Courtesy Reuters

The Return of Infectious Disease

THE POST-ANTIBIOTIC ERA

Since World War II, public health strategy has focused on the eradication of microbes. Using powerful medical weaponry developed during the postwar period--antibiotics, antimalarials, and vaccines--political and scientific leaders in the United States and around the world pursued a military-style campaign to obliterate viral, bacterial, and parasitic enemies. The goal was nothing less than pushing humanity through what was termed the "health transition," leaving the age of infectious disease permanently behind. By the turn of the century, it was thought, most of the world's population would live long lives ended only by the "chronics"--cancer, heart disease, and Alzheimer's.

The optimism culminated in 1978 when the member states of the United Nations signed the "Health for All, 2000" accord. The agreement set ambitious goals for the eradication of disease, predicting that even the poorest nations would undergo a health transition before the millennium, with life expectancies rising markedly. It was certainly reasonable in 1978 to take a rosy view of Homo sapiens' ancient struggle with the microbes; antibiotics, pesticides, chloroquine and other powerful antimicrobials, vaccines, and striking improvements in water treatment and food preparation technologies had provided what seemed an imposing armamentarium. The year before, the World Health Organization (WHO) had announced that the last known case of smallpox had been tracked down in Ethiopia and cured.

The grandiose optimism rested on two false assumptions: that microbes were biologically stationary targets and that diseases could be geographically sequestered. Each contributed to the smug sense of immunity from infectious diseases that characterized health professionals in North America and Europe.

Anything but stationary, microbes and the insects, rodents, and other animals that transmit them are in a constant state of biological flux and evolution. Darwin noted that certain genetic mutations allow plants and animals to better adapt to environmental conditions and so produce more offspring; this process of natural selection, he argued, was the mechanism of evolution. Less than a decade after the U.S. military first supplied penicillin to its field physicians

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