease comes a fear of extinction itself. The
fear envisions a large proportion of humans succumbing to infection, leaving no survivors or so few that the
species can’t be sustained. I’m not afraid of this apocalyptic scenario, but I do understand the impulse. Worry about the end is a quintessentially
human trait. Thankfully, so is our resilience. For most of mankind’s history, infectious diseases were the existential
threat to humanity—and for good reason. They were quite successful at killing people: The 6th century’s Plague of Justinian
knocked out an estimated 17 percent of the world’s population; the 14th century Black Death decimated a third of Europe; the 1918
influenza pandemic killed 5 percent of the world; malaria is estimated to have killed half of all humans who have ever lived .

Any yet, of course, humanity continued to flourish. Our species’ recent explosion in lifespan is almost
exclusively the result of the control of infectious diseases through sanitation, vaccination, and
antimicrobial therapies. Only in the modern era, in which many infectious diseases have been tamed in the industrial world, do people have the luxury of death from cancer, heart disease, or
stroke in the 8th decade of life. Childhoods are free from watching siblings and friends die from outbreaks of typhoid, scarlet fever, smallpox, measles, and the like. So what would it take for a

disease to wipe out humanity now? In Michael Crichton’s The Andromeda Strain, the canonical book in the disease-outbreak genre, an alien microbe threatens the human race
with extinction, and humanity’s best minds are marshaled to combat the enemy organism. Fortunately, outside of fiction, there’s no reason to expect alien pathogens to wage war on the human race any time soon, and my

any real-life domestic microbe reaching an extinction level of threat probably is just as
analysis suggests that

unlikely. Any apocalyptic pathogen would need to possess a very special combination of two attributes. First, it would have to be so unfamiliar that no
existing therapy or vaccine could be applied to it. Second, it would need to have a high and
surreptitious transmissibility before symptoms occur. The first is essential because any microbe from a known class of pathogens would, by
definition, have family members that could serve as models for containment and countermeasures. The second would allow the hypothetical disease to spread without being detected by even the most astute clinicians.

The three infectious diseases most likely to be considered extinction-level threats in the world today—influenza, HIV, and
Ebola— don’t meet these two requirements. Influenza, for instance, despite its well-established ability to kill on a large scale, its contagiousness, and its unrivaled ability to shift
and drift away from our vaccines, is still what I would call a “known unknown.” While there are many mysteries about how new flu strains emerge, from at least the time of Hippocrates, humans have been attuned to its
risk. And in the modern era, a full-fledged industry of influenza preparedness exists, with effective vaccine strategies and antiviral therapies. HIV, which has killed 39 million people over several decades, is similarly
limited due to several factors. Most importantly, HIV’s dependency on blood and body fluid for transmission (similar to Ebola) requires intimate human-to-human contact, which limits contagion. Highly potent antiviral
therapy allows most people to live normally with the disease, and a substantial group of the population has genetic mutations that render them impervious to infection in the first place. Lastly, simple prevention
strategies such as needle exchange for injection drug users and barrier contraceptives—when available—can curtail transmission risk. Ebola, for many of the same reasons as HIV as well as several others, also falls short
of the mark. This is especially due to the fact that it spreads almost exclusively through people with easily recognizable symptoms, plus the taming of its once unfathomable 90 percent mortality rate by simple supportive
care. Beyond those three, every other known disease falls short of what seems required to wipe out humans—which is, of course, why we’re still here. And it’s not that diseases are ineffective. On the contrary, diseases’

failure to knock us out is a testament to just how resilient humans are. Part of our evolutionary heritage is our immune system, one of the most
This system, when viewed at a species level, can adapt to almost any
complex on the planet, even without the benefit of vaccines or the helping hand of antimicrobial drugs.

enemy imaginable. Coupled to genetic variations amongst humans—which open up the possibility for a range of advantages, from imperviousness to infection to a tendency for mild symptoms—
this adaptability ensures that almost any infectious disease onslaught will leave a large proportion of the population alive to rebuild, in contrast to the fictional Hollywood versions. While the immune system’s role can
never be understated, an even more powerful protector is the faculty of consciousness. Humans are not the most prolific, quickly evolving, or strongest organisms on the planet, but as Aristotle identified,

humans are the rational animals—and it is this fundamental distinguishing characteristic that
allows humans to form abstractions, think in principles, and plan long-range . These capacities, in turn, allow humans to
modify, alter, and improve themselves and their environments. Consciousness equips us, at an individual and a species level, to make nature safe for the species through such technological marvels as antibiotics,

antivirals, vaccines, and sanitation. When humans began to focus their minds on the problems posed by infectious disease, human life ceased being nasty, brutish, and short. In many ways , human
consciousness became infectious diseases’ worthiest adversary . None of this is meant to allay all fears of infectious diseases. To totally adopt a
Panglossian viewpoint would be foolish—and dangerous. Humans do face countless threats from infectious diseases: witness Zika. And if not handled appropriately, severe calamity could, and will, ensue. The West

When it comes to infectious diseases, I’m

African Ebola outbreak, for instance, festered for months before major efforts to bring it under control were initiated.

worried about the failure of institutions to understand the full impact of outbreaks. I’m worried
about countries that don’t have the infrastructure or resources to combat these outbreaks when
they come. But as long as we can keep adapting, I’m not worried about the future of the human
race.

H1N1 proves the threat of pandemics are overestimated

Gross '06 (Terry Gross, bachelor's degree in English and M.Ed. in communications from the
State University of New York at Buffalo & recognized with the Columbia Journalism Award and an
Honorary Doctor of Humanities degree from Princeton University in 2002, "The Next Pandemic:
Bird Flu, or Fear?", NPR, Feb 2, www.npr.org/templates/story/story.php?storyId=5183999, CL)
Fear and paranoia often take hold when a disease threatens to become an epidemic . Dr. Marc K. Siegel is the
author of the new book Bird Flu: Everything You Need to Know About the Next Pandemic. Bird Flu takes on the issues that are injected with a sense of panic and dread, as many parts
of the world have grown to fear the spread of a deadly influenza outbreak in recent years. That outbreak, says Siegel, is a distinct possibility. But he urges those who may be at risk to

progress in vaccine work

trust in reason — and ignore the hype — in judging the risks. In making his case for an honest appraisal of the dangers, Siegel cites

and improved living conditions world-wide as two improvements that should make an epidemic
far less deadly than that of 1918. Siegel's previous books include False Alarm: The Truth About the Epidemic of Fear, in which he argues
against paranoia and reactionary strategies in health care and public safety. Siegel, who teaches at the New York
University School of Medicine, is also a weekly columnist for The New York Daily News. He is a frequent contributor to The Los Angeles Times and The Washington Post. All bird flus
are influenza A. Influenza A is primarily a respiratory virus, causing coughing, congestion, sore throat, muscle aches, fatigue, and fever in most species it infects. This strain (also called
the H5N1 virus) surfaced in Hong Kong eight years ago, although it may have been around for four decades previous to this. It has mostly been affecting Asian poultry. When tested in
the laboratory, it has been found to be quite deadly, killing ten out of ten chick embryos against which it was tested. It is difficult to tell how many birds it has killed in Asia, though,
because millions of birds have been killed by humans to prevent its spread. As soon as one chicken develops symptoms, it is killed along with all the chickens that may have come in
contact with it. BIRD FLU BASICS It appears to be quite deadly to humans as well, although in Hong Kong in 1997 many humans reportedly developed antibodies to the virus and did
not get sick. There is concern that if the virus mutated, it could cause a pandemic because we do not have built-up immunity to it. This mutation could occur either at random or if the

it may never mutate at all or

virus mixes its DNA with a human flu virus inside a pig or a human. But it's also quite possible (in fact it's even more likely) that

that if it does mutate, the mutated virus would result in a much less severe illness in humans.
What is influenza? Influenza is a virus. Unlike bacteria, which are single cells, a virus is not a full cell and cannot reproduce on its own. To reproduce, a virus infects a cell and uses the
resources of that cell. Essentially, a virus is just a sack of genetic material enclosed by a protein envelope. Viruses don't even fit the definition of "alive," though most scientists agree
that they are. There are two types of viruses: DNA (deoxyribonucleic acid) and RNA (ribonucleic acid). Influenza is an RNA virus. Influenza comes in two main varieties: A and B. (It
also comes in a C, which rarely causes illness.) Influenza A viruses are found in many different animals, including ducks, chickens, pigs, whales, horses, and seals. Influenza B viruses
circulate widely only among humans and generally do not make us as sick as influenza A does. Influenza A viruses are divided into subtypes based on two bumpy proteins on the
surface of the virus: the hemagglutinin (H) and the neuraminidase (N). These two identifying proteins are why the current bird flu is referred to as H5N1. There are 16 different
hemagglutinin subtypes and 9 different neuraminidase subtypes, all of which have been found among influenza A viruses in wild birds. H5 and H7 subtypes include all the current
pathogenic strains. How does influenza spread and what complications does it cause? Influenza is spread by airborne droplets and is inhaled into the respiratory tract. It incubates in
the body from one to four days before a person feels ill. Complications tend to occur in the very young, in the elderly, and in patients with chronic cardiopulmonary diseases. The major
complication of flu is pneumonia from influenza itself, or bacterial pneumonia from pneumococcus or haemophilus. How is influenza diagnosed? Influenza is most commonly
diagnosed by recognizing symptoms or by direct examination of respiratory secretions. Blood examination (serology) can determine exposure. What is a pandemic? A pandemic
occurs when many people in several different regions of the world are suffering from a specific illness at the same time. Human pandemics may occur when we are exposed to a virus
strain for the first time and we lack immunity to it. Is there a bird flu test? The current bird flu is diagnosed by testing the blood for antibodies to the H5N1 strain. The test is 100
percent accurate, though it doesn't tell how sick a bird (or a person) is. Transmission from bird to human is possible but rare, and almost exclusively from close or frequent contact.
How does a bird get it? It's endemic in birds, especially waterfowl like geese and ducks. It's usually a benign infection of the gastrointestinal or respiratory tracts of waterfowl, and it
has existed in birds for many thousands of years. It can pass from wild birds to the poultry on farms when they come into contact, and certain strains, known as pathogenic avian
influenza, make these domestic birds very sick. The flu virus mutates frequently, changing its genetics, but it rarely goes through the changes that allow it to routinely infect mammals.
How do birds transmit it to each other? Birds transmit viruses the same way we do: by sneezing, coughing, and touching other birds. Is there a cure once you have it? There is no cure
for any influenza for either birds or people. The body's own immune system fights it, and antiviral drugs such as amantadine, ramitidine, Relenza, and Tamiflu are probably all
effective against H5N1 bird flu, though the degree of effectiveness hasn't been shown. Although there have been over a hundred reported human cases in Asia, it's not clear if more
people have it, but it just didn't make them sick. With most cases of the annual flu virus, the vast majority of people get better without serious treatment as their immune system fights
off the virus. It's the cases where prolonged recuperation or hospitalization becomes necessary that worry doctors. How fast would a human pandemic spread? There is concern that
air travel would accelerate transmission around the world, although scientific recognition of the mutation early on and the worldwide communication network could help to slow its
spread by warning people. What should I be doing to protect myself? People are concerned about the possibility of a coming pandemic. The way this information has been

This makes a worst case

communicated in the media and via several of our public health officials carries the message that something major is in the offing.

seem like the only case. In fact, the government has a reason to consider worst-case scenarios as it attempts
to protect us, but we need to consider that a massive pandemic may well not be in the offing . As I suggest here
specific measures of personal preparation, I, too, must be careful about hidden messages. When I advise a certain kind of preparation, I must consider if I am inadvertently suggesting

do not think a massive bird flu pandemic that kills many millions of people worldwide is
that something must be about to happen. I

about to happen, for reasons that I will go into throughout this book. The major reason is that, as with mad cow disease, which has killed hundreds of thousands of cows
but only a little over a hundred people, we are currently protected by a species barrier. For bird flu to pass human to human, further changes in its structure have to occur.

Influenza viruses change frequently, but this form of H5N1 appears to have been around since
the 1950s, and in the eight years that it has infected millions of birds (1997–2005), documented human cases have been
rare (less than 150 clinical infections with 70 deaths at the time of this writing). We don't know how many thousands have developed antibodies to this virus and not gotten sick from

If it mutates sufficiently to infect us routinely, it may do so in a way

it, so it may not be as deadly as it seems to be to humans.

that causes it to be far less lethal. Should I prepare emergency supplies of food and water just in case? Absolutely not. We've been asking one another this
question ever since experts told us that the year 2000 bug in our computers would shut down communications and banking nationwide. Sinister things scare us out of proportion to
their actual risk of affecting us, and we respond, quite naturally, by wanting to be afraid. But bird flu can be seen as one in a long line of things we've been warned about, and for which
we supposedly need some kind of "safe room" with an ample supply of food and water just in case. In one sense, there is little difference between a grizzled terrorist and a mysterious

bird flu. Both scare us beyond their reach, beyond the likelihood that they will hurt us. In the wake of 9/11, our leaders have been playing Chicken Little. First it was
anthrax, then West Nile virus, then smallpox, then SARS. In each case we were warned that we
had no immunity and could be at great risk. In each case there was no accountability going
forward, no "We're sorry, we got this one wrong, but we just wanted to prepare you just in case ."
It is difficult to trust an official who scared us unnecessarily about smallpox to inform us contextually about bird flu, even if that person is a devoted scientist. The national

psyche has been damaged by all these false alarms . We each make risk assessments, scanning our environment for potential threats,
worrying more and more of the time. The emotional center of the brain, the amygdala, cannot process fear and courage at the exact same moment. If we could train ourselves to filter
out dangers that don't threaten us by setting our default drives to courage or caring or laughter, we'd be a lot better off. We don't need emergency supplies of food — we need leaders
and information sources we can trust. In a true emergency, our satellite-driven communication system will be our ally, as long as the warnings we receive are accurate and not
overblown. Fear is our ultimate warning system, designed to protect us against imminent danger. Our fear responses should not be overdetermined. By jumping from one fear to the
next, we create a climate of distrust. One of my patients told me that he is readying for the coming flu pandemic not only by stockpiling food but by keeping two rifles, ammunition, and
a trained German Shepherd at the ready. He envisions a scenario where he may have to barricade himself into his house in order to protect his wife and his two young children. He

Hitchcockian image is
expects people to be dropping dead in the streets of flu, and he anticipates strangers trying to get into his house to hide from the virus. This

not only extremely unlikely, it contributes to a pattern of thinking that pits us against one
another. It is only a half stop from this kind of irrational fright to deep-rooted prejudices where
everyone is "the other" and the only way to maintain safety is to cordon off your house.

Empirics indicate that we always focus on the threat to humans when it won’t
spread—combatting the root cause solves better
Gross '06 (Terry Gross, bachelor's degree in English and M.Ed. in communications from the
State University of New York at Buffalo & recognized with the Columbia Journalism Award and an
Honorary Doctor of Humanities degree from Princeton University in 2002, "The Next Pandemic:
Bird Flu, or Fear?", NPR, Feb 2, www.npr.org/templates/story/story.php?storyId=5183999, CL)
How should the government prepare to protect us against the worst case as well as against more likely
scenarios The first thrust should be made toward trying to control bird flu in the bird population. Most people who hear about bird
flu vastly overestimate how bad this is likely to be for humans, while underestimating how terrible
it already is for birds. This particular pathogenic, H5N1, has been spreading and reappearing in birds in Southeast Asia since
1997, and it is quite deadly in birds. Recently it has spread to Turkey and China, and all attempts to stamp it out completely have failed.
No one knows what the risk is of it mutating to a form that can routinely be transmitted among humans, but Dr. De Haven, the USDA's
chief administrator of the Animal and Plant Health Inspection Service, and many other animal and public health experts believe that the
best strategy is to decrease the worldwide viral load by vaccinating large populations of birds in countries
where the disease has appeared and culling birds in affected populations.
 Alt Causes
Alt causes—lack of government transparency and public trust
Buckley '16 (Chris Buckley, reporter based in China for over a decade whose coverage has
included politics, foreign policy, rural issues, human rights, the environment, and climate change for
The New York Times, "China’s Vaccine Scandal Threatens Public Faith in Immunizations", The New
York Times, April 18, www.nytimes.com/2016/04/19/world/asia/china-vaccine-scandal.html?
_r=0)
The greater danger may be more insidious. The erosion of public trust could damage China’s immunization program,
which has been credited with significant declines in measles and other communicable diseases. “Confidence is easy to shake, and tha t’s happened

across the world and has happened here,” said Lance Rodewald, a doctor with the World Health Organization’s immunization
program in Beijing. “We hear through social media that parents are worried, and we know that when they’re worried, there’s a very good
chance that they may think
it’s safer not to vaccinate than to vaccinate . That’s when trouble can start.” After
unfounded reports of deaths caused by a hepatitis B vaccine in 2013, such vaccinations across 10
provinces fell by 30 percent in the days afterward, and the administration of other mandatory vaccines fell by 15
percent, according to Chinese health officials. The illicit vaccines in the current case were not part of China’s compulsory, state-financed
vaccination program, which inoculates children against illnesses such as polio and measles at no charge. The
illegal trade dealt
in so-called second-tier vaccines — including those for rabies, influenza and hepatitis B — which
patients pay for from their own pockets. The pharmacist named in the investigation, Pang Hongwei, bought cheap vaccines from drug
companies and traders — apparently batches close to their expiration dates — and sold them in 23 provinces and cities, according to
drug safety investigators. She began the business in 2011, just two years after she had
been convicted on charges of
illegally trading in vaccines and sentenced to three years in prison, which was reduced to five
years’ probation. Officials have not explained how she was able to avoid prison and resume her
business. Ms. Pang, in her late 40s, and her daughter, who has been identified only by her surname, Sun, kept the vaccines in a rented
storeroom of a disused factory in Jinan. The storeroom lacked refrigeration, which may have damaged the vaccines’ potency. The police
have detained them but not announced specific charges, and neither suspect has had a chance to respond publicly to the accusations.
Lax regulation in the second-tier commercial system allowed Ms. Pang’s business to grow, several
medical experts said. Local government medical agencies and clinics were able to increase their profits
by turning to cheap, illegal suppliers, People’s Daily, the official party paper, reported on Tuesday. Police investigators
discovered Ms. Pang’s storehouse last April, but word did not get out to the public until a Shandong news website reported on the case in
February of this year. Most Chinese had still heard nothing about it until another website, The Paper, published a report that drew
national attention a month later. It was the
government’s intolerance of public criticism, critics said, that kept the
scandal under wraps, a delay that now makes it harder to track those who received the suspect injections.
“We’ve seen with these problem vaccines that without the right to know, without press freedom, the public’s right to health can’t be
assured,” said Wang Shengsheng, one of the lawyers pressing the government for more answers and redress over the case. In the last few
weeks, official reticence has been supplanted by daily announcements of arrests, checks and assurances as the central government has
scrambled to dampen public anger and alarm. Premier Li Keqiang ordered central ministries and agencies in March to investigate what
had gone wrong. Last week, the investigators reported that 202 people had been detained over the scandal, and 357 officials dismissed,
demoted or otherwise punished. Health and drug officials promised to tighten vaccine purchase rules to stamp out under-the-counter
trade. “How could this trafficking in vaccines outside the rules spread to so many places and go on for so long?” Mr. Li said, according to
an official account. Without decisive action, he said, “ordinary people will vote with their feet and go and buy the products they trust.” Mr.
Xi has so far not publicly commented on the scandal. Dr. Rodewald, the World Health Organization expert, said the proposed changes
were promising and would mean clinics would not have to rely on selling patient-paid vaccines for their upkeep. Xu Huijin, a doctor in
Heze, said that the concern
over the scandal — and unfounded rumors of deaths — had depressed the
number of parents bringing children to her clinic for inoculation s. “This was badly handled,” she said. “There was
a lack of coordination, not enough information. We should have found out about this long ago. Doctors are taught to tell patients the full
facts.”
Can’t solve—environmental degradation is strongly linked with disease breakouts
Cook and Ahoobim '16 (Sonila Cook and Oren Ahoobim, partner and associate partner at
Dalberg, "The planet's health is essential to prevent infectious disease", The Guardian, May 15,
www.theguardian.com/global-development-professionals-network/2016/may/15/the-planets-
health-is-essential-to-prevent-infectious-disease, CL)
The Zika virus, now detected in 42 countries, is only the latest in a series of diseases establishing a new normal for pandemics. Sars
ravaged South China in 2003, Middle East Respiratory Syndrome (Mers) shocked the Middle East in 2012, and Ebola devastated west
Africa in 2014. We have seen avian influenza emerge in new geographies alongside mosquito-borne viruses, such as Chikungunya. Over
the past 50 years, more than 300 infectious pathogens have either newly developed or reemerged in places where they had never been
seen before. These trends raise questions: Why are infectious diseases occurring with such frequency? Why
are pandemics the new normal? The increased rate of outbreak is typically framed as a failure of the health system. Indeed,
that is a critical component. But the conditions that allow for outbreak in the first place are rooted in
environmental change. The environmental degradation of natural ecosystems has resulted in many negative outcomes, one of
which is the outbreak of infectious disease. The vast majority of human infectious diseases, such as malaria,
Zika, and HIV/Aids, originate in animals . When we disrupt the natural environment and habitat of animals, we are
poking the beast, so to speak. Take deforestation. Destroying the delicate balance of ecological conditions
in forests increases contact between humans and potential reservoirs of disease in the animal
population. Evidence shows that Ebola may have been spread to humans who came into contact with
infected wildlife, enabled by widespread deforestation. The environment plays a critical role in serving as a buffer
against infectious disease. A failure to recognise the value of this service that forests provide means that
deforestation and infectious disease outbreaks are likely to continue at alarming rates. Infectious
disease is a systems problem that requires systems solutions. Treating only one part of the overall problem – whether
by vaccination, quarantine or awareness campaigns – merely scratches the surface. Effective solutions must
address the system as a whole, including changes to underlying ecosystem s. The field of planetary health
has emerged to better understand and solve the integrated relationship between human health and the environment. It aims to shed light
on health problems induced by large-scale changes to the environment, and to highlight new ways of working to address these often
intractable issues. The
connection between environmental change and human health is increasingly
clear, but this big-picture view is not how we currently orient ourselves . Take existing public health
solutions to Ebola, for example, which are to treat the disease, contain its spread, and prevent it by developing a vaccine. These are all
necessary, but they miss a large set of tools found further upstream. A way to access these tools might be to ask ourselves: can we
prevent transmission of the Ebola virus from animals to humans to begin with? With planetary health, we have an opportunity to
redefine prevention to include upstream solutions that safeguard the environment. For Ebola, this would mean that forest protection
efforts would be added to the arsenal of tools we use to fight the disease. These solutions can have multiple benefits to the environment
and to human health; for example, in addition to preventing pandemics, reducing deforestation can combat climate change, protect
biodiversity, and preserve watersheds that provide clean water to nearby communities. “Public health alone can take us only so far in
addressing today’s complex health challenges,” said Michael Myers, managing director of the Rockefeller Foundation. “ We see the
need for a new interdisciplinary field that’s as relevant for this century as public health was for the last – planetary
health, or what we consider public health 2.0. By embracing the new reality that our health and the planet’s health are
inextricably linked, the field of planetary health will identify more effective approaches to ensuring our own health.” We don’t
know what pandemics are coming in the future. What we do know is that with continued
environmental degradation, outbreaks will occur with greater frequency, and the toolkit we are
using to control them is incomplete. Planetary health can help us expand the toolkit by finding ways to prevent outbreaks
occurring in the first place, allowing us to proactively manage the health of the human population, rather than reactively try to control
deadly diseases that we don’t fully understand. In recent years we’ve become more sophisticated at understanding and assessing
nature’s value to people; from food and fuel production, to water purification and spiritual renewal, natural ecosystems provide
It is time to build a field
countless services that sustain us. Protection against infectious disease is another critical service.
that fully recognises the important role that the environment plays in our collective health . The
survival of our planet and our species depends on it.
Pandemic control depends on vaccination—recent discovery of counterfeit drugs
has deeply shaken Chinese trust in the public health system, causing parents to
withhold from vaccinating their children
Buckley '16 (Chris Buckley, reporter based in China for over a decade whose coverage has
included politics, foreign policy, rural issues, human rights, the environment, and climate change for
The New York Times, "China’s Vaccine Scandal Threatens Public Faith in Immunizations", The New
York Times, April 18, www.nytimes.com/2016/04/19/world/asia/china-vaccine-scandal.html?
_r=0, CL)
HEZE, China — First the news rippled across China that millions of compromised vaccines had been given to
children around the country. Then came grim rumors and angry complaints from parents that the government had kept them
in the dark about the risks since last year. Now , the country’s immunization program faces a backlash of public
distrust that critics say has been magnified by the government’s ingrained secrecy . Song
Zhendong, like many parents here, said he was reluctant to risk further vaccinations for his 10-
month-old son. “If he can avoid them in the future, we will not get them,” said Mr. Song, a businessman. “Why didn’t we learn about
this sooner? If there’s a problem with vaccines for our kids, we should be told as soon as the police knew. Aren’t our children the future
of the nation?” The faulty vaccines have become the latest lightning rod for widespread, often visceral distrust of China’s medical system,
and a rebuff to what many Chinese critics see as President Xi Jinping’s bulldozing, top-down rule. The scandal is just the latest
crisis to shake public faith in China’s food and medicine supplies , but it is the first big scare under Mr. Xi, who
had vowed to be different. He came into office promising to “make protecting the people’s right to health a priority.” “ If our party
can’t even handle food safety properly while governing China , and this keeps up, some will wonder
whether we’re up to the job,” Mr. Xi said in 2013, the year he became president. The anger here in Heze, the city in the
eastern province of Shandong where the scandal has its roots, is evident. About two million improperly stored vaccines were sold around
the country from an overheated, dilapidated storeroom. The main suspect in the case is a hospital pharmacist from Heze who had been
convicted of trading in illegal vaccines in 2009 and was doing it again two years later. Many parents said they were especially alarmed
that nearlya year had elapsed from the time the police uncovered the illicit trade and the time the
public first learned about it in February. “Withholding information doesn’t maintain public credibility ,”
said Li Shuqing, a lawyer in Jinan, the capital of Shandong Province, who is one of about 90 attorneys who have volunteered to represent
possible victims in the case. “In
the end, it makes people more distrustful.” To many here, the combination of lax
regulation and the secrecy surrounding a potential public health crisis seems like déjà vu. In
the SARS crisis of 2003, 349
people died across mainland China and hundreds more died elsewhere after officials hid the
extent of its spread. In a scandal that came to light in 2008 , at least six children died and 300,000
fell ill with kidney stones and other problems from infant formula adulterated with melamine, an
industrial chemical. “The customers worry about fake milk powder, fake medicine, fake vaccines,
fake everything,” said Ma Guohui, the owner of a shop on the rural fringe of Heze that sells baby products. “ This is certainly
going to affect people’s thinking. My boy got all his vaccination shots. If he were born now, I’d worry.”

Nanotech solves better for disease control

Honda '09 (Michael Honda, Opinion Editorial Contributor, "Opinion: Nanotech deserves public
and private sector support", The Mercury News, March 4, www.mercurynews.com/ci_11837367,
CL)
Nanotechnology's benefits to society may not be obvious . The concept can be convoluted and controversial. Yet
it is a powerful, enabling technology, like the Internet, the internal combustion engine and electricity. It fosters new
potential in almost every conceivable technological discipline, and its societal impact will be
broad and often unanticipated. Like any new invention, the potential for good is as great as the potential for harm.
Excitement in the technology industry is matched by a parallel concern regarding nanotech's potentially adverse impacts. This argues for
public engagement in private sector nanotech development, which involves the control of matter on a molecular scale. If we shy away
from the debate, we lose the ability to shape it. For these reasons, I recently introduced a bill in Congress called the Nanotechnology
Advancement and New Opportunities (NANO) Act (HR 820) and supported a nanotech bill (HR 554) by House Science Committee
Chairman Bart Gordon, D-Tenn. My bill makes use of California nanotechnology experts' recommendations from my 2005 Blue Ribbon
Task Force on Nanotechnology. But before explaining my bill, it's
worth mentioning the benefits of nanotechnology
and its surprising possibilities. Transportation is one example. Nanotechnology helps automakers build batteries for new
zero-emissions electric vehicles that charge in less than 10 minutes and allow travel of 130 miles between charges. Efficiency like this
moves us closer to our goal of reduced emissions and a cooler planet. Food safety is another area of potential. Nanotechnology
enables health professionals to develop swabs for detecting E. coli and avian influenza. Such early
warning systems have enormous implications for the developing world, which continues to struggle
with rising disease and pandemics. Nanotech can improve health care . In preventive medicine, contact lenses
can be created with color-shifting sensors that check diabetic blood-sugar levels. Similarly, an electrically conductive grid of nanofibers
in clothing can monitor the heart and vital signs, detecting problems early for immediate treatment. There
is the potential to
use nanotechnology for detecting cancer and heart disease, developing cures for cystic fibrosis
and designing implants such as artificial hips and kidneys.
 Economy
No impact and turn—New data proves economic decline bounces back and help
some industries
Begley '13 (Sharon Begley, senior science writer at various news correspondences including
Reuters, Newsweek, The Daily Beast, The Wall Street Journal, and regular public speaker for science
writing, neuroplasticity, science literacy at Yale University, the Society for Neuroscience, the
American Association for the Advancement of Science, and the National Academy of Sciences, "Flu-
conomics: The next pandemic could trigger global recession", Reuters, Jan 21,
www.reuters.com/article/us-reutersmagazine-davos-flu-economy-idUSBRE90K0F820130121, CL)
HOW MUCH THAT IS LOST IS MADE UP? It may seem heartless to count such spending as an economic plus, on a par with welcoming an
earthquake for the construction boom it triggers, but a dollar spent on medicine still contributes to a company's bottom line and to the
GDP. In fact, analysts do a robust business figuring out how investors
can profit from an epidemic. Sales of
vaccines and drugs to combat H1N1 (swine flu) in 2009 boosted some pharmaceutical companies . By early
2010, when the mild epidemic had petered out, Sanofi-Aventis had registered net profits of $10.1 billion, up 11 percent year-to-year.

Wall Street never encountered a disaster it couldn't profit from, and pandemics are no
exception. Several companies have produced investor guides to avian flu. In the event of an outbreak,
Citigroup concluded in a 2005 report, investors should short companies whose revenues come from malls, casinos, air travel, and
tourism. Analysts were also bearish on labor-intensive industries and countries with "inflexible" labor laws (most of Europe) because
companies cannot easily fire workers if demand for their products falls off a cliff. In contrast, Citi says avian
flu will not only
benefit healthcare companies but also those that provide products and services people turn to
when they're afraid to leave home: telecoms, Internet commerce companies, home entertainment
and even utilities. Finally, because any worldwide calamity sends currency traders scurrying for safe
havens, Citi expects the dollar to rise in the event of a pandemic . Overall, it concluded, "We would expect
global economic activity to decline, raw material prices to collapse, risk aversion to rise, monetary policy to ease, and interest rates to
fall." Economists acknowledge that there are still plenty of unknowns here. For one thing, they're not
sure how much of
the economic activity lost is eventually made up. Another unknown is the effect on factory production. Illness and fear
keep most people home during a pandemic, but not in China. During SARS, employees were quarantined to inhibit contagion,
yet because many of them lived in company-owned dormitories , they continued to work, and their employers
built up enormous inventories.
The greatest unknowns are such macroeconomic effects as interest rates and inflation. Some analyses
suggest that when
production is scaled back, the shortage of goods creates inflationary pressures. That might not
occur if the supply cutback were met by a fall in demand as people shopped less . Researchers are
making progress on these fronts, but it hasn't been easy. "When we economists first came to CDC in 1995, many people told us it was
immoral to include economic analyses in questions of public health," says health economist Martin Meltzer. "But taxpayers have a right to
know, if they're putting x dollars on the table (for vaccinations, quarantines or other flu-fighting measures): What are they getting?" Until
all those questions are answered, savvy investors won't be putting money on the table to cash in on the next global pandemic. But
as
surely as a devastating swine flu epidemic is coming, some shrewd, and perhaps soulless, quants wizard will
figure out how to profit from it.

Pandemic outbreak doesn’t affect the economy that much—empirics prove

The Economist '03 (The Economist, esteemed reporter on international affairs, "How big a
dent in the economy?", May 15, www.economist.com/node/1785367, CL)
TWO months ago, Zhu Rongji, China's outgoing prime minister, was in denial. On March 5th, in his annual address to the country's
legislature setting out economic goals for the year, he uttered not a word about a disease that was sweeping across one of the country's
most important manufacturing regions and terrifying Hong Kong's businessmen. Luckily, however, he did not set his sights too high. Mr
Zhu set a goal of 7% GDP growth for 2003, down from last year's 8%. This growth rate is both necessary and achievable through hard
work, he told the parliament. With SARS (severe acute respiratory syndrome) now reported in 24 out of mainland China's 31 provinces
and municipalities and bringing a sledgehammer down upon the country's tourism, transportation and retail sectors, Chinese officials
accept that the disease will dent the economy. But many economists believe the 7% target that was once widely
regarded as too conservative may actually be close to the mark (insofar as anyone can tell what GDP growth is in a country as creative
with statistics as China). This assumes that SARS is brought under control in China by the end of June. World Health Organisation (WHO)
officials say it is still too early to declare that the disease is being tamed in the worst affected area, Beijing. But
the numbers look
encouraging. After two or three weeks in which the capital was reporting more than 100 new cases a
day, for the past few days the number has dropped to double digits. In Guangdong province, the manufacturing
heartland of southern China, where total SARS cases soared into the hundreds in February and March, no new cases were reported on
Tuesday this week and only a handful a day for the previous few days. Shanghai, the financial capital, remains relatively little affected,
with only seven confirmed cases. Elsewhere in China, the picture is murkier. In Hebei province, which surrounds Beijing, dozens of cases
have emerged among migrant labourers returning to their rural homes from the capital. Chinese officials say a major outbreak in the
countryside, where medical facilities are inadequate, is their biggest fear. Should SARS remain entrenched in the countryside, it could
pose risks for manufacturers who depend on cheap rural labour. One suspected case in a factory could disrupt operations for days. Jack
Perkowski, the head of ASIMCO, which manufactures car parts in nine provinces, says his factories are taking a lot of steps to keep the
disease out. However, so far only a handful of suspected SARS cases has been reported in factories (Motorola's headquarters in Beijing
closed for a few days after a member of staff there was infected). And as far as anyone can tell, given the tattered state of health
monitoring systems in the countryside, SARS is still mainly occurring in urban areas. Unlike
shops, hotels, restaurants
and offices in SARS-affected areas, most factories have carried on working as normal. This is good
news given that, as noted by Hu Angang, of Tsinghua University in Beijing, manufacturing and construction accounted for 55% of China's
GDP growth in the first quarter of the year. The service sector, which has suffered the worst from SARS, accounted for about 40%, he
estimates. As our picture suggests, some restaurants and bars are short of customers, but will bounce back
with the retail sector if the SARS outbreak soon comes under control. Fortunately too for China, the economy grew by a vibrant
9.9% from January to March compared with the same period last year. This was the highest first-quarter growth rate in six years, buoyed
by surging foreign direct investment (up 56.7%) and exports (up by 33%). Mr Hu believes that without SARS, China
could have achieved 9-10% growth this year. He now believes it will be 8-9%. The World Bank has revised its estimate to 7%, down from
7.5% before the SARS outbreak. Half a percent less of growth means a loss of about $6.2 billion. Exports
and foreign
investment are not entirely immune. China is beginning to lose orders because buyers and quality-control inspectors from
other countries are staying away. Supply chains are sometimes being snarled by delays as truckers stop at roadblocks erected by local
citizens to check those passing through for signs of the disease. At Guangzhou's annual trade fair held last month, the value of contracts
signed was less than a quarter of last year's $17 billion. But even
in Beijing, as long as SARS is contained within a
few weeks the economic impact is unlikely to be catastrophic . Mr Hu estimates that the city's GDP will grow by
around 10%, two percentage points down from what he thinks Beijing could have achieved without SARS. Even if this prediction proves
optimistic, Beijing's GDP accounts for only about 3% of the national total. The localised nature of the epidemic, with Beijing seemingly far
worse affected than the nearby port city of Tianjin, has protected much of China's economy from SARS's side-effects. What if the
assumptions behind these forecasts are wrong? Chinese officials have long believed that a national GDP growth rate of around 7% is the
minimum needed to keep urban unemployment from reaching levels that would seriously threaten social stability. Beijing's government
is worried that the declining number of SARS cases in the capital is causing citizens to slacken their vigilance. WHO officials talk of
putting the SARS genie back in its bottle. But they question the ability of China's dilapidated health-care system to cope. However ,
the
country has weathered sharp slowdowns before . There is grumbling in Beijing about the government's
attempted cover-up of the outbreak. But it has been quick to offer tax breaks to affected businesses. And if
GDP growth threatens to plummet, the government could always respond by boosting its
spending, a tool it has previously used to keep growth high. Its leaders know that their strength rests on popular support more than
on ideology these days.
Soft Power
 Non-Unique
U.S. soft power still strong now, but clash is inevitable with rising competitors
Shah '14 (Ritula Shah, is a journalist and news presenter on BBC Radio, 24 hours international
news coverage, "Is US monopoly on the use of soft power at an end?", BBC, November 19,
www.bbc.com/news/world-29536648)
There is another complicating factor, the
US may still be the only superpower but there are now new,
competing visions of what the world should look like . The success of China's economy provokes both fear and
admiration though China would like more of the latter. The 2008 Beijing Olympics probably marked the beginning
of the Chinese government's efforts to nurture a soft power message. Since then, things have stepped up. There has been
an expansion of Chinese Central Television, with the broadcaster producing English language programming from Washington and
Nairobi. The Education Ministry is funding more than 450 Confucius Institutes which aim to spread Chinese language and culture. Their
locations include some 90 universities in North America. But this attempt at building soft power has gone awry. Earlier this year, the
American Association of University Professors wrote a report criticising the presence of Confucius Institutes on US campuses. The
academics argued the Institutes were an arm of the Chinese state, which worked to "advance a state agenda in the recruitment and
control of academic staff, in the choice of curriculum, and in the restriction of debate". Tibet, Taiwan, and Tiananmen are said to be
among the subjects that aren't open for discussion in the Institutes. And in recent weeks, two prominent US universities have suspended
their affiliated Confucius Institutes, as concerns about them grow. So for now, China's state funded soft power message, is treated with
some suspicion and has nothing like the impact of the more grassroots US version. China is still feared rather than admired by most of its
Asian neighbours (not least because of its military or hard power capacity) but over time, who is to say that Beijing's
economic success, regardless of its political system, won't win over global admirers ? So does soft
power really matter? Governments seem to value it even though soft power alone won't prevent wars or
silence your critics - although it may help to win support for your point of view. For now, US soft power, remains
pre-eminent, America continues to succeed in selling us its culture, its ability to innovate and its way of life. But there are
competing economic powers and competing ideologies , all demanding to be heard, all wanting to
persuade you to see it their way. Wielding soft power effectively is set to get more complicated .
 No Link
Soft power does not correlate with tangible power and can actually lead to
complacency
Michael et al. '12 ( Bryane Michael is Non-Resident Senior Research Fellow, SKOLKOVO
Institute for Emerging Market Studies, Christopher Hartwell is Head of global markets and
institutional research, SKOLKOVO Institute for Emerging Market Studies, Bulat Nureev is Deputy
director, SKOLKOVO Institute for Emerging Market Studies, "Soft Power: A Double-Edged Sword?",
BRICS Business Magazine, bricsmagazine.com/en/articles/soft-power-a-double-edged-sword)
While digital density may show how soft power is spread, the reality of soft power and its exercise is a complex issue. In much of the
research, and especially in the popular press, soft power is shown as an unmitigated good: a country wants to have soft power, it should
acquire soft power, and it improves its standing in the world through the exercise of soft power. However, it is possible that soft
power may hurt, as well as help, a country, especially if its acquisition obscures the need to cultivate
hard power as well. Additionally, soft power could lull a country’s leaders into a false sense of security .
While being respected abroad may help to smooth over some difficulties, it can also lead to
complacency. As the English adages have it, countries should not believe their own press, or rest on their
laurels. This reality has been observed both in the trends in our data, as well as in the real-life example of Ukraine. Soft power, like all
power, has its good and bad sides. Ukraine illustrates the paradoxes and prospects of soft power. It ranks in our top 20, compiled just
before the recent unrest. Its soft power has made it attractive to both the EU and Russia, but has also made it the cynosure of all eyes,
leading to a internal struggle for the rewards of that power. BRICS economies – and those learning from them, like Ukraine – must learn
how to manage the risks as well as the returns that soft power provides, both at home and abroad. Ukraine has seen an increase in
international soft power since its independence in 1991, carefully balancing Russian and European Union interests but drawing on its
location, large population, and large foreign émigré base to give the country a voice in international affairs larger than its GDP alone may
warrant. Even as the country itself has endured political and economic stagnation, the reputation of Ukraine as a bridge between East
and West has survived. Successes such as the peaceful separation from the Soviet Union, coupled with ultimately successful negotiations
to denuclearize the country, have also raised Ukraine’s visibility in the world. For
example, Ukraine was the first former
Soviet republic to co-host the UEFA European Championship, along with the more westernized Poland. Yet,
while Ukraine’s soft power has been directed externally and raised the country’s standing in the
eyes of the world, a successive run of Ukrainian leaders could not translate this international
standing into tangible successes within the country. Like countries further east that have been plagued with political
instability, Ukraine has seen itself undergo two political revolutions, the first leaving it even worse off economically than before. In terms
of its economy, the country has stagnated due to corruption, lack of structural reforms, and a reliance on Soviet-era heavy manufacturing
– all issues which have led to discontent and a disconnect with the country’s image abroad.

No link—the damage has already been done and cannot deter other countries; also
hurts smaller countries
Charen '14 (Mona Charen, an American columnist, political analyst and author of two books,
"Mona Charen: Obama’s ‘soft power’ ineffective, dangerous", The Spokesman Review, March 4,
www.spokesman.com/stories/2014/mar/04/mona-charen-obamas-soft-power-ineffective/)
Among the academic set from which President Barack Obama springs, everyone agrees that wars are the result of “arrogance” and
bullying by the United States. So concerned was then-Sen. Obama about the potential for U.S. aggression
that he declined to vote for 2007 legislation that would have designated Iran’s Revolutionary Guard Corps as a terrorist organization. The
IRGC had been involved in training and arming terrorists worldwide, particularly in Lebanon (Hezbollah) but also in Afghanistan, Iraq
and the Palestinian territories. But Obama worried that such a vote would be “saber rattling.” Our standing in the “world community” (an
oxymoron to beat all oxymorons) and our credibility had been badly damaged by just such bellicosity, Obama argued. His
administration would deploy “soft power” and diplomacy to make the world safer and more
peaceful. It would be nirvana to live in the world of the left’s imagination – a world in which the U.S. is the greatest threat to peace
and stability. Obama has shown greater bellicosity toward Republicans (described as “terrorists with bombs strapped to their chests”)
than toward our actual adversaries. When Mitt Romney cited Russia a long-term adversary of the U.S. in 2012, Obama’s contempt was
glacial: “The ’80s called and they want their foreign policy back.” Though the president has repetitively declared that Iran’s possession of
nuclear weapons would be “unacceptable,” his
true wish – to accept Iran as a nuclear power in hopes that
they will change their behavior – is now unfolding. In Vienna, diplomats from the P5+1 (U.S., U.K., Russia, China,
France and Germany) dine on fine cuisine washed down with excellent wines and periodically issued declarations of progress – which
usually only means the agreement to meet for more empty discussions. Meanwhile, the severest sanctions against the Iranian regime
have been lifted just as they were beginning to bite. It can’t do any harm to talk, right? That was Obama’s claim
in 2008, when he suggested that he would meet with any rogue leader. He thinks words are like chicken soup – they may not help but
they cannot hurt. We’re now seeing how dangerous that view is. First, as Claudia Rosett of Forbes writes, the pattern of talks
we’re engaged in with Iran is identical to what we did with North Korea. “The pattern was one of
procedural triumphs … followed by Pyongyang’s reneging, cheating, pocketing the gains and
concessions won at the bargaining table, and walking away .” Formal conclaves that permit evil regimes to gain
concessions in exchange for promises they quickly break are one form of dangerous talk. Obama has been perfecting
another type as well: the empty threat. “For the sake of the Syrian people, the time has come for
President Assad to step aside,” the president declared in 2011.
Shockingly, the tyrant willing to murder more than 100,000 people and displace millions didn’t immediately grab his coat and obey.
Obama did nothing to back his words with actions (like arming the opposition, which was then not dominated by al-
Qaida). Later he did something – he spoke more words. This time, it was Obama threatening that well, OK, Bashar Assad didn’t have to go,
but if he used chemical weapons, that would cross a “red line for me.” (Talk about saber rattling.) When Assad flamboyantly
hopscotched over Obama’s red line and received no response, the world rocked on its axis . Though
the Obamaites couldn’t see it, every small, peace-loving nation in the world was instantly made more
vulnerable. Perhaps now, with Russian ships and tanks aiming at Ukraine, they are beginning to understand how international
relations work. (“It’s not some chessboard,” the president asserted recently, displaying his continuing confusion.) No, the game
isn’t chess; it’s more like boxing, where the winner is the stronger one . The Ukraine crisis flows directly
from the Syria debacle, as Vladimir Putin, like Assad, has taken Obama’s measure. The left heaped scorn on George W. Bush for initially
praising Putin, but Bush wised up fast. Obama, by contrast, has submitted passively as Putin put one thumb
after another in his eye (Edward Snowden, Assad). Not only has Obama failed to respond vigorously, but
he’s permitted Putin to play peacemaker in Syria, supposedly presiding over Assad’s surrender of chemical
weapons. This would be regarded as too risible for fiction, as Russia is Assad’s chief sponsor and arms supplier. In January, the
administration, so easily surprised by the world, announced that Syria was “dragging its feet” on
removing chemical weapons stockpiles and that only an estimated 4 percent of its supply had
been relinquished. “It is the Assad regime’s responsibility to transport those chemicals to facilitate removal,” spokesman Jay
Carney said. “We expect them to meet their obligation to do so.” Weakness invites aggression. Prepare for more .
 Alt Causes
Soft power is dependent on having hard power first
Michael et al. '12 ( Bryane Michael is Non-Resident Senior Research Fellow, SKOLKOVO
Institute for Emerging Market Studies, Christopher Hartwell is Head of global markets and
institutional research, SKOLKOVO Institute for Emerging Market Studies, Bulat Nureev is Deputy
director, SKOLKOVO Institute for Emerging Market Studies, "Soft Power: A Double-Edged Sword?",
BRICS Business Magazine, bricsmagazine.com/en/articles/soft-power-a-double-edged-sword)
While soft power is to some degree separate from hard power, through the influence of philosophy, religion and
culture, it is also dependent on hard power . The world is more likely to pay attention to the soft
power of a country already possessing a certain amount of hard power . Of course, there are plenty of countries
whose ranks in combined soft and hard power are above or below their rank in hard power alone. But it is an illusion to think
that a country can develop much outsized soft power without having a minimum amount of
decent hard power. Small countries with very limited hard power can have a voice that is more than proportionate to their hard
power. Some of the Nordic countries in the last 30 years are great examples of this. Their actions suggest that they also realize that they
are more effective when acting in concert with other countries with a lot of both hard and soft power. While the term ‘soft power’ in
English is relatively recent (due to Joe Nye), the substance of the notion far predates the English language term. The Confucian notion of
‘using virtue to govern,’ the associated body of teaching, and the meritorious system of selecting civil servants, are a form of soft power.
The culture and political systems of Vietnam, Korea, Japan, etc., were all influenced by Confucian ideas. The influence of Confucianism,
Buddhism, Christianity, and Muslim went far beyond their countries of origin; they are powerful early examples of soft power.

Every time I think of soft power, I am reminded of travelling abroad and being asked by customs officials or taxi drivers which country I
come from. When I say Bulgaria, they usually reply “Stoichkov” or “Berbatov,” depending on their age, referring to our best-known soccer
players. Some would add “weight lifting” or “wrestling,” referring to the old glory of Bulgaria in producing many Olympic champions in
these sports. The reference points are different when you meet people from other professions. They vary from “great opera singers” to
“you saved the Jews from the Nazis” to “nice resorts on the Black Sea,” to “the best yoghurt” to “Christo,” the environmental artist who
wraps large buildings, bridges and rivers in canvas. Note that none of these references have to do with national income or economic
growth or average life expectancy, the statistics most often used when ranking countries on economic power or national well-being. To
me, they best exemplify the concept of soft power – what comes to the mind of people from other
countries when they hear your country’s name. There is a clear pattern: Sports and art are truly
international due to their global coverage, and hence soft power is highly associated with these
two. History, as long as it has made it into the international history books, is next. Success in international politics,
usually the domain of large countries, also matters. Science, including Nobel Prize winners, have a disproportionately large effect on
forming people’s opinion about a country. Ireland is known as the country with most Nobel Prize winners in literature per capita, and
proudly markets itself as such. There
is, of course, a correlation between soft and hard power. Richer
countries can afford to spend money on promoting their arts and sciences, on developing sports
and memorable resorts. But the correlation is far from perfect – as shown in the Bulgarian example. Hristo Stoichkov, Bulgaria’s
soccer legend, belongs to a generation of sportspeople who did their work during the most difficult years of the post-communist
economic transition. For this reason it is useful to capture the main characteristics of soft power and document their development over
time. This can tell us a lot about how others perceive us.

The currentturmoil in the country, which appears to be split along geographic lines, also appears to be a result of the
source of Ukraine’s soft power. The same balancing act between the EU and Russia which gave Ukraine its soft power
internationally looks ready to tear the country apart. Like all investments, those in soft power have both risks and returns, but in
Ukraine’s case the reality of the country has diverged from its image abroad. Unfortunately, in such a situation, reality always wins.
Ukraine’s trouble in aligning hard power with soft power shows that the latter doesn’t necessarily
equal a good image internationally. In some instances, it’s better to be seen and not heard. The case of India is instructive
here, as it may benefit both from a relatively lower profile than other BRICS countries regarding many of its foibles – with
correspondingly lower-key successes too – and by being the world’s largest democracy. As Alex Lo wrote in Hong Kong’s South China
Morning Post last year, “India
largely gets a free pass while China is scrutinised with its every move.
That’s India’s soft power that Beijing can learn from.” Apart from cultural heritage (Hinduism, Buddhism, yoga,
Indian cuisine and so on), it is India’s successful 60-year democratic tradition that helps New Delhi to be regarded as an example for
post-colonial and developing countries. Any nation willing to build a transparent and democratic society is more likely to follow India’s
footsteps than China’s. And, given the post-Cold War prevalence of free-market democracies, to be accepted as a partner a country should
be either democratic or have considerable economic prowess. Finally, by being accepted as democratic, a country is less likely to be
sanctioned in the name of spreading democratic values.

Culture is more important than health in public diplomacy

Kim '11 (Hwajung Kim, "Cultural Diplomacy as the Means of Soft Power in an Information Age",
Cultural Diplomacy, December 2011, www.culturaldiplomacy.org/pdf/case-
studies/Hwajung_Kim_Cultural_Diplomacy_as_the_Means_of_Soft_Power_in_the_Information_Age.p
df, CL)
Cultural diplomacy is regarded as forming international bridges and interactions, identifying
networks and power domains within cultures and transcending national and cultural boundaries .
With information technologies presence, soft power incorporates national culture including knowledge, belief, art, morals
and any other capabilities and habits created by a society. The importance of public diplomacy has been emerging
since soft power has growing out of culture, out of domestic values and policies, and out of
foreign policy.1 It draws the significant role of cultural diplomacy as linchpin of public diplomacy.
According to Richard T. Arndt, in the book The First Resort of Kings: American Cultural Diplomacy in the Twentieth Century, after
completing a survey regarding the effectiveness of cultural diplomacy, he observed that cultural diplomacy is a cost effective practice
considering its outcomes and impacts on international ties between countries. 2 The survey proves that cultural
diplomacy
helps create a foundation of trust with other people, which policy makers can build on to reach
political, economic, and military agreements. Cultural diplomacy encourages other peoples to give the nation the benefit
of the doubt on specific policy issues or requests for collaboration, since there is a presumption of shared interest. In addition,
cultural diplomacy demonstrates national values and creates relationship with people, which
endure changes in government. Furthermore, cultural diplomacy can reach influential members of foreign societies who
cannot be reached through traditional embassy functions. In the meantime, it provides a positive agenda for
cooperation in spite of policy differences, creates a neutral platform for people-to-people contact, and serves as a
flexible, universally accepted vehicle for approach with countries where diplomatic relations have been strained or are absent. As the
information age arrived, a new way of communication in a cyberspace has been formed and developed alongside rapidly evolving
information technologies. This new way of communication provides new opportunities for cultural policy makers to broaden their target
audience and to promote culture even more widely with its new media platforms. Likewise,
cultural diplomacy using
information technologies will gain and strengthen soft power if cultural policy makers make use
of new communication technologies effectively and strategically.

Soft power is driven by culture

Department of Culture, Media, and Sport '14 (UK Dept., "Culture and creativity –
the key to our ‘Soft Power’ success", UK Government, January 22,
https://www.gov.uk/government/news/culture-and-creativity-the-key-to-our-soft-power-success,
CL)
The value of the arts and culture to the UK can be seen in the way it affects our international standing – the
‘soft power’ it brings – and its role as the driving force behind our booming creative industries, Culture Secretary
Maria Miller said today. In a keynote speech to cultural leaders today she said: Culture matters. That’s why it holds a unique place in our
hearts. It has a central place in shaping our national identity, and has an enormous impact on our
global standing– our reputation as a place worth doing business with; our reputation as a place worth visiting; and our reputation
as a place worth experiencing culture in its many varied forms. The reputation of UK culture equips us with a level of
trust, soft power and influence to which other major countries can only aspire . It is our culture that
underpins our creativity and our creativity which yields the results which might well be technological developments, but can also make
our hearts sing, 1.68 million people work in the UK’s creative industries. These people contribute to a sector worth more than £70 billion
last year and which grew faster than any other sector in the economy. I absolutely believe that our arts, culture and creative industries
here in this country are not only the best in the world, but that there are vital to our future national well-being and prosperity.
AT: Add-Ons
 2NC ASEAN
ASEAN is ineffective to solve anything
Tay '12 (Simon Tay, Co-Chair of the Asia Society Global Council Co-Chair, Chairman of the
Singapore Institute of International Affairs, and a law professor at the National University of
Singapore, "ASEAN risks being ineffective and neutered", Dinmerican, July 27,
https://dinmerican.wordpress.com/2012/07/27/asean-risks-being-ineffective-and-neutered/, CL)
ASEAN’S failure to issue a communiqué at the end of the ministerial meeting hosted in
Cambodia last week shocked many. Reports indicate that drafting floundered on the issue of the South China Sea, where the
sovereignty of different islets is disputed. The Philippines wished to record that the matter had been discussed whereas Cambodia, which
currently chairs the group, felt that any mention would compromise ASEAN neutrality. The claims in the South China Sea were never
going to be resolved by a statement, however worded. As such, the
quite unprecedented failure shows up not so
much the struggle to deal with a sensitive issue but rather what it may suggest are more systemic
concerns about divisions within ASEAN. These come precisely at the wrong time when the group needs to
show unity and resolve to create an ASEAN Community by 2015. It also dents ASEAN’s credibility
as host for dialogues that span, not just its own region, but a wider footprint, like the newly created East Asia Summit. Factors of division
within the group have been emerging over time. These relate not just to the South China Sea, but more broadly to the roles of the United
States and China and such issues as the Mekong River and Myanmar. The Obama administration’s “pivot” to give more attention to Asia
over these last four years has been evident and has largely been well received. But this comes after more than a decade in which China
has emerged as the best friend to many. Given the economic dynamics, there is a sense that China will not go away but will grow in
importance. This is especially notable in Beijing’s largesse to some in ASEAN. Take Cambodia, the host of the failed meeting. Over the last
decade, Beijing has provided billions for infrastructure, including the building for the Kingdom’s Council of Ministers. In April, Chinese
leader Hu Jintao made a four-day state visit and just a month before the ASEAN Ministerial meeting, a senior Communist party leader
visited Phnom Penh with promises to “take strategic approaches to step up the bilateral cooperation to new heights”. Given that the US
market currently remains its largest trade partner, Cambodia seems to be playing a risky game. Intended or otherwise, the failure at the
Phnom Penh meeting is seen as favouring China. Other ASEAN members have come to quite different positions. The Philippines has
strengthened its US alliance as Manila asserts its claims to areas in the South China Sea. Vietnam has tilted towards America and the
recent visit by US Defence Secretary Leon Panetta to Hanoi raises the possibility for arrangements to host an American military presence
at Cam Ranh Bay. What can the small- and medium-sized states in ASEAN do, given these great power dynamics? There are things
beyond their control. ASEAN could breathe easier if Beijing and Washington recognise their interdependence and that the region is big
enough for them both. But if the rhetoric of differences grows louder and it comes to push and shove, ASEAN will be in an
invidious position. Other things are hard but possible. For too long, individual countries’ policies toward China and the US have
been little discussed. Dialogue could help each ASEAN member understand the other’s concerns and,
from this, seek common positions. Agreeing upon anchor points about the critical relationships
with these giants would help ASEAN maintain centrality. Last comes what should be do-able and indeed ought to
have been done at this last meeting. This is to agree to a form of words, a set phrase, about the South China Sea. Critics will say that
papering over differences will not resolve the issue. Of course not, but there are other uses. Think of papered-up forms of words like the
“one-China” principle in relation to Taiwan. While this is open to varying interpretations, it has helped frame a range of differences that is
understood (but not conceded) by each party. Not least, if ASEAN can reach such a form of words about the South China Sea, then its
communiqués need not be held captive to a single issue. Noting but setting aside what is unresolved, the group would then be able to go
on to deal with the rest of its agenda, where consensus is possible. ASEAN
has achieved centrality as a kind of
default position, and largely because great powers lack sufficient trust amongst themselves .
There are however still necessary conditions to be of use in this role. Perfect neutrality is
impossible, when some of its members are formal allies with one power or receive large amounts
of high profile aid from another. But open and healthy dialogue about the fullest possible range of issues is critical for
ASEAN-led dialogues to remain relevant. For this, each ASEAN member must be willing to keep the group’s interest as a whole in view,
and not focus solely on its bilateral ties with China or America. Otherwise, ASEAN will not only fail to be neutral,
but be ineffective and indeed neutered.
 2NC CCP Collapse
CCP legitimacy is not dependent on economic performance—it’s an outdated myth
Panda '15 (Ankit Panda, an editor at the Diplomat covering security, economics, and politics,
"Where Does the CCP's Legitimacy Come From? (Hint: It's Not Economic Performance)", The
Diplomat, thediplomat.com/2015/06/where-does-the-ccps-legitimacy-come-from-hint-its-not-
economic-performance/, CL)
There’s a pernicious and persistent piece of conventional wisdom in conversations about China’s political stability
that is often presented as a truism: the Chinese Communist Party’s (CCP) legitimacy stems from its ability
to deliver high economic growth; if economic growth disappears, so will its legitimacy; this in turn will lead to the beginning
of the end of the CCP. The a priori appeal is evident since the reason stands the test of common sense. After all, assuming a broad
definition of “legitimacy,” it would make sense that keeping citizens happy through high economic growth would prevent social unrest or
calls for a new form of government. How do you keep citizens happy? Well, you can expand the economic pie, ensuring that
everyone gets a larger slice—more per capita GDP leads to more per capita happiness leads to less revolution and upheaval. For
CCP
elites, mass upheaval over economic outcomes is best avoided by keeping China’s year-on-year
growth rates as high as possible. New research challenges this conventional wisdom with evidence. A new Global Working
Paper (PDF warning) from the Brookings Institution inverts the reasoning I outlined above. Measuring “legitimacy” is of
course a tricky endeavor, so the paper instead measures well-being—roughly how happy citizens
are—against China’s economic performance (the word “legitimacy” does not appear in the paper). The paper
additionally looks at the prevalence of mental health disorders in China. The finding of interest, distilled in a Brookings blog post, is as
follows: We
find that the standard determinants of well-being are the same for China as they are
for most countries around the world. At the same time, China stands out in that unhappiness and reported
mental health problems are highest among the cohorts who either have or are positioned to benefit
from the transition and related growth—a clear progress paradox. These are urban residents, the more
educated, those who work in the private sector, and those who report to have insufficient leisure time and rest. The paper’s finding has
already drawn intelligent commentary from a few commentators (political scientist Jay Ulfelder and blogger T. Greer have posted
important reactions). The finding that well-being, particularly among Chinese economic “elites,” i s
decoupled—and even
inversely correlated—with China’s overall economic growth would suggest that the CCP’s
survival might be independent of China’s overall economic performance. Thus, the CCP thrives not
because it makes Chinese elites happy, but despite Chinese elites’ unhappiness.

As Ulfelder summarizes: these survey results contradict the “performance legitimacy” story that many observers use to explain how the
Chinese Communist Party has managed to avoid significant revolutionary threats since 1989 (see here, for example). In that story,
Chinese citizens choose not to demand political liberalization because they are satisfied with the government’s economic performance. In
effect, they accept material gains in lieu of political voice. The decline in overall well-being among elites does present a serious challenge
to the conventional explanation of the CCP’s legitimacy. The authors of the Brookings report also highlight previous studies of well-being
and life satisfaction in China that measured a large decline in happiness among “the lowest-income and least-educated segments of the
population.” In
previous studies, China’s “upper socioeconomic strata” exhibited a rise in happiness,
somewhat confirming the conventional wisdom explanation . Additionally, the authors note numerous
independent variables that affect happiness, including rural/urban status, internal migration status (urban households and migrant
households report lower happiness levels than their rural, non-migrant counterparts). Where
does the CCP’s legitimacy
come from then? As Greer notes, maybe looking at the per capita distribution of wealth in China has been the
wrong measure all along—it’s unnecessarily reductive and dismissive of the opinions of actual Chinese people. Instead,
Chinese people would attribute the legitimacy of the CCP to specific policy initiatives (i.e.,
fighting corruption, delivering justice to wrong-doers within the country’s power apparatus) as well
as more diffuse, nation-level factors (i.e., the CCP’s “role in helping China, as a country and a nation,
become wealthy, powerful, and respected on the international stage ”). The long-term survival of the CCP may
be the most consequential question for China in the 21st century, both for external observers watching China’s rise and for internal
stakeholders. It’s undoubtedly important thus to understand how Chinese citizens relate to their government and experience life as
China continues to grow. Still, it’s best to update our beliefs on how the CCP sustains its political legitimacy when presented with new
data. The
often-repeated economic performance explanation of the CCP’s legitimacy is not only
outmoded—it appears to have never really been based in reality.

Empirics prove economic policy is not the only thing sustaining CCP legitimacy
The Politic '13 (The Politic, "Performance Legitimacy: An Unstable Model for Sustaining
Power", The Politic, January 10, thepolitic.org/performance-legitimacy-an-unstable-model-for-
sustaining-power/, CL)
Chinese politics under Mao’s rule evince that a regime can justify its rule solely through ideology , much
like China has done with performance legitimacy in the past 30 years. It has been shown that performance legitimacy alone can be an
insufficient model for sustaining power, suggesting that in terms of relative effectiveness, ideological legitimacy can be an equally, if not
more, effective model for power legitimation. Zhao writes that theCCP maintained a “high level” of legitimacy under
Mao’s rule, even though his programs brought economic disaster to the Chinese people .[16] The
people were willing to follow the party line at the expense of their own well-being and believed that the
tragedies endured during the Cultural Revolution were necessary costs on the path to a better future.[17] The famines and
economic turmoil caused by Mao’s policies severely weakened the CCP’s performance legitimacy;
in fact, it could be argued that despite delivering on social stability, the CCP lost every last vestige of its performance legitimacy. Thus,
Mao sustained a “high level” of legitimacy through ideology alone. Mao’s
successful use of ideology to justify rule
suggests that ideology can be a dominating determinant of a regime’s ability to maintain powe r.
China’s current regime, then, may not be in a stable situation, since it relies almost fully on performance legitimacy and lacks ideological
legitimacy. A
performance-based model for sustaining power is inherently unstable if uncoupled
from other forms of legitimacy, such as moral or ideological legitimacy. Conversely, a regime that intertwines performance
legitimacy with moral and ideological legitimacy is intrinsically more stable than one that lacks these alternative forms of power
justification. However, for the past 30 years, the CCP has been very reliant on performance legitimacy and has still managed to maintain
its rule. Even so, the rise of civil protests in recent years and the growing role of social networking in political activism forebode a future
in which China’s performance-based model may one day falter. Although history suggests that performance legitimacy will be enough
for China to maintain its hold on power, there are growing threats to performance itself, such as environmental damage. What is clear is
that China will have to navigate through these challenges to its performance. However, it remains unclear whether China will undergo
reforms that bolster its ideological and moral legitimacy.
 2NC U.S. Health
U.S. economy steady and unaffected by changes
Crutsinger '16 (Martin Crutsinger, AP Economics writer, "US economic growth revised up to
show slow, steady growth", Star Telegram, May 27, www.star-
telegram.com/news/business/article80391252.html, CL)
The U.S. economy’s slowdown in growth at the beginning of the year wasn’t quite as bad as first
thought, thanks to a bigger boost from housing and less drag from business investment and trade .
The gross domestic product, the broadest measure of economic output, grew at an annual rate of 0.8 percent in the first quarter, the
Commerce Department said Friday. That’s slightly better than the initial estimate of 0.5 percent but is still the weakest pace in a year. It
was the second lackluster quarter in a row, following a modest 1.4 percent gain in the fourth quarter. At the beginning of this year, the
economy was held back by turbulence in financial markets and global economic problems. Economists are forecasting a
rebound in the current quarter to growth of around 2 percent. They expect employers to keep adding jobs
at a solid pace, which in turn should support increased consumer spending. Paul Ashworth, chief U.S. economist at Capital
Economics, said even though the revised growth rate for the first quarter was still modest, the result
was less worrisome given that “more recent incoming data point to a big pick-up in second-
quarter growth.” Ian Shepherdson, chief economist at Pantheon Macroeconomics, said GDP growth in the current quarter could be
as strong as 3 percent. For the first quarter, consumer spending, which accounts for 70 percent of economic activity, grew at a 1.9
percent rate. That was the weakest performance in a year, reflecting a sharp slowdown in auto sales. The growth revision reflects a
weaker drag from business investment in structure and equipment, primarily because of new-found strength in construction of
commercial structures such as shopping centers. In addition, the trade deficit did not widen as much as previously estimated and
businesses did not slow their restocking of store shelves as much as first thought. Capital investment fell at an 8.9 percent rate in the first
quarter, better than the 10.7 percent drop first reported. The plunge in spending on oil and gas exploration has been a major source of
weakness. While business investment remained weak, investment in residential construction was growing at a sizzling 17.1 percent rate,
the strongest advance in more than three years. In the second half of the year, economists are forecasting that overall growth will
strengthen further to around 2.5 percent. Employers added another 160,000 jobs in April, a solid gain even if it
was down from an average increase of 243,000 in the prior six months. The
unemployment rate remained at a low 5
percent, down by half from the 10 percent high hit in the fall of 2009 when the economy was struggling to emerge from the worst
economic downturn since the 1930s. The U.S. economic expansion will celebrate its seventh birthday next month, making it the fourth
longest recovery since World War II. But it has also been the slowest, averaging modest annual growth of 2.1 percent. “While that growth
is nothing to write home about, we are relatively better off than many of our trading partners,” said Sung Won Sohn, an economics
professor at California State University, Channel Islands. Financial
markets went into a nosedive at the beginning
of the year, dragged down by worries about global growth and a sharp slowdown in China , the
world’s second largest economy. There were serious concerns that the U.S. economy, because of stalling global growth, could be headed
back into recession. Since then, markets have recovered all their early-year losses. Recent data has shown that key
sectors of the economy, from consumer spending to housing, have improved. The Federal Reserve surprised investors last week when it
released minutes of its April meeting showing that Fed officials believed that a rate hike in June was likely if the economy kept improving.
The Fed raised a key rate in December by a quarter-point but has left rates unchanged so far this year.
Disads
India DA
 Link
Any risk that China becomes stronger fuels an arms races between India and China
Wortzel & Dillon '00 (Larry M. Wortzel is a fellow at the The Kathryn and Shelby Cullom
Davis Institute for National Security and Foreign Policy, Dana Robert Dillon is a senior policy
analyst at the Asian Studies Center, "Improving Relations with India Without Compromising U.S.
Security", Heritage, December 11, www.heritage.org/research/reports/2000/12/improving-
relations-with-india, CL)
A Regional Arms Race
India claims that its nuclear and missile development programs are in part a response to the
growing security threat it perceives from China--an assessment not fully shared by Washington . The
United States believes that Beijing has greater territorial concerns, such as Taiwan, the South China Sea, and "American hegemony" in
Asia, than border disputes with India. Indeed, the
border disputes that led to the Sino-Indian war in 1962 are
the subject of continuing negotiations, and armed separatist movements in Tibet have not received India's support for
many years.8 Nevertheless, India's concerns about China's potential threat cannot be simply dismissed.
Now that India's long-time rival, Pakistan, also is a nuclear state, the fact that China is Pakistan's
principal source of nuclear weapons and missiles deeply concerns New Delhi . China believes Pakistan
has the influence needed to defuse Islamic separatist movements inside China's borders, while it views India as a strategic rival.
Meanwhile, India and Pakistan have sacrificed significant blood and treasure over the disputed territory of Kashmir and have even
brought their peoples to the brink of a nuclear abyss in an attempt to resolve the dispute through military force. Beijing's
proliferation activities with Islamabad also intensify India's concerns that China is supporting an
arms race in South Asia. China is selling small arms, armor, and artillery to Burma, which lies along India's borders to the
southeast. Strategic thinkers in New Delhi are concerned that China's People's Liberation Army could someday gain access to
geographically strategic bases in Burma along the approaches to the Strait of Malacca, the world's busiest waterway. China already is
building deep-water ports off Burma and overland routes to move goods to and from these ports, as well as radar and listening posts in
the Coco Islands. These activities threaten India's aspirations of becoming a regional power that could
project its own navy in the Indian Ocean and through the Malacca Strait into the South China
Sea.9 Though the United States should not become embroiled in internecine territorial disputes between competing regional powers,
the free flow of goods through these sea lanes could be threatened if either India or China gains naval regional dominance or a naval
arms race develops.

For India, China would be a formidable opponent . A massive country with a military three times the size of India's
armed forces, China has a nuclear arsenal that far exceeds India's capabilities and enables it to strike any target within India. By
comparison, India's short-range missiles could not inflict strategically significant damage within China. Becausethe border
disputes with China and the arms race with Pakistan are fueling nationalist sentiments and
domestic support for India's nuclear program, New Delhi will likely continue to seek nuclear
weapons with greater destructive power, as well as longer-range missiles and systems capable of
striking multiple targets. India's effort to gain U.S. assistance in developing its satellite and space launch capabilities ostensibly
is meant to help bring India into the 21st century in telecommunications and commercial enterprise. However, such technologies could
be used to advance India's strategic missile programs. Privately, in fact, Indian officials have indicated that New Delhi hopes to develop
thermonuclear weapons, multiple independently targeted reentry vehicles (MIRVs), and intercontinental ballistic missiles (ICBMs).
Moreover, some of these officials have argued that India needs a "360 degree" deterrent ,10 suggesting
that its future missile programs could target regions other than China.
Elections
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Most libertarians hate foreign aid because it directs focus to outside the country
Cummings '15 (Michael Cummings, "CUT IT? Conservatives’/Libertarians’ Foreign Aid
Dilemma", Clash Daily, January 23, clashdaily.com/2015/01/cut-conservativeslibertarians-foreign-
aid-dilemma/)
I love America. We are the most prosperous, beautiful, safe, tolerant, benevolent, and charitable nation to have existed. For a host of
reasons, large and small, serious and silly, overall the world is better because we’re here. We should be proud of what we’ve
accomplished in our historically short life, and we should be hopeful for a bright future. About that… As we approach the next
presidential election, and of course we’ve already enjoyed the Me-Too and Let’s -Try-This-Again campaigns getting off to a
mouse-roaring start (I’m intentionally not naming them), one topic most libertarians and a good chunk of conservatives
take on is foreign aid. At first pass, taking a position on foreign aid seems straightforward. In the form of cash, loans, products,
or services, aid is ostensibly intended to help a nation with its — and by extension our — security, economy, or humanitarian cause. In
the best of worlds, we should only give money to countries we like and that like us back. Life is fair, right? Hard
liners are usually
against foreign aid of any kind or degree, and I understand this position. The US is so deep in debt, both in
fiscal operating budget ($17 trillion) and unfunded liabilities ($100+ trillion), that for us to be charitable seems
nonsensical or even moronic, especially when charitable to a nation that hates us. But the fact is foreign aid, according to
ForeignAssistance.gov represents about 1% of our operating budget every year. Mon ey
is money, however, and a good
chunk of that $1 trillion could go elsewhere. We should evaluate what we give and to whom, and
be ready with the cleaver, but we must acknowledge that withholding all foreign aid from everyone will carry with it a price we
would not want to pay. Reports from a few years ago indicate our top five aid recipients include Egypt, Iraq, Afghanistan, Pakistan, and
Israel. Would you be interested to know that 2015 is looking to be the breakout year for our largest and most evil enemy, who will
receive over four times what we typically give Israel? Iran. The other night Mark Levin spoke of a Washington Free Beacon article by
Adam Kredo that shows American
taxpayers and their multiple scions will hand over nearly $12 billion
dollars in cash to the Iranians by June of this year. Do we have any idea what we’re doing? Iran
denies the Holocaust. These people call Israel Little Satan and us Big Satan. Any American finding himself crossing the border
into Iran, even by accident, would most likely be jailed, tortured, and put to death — simply for being an American. Of freedom hating
countries, Iran is #1. My fellow Americans, as with the new Cuban disaster, for
this $12 billion we get nothing in return.
Nothing.
This forced “investment” is just to keep these moral midgets at the negotiating table, with no
strings attached to their behavior. Unmolested, the Iranians continue to push toward becoming a nuclear power and fund
other terrorist groups (Iran is said to pay Hezbollah up to $200 million a year). Certain Republican lawmakers like Mark Kirk (IL), Kelly
Ayotte (NH), and John Cornyn (TX) tried to require Iran to prove they aren’t helping terrorist groups, but you can imagine how far their
efforts went. Lest
you think Iran hasn’t hurt us yet, we have evidence Iran provided material support to
al Qaeda before and after 9/11/01: In Havlish, et al. v. bin La den, et al. , Judge Daniels held that the Islamic Republic of Iran,
its Supreme Leader Ayatollah Ali Hosseini Khamenei, former Iranian president Ali Akbar Hashemi Rafsanjani, and Iran’s agencies and
instrumentalities, including, among others, the Iranian Revolutionary Guard Corps (“IRGC”), the Iranian Ministry of Intelligence and
Security (“MOIS”), and Iran’s terrorist proxy Hezbollah, all materially aided and supported al Qaeda before and after 9/11. We aren’t just
watching it from the stands, we are actively, financially, supporting our own destruction . If anything should give
fire and spine to Boehner, McConnell, all Republicans, and even a few Democrats to cut off funding for all activity related to aiding Iran —
including the possibility that 17% of the US government might not get their checks for a few weeks (i.e. shutdown) — this is it. Say your
prayers.

Foreign aid is very unpopular right now

Auerbach '13 (Matthew Auerbach, "Poll: Foreign Aid Should be Top Spending Cut"" , Newsma,
Feb 23, www.newsmax.com/Newsfront/foreign-aid-spending-cuts/2013/02/23/id/491651/, CL)
Reducing foreign aid is the overwhelming choice for most Americans when it comes to spending
cuts. In a poll released Friday from Pew Research Center that offered 19 options for reducing government spending, cutting
foreign aid was supported by more than 40 percent of Americans . Reducing funding for the State
Department and limiting unemployment aid are both supported by around one-third of Americans. Approximately
one-quarter of Americans favor reductions to the Defense Department and to aid for the needy in the U.S. Cuts in other areas
supplied by Pew, including health care, energy, entitlement programs, infrastructure, scientific research and combating crime,
garner even less support. For most categories, a majority of Americans want to keep spending at the same level. There’s majority
support among Republicans for cuts in only two areas: foreign aid an unemployment assistance .
Foreign aid takes up about 1 percent of the federal budget. Social Security, which only one in ten Americans support cutting, makes up
about 20 percent. Cuts to Medicare and Medicaid are supported by under a quarter of Americans, but take up around 21 percent of the
budget. A majority of Americans want to hike spending in only two areas. Sixty percent want more spent on education, and 53 percent
said the same of veterans’ benefits.
 Swing Voters
Libertarian votes will be the deciding vote this season
Kwong '16 (Matt Kwong, Washington based correspondent for CBC News, "Libertarian Gary
Johnson could swing votes from Donald Trump, Hillary Clinton", CBC News, June 5,
www.cbc.ca/news/politics/libertarian-party-gary-johnson-donald-trump-hillary-clinton-spoiler-
1.3612883)
If the Libertarians can appeal to an electorate dissatisfied with the two major-party candidates , it
could set up a replay of the 2000 election's spoiler scenario. Democrats that year blamed Green Party candidate Ralph Nader for
diverting support in hotly contested Florida from Al Gore, who lost the White House to Republican nominee George W. Bush. The Green
Party took 2.7 per cent of the popular vote, which Democrats claim would have otherwise gone to Gore. Five months before this general
election, it'shard to imagine someone other than Clinton or Trump crossing the finishing line. But
Philip Wallach, a Brookings Institution fellow who has written about third-party campaigns , isn't
counting out a Nader-like repeat. "I do think it is a matter of spoiler," he said. With Nader fresh in Americans' minds, he said, left-
leaning voters "might be very nervous about the Libertarians playing the Ralph Nader role, and
helping to swing the election to Trump." Wallach foresees some disaffected supporters of Democratic candidate Bernie
Sanders finding alignment with Libertarian principles on issues like drug legalization. For his part, Trump this week dismissed the
Johnson-Weld ticket as "a total fringe deal." To voters on the right, Wallach suggests the Libertarian ticket could appear
more politically conventional. Particularly to displaced Republicans turned off by Trump and "worried about Trump as
somebody who could abuse power." It could ostensibly be the moderate option for displaced Republicans turned off by Trump. "An
unusual place for a Libertarian to end up," Wallach said. What remains to be seen is whether Libertarians pull
disproportionately from one party.

Libertarians are empirically the swing voters

HOT '06 (Hammer of Truth, community and medium of ideas for libertarians, "Libertarians: the
largest swing vote in America?", Hammer of Truth, October 16,
hammeroftruth.com/2006/libertarians-the-largest-swing-vote-in-america/, CL)
For those who’ve been despairing about the state of politics in America, I have some good news from the Cato Institute. We’re
actually the largest swing voter group out there at roughly 13-20% of the population , it’s just slightly
harder to reach out to us because we aren’t organized in labor unions or churches. But we’ve basically determined the last
few elections. The (small-l) libertarian vote has traditionally gone to the Republicans; they’ve been seen as the lesser
evil. However, a massive demographic revolt occurred in 2004, and Bush only received 59% of the libertarian vote
(as opposed to 72% in 2000, when he campaigned talking like a libertarian). And as the libertarian demographic is about evenly split on
the war, most of the pro-war libertarians basically voted for him for that reason alone. This revolt occurred despite Kerry being rated
even lower than Gore on average in the libertarian grouping… meaning it was a vote to punish Bush, not because we were enamored with
Kerry. But what would have happened if a more libertarian-leaning candidate was run by the Democrats, such as Howard Dean? The
Democrats would only have had to bring Bush down to a 50% libertarian vote (9 points) to cost him Colorado, New Mexico and Nevada…
and therefore the election. And it would have happened, too- despite
libertarian tendencies to vote Republican,
we’re the most easily-parted group from the GOP fold . More libertarians voted for Perot than any other
constituency. And we were almost persuaded to let the jackasses have a go at the Presidency this year.