Runaway Diseases: And the Human Hand behind Them

In the wake of Richard Preston's 1994 thriller The Hot Zone, a best-seller in 26 countries, the publishing industry has released a torrent of books about emerging disease threats. Nearly every major fighter of the Ebola virus has published a memoir, several scientists have produced warning missives, and fiction writers from Stephen King to Tom Clancy have made microbes prominent plot devices.

Amid the plethora of paranoia-inducing publications, barely a handful offer insights that could guide public policy, particularly from a global point of view. And practically speaking, the only relevant point of view for microbial issues is global, since bacteria, parasites, and viruses exploit appropriate ecospheres wherever they find them, regardless of national boundaries.

Despite the chatter on everything from "mad cow disease" to mutant strains of the Ebola virus, there are serious causes for concern. The Clinton administration has formally designated emerging infectious diseases as a national security issue. That has drawn big political players such as the CIA, the National Security Council, the Defense and State Departments, and the U.S. Agency for International Development into an arena that before the mid-1990s was the province of scientists.

The most recent entrants in the debate on emerging diseases are the historian Sheldon Watts of American University in Cairo and the virologist Michael Oldstone of the Scripps Research Institute in La Jolla, California. Watts, who has spent his career in Nigeria and Egypt, sees humanity's relations with the microbes from the side of the victims of European imperialism. In his analysis-which is indebted to William McNeill's 1976 landmark Plagues and Peoples-most of the scourges of the last millennium are direct results of Christian or European cultural and colonial practices. In contrast, Oldstone, a prominent American laboratory scientist, pays only cursory attention to the socioeconomic foundations of disease transmission, focusing his optimistic work on the triumphs of Western science. His book consciously emulates Paul De Kruif's gem, Microbe Hunters, although it is not nearly as strong.

Both Watts' and Oldstone's books leave a great deal to be desired, although their shortcomings are different. Watts is didactic, while Oldstone condescends. As for content, it is doubtful the authors could find much on the subject on which they could agree. Of the two, Watts sounds the more profound challenge to contemporary health policy. His perspective is stridently anti-development, anticolonialist, and critical of Christianity. In temper it resembles much of the writing by contemporary African intellectuals. And as is typical of that body of work, it draws from an awesome trove of historical evidence. Watts' scouring of Europe's and the Islamic world's ancient databases has resulted in a demanding work that compels readers to take his southern hemisphere-centric arguments seriously.

THE LIMITS OF MEDICAL SCIENCE

The bulk of the world's remaining literature on infectious disease, including Oldstone's Viruses, Plagues, and History, has a highly American or European point of view. "The obliteration of diseases," Oldstone writes, " . . . is a regal yardstick of civilization's success, and those who accomplish that task will be among the true navigators of a brave new world." The way to reach that world, he believes, is primarily through development of a broader range of vaccines, particularly against HIV (his personal area of research). That will require "the best efforts of scientists in medical research . . . not inhibited by political or religious interests, but supported by the full resources of governments and industry with conscientious participation by the general public worldwide."

Unfortunately, Oldstone doesn't discuss the enormous economic and legal barriers to vaccine production. With fewer than a dozen companies still in the business, and with the current profits for all vaccine sales combined less than those for a single patented anti-ulcer drug, there is little corporate interest in developing products that target diseases found mainly in poor countries. Moreover, consumer litigation so envelops the industry in the industrialized nations that budgets must include as much money for legal defense and insurance as for actual vaccine distribution.

Oldstone's heroes are the giants of vaccinology, and of the eight he discusses at length, only Carlos Finlay, a Cuban, was from the South. The history Oldstone recounts is one of scientific inquiry and success of men from the North, often in response to diseases that arose in the South. The social factors that turn sporadic cases of disease into epidemics are noted only in passing, usually drawing on nineteenth-century North American examples.

Western science, Oldstone argues, has triumphed over the world's biggest infectious killers, and there are only five significant foes left: aids, Lassa fever, the diseases caused by the hemorrhagic fever viruses (such as Ebola), mad cow disease, and hantaviruses. It's a curious list, for the first four are amenable to well-understood preventive measures (in order: condoms and clean syringes, rat control, sterile hospital and funeral procedures, and proper livestock and meat production practices). Further, Lassa can be cured with proper use of the antiviral drug ribavirin.