ZKEA

Emerging Diseases : Biological Terrorism : Biological Warfare

Health Policy

We tend to ignore history, especially the commonplace tragedies that once afflicted our species. Who remembers the terror of polio, or of yellow fever? Who considers what life must have been like in the days of the Black Death? We forget what happened only a few decades ago - let alone what happened centuries ago. We think every day is just like this day. We lack perspective.

This lack of perspective is a fault of our species. In evolutionary terms, Homo sapiens had little reason to evolve fine discrimination of long term trends and patterns. Life was short, and it was more important to know how live on a daily basis. This served us well when we lived in caves, ate mammoth meat and considered 30 years a ripe old age. Worrying about the longterm future or ruminating too much on the past didn't profit a person - for the past, present and future were always pretty much the same. Therefore why waste precious calories even considering them? But in this modern world, changing at ever-increasing velocities, this attitude can be fatal. Yet we still live with a Neolithic consciousness.

We see the effect of this in the case of health care and governmental health policy. Our sense of history is skewed and our understanding of the relative nature of threats is lacking. Because of this we are ill-prepared to face the coming biological storm.

Throughout history infectious disease has been the great killer of humanity. Billions have perished, nations and entire cultures have been destroyed, untold lives have met with tragedy. No one needed to be educated about this threat - it was a clear and present danger in everyone's life prior to the 20th century. Even ignoring the great epidemics, daily life was burdened by the latent fear and reality of disease. Letters to relatives invariably started with anxious enquiries about their recipient's health. Even in the hottest war, soldiers were more likely to die from disease than actual combat. Children in some societies were not named until they were a few years old, given it was more likely than not that a childhood virus would kill them. Why bother giving a baby a name until you knew he'd live to be five years old? Disease was the foundational terror of humanity.

Therefore, with very good reason, modern health policy had a very disciplined focus towards disease. This took a variety of forms, such as ensuring non-polluted water supplies (managing cholera), rat and mosquito control (managing plague and malaria), widely-distributed health clinics and antibiotics (for early warning and quick management of outbreaks) and wide-spread mandatory vaccination programs (for many viral diseases). These and other programs grew organically, withstood the test of time, and in many countries largely eliminated the terror and huge mortality these diseases inflicted. Because of this such epidemics have passed into dim history. No longer do we need to worry about millions dying one month from a viral outbreak, no longer do we need to hide our children at home during periodic polio epidemics. We believe all that is ancient history, no longer a threat to our lives.

Therefore in much of the world, health care has been cut back or refocused to other issues. In an era of "small government" and hyper-capitalism, health care for the poor is increasingly marginalized. Meanwhile, the wealthy segment of the population fears other things, such as cancer, heart disease and geriatric diseases. Health care is therefore increasingly focused on these illnesses, to the exclusion of the classic pathogenic challenges.

Thus drug companies, for their part, have largely abandoned new antibiotic and vaccine development due to the lack of investment return and concerns over legal liability. Meanwhile, governments increasingly view basic health management has an optional expense, one that can be cut or perhaps privatized with no health cost to the public. And there have been pernicious social changes as well. For example, there is now widespread resistance to the very idea of vaccination. Some even doubt that viruses and bacteria cause disease, instead preferring crazy New Age explanations or conspiracy theories (witness the belief by some that HIV does not cause AIDS). Although these are personal stances, they will eventually have fatal repercussions for the ability of societies to manage disease and avoid future epidemics.

In many countries outright governmental and social failure is another critical contributer to the problem. In large parts of Africa, for instance, failed states have largely abandoned their health systems. What does function is often financed instead by western donors and aid agencies. The problem is less acute in Asia and Latin American, but even here weak states are increasingly unable to fulfill their basic health system obligations.

As a result of this, infectious disease is on the increase throughout the world. Pathogens are increasingly immune to current drugs and new drugs are no longer being developed. New pathogens are emerging due to human population growth and environmental degradation. Some richer people in the western world might believe these problems are far away and could not possible affect them. These people need only consider that fact that microorganisms pay little heed to national boundaries. Nor are they confined to a specific social class or race. Thus a seemingly abstract problem with the breakdown of health care in southern Africa can have direct implications for a wealthy person living in Dallas. We live in a very small and interconnected world - something our Neolithic consciousness hasn't quite yet grasped.

Already the effects are stark and far ranging. Deadly pathogens, having evolved resistance to most drug regimes, now stalk the world. Hospitals are one of their prime incubators. In fact, a heart-transplant patient in a U.S. hospital is nowadays far more likely to succumb to a drug-resistant virus or bacteria than to any effects of the surgery itself. Similarly, drug-resistant malaria is now creating new threats in much of the developed world. However, few new drugs are being developed to deal with the rapidly-evolving microbial world. And degraded health systems are increasingly unable to monitor and detect new threats. Mankind is on the precipice.

And yet, this risk is still largely unfelt. Having little sense of history and relative risk, the public is largely oblivious of these approaching dangers.