SARS-CoV-2. Monkeypox. Polio. Marburg. Because of their recent intrusions in human populations, these viruses have become household names and not just a matter of concern for public health experts. While pathogens are not new to the world, people have had to deal with them in the past. However, these attacks are more frequent and more severe than before.
“We are going through an era of epidemics and pandemics, and they are going to be more complex and more frequent,” says Jeremy Farrar, director of Wellcome, a global health charitable foundation that addresses health challenges. “We tend to see each [outbreak]Each episode can be considered an episode in itself. But the truth is that they are almost all a symptom of underlying drivers, all of which are part of 21st-century life.”
We have seen cases of Marburg (a deadly cousin to the Ebola virus) and polio infected individuals before. We’ve even seen earlier versions of SARS-CoV-2 in the coronavirus outbreaks of 2002 and 2012. These outbreaks are growing rapidly, almost simultaneously, so why?
The explanation lies in a gathering perfect storm of factors that taps into nearly every way we live our contemporary lives—from the ubiquity of worldwide travel to humans’ deeper encroachment into previously untouched natural habitats and the modernization that has led to climate change, urbanization, and overcrowding. Social media communication is a contributing factor, as misinformation can be shared and believed and elevated in the same way that trustworthy information. There is also the unstable and volatile balance of geopolitics, driving millions out their homes to seek refugee camps or migrant housing. These are prime areas for spreading infectious diseases.
Simply put, the multitude of infectious diseases facing the world today is “just the evolution of microbes and humans coming to a collision course,” says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
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As people become closer to nature, this interface becomes more frequent. For example, influenza viruses live in birds, but coronaviruses are found in bats. Both viruses can spread to other animals, and this is increasingly affecting areas where people come into contact.
These interactions are more common due to climate change, deforestation and urbanization. Experts believe that Ebola’s 2014 outbreak was likely exacerbated by urbanization, which has resulted in more people moving into cities with dense populations than was the case in 1970s when it was first identified. “In the 1990s and 2000s, Ebola hadn’t changed; what changed was that Ebola had been a rural-village disease that had affected isolated villages, but hadn’t reached big urban centers,” says Osterholm. Urbanization and overcrowding in large cities where sanitation and social distancing aren’t always practiced mean that viruses and bacteria find it easier to seek new hosts.
Urbanization has also led to improvements in travel. And air travel doesn’t just transport people; it also brings whatever viruses and bacteria they may be harboring to other parts of the world in a matter of hours. A recent example of this is monkeypox, which reached 94 countries within three months. This virus which is highly contagious in Central Africa and Western Africa, traveled to other countries via festivals and then arrived in countries with few cases. “If monkeypox had happened 100 years ago, the world would hardly have seen any real global challenge, because transportation was so slow and incomplete that it wouldn’t have spread the way modern air travel can make happen,” says Osterholm.
Another force may also be at work, making these confrontations between pathogens and people more serious and more fatal. Viruses and other microbes aren’t individual agents of disease, but exist as a dynamic and ever-evolving community. Pathogens such as viruses can adapt to every human contact, becoming more proficient at infecting or causing disease. That’s likely the case with coronaviruses; SARS and MERS, for example, caused infections with high fatality rates but were not transmitted very effectively from person to person. SARS CoV-2, the next-generation virus, was finally able to easily spread from one person to another.
Monkeypox may have a similar effect. The virus began showing signs of improvement in U.S. scientists working in conjunction with Nigerian counterparts several years back. “They were seeing that the virus was more efficient at transmitting disease from human to human,” says Dr. Raj Panjabi, senior director for global security and biodefense at the White House National Security Council. “That’s an alarm bell. The virus has adapted more to this signal, so it could be that transmission was altered. [live] among us.” Farrar notes that with each previous monkeypox outbreak in Africa, the chain of contagion—one person infecting another—has gradually gotten longer, “and the infections last longer,” he says. “Instead of one or two people infected, it’s now five to six people, then 10 to 12 people.”
Osterholm claims that the entire world is in danger because of all these converging forces. “Any one of these on their own is a problem for public health,” he says. “Add them all together, and you get a crisis.”
Are humans really capable of surviving? “I think we are at the most vulnerable we have ever been in my professional career,” says Farrar. He sees the biggest threat to people’s ability to stave off major pandemics coming from our inability to cooperate, share public-health information, and mount an effective defense against infectious diseases. “Putting aside biodiversity, land use, protection of habitats, and social media, the biggest challenge is geopolitics,” he says, citing the aggressions in Eastern Europe, East-West tensions and the inequity of health resources and health infrastructure between developed and developing countries. “Unless we resolve geopolitical issues, then I’m afraid that we won’t have sight of what is emerging from China, Europe, Africa, the Americas, and Southeast Asia. We’ve got to get back to understanding that the world is very small, and we are interconnected.”
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It is possible that COVID-19 or other outbreaks will finally bring about a greater global understanding of the importance for cooperation. The World Bank recently mobilized a $10 billion annual fund dedicated to helping countries in the developing world improve their surveillance methods for detecting and—most importantly—sharing information about unusual cases of infectious diseases that could represent new public-health threats. The funds will bolster these countries’ networks of community health workers and lab-testing capabilities, as well as their access to tests, vaccines, and treatments. Farrar notes that global contributions to the fund, including from China, are hopeful signs that “maybe this is one way to bring the world back together again” around the challenge of pandemic preparedness.
However, developed nations must set an example. American is showing some improvement. After it had been disbanded under the Trump Administration, President Biden reinstated the Directorate for Global Health Security and Biodefense. Biden proposes a record $88billion in preparation for next pandemic. The investment will be made over five years and would focus on testing, vaccine research and treatment. It also prioritizes investment in new diseases monitoring and the building of supplies of personal protection equipment. “There has never been that much money requested for pandemic preparedness and global health security ever,” says Panjabi.
It will not be easy to secure this money. But such investment is ultimately the most cost-effective way to combat public-health threats, before cases of a new disease turn into clusters—then outbreaks, epidemics, and pandemics. “The more we do to strengthen national public-health institutes—not just in the U.S. but around the world—the more prepared we will be,” says Panjabi. “These investments build towards the ambitious goals, such as developing effective vaccines and therapeutics within 100 days of identifying a threat, producing sufficient quantities to vaccinate the United States population within 130 days, and supporting surge production to rapidly meet global needs.”
To survive the constant stream of emerging diseases, we must be able to quickly respond and do so effectively. “Microbial evolution is alive and well,” says Osterholm. “We are fighting an enemy that is growing and changing every day to accommodate as the world changes.”
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