Deadliest Enemy: Our War Against Killer Germs

by Mark Olshaker

one dot is just that: an isolated person, bacterium, virus, parasite, place, or time. But a bunch of dots begins to make a line if they become organized by chance or by design. That’s our job in public health: to see the dots before they become a line and do whatever we must so that line never materializes.

“Infectious diseases turn out to be a surrogate for an alien invasion,” Bill declared. “It’s why we were able to do smallpox eradication in the midst of the Cold War. Both sides could see this was an important thing to do.”

In 1900, the average life expectancy in the United States was forty-eight years. By 2000, just one hundred years later, it was seventy-seven. For every three days we lived in the twentieth century we gained a day of life expectancy. Consider that in light of the fact that early humans in the form of Homo erectus emerged 2.4 million years ago, and it took us until 1900 to achieve our forty-eight-year life expectancy. That means it took 80,000 generations to reach the 1900-era life expectancy, and only about 4 to reach our current level. With clean water, sewer systems, safer food, pasteurized milk, and vaccines, we made historic advances in eliminating the diseases that killed children, who are particularly vulnerable to the illnesses related to these environmental conditions.

There is a naïve belief that the kinds of supplies we need to respond to a pandemic, such as medical products, drugs, vaccines, and N95 respirators—commonly known as face masks—will be a click away on the Internet. Not so.

The first priority is to confront head-on those microbes that cause deadly pandemics, or as we refer to them in our business, pathogens of pandemic potential.

Research and policy: Like chocolate and peanut butter, these two have a natural connection. If we approach science without policy, we will accomplish nothing. And if we try to institute policy without good science behind it, we will squander precious time, money, and lives.

What we call criminals in the human sphere we call pathogens in the microbial realm.

There are more microbes in the human gut than there are cells in the entire body, and there are microbes virtually everywhere within us.

If you look at three diseases, the three major killers, HIV, tuberculosis and malaria, the only disease for which we have really good drugs is HIV. And it’s very simple, because there’s a market in the United States and Europe. —JIM YONG KIM, MD, PRESIDENT, WORLD BANK

We keep coming back to the reality that what kills us, what hurts us, and what scares us are not one and the same.

60 percent of emerging infectious diseases are leaping into the human population through animals.

That’s the challenge of proactive public health practice. If you prevent something from happening because of your actions, you’ll always be second-guessed as to whether the action was necessary. On the other hand, if you don’t act on the information you have and an outbreak occurs, you will be burned at the stake by the media, elected officials, and even your colleagues.

More people died in a six-month period over the fall, winter, and spring of 1918–19 than have died from AIDS in the roughly thirty-five years since that virus was identified in the human population.

Our most dangerous adversary will not originate in the tribal areas of Afghanistan or some other remote place. It is everywhere man and animal live in close proximity.

In any given year, or even in any given decade, the probability of a major influenza pandemic is low. As a possibility for some unknown point in the future, it is virtually a dead certainty.

We shouldn’t have to wait for something to happen before we react. The dots are there to be connected. When we say we were surprised by Zika, we shouldn’t have been. When we say we were surprised by Ebola, or yellow fever, or chikungunya, or so many others, we shouldn’t have been. And we shouldn’t be surprised if tomorrow’s crisis is caused by Mayaro virus, Nipah, Lassa, Rift Valley fever, or a new coronavirus.

And if, in the future, we are unprepared for a pandemic of a deadly strain of influenza, or antibiotics that no longer prevent common infections from causing serious or fatal illness, we certainly won’t be able to say we weren’t warned. Because we’ve had the warning and we have the solutions; we just need to act on them.