The Coming Plagues

What’s your reaction to this list of pandemic diseases: HIV, drug-resistant tuberculosis, virulent influenza, severe acute respiratory syndrome (SARS), methicillin-resistant Staphylococcus aureus (MRSA), Dengue fever, enterovirus 71, and vibrio cholera? A pretty chilling list of players for modernity’s stage, I think.

Each disease has its own etiology, pathology, diagnosis, treatment, control and prevention. For this article, however, I wish to discuss the collective impact of pandemics on society at-large from the perspective of a biologist – and the only logical way forward in managing them effectively.

Let me note first that this small handful of diseases affects individuals independent of age, sexual behavior, socioeconomic class, and geography. In other words, every human on the planet – men, women, and children – is at risk no matter whether you’re a Mother Teresa of Calcutta or a Joe Public. We humans are a relatively young animal species with a swelling global population over 7 billion often in dense populations called towns and cities – an enticing prospect for any opportunistic pathogen “smart” enough to figure out our immunological and pharmaceutical defenses.

We’ve described over 100,000 human diseases thus far. Science and health surveillance professionals continue to watch for newly emerging (or re-emerging) diseases around the world. Emerging infections account for at least 12% of all human pathogens.

Since the 1970s, about 40 infectious diseases have been discovered including SARS, Ebola, avian flu, and swine flu. They’re caused by newly identified species or strains that may have evolved from a known infection (e.g., virulent influenza), from their spread into a new population (e.g., West Nile virus), from an area undergoing ecological transformation (e.g., Lyme disease), or from re-emerging infections (e.g., drug-resistant tuberculosis). Factors for their transformations include everything from climate change and microbial adaptation to poverty and social inequality. Even something as seemingly harmless, even laudable, as dam and irrigation system construction can result in an inadvertent spread of malaria or schistosomiasis.

With people traveling much more frequently and at far greater distances than in the past, the potential for emerging infectious diseases to spread rapidly and cause global epidemics is a major concern. Additionally, the deliberate introduction of pathogens into human populations or into the environment constitutes an act of bioterrorism that scares the bejeebers out of politicians and military experts alike.

Sometimes the only safeguard we have against a local disease going pandemic is happenstance: the “bugs” causing the diseases haven’t yet developed resistance or evolved a new attack strategy. Imagine if HIV went from sexual transmission to airborne transmission via coughing or sneezing!

The mortality rate of the 1918 influenza pandemic topped out around 2 percent. The H5N1 variant (commonly called avian flu) has a mortality rate in the neighborhood of 60%. Imagine if that flu virus made a few tiny mutations and then acquired the ability to move effectively from person to person! Sixty percent of 7 billion people is a lot of dead people.

Our only immediate course of action is education, vigilance, and policy. In 1994, Dr. Laurie Garrett published The Coming Plague: Newly Emerging Diseases in a World out of Balance, a New York Times bestseller. As Garrett noted on her website, what seemed an acutely controversial premise in 1994 is mainstream thought in the second decade of the 21st century. Because of the extraordinary potential of pandemics to disrupt society at-large, they are now viewed as national security concerns by world leaders.

This brings me to the need for “free” universal health care. Benjamin Franklin once noted that an ounce of prevention is worth a pound of cure. Thus, for at least 200 years, it’s been painfully obvious to everyone except a few stubborn politicians and conservative ideologues that health care is worth an upfront investment for individuals as well as for society at-large. And now, in light of the spectre of global plague, I am baffled that we would not offer “free” preventative health care for all citizens, especially here in the United States, a nation with the highest GDP in the world.

In other words, as a matter of national security, the government needs to ensure that all individuals have health insurance. After all, child education in the United States is compulsory: a total 13-year public investment of about $100,000 to $122,000 per student. If public education is universally available, why shouldn’t public health insurance? Of course, neither is a truly free program; but they are both strong investments by taxpayers in our future as a nation, making sense from the viewpoints of ethics, economics, and biology.

The coming plague worries me. We simply must ready ourselves. Many signs point to the likelihood of pestilence on the horizon, but good health and good education will assist our vigilance. I’m reminded of that famous quote from Louis Pasteur that “In the field of observation, chance favors the prepared mind.” Resistance to emerging diseases lies not in the pockets of a privileged few who have the means to purchase comprehensive health coverage, but rather in the hands of all citizens who, collectively, can manage their lives with the assurance of good universal education and good universal health care. It is the only way forward to manage modern day plagues effectively. Healthy citizens will mean vigilant citizens prepared to combat the diseases that beleaguer us.

H. Bruce Rinker, Ph.D.

Ecologist, Educator, and Explorer

[email protected]