CIA Transnational Health and Economic Activities - Alternative Scenarios

Alternative Scenarios

The 1999 estimate looked at three plausible scenarios for the course of the infectious disease threat over the next 20 years:

1. Steady progress to a "health transition" in which such noninfectious diseases as heart disease and cancer would replace infectious diseases as the overarching global health challenge. The intelligence community states this is unlikely, givem inadequate emphasis to persistent demographic and socioeconomic challenges in the developing countries, to increasing microbial resistance to existing antibiotics, and because related models have already underestimated the force of major killers such as HIV/AIDS, TB, and malaria.
2. "Progress stymied" is a more pessimistic—and more plausible—scenario projects little or no progress in countering infectious diseases over the duration of this Estimate. Under this scenario, HIV/AIDS reaches catastrophic proportions as the virus spreads throughout the vast populations of India, China, the former Soviet Union, and Latin America, while multidrug treatments encounter microbial resistance and remain prohibitively expensive for developing countries. Multidrug resistant strains of TB, malaria, and other infectious diseases appear at a faster pace than new drugs and vaccines, wreaking havoc on world health. Although more likely than the "steady progress" scenario, the IC judges this unlikely, because it is overoptimistic about the prospect of development, collaboration, and medical advances to constrain the spread of at least some widespread infectious diseases.
3. "Deterioration, Then Limited Improvement" is judged most likely by the IC. The infectious disease threat—particularly from HIV/AIDS—worsens during the first half of our time frame, but decreases fitfully after that, owing to better prevention and control efforts, new drugs and vaccines, and socioeconomic improvements. In the next decade, under this scenario, negative demographic and social conditions in developing countries, such as continued urbanization and poor health care capacity, remain conducive to the spread of infectious diseases; persistent poverty sustains the least developed countries as reservoirs of infection; and microbial resistance continues to increase faster than the pace of new drug and vaccine development. More positive demographic changes such as reduced fertility and aging populations; gradual socioeconomic improvement in most countries; medical advances; expanded international surveillance and response systems; and improvements in national health care capacities take hold in all but the least developed countries. Barring the appearance of a deadly and highly infectious new disease, a catastrophic upward lurch by HIV/AIDS, or the release of a highly contagious biological agent capable of rapid and widescale secondary spread, these developments produce at least limited gains against the overall infectious disease threat. The remaining virulent diseases, led by HIV/AIDS and TB, continue to take a significant toll.