When the Past Is Prologue

Humans don’t see threats until they’re kicking at the door. But that does not mean you can’t put a crisis to good use.

Chance rules the world. As Nassim Taleb showed in “The Black Swan” and other books, low probability events can create  high impacts.

But the threat to the U.S. is not from Ebola. Despite ham-fisted preparedness and incendiary political grandstanding about perilous borders and cocktail parties, chances are very, very low we will see an Ebola epidemic in this country. Other parts of the world are proving less fortunate. As our military now recognizes, their security is our security. If we don’t help them, we hurt ourselves.

Yet biology cares little for individuals. Species survive – single individuals are expendable. In the many epidemics that have shaped human history, our profusion of varied genetic and environmental responses has kept humanity alive. Few recall that mankind almost died about 70,000 years – and probably came close many times since. Yet hundreds of million of individuals have perished.

We live and think as individuals. To preserve our survival for the next epidemic – and the next – we better change our tune,  and consider public health.   For we are unprepared:

1. Unprepared for bioweapons. Bioweapons are not new. Lord Jeffrey Amherst gave smallpox blankets to the Delaware Indians, perhaps easing British victory in the Indian wars that acted as a warm-up to the American Revolution. Nature is scary, but humans may prove scarier. Our present biotechnologies – researched by the Russians, if we can believe defectors like Ken Alibeck – might in the not distant future create weapons that are existential  threats. If the response of Presbyterian Hospital in Dallas – a teaching hospital of one of our better medical schools – is any indicator, we are very unready for a pandemic attack.
2. Unprepared for Natural Epidemics. Many people have heard of MRSA – methicillin resistant staphylococcus aureus. They know it kills tens of thousands in the U.S. They don’t know that it has been virtually eradicated in Norway. They don’t know that simple programs in Britain brought the illness rate down 80%. Few Americans recognize the overuse of antibiotics has killed tens of thousands by sparking infection by another bacterium, clostridium difficile. Our wholesale feeding of animals with antibiotics is scandalous. So is the foolish, celebrity led anti-vaccination campaign – already helping to stoke new outbreaks of measles and other “common” viruses. Chances are good- tens of thousands more Americans will die from lack of vaccination than from Ebola. If we don’t effectively vaccinate against measles and flu, how will be prepared for vaccinate for new epidemics?
3. The scandal of infection control in the U.S. Remember that nurse who injected you with anesthetics during your epidural? She’s wearing the same scrubs when she says hello at Publix. Infection control has become the practice of ritual rather than the practice of medicine. Hospital administrators care deeply about passing Joint Commission of Hospital audits, far more than whether the procedures really work. It’s about the “bottom line.” Biology doesn’t care about JCAHO. Microbes never stop regenerating and innovating.
4. The scandal of antibiotic development. Have you noticed that your doctor is giving you an antibiotic whose use stopped in 1958 due to unacceptable side effects? Did they tell you?  The reason is simple – the bugs have gotten smarter, but we have not. Big Pharma complains it doesn’t make enough money on antibiotics. They are used a few times and – presto! Patient “cured.” No more profits. Compare that, executives explain, with cancer drugs or drugs combating high blood pressure and heart disease. We make money on those every day – for decades. Why bother researching antibiotics? Forget about your communities, your country and your children – where is the money?

Governments are now attempting to bribe Big Pharma companies into antibiotic development. Similar work should be done on antivirals. And to think they used to call pharmaceuticals the “ethical drugs” industry.

The Way Out

Biological changes often move light years faster than politicians. It is remarkable that the same people who declare global climate change a myth also have called for “quarantines” for West Africa. Do they want failing states to collapse? Warlords to win control? Economies to depress? You can stop airlines – people will still move.

Perhaps the only way to get infection real attention – since virtually no politician utters the  term “public health” – is to define it as a security issue. There is precedent. In past centuries, public health services were part of military or police services, absolutely necessary to protect the nationc.

Now we really need to protect the public health. Some measures we can take include:

1. Setting up a series of military and university hospitals to act as centers for epidemic treatment. If Presbyterian Hospital in Dallas screwed it all up, just imagine what our community hospitals will do if a real epidemic tests their infection control systems.
2. Demand vaccinations for people without the many loopholes allowed to “opt-outs.” We need vaccination programs that work and are efficient – particularly when the day comes that we’ll need their instantaneous use. If Ebola in Africa is a threat to America, your kid’s measles is a threat to mine.
3. Markedly stepped up research and funding for vaccines, antibiotics and antivirals. Big Pharma amply deserves to be publicly shamed – especially in the U.S., where our ludicrous government drug procurement policies guarantee us the most expensive drug care ever.
4. Put health to the fore rather than medical care. In the twentieth century, lifespan vastly increased especially in “developed” countries. The reasons? Vaccination, education, sanitation and nutrition. That is still true. Health is where you save big bucks, not medical care. A healthy economy requires a healthy population.

So does a truly healthy nation. What did we learn from 9/11? As the mess with ISIS, the advantaging of Iran, and our unpreparedness for novel bioweapons shows, we learned something important – that we don’t learn well or quickly.

We need to get smarter pretty fast.

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