A few years ago, I read a riveting and prescient book called Spillover, by David Quammen. It’s about diseases in animals spilling over — breaking the species barrier — and infecting people. Quammen has studied the most famous of these “zoonotic” diseases (including Ebola, SARS, MERS, and Zika, all famous for having caused epidemics in the last 20 years). He and a lot of scientists have been very clear about the threat of global viral pandemics. They have said over and over that it was not a question of if; it was a question of when.
Did anyone listen or do anything to prevent it? Sadly, as we all now know, very little was done. President Obama tried to do something modest — a USAID program called PREDICT, using surveillance and modeling to identify possible new vectors of zoonotic disease. Funding has petered out. President Trump has proposed a prevention program called Stop Spillover, with a proposed budget of $50–100 million over a period of five years. Do you know how pathetically little that amount of money can accomplish? That’s like saying to the U.S. military: you need a new Humvee? Okay, we’ll pay for the rear-view mirror. Good luck paying for the rest.
In 2018, scientists gathered at the World Health Organization headquarters in Geneva to create a list of the spillover viruses considered most dangerous to human beings. They discussed and debated and came up with a fairly short list, the most noteworthy of which is “Disease X”, which represents all of the disease-causing agents we don’t yet know about. They were, of course, predicting something like SARS-CoV-2, the virus that causes the disease Covid-19, which has infected way more than the millions of cases officially counted to date.
One of those scientists, Peter Daszak, laid out the sad truth: “The problem isn’t that prevention was impossible. It was very possible. But we didn’t do it. Governments thought it was too expensive. Pharmaceutical companies operate for profit.” We need to dig into this statement: “Governments thought it was too expensive.” Expensive compared to what, ask the sickened and financially devasted citizens of the 188 countries known to be affected.
We in the U.S. spend astronomical amounts of money on military preparedness, and most Americans don’t even blink. We have old habits on the one hand (military preparedness) and a large blind spot on the other (pandemic preparedness). There’s are various ironies here:
· Global pandemics are more devastating than so-called global military threats, such as terrorism. Consider what has happened to the U.S. since 9/11 vs. what’s going on in our country right now. We have worked to impede the spread of terrorism, have warded off certain threats, and have engaged in two long, expensive, and fruitless wars. In contrast, we let Covid-19 blindside us and then we mismanaged virtually everything, which is why the U.S. has won the global grand prize in Covid-19 cases and deaths.
· Our failure to tackle pandemic preparedness is linked to another of our political blind spots, our lackluster response to the climate crisis. The former has a relationship with the latter. The more humans encroach on wildlife habitats, the more zoonotic spillover occurs. We know that because of globalization and especially because of international and domestic travel, there is no safe place on earth. It will be ever thus.
An awful lot of the pandemic prevention debacle, sad to say, is linked to lack of political will. As Daszak notes, when President Obama catalyzed our country spending $5 billion to contain the Ebola epidemic in West Africa so it wouldn’t go global, his effort was considered heroic. Daszak adds: “How heroic is it, three years before Ebola, to say, ‘We’re going to fund a massive program in West Africa to help these poor countries get ready in case an outbreak happens?’ He’d be laughed out of the room.” But that is the wrong concept. There’s no such thing as a regional problem any more. Well, I take that back. If we are prepared, quick, and lucky, then yes, we might be able to contain a zoonotic disease in an overseas region. But that’s a big “if”; there’s no guarantee. Some viruses are extremely infectious, including when people don’t realize they’re ill. If we seek to be safer, we have to be prepared to tackle emerging viral pathogens over and over, with international cooperation, as spillover will absolutely keep happening.
What scientists and public health officials already fear is complacency — that when this crisis is contained, we will subside back into apathy. To me, this is like choosing global tragedy for our children and their children. We won’t prepare pan-viral vaccines and drugs. We won’t do the research and the surveillance. We will stick our heads back in the sand. Frankly, I think it’s up to us — the public — to speak up about this and demand that our government, especially at the federal level, do a way better job of protecting us and future generations in the future.
The reason why the effort needs to be largely financed by the government is that pharmaceutical companies typically don’t care. They don’t care because certain things aren’t profitable and they’re in the business of being profit machines. Literally. The industry has a higher profit margin than most. The highest drug prices on the entire planet are in the U.S. This is partly because our elected officials have been bought by the drug lobby, because we the public drink the Kool-Aid the industry pours for us about what it costs to develop a single new drug (they even count their huge advertising budgets), because we have mismanaged aspects of the medical industry, and because the pharmaceutical companies would rather make one more cancer treatment drug (huge profit margin) that may have little marginal benefit over existing drugs than deal with, for example, our urgent need for new antibiotics. Even the oil and gas industry is subject to more regulation.
The pharmaceutical industry prefers drugs for chronic illness — big sellers — to drugs that prevent or quickly cure, as those market might be small or short-lived. If we the people don’t like that, we need to have more government regulation of the industry. Note that every other developed nation in the world has found industry regulation to be the best way to protect its citizens. Only we in the U.S. are hung out to dry. Wouldn’t it be amazing if we weren’t so afraid of losing something and were instead asserting our needs? What if pharmaceutical companies were required to devote some of their annual research and development effort to public health? What if it became part of their business model because it was the cost of operating in the U.S.? It would be the analogue of having to mitigate pollution if your products damage the environment. Remarkable things — the proverbial win-win — could be the result.
There is hope for the future, of course. Nonprofits such as the Gates Foundation and the Coalition for Epidemic Preparedness Innovations (CEPI) have been working on our problems for years. They can’t do all of the heavy lifting alone; they need help. There is way more international cooperation right now than usual, and intellectual property is being shared out of a sense of common purpose. That, too, should give us hope.
Photo Credit: Angus Gray / Unsplash