The Pandemic Century by Mark Honigsbaum

Author:Mark Honigsbaum
Language: eng
Format: epub
Tags: Epub3
Publisher: W. W. Norton & Company

EVEN MORE SO than Legionnaires’ disease, the AIDS pandemic forced scientists to confront the hubristic assumption that medicine was on the verge of conquering infectious disease. This was not only because AIDS patients presented with conditions—PCP, KS, thrush—that were thought to have been consigned to the medical curiosity chest, but because by the time experts woke up to the new syndrome, HIV was widely dispersed and spreading on several continents. As we have seen, this was not the fault of epidemiologists or cancer specialists. On the contrary, AIDS became a pandemic at precisely the moment when, for the first time in history, scientists had the technology and intellectual tools to identify a new retrovirus and devise tests and treatments for it. However, AIDS also underlined something that had been overlooked by scientists and public health officials in the wake of the celebrations that followed the eradication of smallpox in 1980. The first was that pathogens are constantly mutating in ways that are difficult to predict. The second is that humans, either through their changing social and cultural behaviors, or through their impact on the environment and animal and insect ecologies, exert powerful evolutionary pressures on microparasites. Sometimes, these pressures select for a particularly virulent strain of the parasite. At other times, they present the parasite with an opportunity to colonize a new host and extend its ecologic range. This is a particular risk in the case of zoonotic diseases bridged by rodent and insect vectors, such as plague, yellow fever, and dengue. However, it was realized that in an era of increasing globalization, it was also true of other zoonoses that were not nearly as mobile. In particular, it was argued, AIDS would not have been able to escape Africa had humans not changed the rules of “viral traffic.” According to the virologist Stephen Morse, who coined the phrase, these rules included not only environmental and social changes that afforded the simian progenitor of HIV new opportunities for interspecies transfer and amplification within human populations, but such factors as better road and rail connections and international jet travel. Morse’s concerns were soon echoed by other scientists, including the bacterial geneticist and head of Rockefeller University, Joshua Lederberg. In 1989 Lederberg and Morse organized a conference in Washington, DC, then followed it up in 1991 with a scientific report looking at the threat posed by “EIDs.” As defined by the Institute of Medicine report, EIDs included diseases such as AIDS and Ebola that were previously unknown as afflictions of human populations and whose “emergence may be due to the introduction of a new agent, to the recognition of an existing disease that has gone undetected, or to a change in the environment that provides an epidemiologic ‘bridge.’ ” Taking up a theme explored by René Dubos, Lederberg went on to argue that in an era of increasing “globalization,” air travel and the rapid mass movements of goods and people from one part of the globe to another had tilted the balance in favor of microbes, “defining us as a very different species from what we were 100 years ago.

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