Gentlemen, it is the microbes who will have the last word

by U.S. Medicine

November 12, 2016
Editor-In-Chief, Chester "Trip" Buckenmaier III, MD,  COL (ret.), MC, USA

Editor-In-Chief,
Chester “Trip” Buckenmaier III, MD,
COL (ret.), MC, USA

Gentlemen, it is the microbes who will have the last word — Louis Pasteur (1822-1895) 

After seven months of bickering and posturing by both parties in Congress, a bill allocating $1.1 billion to deal with the emerging Zika crisis was finally passed on Sept. 28, 2016.  The Zika funding was part of another bill to avert a government shutdown at the end of the fiscal year. 

While the failure of Congress to pass a bipartisan budget plan for the country is concerning as an issue itself, congressional failure to fund a timely and comprehensive response to this latest viral outbreak concerns me greatly. Zika, spread mostly by the bite of an infected mosquito, can pass from an infected pregnant woman to her fetus and is associated with dreadful birth defects. With no vaccine for the virus presently, Zika is spreading with some rapidity in the United States.1

Viral plagues are not unusual in human history, and the impact of these events on the human condition can be overwhelming. With the arrival of Europeans in the Americas, native populations were devastated by a variety of illnesses, with the most notable being smallpox. The smallpox virus wiped out entire Native American villages and likely facilitated the eventual dominance of European settlers over the continent.

Perhaps one of the better modern examples of the catastrophic impact of viral illness on a human population was the influenza pandemic of 1918 that I have described in this column previously.2 During this worldwide viral pandemic, approximately 675,000 Americans succumbed to a particularly virulent “Spanish flu” virus, far outpacing the death toll of Americans in WWI. America and the world were particularly unprepared to deal with this deadly flu.

In more-recent memory, the Ebola virus outbreak that began in 2014 represents another example of an anemic and discordant American response to a global health crisis. The Presidential Commission for the Study of Bioethical Issues published Ethics and Ebola: Public Health Planning and Response in 2015.3 The goal of the report was to “create recommendations that support policies and practices that enable a proactive response to public health epidemics.”3

The response to the Ebola outbreak in Africa raged out of control for months, with thousands of Africans succumbing to the disease before our government finally reacted–only after infected Americans began arriving back from Africa within our own borders. Although the American response did turn the tide of this outbreak, the Presidential Commission was highly critical of the government’s slow response to the crisis, highlighting the need to respond to epidemic outbreaks at their source in a timely manner to effectively protect the American population from disease that can spread rapidly throughout our world.  The commission chair, Amy Gutmann, PhD, in explaining why the commission developed the report on this issue stated, “Both justice and prudence demand that we do our part in combating such devastating outbreaks. Once we recognize our humanitarian obligations and the ability of infectious diseases to travel in our interconnected world, we cannot choose between the ethical and the prudential. Ethics and enlightened interest converge in calling for our country to address epidemics at their source.”

The recent response to Zika is only the latest example of our government’s inability to respond to global health threats in a proactive and timely manner. Lawmakers were not confused about the need to fund efforts to combat the spread of Zika; rather, the bill was bogged down when it became another battleground for partisan politics waged through amendments having nothing to do with funding for the Zika outbreak. From my perspective, we must become more nimble and efficient in responding to disease outbreaks globally, if the government has any expectation of protecting our population from the next pandemic on the scale of the Spanish flu in 1918. The world’s population has expanded vastly since 1918, and the movement of people around the planet is unparalleled in history. National borders, oceans and distance, as we have seen with the recent spread of Zika, are ineffective barriers to the spread of infectious disease to the American population. 

The 2016 report from the independent Commission on a Global Health Risk Framework for the Future4 stated, “For far too long, infectious disease has been the neglected dimension of global security. Few threats pose such risks to human life and well-being.” I absolutely agree. I believe the threat to the nation’s social and economic security from a global pandemic far outpaces other threats that seem to occupy far more attention and investment from our leadership. We must become as dexterous and efficient at responding globally to disease outbreaks as we have become at hunting and eliminating terrorist leaders. The investment in global health outreach should be no less of an issue for Homeland Security that the investment in combating terrorism. If the history of infectious disease outbreaks is any gauge, the threat to the American population from disease is the more distressing and immediate danger to our security and way of life. 

Fortunately, federal medicine is waking up to the critical need for global health engagement. At the Uniformed Services University (USU), a new Center for Global Health Engagement (CGHE) has been established with a mission “to ensure national security by supporting the missions of the Joint Force through health-related capabilities.”5 International health engagements of this type through medical force projection (the soft side of the spear) not only will improve the health of host countries but provide critical health related intelligence and early warning for potential disease outbreaks that can threaten our population. Furthermore, investment in health-related expeditions to foreign nations positively influences governments and populations to move in a direction that supports our nation’s strategic interests in a manner that is far less expensive (both in treasure and human lives) or morally distasteful as achieving those goals through military force. The CGHE is a welcome addition to America’s Medical School, USU, and an idea of which, I believe, Dr. Pasteur would certainly have approved. 

  1. https://www.cdc.gov/zika/about/. Accessed Oct. 11, 2016.
  2. “If the epidemic continues its mathematical rate of acceleration, civilization could easily disappear from the face of the earth within a few weeks.” Victor Vaughan (1851-1929)–US Medicine editorial. January 2015.
  3. http://bioethics.gov/node/4637. Accessed Oct. 11, 2016.
  4. https://nam.edu/wp-content/uploads/2016/01/Neglected-Dimension-of-Global-Security.pdf. Accessed Oct. 11, 2016
  5. http:// http://www.cghe.org/. Accessed Oct. 11, 2016

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