There is growing concern that weak and failing states breed new pandemics, thereby endangering global health. Public health has become a fundamental responsibility of the state and a precondition for national security. When fragile states fail to invest in the well-being of their population or to respond to the outbreak of infectious disease, they can become vectors for the spread of disease beyond their borders. This chapter shows that a pandemic disease with global ramifications could occur almost anywhere—but there is no reason to presume that it will originate in the world's weakest states, rather than in another part of the developing world. To the extent that the most direct threat to US security comes from truly global, rapid-onset pandemics, the risks may actually be concentrated in relatively developed countries. Of course, this should not preclude efforts to combat endemic diseases in poor states, given their disastrous economic and human consequences.
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