The Age of Plagues

It wasn't that long ago that medicine declared a victory over infectious disease. Now a raft of new and mutating bugs are at the door, and a declining public health system is in no shape to fight them.

And still, he says, there's nowhere near enough. Triage is standard practice, he says, as the department chooses which of the potentially threatening leads it receives will be followed up on. Federal funding is projected to stagnate through 1997; salaries for the researchers are way below what they would be in the private sector. The department's freezers are holding thousands of vials of blood from newborns, waiting for the CDC to resume funding for an HIV screening program; if cutbacks continue at the present level, Osterholm says, "we're not even going to be able to tell you in a meaningful way what's going on with AIDS in this state. We feel as if we're in societal quicksand much of the time."

It's a fairly safe bet that funding to tackle emerging infections won't reach a level that public health officials deem adequate anytime soon. Even if it does--if, say, there's a particularly mediagenic plague that forces policy makers into action--it won't be enough. Epidemiologists may be able to spot diseases sooner rather than later, which would have benefits: Finding the Schwan's salmonella outbreak even a week earlier, Osterholm says, would have saved millions in health expenditures. Still, epidemiology's work by nature is after-the-fact. They can do very little, except issue warnings, about the reasons why bugs emerge in the first place.

There are two main culprits: poverty and environmental destruction. Already, close to half the world's population lives in a couple dozen "megacities" with populations of more than 10 million each. Most of them are in the Third World, but they also include Tokyo, New York, and Los Angeles. Slums of some description make up an ever greater share of these cities; the people who live in them lack decent nutrition (which in itself staves off many of the basic infections), housing, or health care. Of the halfway lucrative jobs, many are in drugs and prostitution. Open sewers, common in Third World cities, can make one person's waste the next person's drinking water. And in New York City, reports of rat bites to humans went up 70 percent between 1992 and 1993. (The city's rat-control budget continued to be slashed during the same period.)

On the environmental score, scientists have long pointed out that they have no clue what exactly lives in the forests of the world. There's some evidence that bugs that so far have bothered only deep-woods creatures are making the jump to humans as urban sprawl, mining and oil drilling encroach on their habitat. Global warming is one of the suspected causes of massive algae "blooms" on the world's oceans, offering parasites unprecedented options. (Contaminated algae, picked up in the bilges of ships, are thought to have brought the current so-called Seventh Pandemic of cholera to South America.) And insects and other disease "vectors" change their habits when the climate shifts: The mosquitoes that carry dengue and yellow fever have been slowly expanding their range throughout the southern and central U.S. They are not "in Minneapolis right now," Notre Dame entomologist George Craig told the Los Angeles Times in 1991, "and the reason is temperature. Will [they] go to Minneapolis if global warming occurs? The answer is yes."

"The survival of the human species is not a preordained evolutionary program," writes Joshua Lederberg, a Nobel laureate and one of the most prominent prophets of emerging infections. "We have beaten out virtually every other species to the point where we may now talk about protecting our former predators. But we're not alone at the top of the food chain."

Or, as science writer Laurie Garrett puts it, "humanity will have to change its perspective on its place in earth's ecology if the species hopes to survive." People will never win the "war" on microbes, she suggests; the metaphor itself is useless, suggesting a malevolent enemy that can be wiped out with just the right weapon. The best hope is not to conquer the microbes--witness the short history of antibiotic euphoria--but to avoid fatally tilting the balance. "It's either that," Garrett concludes, "or we brace ourselves for the coming plague."

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