# 564
In an increasingly crowded world, one where people in developing countries often live in close proximity to livestock, and one where we continue to burrow ever deeper into jungles and swamps to carve out new places to live, work, and grow crops, the danger of emerging infectious diseases only grows greater with every passing day.
While the focus of this blog as been on the H5N1 threat, it isn't the only one out there. Not by a long shot.
The truth is, the world is filled with pathogens. Nasty ones, capable of killing millions. And we are at risk of seeing one or more of them bloom into an epidemic, or a pandemic, at almost anytime. New strains of bacteria and viruses are showing up, or are being discovered, and old enemies, once believed defeated, are coming back for another round.
The calls for Avian Flu preparedness, while centered on the bird flu virus, also takes into account these other threats. If we were prepared to handle an influenza pandemic, we would, at the same time, be prepared to handle an outbreak of SARS, or XDR-TB, Dengue, Chikungunya, or some other, as yet to be identified disease.
But the truth is, we’re not anywhere near prepared.
We worry the most about influenza, because it is so easily spread. Once unleashed, it can spread around the world in a matter of weeks or months. And a novel strain, such as the H5N1 virus, has the potential to kill many millions of people.
But many scientists see XDR-TB (Extreme Drug Resistant Tuberculosis) as being an equally devastating, although slower growing threat, should it continue to spread. XDR-TB is a new version of an old scourge. Tuberculosis, what used to be called consumption, and what was, when I was a child, still a major problem here in the United States, is on the rebound.
XDR-TB is a new and improved version of Tuberculosis. Unlike its predecessor, it is highly resistant to the drugs we have available. Another version, MDR-TB (multi drug resistant Tuberculosis) is even more prevalent today, although there are still second line drugs available to treat it. XDR is virtually untreatable.
MDR and XDR TB are both the result of, and an indictment of, our poor global public health system. It appears to have sprung forth from inadequate treatment of traditional tuberculosis, where patients received, or followed, an incomplete regimen of treatment.
It is, quite literally, a self inflicted wound. One caused by apathy, and incompetence.
We’ve largely ignored the problems of disease in developing nations because it didn’t appear to directly affect us. After all, what happens in a village in South Africa, or a refugee camp in the Sudan, while tragic, falls pretty far down our list of priorities.
We do provide foreign aid, and medical supplies to these regions, and without that generosity, things would be far worse. But it is nowhere near what they need. And that shortsightedness may come back and bite us in the posterior.
Admittedly, developing nations have done a poor job utilizing the aid we’ve provided, and one could argue that sending more resources for poor stewards to mismanage does little good. But the alternative is worse, and we could certainly improve the way the money is spent, if we tried.
The disease that runs rampant through Sub-Saharan Africa today could well end up on our plate tomorrow.
Public health expenditures are an investment in our future. We don’t always see a return on that investment immediately, but in the long run, they do pay dividends. The pandemic that was avoided, the outbreak of disease that was stopped at its source, or the eradication of a disease threat, while not something that makes the newspaper headlines, is no less of a victory for mankind.
We can no longer hold onto the old idea that we are somehow protected by oceans, or distance, from these emerging infectious diseases. They are but an airplane ride away from anywhere in the world. A failure to stop them at the source all but guarantees that someday, we will be dealing with them on our doorstep.
AIDS, which has killed as many as 25 million people since it emerged in the late 1970’s, is a prime example of what can happen when an emerging infectious disease is poorly addressed. Unlike Influenza, AIDS is a slow moving, yet continually escalating pandemic. Our slow response, along with the rest of the world, to AIDS in the early 1980’s is largely responsible for its prevalence today.
We spend tens of billions of dollars each year to protect ourselves against threats, real or imagined, that would, if they happen, claim far fewer lives than a mild influenza pandemic. And yet, another pandemic is inevitable. It is just a matter of when.
This year, the budget for the DHS (Department of Homeland Security) is 42.7 billion dollars. The 2008 budget for the CDC (Centers for Disease Control) is just 8.8 billion, which reflects a decrease of 168 million dollars over the 2007 projection.
While protecting the homeland from terrorism is a laudable goal, which threat poses the greatest risk to Americans? Disease or terrorism?
It doesn't have to be a choice of between funding one department or the other. At least it shouldn’t be.
We waste money, lots of money, on dubious projects all the time. Billions of dollars in pork spending, most of it designed to aggrandize political ambitions and to assure re-election of public officials, gets neatly tucked into spending bills each year, and yet we ignore the real threats to our nation.
Our `war on drugs’ incurs an annual budget of $20 billion dollars, and has shown little in the way of positive returns. Escalated 35 years ago by President Nixon, this `hot button' issue has cost us hundreds of billions of dollars. Money that arguably, could have been far better spent.
Our war in Iraq has cost us over the past 4 years, conservatively, $400 billion dollars. Right or wrong, the decision to wage that war was based on a perceived threat. But which threat endangers our country more? A dictator in Iraq, or a failing public health system in the face of multiple emerging infectious diseases?
The debate over our war in Iraq is a contentious one. But even allowing that it may have been necessary (demonstrating an enormous amount of largess on my part) , if we can find the money to fight that threat, we should be able to find the money to fight an even greater threat to our nation.
Imagine what even $100 billion extra dollars would have bought, a quarter of what we've spent on the war, had it been spent on public health. How many American lives it would have saved over the past few years, and how much better prepared we could be today to face a pandemic.
We might already have a universal flu vaccine by now. Or at the least, the capability of producing a pandemic vaccine in sufficient quantity. We could have substantially improved our emergency departments in hospitals around the country, trained more nurses and first responders, and have stockpiled the equipment needed to mitigate a pandemic.
And yes, we might have been able to provide enough assistance to developing countries so that they could have eradicated the H5N1 virus early on, thereby removing the threat.
But of course, we didn't.
Somehow, investing $100 billion dollars to save millions of lives, both here and abroad, is all but unthinkable. But it would have been a wise investment.
Simply alleviating our critical nursing shortage and improving our hospital facilities would be paying dividends today in terms of lives saved, even without a pandemic.
Obviously, our priorities are all screwed up.
We’re told it will take an investment of $10 Billion dollars to set up a global influenza vaccine development program. A horrendous expense, according to some. Yet that is 1/40th of what we’ve spent in Iraq to date. How many lives would this save from seasonal influenza alone? Even if a pandemic never happens.
Should H5N1 break out tomorrow, or if SARS should return, or XDR-TB takes off, we will have inadequate resources to combat them. Hospitals have insufficient staffing, far too few beds, and not nearly enough PPE’s (Personal Protective Equipment) to deal with a crisis. Our supplies of medications, such as Tamiflu, and even antibiotics, will prove far from adequate.
Officials will simply shrug their shoulders, speak of `inevitable but unavoidable losses’, and point out we had other priorities. Pandemics happen. People die.
But we had a choice in the matter. We could have invested in our future, and our children’s future, by spending our tax dollars where they would have done the most good.
We just couldn’t see it.
And that's the problem. We almost never see it until it is too late.
Our failure to upgrade the levees in New Orleans in the 1970's, at a time when it would have cost perhaps $10 billion dollars, has now cost our nation hundreds of billions in damage and lost revenue, and an appalling loss of human life. For thirty years, experts had warned what would happen should a major hurricane strike that city, and no one listened.
It isn't too late to change our priorities, and to address the real threats we face. We just have to be willing to see them.
Our public health system is our national levee against a rising tide of emerging infectious diseases. It is an all too thin line that separates us from a public health disaster.
We can either choose to build them up to withstand emerging threats, or we can suffer the consequences.
Again.
