U.S. Unready for Viral Invasion
Dunkel, Tom, Insight on the News
Summary: Those who think killer pandemics are a thing of the past could be in for a rude awakening. Viruses and bacteria are adapting and becoming resistant to treatment even as modern society brings them closer to people.
About two years ago, Barry Bloom, an immunologist at Yeshiva University's Albert Einstein College of Medicine in New York, was talking shop with colleagues when a curious fact came to light: Mosquitoes known to carry deadly yellow fever and the less-fatal but worrisome dengue have appeared in states along the Gulf of Mexico.
The scientists whipped out their pens and made some feverish calculations on a hypothetical yellow fever epidemic. Their conclusions sounded like the premise for a TV disaster movie. "In something like two months you'd wipe out one-fifth of New Orleans," recalls Bloom, "and you'd run out of existing vaccine in 48 hours because it's made in Brazil and nowhere else in the world."
Revelers need not cancel their Mardi Gras plans, but such a scourge falls uncomfortably within the realm of plausibility. In fact, that's why Bloom and his fellow scientists had gathered in the first place. They were part of a 19-member committee appointed by the National Academy of Sciences' Institute of Medicine, or IOM, to investigate public health hazards posed by the microscopic word of stubborn viruses. The committee's report, "Emerging Infections: Microbial Threats to Health in the United States," released last October, still is sending ripples through scientific and government circles, perhaps because of its unapologetically blunt tone.
"The medical community and society at large have tended to view acute infectious disease as a problem of the past," Robert Shope, committee cochairman and a professor of epidemiology at Yale University School of Medicine, declared at a Washington press conference that coincided with the release of the IOM report. "But that assumption is wrong. We claimed victory too soon." The danger of infectious disease not only hasn't gone away, it's getting worse, he said. The country is vulnerable to a disaster on the order of the 1918-19 influenza pandemic that claimed 20 million lives worldwide. "It's happened once," Shope warned. "It can happen again."
Although conditions are ripe for a replay, America's public health and public policy apparatuses seem incapable of cutting off the viral bad guys at the pass. "The biology of infectious diseases in that they are continually evolving," explains Bloom, "but the politics of addressing infectious disease is done discontinuously, only after an outbreak. And so the policy is always dealing with the disaster after it occurs."
The emergence of a drug-resistant strain of tuberculosis, which since 1989 has surfaced in 17 states and resulted in 11 deaths at one New York hospital alone, is a case in point. According to Bloom, the U.S. now is spending an estimated $4 billion a year trying to catch up with a crisis that should have been addressed sooner. "It took three bloody years to get the new dollars into the system," he says. "That's not what I would call a very serious way to address an epidemic."
The ghost of TB rising up to devour a new generation is a stark scenario given credence by other signs that public health officials are interpreting as prescient of serious germ warfare:
* The World Health Organization estimates that by the year 2000, 40 million people will be infected with human immunodeficiency virus, which first appeared in Africa in the early 1960s and gained a foothold in the U.S. 20 years later.
* Worldwide, 150,000 cases of a new form of hepatitis are occurring each year.
* In Peru and Bolivia, 6,300 people died and 740,000 became ill in 1991 and 1992 in an ongoing cholera epidemic. India and Bangladesh are feeling the bite of a vaccine-immune strain of the disease, dubbed "Bengal cholera," which has taken 5,000 lives this year. …