Lurching from Complacency to Panic in the Fight against Dangerous Microbes: A Blueprint for a Common Secure Future †

By Gostin, Lawrence O.; Cathaoir, Katharina E. Ó. | Emory Law Journal, January 1, 2018 | Go to article overview

Lurching from Complacency to Panic in the Fight against Dangerous Microbes: A Blueprint for a Common Secure Future †


Gostin, Lawrence O., Cathaoir, Katharina E. Ó., Emory Law Journal


INTRODUCTION

In the modem era, the world faces a stark paradox in understanding the risk of fast-moving pathogens. While science brings enormous acumen for discovering and developing countermeasures (vaccines and pharmaceuticals), the potential for explosive pandemics has never been greater.1 Why? Globalization propels pathogens more rapidly than ever across borders, regions, and the world. Mass migration, intercontinental travel, urbanization, and intense animal-human interchange facilitate the emergence of microbes from the forests and animal life to humans; then, these dangerous microbes spread uncontrollably.2

These dynamics have resulted in a significant increase in outbreaks since 1980: 12,012 outbreaks of 215 infectious diseases were recorded between 1980 and 2013, accounting for more than 44 million cases in 219 countries.3 In recent years, the world has experienced a series of health crises spanning severe acute respiratory syndrome (SARS), Middle Eastern respiratory syndrome (MERS), Ebola virus disease, and novel avian (H5N1) or human (H1N1 and H7N9) influenzas.4 At the height of each crisis, politicians often overreact (e.g., implementing unnecessary travel and trade restrictions or quarantines).5 In interpandemic periods, authorities underprepare. Lurching between complacency and panic is a dysfunctional strategy; while scientists cannot predict when the next pandemic will occur, or the exact pathogen at play, there will be a destructive pandemic in the foreseeable future.6

Naturally occurring infectious diseases are not the only threat. In an age of terrorism, it is not just guns, explosives, and chemical or radiologic hazards that destabilize communities and countries; there is also the prospect of accidental or deliberate release of dangerous pathogens. One week after the September 11th terrorist event, anthrax spores were mailed to media and U.S. senators, killing five people, infecting seventeen others, and grinding the postal system to a halt.7 In 2004, a Russian scientist (working at one of two known repositories of smallpox virus) died after accidentally pricking herself with a needle contaminated with the Ebola virus.8

Given the proliferation of scientific information on the internet, reputable scientists can create dangerous pathogens. So-called "garage" laboratory scientists can also acquire this skill, by which individuals handle highly virulent microbes without adequate scientific training and security precautions.9 As early as 1994, researchers genetically sequenced the extinct and deadly smallpox virus, openly publishing the results.10 A researcher in Canada recently synthesized the extinct horsepox virus-a cousin of the smallpox virus-using commercially available genetic materials.11 New genetic technologies make it possible to recreate or "enhance" pathogens, making them more transmissible, virulent, or both.12

Even more worrying is when pathogens evolve and adapt to form resistant strains. Pathogens that gain resistance to most, or all, antimicrobial medications could unravel the gains made by modern medicine, returning the world to a pre-antibiotic era. The prospect of losing once highly effective drugs goes well beyond emerging novel infections: antimicrobial resistance makes common hospital-acquired infections (e.g., staph infections) potentially lethal, and undermines progress against enduring infectious diseases such as HIV/AIDS, tuberculosis, and malaria-causing a drumbeat of suffering and death worldwide.13

There is another truth that society must confront: dangerous pathogens will never be conquered. Despite awe-inspiring scientific advancement, pathogens are an enduring part of the ecosystem. While public health has achieved notable victories such as the eradication of smallpox and the near elimination of wild polio, microbes have had millennia to learn how to adapt and survive.14 Instead, "smart" public health does not pretend to be able to eliminate infectious disease threats, but rather ameliorates the risk through rapid detection and effective response before outbreaks spread widely within communities, countries, and regions. …

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