ZKEA

Biological Terrorism : Emerging Diseases : Biological Warfare

Drug Development & Vaccines

Humanity has held a variety of beliefs about the origin of disease. In the past, illness was variously attributed to animistic spirits, witchcraft and the imbalance of the fluids or "humours" of the body. The ancient Chinese devised a complex system revolving around a set of abstracted basic elements, such as wind and water, and their relative place within the energy fields of the body. The Greeks and Romans blamed disease on the effects of bad air. (The Latin term for which evolved into the word "malaria".) Mankind never lacks for explanations on any given phenomena, and disease was no exception.

Treatment of disease was determined by the prevailing medical theory of the time. Bad air was treatable by perfumes and vapors, whereas animistic causes demanded charms and spiritual intervention. Imbalanced humours often required more direct action, such as bloodletting. These methods were usually not very effective, but were rarely questioned. This is also a hallmark of our species: we tend to believe things that make us feel comfortable but have no foundation in empirical fact.

That said, by simple observation and trial-and-error, some societies evolved effective strategies against a few diseases. For example, the Chinese invented a form of vaccination many centuries ago. This vaccination method became very visible during the early Islamic period when traffic along the old Silk Road was at a peak. Then it was commonplace for merchants to have a deep cut made between their thumb and first finger, into which cut was rubbed the dried scabs of a smallpox victim. Usually the patient developed a mild form of smallpox. Sometimes the patient was unlucky and developed a full and fatal case of the disease. But the risk was worth it, for the shock of this procedure flooded the body with smallpox antibodies, enabling the merchant to traverse Asia with immunity to this deadly disease.

Other societies applied different techniques. For instance, ancient hunting-and-gathering people had intimate knowledge of medicinal plants, many of which had powerful and precise antibiotic and antifungal properties, that were quite effective against a range of pathogens. In addition, such societies were often quite aware of the ecological matrix of disease. Tribesmen of New Guinea knew to stay above a certain elevation at all times - for descending into the lower elevations meant certain death in the form of deadly disease transmitted by insects. Virtually the entire New Guinean population lived in the mountain plateaus whereas the lowland jungles were uninhabited. Similarly, nomads in Mongolia knew to keep away from indigenous rodents, which were carriers of bubonic plague.

With increasing urbanization, much of this lore was lost. Individuals lived divorced from their environmental context and therefore had little feel for how illness spread. Simultaneously, mankind became much more victimized by disease due to concentrated population. The ironic effect was that "civilized" man suffered far more illnesses and greater mortality than his primitive ancestors; the average lifespan of a city-dweller prior to the 19th century was much lower than that of contemporary forest tribesmen or ancient mammoth-hunters. Cities were good for many things, but not for human health. They were, in fact, usually population sinks; deaths exceeded births. If not for regular migration from rural areas, such cities would not have been able to maintain their population levels. It is little wonder that wealthy urban families, from Roman to modern times, usually kept a rural villa as well. The countryside was far safer.

This situation continued well into the 19th century. Only then, as a result of improvements in public health, the adoption (over fierce medical and religious resistance) of the Germ Theory of Disease, and the early beginnings of effective drug treatments, did pathogens become more manageable. Interestingly, many of these early efforts were in fact rediscoveries of ancient practices. For example in the early 18th century, Mary Montague, a British aristocrat, learned of the ancient Chinese practice of smallpox inoculation while living in Turkey. She introduced the practice in Britain. Eventually the technique was picked up, refined and popularized by Dr. Edward Jenner, who thus became the "inventor" of vaccination. (Mary Montague received no recognition and, in fact, avoided the public eye because she suffered severe facial scarring from her own bout with smallpox.)

Similarly, the gold-standard of malaria treatment for many centuries was quinine. This drug was "discovered" by monks in the Andean forests, who observed that the native Incans made a beverage from the bark of an indigenous "fever tree", the chichona. The active ingredient of this preparation - the alkaloid quinine - eliminated the symptoms of malaria. As there was no alternative treatment for malaria at that time, quinine was rapidly accepted. Beyond saving Europe itself from the ravages of malaria, quinine became essential to European colonial efforts. Without it, it would have been impossible for Europeans to inhabit many of their malarial tropical outposts. Quinine literally became a life-saving drink for the white man.

In the 20th, century drug-discovery and development became big business. With the basic scientific foundations in place, antibiotics and vaccines eliminated disease after disease. It was a golden age, and it was widely assumed that epidemic disease was relegated to the past. By the close of the century, the plagues that had terrorized humanity for ages became footnotes in books - not even a memory to most people. Most new anti-bacterial and anti-viral drug research ceased. Vaccinations for childhood diseases became increasingly "optional". (With the general fall in education standards and backlash against science in the U.S., some even doubted that vaccines and drugs worked at all. Witness the recent efforts to deny that HIV is the cause of AIDS.)

But beneath this bright surface, dark forces were rising. As the global environment deteriorated and populations multiplied, the quality of public health began to decrease over much of the globe. As a result new viruses such as HIV and ebola appeared, for which there was no cure. In addition, old diseases silently evolved resistance to drugs and became more menacing. This evolution was greatly aided by over-prescription of antibiotics by physicians and the increasingly compromised immune systems in individuals, providing millions of ideal genetic recombination labs for mutating viruses and bacteria. Very quickly mankind's defenses against disease began to weaken. For example, quinine is now totally ineffective against malaria - as are a host of other drugs that once provided protection. There exists in the world today untreatable malaria, a situation not seen in two centuries. Other diseases such as tuberculosis developed similar resistance to multiple classes of antibiotics. As a result, illness and mortality from disease is increasing around the globe. Even in the best hospitals in the western world, viruses and bacteria that are resistant to all known treatments are becoming increasingly common.

Even darker trends are now at work, for the advancement of biological science is increasingly put to negative as well as positive use. The molecular basis of pathogenesis is increasingly well understood. It is now possible to engineer deadlier diseases, more virulent and resistant to all forms of treatment. Such pathogens, released either by war, by terrorism, or simply by accident, would devastate our species. Medical science currently has no answer to this threat.

Some individuals are addressing this situation and working towards solutions. A few drug companies have begun development of new classes of antibiotics. Public policy is very slowly becoming more aware. For example, physicians are now encouraged to avoid the overuse of existing antibiotics, so as to slow down the evolution of bacterial resistance. Various non-profit groups are working to introduce new treatments to the developing world, where the options are limited and becoming fewer. Also, smallpox vaccines are now being redeveloped and applied on a large scale.

Even so, we face a massive crisis, a "Revenge of the Germs". This section documents efforts in developing new drugs and treatments, and also provides a historical perspective.