THE GIST: Our global society offers germs a frequent-flier upgrade, even as indiscriminate apps of antibiotics put bad bugs on a strength-and-conditioning program. We've been warned but we're not acting fast enough - so we're about to get our butts kicked.
FALSE ALARM: But can't modern science heal everything? Not yet. The benefits of genomics and tissue engineering lie years in the future. And the headline-grabbing hurt caused by bovine spongiform encephalopathy, much less the human immunodeficiency virus, could be upstaged by tomorrow's news: More than 20 new pathogens have emerged since the late 1970s - like 1999's Nipah virus in Malaysia, which seems to have jumped from pigs to people, killing 111. Some years, say experts, we barely dodge a global flu pandemic.
EXHIBIT A: Just look around. Germs hitch rides on international trade: Raspberries picked in Guatemala can be on US grocery store shelves the next day, along with Cyclospora cayetanensis, a parasite. War, natural disaster, political unrest - these erode public health and send masses of carriers across borders. TB caused 30 million deaths worldwide from 1990 to 2000, and now, multiple drug-resistant tuberculosis (MDRTB) is rampant in Russia, Peru, and other countries. Latest superbugs? A new drug-resistant plague reported in January 2001 in Madagascar and an African plant fungus that kills people and is apparently immune to antifungal drugs. Oh, and bioterrorism is looking like a real threat - possibly involving smallpox, the bug that supposedly went away forever.
WORDS TO LIVE BY: "This blend of new as well as resurgent older diseases is planetary in scope and threatens all countries, rich and poor." Health as a Global Public Good
ON THE RISE: Governmental public health operations are lurching into motion. In September 2000, the national Centers for Disease Control and Prevention authorized new production of smallpox vaccine - the stuff was 20 years old and the US had only 15 million doses. The CDC is haranguing states lacking good public health resources to get on the bandwagon - as of February 2001, only nine states were part of the Emerging Infections Program network. And the 140 member countries of the Biological and Toxin Weapons Convention are seeking new rules giving them power to investigate disease outbreaks that look suspiciously like biowarfare. Delegates to an April 2000 meeting of the World Health Organization agreed to establish a Global Outbreak Alert and Response Network like the current 112 flu surveillance centers in 85 countries. But while the bureaucrats talk, experts warn that bugs are here to stay. The only way to prevent a superplague, they say, is a new global public health action plan.
FUTURE REFERENCE: Centers for Disease Control and Prevention (www.cdc.gov/mmwr); Betrayal of Trust: The Collapse of Global Public Health, by Laurie Garrett; ProMED (www.fas.org/promed); World Health Organization (www.who.int/disease-outbreak-news)
