by Raywat Deonandan
June 9, 2022
This article was first published in The Ottawa Citizen on June 9, 2022, with the subtitle, “Robust disease surveillance, vaccine manufacturing and distribution, and antibiotics management are tools that should be strengthened.”
In the early 1970s, Egyptian-American epidemiologist Abdel Omran suggested that human history could be divided into three broad time periods.
First came the Age of Pestilence and Famine, when our hunter-gatherer ancestors suffered through malnutrition and continuous waves of infectious diseases, leading to low life expectancies and high mortality rates.
Then came the Age of Receding Pandemics, when advances in public health and agriculture gave us reliable food sources, potable water and better hygiene, leading to improved life expectancy and societal wealth.
Last came the Age of Degenerative and “Man-Made” Diseases, the current era of our modern world, when infectious diseases have been so well controlled by vaccines and therapeutics that our advancing age and lifestyles of excess have allowed cancers, diabetes and cardiovascular disease to dominate the public health experience.
Now, in the wake of the COVID-19 epidemic and news of unprecedented multi-continental outbreaks of monkeypox — not to mention more than one million annual global deaths caused by drug-resistant bacterial infections — some have begun to wonder if we might not be looking at a new Age of Pandemics, driven in no small part by the silent crisis of antimicrobial resistance. In a 2020 report co-authored by Anthony Fauci, the authors wrote that “evidence suggests that SARS, MERS, and COVID-19 are only the latest examples of a deadly barrage of coming coronavirus and other emergences.”
There are at least four reasons we are seeing an increase in consequential infectious disease threats. First is a thing epidemiologists call “detection bias,” which is when we find more instances of a disease simply because we are looking harder. Since COVID has made us all more sensitive to pandemic threats, it is understandable that the slightest signal offered by a disease the likes of monkeypox would dominate a few news cycles. But news media sensitivity does not always equate to a genuine public health crisis. However, proper disease surveillance can indeed give us proper forewarning of a likely emergency.
Second is our greater global population and shrinking living space. As a species, we are increasingly encroaching into under-explored environmental niches. This is how diseases such as Ebola and Hantavirus entered the human consciousness, from human beings spending more time in unfamiliar habitats. Similarly, our reliance on animal husbandry, most famously in the form of wet markets where unhealthy animals live in close proximity to each other and to humans, is accelerating so-called zoonotic infections, in which diseases jump from non-humans to humans, where they find a vast sea of susceptible naïve hosts.
Third is globalization and its intertwined web of human societies woven tightly across the planet. Globalization has made it such that someone can become infected with a disease in Tokyo and be in New York before the incubation period has barely begun. As well, an outbreak affecting one geographical corner will often be felt acutely by the rest of the world by virtue of nothing more than our unprecedented interdependent economies.
Fourth is climate change, which changes … everything. The changing behaviour of vectors such as mosquitos is causing distributional shifts in diseases such as dengue and malaria; ticks are expanding their habitat, leading to more cases of Lyme disease. Other diseases might be finding new lands as the ecologies they inhabit adapt to changes in agricultural tolerance and its downstream effects on host behaviour and seasonality.
What this all means for our civilization is that we must strengthen the institutions tasked with holding these forces at bay: disease surveillance, vaccine manufacturing and distribution, and antibiotics management, to name but a few. We’ve seen the economic and human impacts that one pandemic can wreak. We would be well advised to invest in preventing another.
Raywat Deonandan is an Epidemiologist and Associate Professor with the Faculty of Health Sciences, University of Ottawa.