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November 15 - November 19, 2020
We know so much about beating disease, yet fragmented governing structures, lack of global accountability, and persistent poverty in so many places ensure that those failures happen and disease propagates.
As it stands, the World Health Organization’s top brass will watch any H7N9 pandemic unfold from their strategic operations centre. Information will flood in; body counts will mount. Governments will be told that their demands for vaccines and drugs cannot be met. They will issue declarations, hold briefings, organise research, tell people to wash their hands and stay home. Mostly, though, they will just watch helplessly.
Science didn’t actually fail us. The ability of governments to act on it, together, did.
The few countries with pandemic plans built them around a very different virus, flu, and regardless, many failed to stockpile or acquire the most basic essentials for making the plans work.
The hard-earned good news is that Covid-19 has shown us what we need to do. We cannot let a virus catch our interconnected global community this stupidly flat-footed again. We cannot let it break those interconnections either, at least not all of them. If this pandemic teaches us anything, it is that up against a contagious disease, we are all in this together. One big early lesson was that no country can really seal off their borders anymore, or go it alone. Our society is global; our risk is global; our response and our cooperation must be global.
On January 18th, the Wuhan neighborhood of Baibuting staged a potluck dinner with 40,000 people in honor of the kitchen god—and in a bid for a Guinness World Record for the number of dishes served. The mayor of Wuhan told a television interviewer later, after gatherings of people in Wuhan had been banned, that the party was allowed because they still thought that human-to-human spread was limited.
Containing a new infectious disease before it has spread far nearly always means reacting before it seems like a big deal, she says. There may be only a few clinical cases, but you know several times that number are already infected and incubating the disease, especially if it is very contagious and spreads early in the course of infection. Covid-19 ticks both boxes. You have to contain such things early before they escalate. This can be difficult, as at that point officials often see the threat as too trivial for such disruption, scoffing that more people die falling down stairs—forgetting
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Wait until the threat is obvious, though, and you are usually too late. “First they accuse you of overreacting,” said Briand, echoing many frustrated public health experts I have heard over the years. “Then the epidemic suddenly explodes, and they say you didn’t act fast enough.”
South Korea had companies making Covid-19 tests by early February. National labs double-checked the test results as people were tested, effectively doing the usual validation trials of a new test on the hoof to save time.
Wuhan had its Guinness-record potluck. But on March 7th, as the pandemic took hold in France—and we all knew the virus was contagious—more than 35,000 people dressed as Smurfs gathered in Landerneau, France. The next day, France banned gatherings over 1,000 people.
Five million people left Wuhan before the lockdown. But even that painful lesson was not learned in time to avoid it elsewhere. More than six weeks later, Italian authorities locked down northern provinces that were the initial hotspots for the virus. The news leaked the evening before,
According to virologist Ab Osterhaus of the Research Center for Emerging Infections and Zoonoses in Hannover, in 1900, infectious disease caused fully half of all human deaths. Malaria alone is thought to have killed half of all humans who ever lived.
In the 1800s, tuberculosis, known as TB, infected 70 to 90 percent of Europe’s city dwellers and caused more than a third of all deaths, spawning a score of “consumptive” characters in Victorian novels.
Lesson five was that health systems should protect health care workers, who made up between one-third and two-thirds of SARS cases in heavily affected countries. Most nurses were (and are) women, and among health care staff, women were 2.7 times more likely than men to get SARS, whereas outside of hospitals, it infected both equally. Yet even now in some rich countries, doctors and nurses are dying and must face Covid-19 with insufficient masks, gloves, and gowns. Lesson not learned.
Lesson three was that travel restrictions can help, the WHO claimed, despite conceding that temperature checks in airports caught only two cases of SARS.
The 2015 report suggested that restoring forests of wild, fruiting trees to entice the bats away from people and horses would be the best way to prevent Hendra. “Bats are not the problem. They don’t cause disease emergence,” says Cunningham. “People do, by destroying and encroaching on their habitat and by catching, trafficking and butchering them. This can even infect other animals nearby that, if infected, might be able to carry and even multiply the bat virus, further increasing the risk.”
Recent history doesn’t do much to support the idea that diseases from animals always become mild as they adapt to spreading in humans. Consider HIV. It spreads before you get sick, so it’s no problem for the virus that after a few years, without the right drugs, 100 percent of infected people die. As we have seen, it hit humanity in the early 20th century, it eventually went very much pandemic, and it’s shown no sign of getting nicer in all that time.
Meanwhile, it’s not just a question of how viruses act on their own: some vaccines can increase virulence. Andrew Read of Pennsylvania State University has done research with several diseases, including Marek’s disease, a common plague of chicken farms, to see how vaccination affects the virus’s evolution. He found that if a vaccine keeps the virus’s host from getting sick, but still allows the virus to persist and spread—like the poultry vaccine for H5N1 did in China—it can select for a more virulent virus.
“Leaky” vaccines, though, induce immune reactions in the host that keep the virus at low levels, so an infected host doesn’t die—but the virus doesn’t completely die out either. If that happens, those viruses can become extra virulent, because they don’t have the problem of killing off their host if they do.
We are unlikely to vaccinate everyone—we never have with any other vaccine, even when we eradicated smallpox. If a virulent mutant of Covid-19 circulated silently among vaccinated people, then reached people who were not vaccinated, it could be bad.
We will have to keep this in mind as we develop Covid-19 vaccines. The virus is likely to keep circulating, at some level, everywhere until we have a vaccine and use it widely. That means countries will need to keep testing and interrupting chains of transmission to contain it—or if they fail to, they will have more large outbreaks requiring social distancing.
Now, imagine we find such a vaccine, but then someone says: you can’t use that, it might cause the evolution of a more severe strain of Covid-19. That might be a hard sell. Meanwhile, adapting to humans seems to have resulted in increased, not decreased, virulence in Ebola.
Greater vulnerability among lower-income people worsens the spread and impact of a pandemic in the most critical parts of the complex system: firefighters, paramedics, police, care workers, the people who produce everyone’s food, drinking water, electric power, the list goes on. The less those people can withstand a pandemic, the more the system that supports everyone is at risk of collapse. More inequality, and more poverty, means more risk.
Instead, O’Neill suggests putting more redundancy back into globalized industries, making them more resilient. It will cost, as efficiency was adopted in the first place to save money. But it may well be less expensive than dealing with collapsing supply systems in the next pandemic.
He says it isn’t just our connectivity that puts us at risk, but also our uniformity, not just biologically as humans but culturally, in our food, ideologies, social media, finances, consumerism, even our antibiotics. If we have the same responses to perturbations everywhere, we risk disaster everywhere if one goes wrong. “Diversity, often a key feature of complexity, can be highly beneficial,” he told me. The problem is not complexity per se—it’s whether it leaves you more, or less, vulnerable.
Now is the time to improve our systems for monitoring and response, first by beefing up surveillance for emerging disease, and second by investing in drugs, vaccines, and diagnostics for the threats we already know exist.
Just having eight billion people filling virtually every available niche on this planet makes us global whether we like it or not. We can no longer run our affairs in isolated groups, while even a fraction of us might do things that affect everyone: besides disease, there are greenhouse gases, ozone-depleting chemicals, overfishing, financial instability, pollution, deforestation, cybersecurity, nuclear weapons—the list goes on. To even try to get ahead of the cascading failures that can result—like pandemics—we have no choice but to organize on a global scale as well. If the pandemic doesn’t
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The IHR is legally binding, and it requires countries to improve their surveillance and public health capability and to assess their own ability to detect and respond to outbreaks, says David Heymann—but like all international treaties, it has no way to enforce this. But enforcement is not how treaties get things done: verification is. There are already treaties in which countries have set aside one tightly circumscribed area of national sovereignty in the name of global security. We have one governing nuclear material, another on chemical weapons, and another on the ozone layer.
There is already a similar type of verification in the program for polio eradication, in which the WHO participates: if a country says it hasn’t found any cases of paralysis that turned out to be polio, it has to have found the number of cases of paralysis that weren’t polio that you would normally expect in its population, so we know it was looking hard enough.
Viruses don’t care about human borders, identities, or ideologies—just human cells. The question now is: Do we care enough about defeating them to truly join forces?
