Abstract

The HIV/AIDS pandemic, now well into its third decade and spreading in states as diverse as Belarus, Ukraine, Indonesia, and Papua New Guinea, has shown us that we truly are sharing an interconnected world. As we struggle to deal with both ongoing and emerging threats to public health, and to reach just balances of the rights of individuals and communities, it is critically important not to lose sight of the many states where neither the rights of citizens nor the well-being of the community drive policy. Secretive, rights-violating regimes make poor global citizens in a world where new threats can emerge from obscure corners of the world (like occupational exposures in the butchering of masked palm civets or chimpanzees) and spread fast and far. The mishandling of public health threats in such states may be due to incompetence, malfeasance, official denial, censorship of science, bureaucratic inertia, or the desire not to lose face on the global stage. This is true for state failure in an array of other arenas, including economics and development. But public health failures are likely to have effects beyond state borders, and to affect us all. And this may be reason for some hope: outbreaks like SARS cast a bright light on ineffective responses, and may be one more reason for the citizens of the world who live in free societies to be concerned over the fate of those who do not