Global Health Blogs with Professor Swahn

In December 2019 I turned in a short essay for my Environmental Health class. The prompt was “what do you think is the biggest threat to your health from the environment?” Now I knew everyone was going to write about air pollution, climate change (in general), the food crisis, or WASH because those had been the main topics of the course, but I wanted to choose something less talked about. I had recently watched a short video about the melting ice caps and the ancient microbes that could emerge, uh scary! This led me into an internet rabbit hole of research on emerging infectious diseases, resulting in my choice of pandemics as the biggest threat to our health from the environment.

I turned that essay in on December 16th, 2019, and by January we were hearing about a novel coronavirus and by March the World Health Organization officially declared COVID-19 a pandemic. Now how did I predict this just a month prior? Well, because the scientific community had already done so. There was ample information out there on the risk of pandemics in our current world, but it was not a subject commonly talked about to the general public. Here I will highlight a few reasons why the scientific community already knew the risk and inevitability of a global pandemic in the near future, using research that was already available years before now.

Factors that Contribute to Today’s Risk of Pandemics:

Emerging and reemerging infectious diseases: 

Emerging and reemerging infectious diseases have been increasing at a rate never seen before since the 1970s. One reason that emerging infectious diseases are on the rise is due to global urbanization.

The rapid urbanization around the world poses many challenges within cities, more so for underdeveloped countries. The increase in urban populations leads to overcrowding and inability to provide safe housing, drinking water, and sanitation facilities, ideal conditions for amplification and transmission of a pathogen. Dense urban populations living in small areas tend to live in close proximity with domestic animals and rodents such as rats, who are known to carry many diseases. Constant interaction with such animals, as well as, urban development’s encroachment on wildlife, increases the probability of zoonotic emerging infectious pathogens, jumping from their normal animal host to humans.

Another factor contributing to the risk of emerging infectious diseases is climate change. Though ancient microbes living in melting glaciers first spiked my interest, after further research this isn’t much a concern due to the low probability such microbes would be able to infect warm blooded humans. But it is not impossible! It’s estimated that the number of microbes trapped beneath the ice sheet may be more than 1000 times that of all humans living. Ice allows these microbes to preserve their genetic material until they’re released in the future; and there is the possibility that ancient pathogens which early humans had gained immunity to, could survive in the ice, waiting until enough time as passed and thus our immunity also. But more so, the risk from climate change is due to the fact that with warming climates, there will be a change in pathogen habitats, spreading to new geographic areas. Changes in distribution could result in global outbreaks in previously non- endemic areas, infecting populations who do not have the experience, adequate medications, or any sort of immunity to deal with the outbreaks. Climate and geographical changes can also cause mutations in the microbes, possibility becoming more (or less) infective.

The risk of reemerging infectious diseases is increasing because of rapid evolution of known pathogens, antibiotic resistance, and decreased vaccine usage. As we should all know by now Influenza has caused pandemics in the past and still poses a significant risk due to its high mutation rates and ability to jump from animals to humans. Also, the continuing increase in antibiotic resistance is a threat. Every year 2.6 million people are infected with antibiotic resistant microbes, with many currently defined as urgent threats to public health. Without antibiotics to stop and prevent infections, an outbreak of such resistant pathogens would be devastating: possibly leading to a pandemic which none of our available medicines would help.

 

Now this wouldn’t be an issue if we were actively researching new antibiotics and ones specifically for antibiotic resistant bacteria, but we aren’t…Due to a lack of return on investment because of the long shelf life and short-term usage of antibiotics, companies have dropped out of antibiotic field. The cost of development is high, but the price of antibiotics needs to be cheap. Thankfully in recent years public health organizations have created incentives to increase such research, but who knows how long results will take!

Don’t even get me started on anti-vaxxers… A decrease in vaccine use, specifically in developed countries, has increased the risk of previously controlled or eradicated diseases of the past reemerging, one example being measles. You can read more about this here.

Why such infectious pathogens could cause a pandemic, rather than just isolated outbreaks:

Well the extensive network of global travel and trade in todays world means that a pathogen could be carried across the world within days. From 1950 to 2013 international tourist arrivals increased from 25 million to 1087 million and by 2030 its expected to reach 1.8 billion. People could carry the pathogen around the world before they even knew they were sick.

With global travel only projected to increase, this leads me into the other major factor that increases the risk of  a pandemic: the lack of resources and an adequate global plan. After the SARS pandemic of 2003, The World Health Assembly updated the International Health Regulations (IHR) to push for all members of WHO to adhere to specific standards for detecting, reporting, and responding to outbreaks. Though these regulations were put in place, many countries are not able to meet the requirements of the IHR, specifically in under-developed regions where infectious diseases and epidemic are still prevalent. Outbreaks in Africa over the past decade have shown gaps in timely detection, tracing contacts, quarantine procedures, and lack of global coordination and response. Also, no matter the development level of a country, during outbreaks facilities have a large influx of patients, leading to an inadequate amount of resources to care for them all, decreasing the integrity of control mechanisms. 

Before the next pandemic we need to:

1. Implement measures to improve living conditions and sanitation in urban communities, while reducing the interaction with animals and wildlife, as to reduce the possibility of emerging zoonic infectious diseases.
2. Fast and efficient global surveillance and alert systems. This global collaboration is necessary to react to a threat in a timely manner with modern global travel.
3. “Scaling up” local surge capacity of health systems, including building a stockpile of medicines and equipment, as well as appropriate health financing and access to necessary medical technologies.
4. More health care workforce training and simulation exercises, as well as strengthening relationships between different stakeholders in the community. 
5. Research! More public health research is needed in the areas of, antibiotic resistance, medications for emerging and reemerging infectious diseases, true risk of climate change on pandemics, and how underdeveloped countries can more efficiently catch outbreaks and communicate with other countries.

Now I sit here, amidst a pandemic which has lasted almost the whole year, and ponder the irony of my December assignment… the irony of how much info was available to take preventive measures. Now I know these measures are easier said than done, costing a significant amount of money and effort, but I hope that with the current pandemic highlighting the failures of global preparedness, (I could write a whole blog about how all these factors have been proven by COVID-19 , but I’ll leave that for you to examine) countries, including our own, will take more action to better prepare for the inevitable next pandemic.