A review of THE COMING PLAGUE: NEWLY EMERGING DISEASES IN A WORLD OUT OF BALANCE by Laurie Garrett, published in 1994. CHAPTER 17: SEARCHING FOR SOLUTIONS
$178 billion a year from the world’s poorest nations to the richest
Former CDC director Dr. William Foege felt that new disease emergence was tightly linked to Thirdworldization: the overall status of health care, immunizations, sanitation, education, and total burden of disease in a society. Structural adjustments ordered by the World Bank and the International Monetary Fund, coupled with a genuine capital crisis following the fall of the Berlin Wall, had severely worsened the human condition and improved odds for the microbes. More than $178 billion a year was flowing from the world’s poorest nations to the richest in the form of debt repayments, while a third of that amount flowed in the other direction in the forms of loans and foreign aid. “This is a public health crisis. One trillion dollars is spent on weapons annually. Of the fourteen million kids who died in 1989, nine million deaths could have been prevented for $2½ billion. And that’s what’s spent in the United States annually for cigarette advertising.” Due to globalization of the microbes it was impossible to ensure a disease-free existence for people in North America and Western Europe without providing similar assurances for residents of Azerbaijan, Côte d’Ivoire, and Bangladesh.
Global thinking was no longer in vogue
After years of battling Lassa, McCormick and Fisher-Hoch saw civil war in Liberia and government instability in Nigeria wash away all their efforts and outbreaks of the rat-borne disease become commonplace. The links between poverty, lack of basic health care, ecological disturbances, and the emergence of dangerous microbes were so obvious as to be basic tenets of public health. Yet this kind of global thinking was no longer in vogue at CDC and WHO or inside the federal health bureaucracies in Washington, Paris, and London. In the spring of 1993, McCormick and Fisher-Hoch left the CDC, moving to Pakistan to do what they believed was the last hope in the war against microbes: train people in poor countries to conduct their own microbial search-and-destroy missions.
Microbes such as HIV will continue to successfully emerge
For the near future it seems that slow microbes such as HIV will continue to successfully emerge globally because Homo sapiens have no means for detecting organisms that enjoy years-long latency periods: detection comes only after disease has appeared. Most of the world is too bereft of infrastructure or too remote for even rapidly appearing microbial events to be recognized before full-scale outbreaks, or epidemics, have occurred. It might be possible to prevent full-scale epidemics, however, by concentrating efforts on sites of amplification: behaviors or conditions that assist microbes in making the leap from emerging into handfuls of Homo sapiens to widespread infection of a given human population. Amplifiers might make the difference between an infection level of less than 0.1% in a group of human beings and a 2% to 10% incidence of infection.
Multiple partner sex
From the information amassed from disease emergences it is possible to identify several amplifiers. At the top of the list in the 1990s has to be sex: specifically, multiple partner sex. The terrifying pace of emergences and reemergences of sexually transmitted diseases all over the world since World War II is testimony to the role that highly sexually active individuals, or places of sexual activity, play in amplifying microbial emergences such as HIV-1, HIV-2, and penicillin-resistant gonorrhea.