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B. National Economic Interests: Trade and Commerce Even the most powerful countries have a narrow interest in preventing the migration of large-scale health threats to their shores. But beyond narrow self-interest, are there broader, “enlightened” interests in redressing extremely high rates of disease and premature death in the world’s poorest regions? There is a strong case that a forward-looking foreign policy would seek to reduce enduring, intractable diseases in developing countries. Epidemic disease dampens tourism, trade, and commerce, as the 2003 SARS outbreaks demonstrated. Animal diseases such as FMD, BSE, and avian influenza similarly had severe economic repercussions on trade and commerce, with mass cullings of flocks and herds, and provoked trade bans on beef, lamb, or poultry. Massive economic disruption would ensue from a pandemic of human influenza, with a projected loss of up to 6% in global GDP. In regions with extremely poor health, economic decline is almost inevitable. HIV/AIDS in sub-Saharan Africa accounts for 72% of global AIDS deaths. Average life expectancy in this region is now 47 years, when it would have been 62 without AIDS. For some of the worst affected countries such as Botswana, life expectancy has declined from 75.7 to 34.2 years of age. Most of the excess mortality is among young adults aged 15-49, leaving the country without entrepreneurs, a skilled workforce, parents, and political leaders. The World Bank estimates that AIDS has reduced GDP nearly 20% in the hardest-hit countries. AIDS, of course, is only one disease in countries experiencing multiple epidemics, starvation and massive poverty, and regional conflicts that devastate the population. Countries with extremely poor health become unreliable trading partners without the capacity to develop and export products and natural resources; pay for essential vaccines and medicines; repay debt; and require increased financial aid and humanitarian assistance. In short, a foreign policy that seeks to ameliorate health threats in poor countries can benefit the public and private sectors in developed, as well as developing, countries.