Microbes and their vectors recognise none of the artificial boundaries erected by human beings

Microbes, and their vectors, recognise none of the artificial boundaries erected by human beings. Their world is bounded only by natural limitations: temperature, pH, ultraviolet light, the presence of vulnerable hosts, and mobile vectors By force of numbers they overwhelm us. That’s what’s spent in the US annually for cigarette advertising.”Foege felt that international and domestic American health were so integrated by the 1990s due to globalisation of the microbes that it was impossible to ensure a disease-free existence for people in North America and Western Europe without providing similar assurances for residents of Azerbaijan, Cote d’Ivoire and Bangladesh.Yet his kind of global thinking was no longer in vogue at CDC and WHO or inside the governmental health bureaucracies in Washington, Paris and London.In the belt-tightening world of the 1990s, no one seemed much interested in contributing cash for the development of primary health infrastructures in countries like Armenia, Romania, Albania, Burma or the Dominican Republic. Of the 14 million kids who died in 1989, nine million [deaths] could have been prevented for two and a half billion dollars.

The situation only worsened in 1994, as more than half a million Rwandans fled their country.”This is a public health crisis,” former CDC director Dr William Foege argued “One trillion dollars is spent on weapons annually. Months after the proposal went out to the wealthy nations of the world, LeDuc was still waiting for some dollars, marks, yen or other solid currency.Meanwhile, physicians working in the midst of crises argued that what was needed was far more fundamental. “You need people on the ground to spot these things first,” one said “You need a health care system. And you need a place to call.” If the government is your enemy – if you and your people are victims of oppression – whom do you call?After years of battling Lassa, the scientists working in West Africa saw civil war in Liberia and government instability in Nigeria wash away all their efforts, and outbreaks of the rat-borne disease become commonplace. All told, it seemed in 1993 that more than 21 million people on earth were living under conditions ideal for microbial emergence: denied governmental representation that might improve their lot; starving; without safe, permanent housing; lacking nearly all forms of basic health care and sanitation. His proposal was formally endorsed on 26 April 1994, by WHO and a panel of experts chaired by Nobel laureate Joshua Lederberg. For the less common haemorrhagic disease-producing microbes such as Ebola, Lassa, and Machupo, virtually none had the biological reagents to even try to conduct diagnostic tests.As a first line of defence against emerging diseases – at least the viruses – LeDuc advocated a modest $1.8m one-shot programme to upgrade all the laboratories and tighten the WHONet voluntary reporting system that linked key hospitals and medical systems worldwide.

The CDC’s Jim LeDuc, working out of WHO headquarters in Geneva, in 1993 surveyed the 34 laboratories worldwide that were supposed to alert the global medical community to outbreaks of dangerous viral diseases. (There was no similar network to follow bacterial outbreaks or parasitic disease trends.) He discovered that only half the labs could reliably diagnose yellow fever; the 1993 Kenya epidemic undoubtedly got out of control because of that regional laboratory’s failure to diagnose the cause of the outbreak.For other microbes the labs were even less prepared: 56 per cent couldn’t properly identify hantaviruses; 82 per cent missed California encephalitis. coli 0157 food poisoning, multiply drug-resistant tuberculosis, or Lyme disease. As more disease crises cropped up, such as various antibiotic- resistant bacterial diseases, beleaguered state and local health agencies loudly protested CDC proposals to expand the mandatory disease reporting list – they couldn’t keep up.At the international level the situation was even worse. Even diseases that physicians and hospitals were required by law to report were going unrecorded.That being the case, officials could only guess about the real incidences of such ailments as penicillin-resistant gonorrhoea, vancomycin-resistant enterococcus, E. He discovered that the tremendous variations in disease reports reflected not differences in the actual incidence of such occurrences, but discrepancies in the policies and capabilities of the departments.What Osterholm and Berkelman discovered was that nearly two decades of government belt-tightening, coupled with decreased local and state revenues, had rendered most local and regional disease reporting systems horribly deficient, often completely unreliable Deaths were going unnoticed Contagious outbreaks were ignored.

Vermont, for example, reported outbreaks at a rate of 14.1 per million residents, Mississippi at 0.8 per million.Minnesota state epidemiologist Dr Michael Osterholm assisted CDC efforts by surveying all 50 state health departments. The project revealed two disturbing findings: no federal or state agency routinely kept track of disease outbreaks of any kind, and once the pilot project was under way, the ability of the target states to survey such events varied radically. Over a six-month period, 233 communicable disease outbreaks were reported. She and her collaborators discovered a long list of serious weaknesses and flaws in the CDC’s domestic surveillance system and determined that international monitoring was so haphazard as to be non-existent.For example, the CDC for the first time in 1990 attempted to keep track of domestic disease outbreaks using a computerised reporting system linking the federal agency to four state health departments. In response to a 1992 treport the CDC gave Dr Ruth Berkelman the task of formulating plans for surveillance and rapid response to emerging diseases. Failing that, they hoped to be equipped to swoop in with a scientific rapid strike force that would identify and destroy emerging microbes before an outbreak progressed to an epidemic.D A Henderson, deputy secretary of Health and Human Services, felt active surveillance would best be conducted through 15 tightly networked tropical outpost laboratories, staffed by CDC scientists, colleagues from public health institutions in the host country, and academic researchers from some 50 US universities.Henderson estimated that the system would cost $150m per year to operate, adding, “Can we afford to invest in such a programme? A better question is whether we can afford not to invest in a programme that could be a determinant in our own survival as a species.”But monitoring systems already in place seemed to be failing. Satellites, biological containment laboratories, computers and polymerase chain reaction devices for genetic fingerprinting were the tools they hoped to use to spot changes in ecologies that might promote microbial emergences.