Deadliest Enemy: Our War Against Killer Germs

by Mark Olshaker

Syphilis, an age-old scourge caused by the Treponema pallidum bacteria, is one of those ailments no group wanted to claim and all groups wanted to blame on some other. After an invasion by the French in the late 1400s, Neapolitans labeled it “the French disease.” The French, on the other hand, called it “the disease of Naples.” The Russians called it “the Polish disease,” while the Polish and Persians called it “the Turkish disease.” The Turks called it “the Christian disease,” the Tahitians called it “the British disease,” the Indians called it “the Portuguese disease,” the Japanese called it “the Chinese pox,” and so on and so on.

What does this mean for the future of MERS? Well, I fear that MERS is only beginning to show its ugly head. There are more than 1.2 million dromedary camels in the Arabian Peninsula, and 78 percent of them are found in Saudi Arabia, the United Arab Emirates, and Yemen. Bactrian camels, the two-humped variety, reside primarily in China and Mongolia. Africa has an estimated 24 million camels, most of which are in the countries in the Horn of Africa, including Somalia (7 million), Sudan (4.9 million), and Kenya (3.2 million).

Shortly before the 2009 outbreak, we conducted a study at CIDRAP in which we surveyed a world-class group of pharmacists who had expertise in the drugs used in the various hospital medical specialties, such as acute care, chronic care, emergency care, and so on. We asked them what drugs they absolutely had to have on a day-to-day basis. Not cancer drugs, not AIDS drugs, but the essential, needed-to-sustain-life-can’t-wait-until-tomorrow drugs. We ultimately compiled a list of more than thirty such critical pharmacological agents, including insulin for type 1 diabetics; the vasodilator nitroglycerine; heparin for blood thinning and dialysis; succinylcholine for muscle relaxation during surgery, intubation, and heart-lung machine hookup; Lasix for congestive heart failure; metaprolol for angina and severe hypertension; norepinephrine for severe hypotension; albuterol to open airways in the lungs; and various other heart and blood circulatory drugs and basic antibiotics. One hundred percent of these drugs were generic; all were manufactured primarily or exclusively overseas, mostly in India and China; there were no significant stockpiles, and the supply chains were long and extremely vulnerable.

The WHO is charged by the United Nations with promoting and protecting global health. But there are 194 member states, constituted as the World Health Assembly, and every single one of them gets an equal vote. As Bill Foege commented to us, “Imagine being the CEO of a corporation that had a 194-member board of directors!”

Says Stewart Simonson, who served effectively under two HHS secretaries and had frequent interactions with the Oval Office, “There is a much more mature dialogue concerning national defense than there is for national preparedness.” Simonson cites the example of former governor Tom Ridge, when he was appointed by President George W. Bush to be the first secretary of Homeland Security after the 9/11 attacks. Ridge wanted to establish a functional operating model and set up regional commands, each headed by an officer—from FEMA, the coast guard, or a number of other agencies—who would be authorized to make decisions and move personnel, equipment, and funds to rapidly deal with an emergency. Ridge’s idea went nowhere, because no government agency wanted to subsume its own authority. The most effective model for the kind of national entity we are talking about would likely require a governmental reorganization. We may now need a Department of Public Health, with its own cabinet secretary who can pull together the resources of the Department of Health and Human Services, including the Public Health Service, the NIH, the CDC, the FDA, and relevant parts of the Departments of Agriculture, Homeland Security, State, Defense, Interior, and Commerce.