The Next Pandemic

Paramedics rushing stretcher into hospital

As Louis Pasteur once put it, ‘Gentlemen, it is the microbes who will have the last word’.

The rats and the cockroaches may have something to say about this, but let’s not worry about that now.

Instead, let’s worry about this terrifying book, with its fierce orange cover and worryingly black-and-white interior.

Dr Ali S. Khan, who has a reassuring beard and a wide grin, is the former director of the U.S. Office of Public Health Preparedness and Response at the Centers for Disease Control and Prevention, which means he fights those microbes, and stops them spreading.

In his 20 years at CDC, he focused on emerging infectious diseases, bio-terrorism and global health security, but somehow he managed to sleep at night.

Whether I will ever again after reading this book is another question entirely. ‘We have maintained a short-sighted and fickle approach to emerging infections and possible pandemics,’ writes Dr Khan.

‘Our failure to more deeply understand and more consistently attend to the bigger issues leaves us, as they say along the fault lines in California, just waiting for the big one.’

But as his book shows, we have been perilously close to ‘the big one’ several times before.

The 2014-15 Ebola epidemic, for instance — is it that long ago? — killed 11,000 people worldwide. Dr Khan was there, in Sierra Leone, in the latter stages.

Ebola is actually carried by bats, but at Kikwit General Hospital in the Democratic Republic of Congo, the original outbreak was blamed on a curse by someone who had not been invited to share a meal with his colleagues at work.

Catching Ebola is not as easy as you might think. You generally need direct contact with blood, saliva or other bodily fluids, and you’re infectious mostly towards the end of your illness, when you’re probably not in the mood for socialising anyway.

No, the real nasty is influenza, which kills between 250,000 and 500,000 people worldwide every year. The virus travels efficiently via large airborne droplets, when infected people sneeze, cough or talk.

And each year it mutates, slightly faster than the flu vaccines can cope. The infamous flu pandemic of 1918 affected at least a fifth of the world population, and caused at least 50 million deaths. The lead villain in the end-of-the-world pandemic thriller, says Dr Khan, will be the flu.

Public health officers do occasionally get it wrong, though. In 1976 a new swine flu virus was detected in New Jersey. A national vaccination campaign was quickly rushed into service. But the vaccinations caused 500 cases of a severe paralysing neurologic illness, and 25 deaths.

The swine flu never really took hold. The incident is remembered in public health circles as ‘the swine flu fiasco’.

Remember the anthrax attacks of 2001? Wow, that was nasty. One lone maniac, sending anthrax spores through the post to U.S. politicians, caused such mayhem that it cost $320 million (£244 million) to clear up. Or the SARS scare of 2003? That goes back to one ‘superspreader‘ — a splendid technical term for a person who can pass on a disease to hundreds without knowing it — who was staying at the Metropole Hotel in Hong Kong.

For a while SARS became a joke, the scare that never happened. But Dr Khan makes it clear that it didn’t happen because public health officials nipped it in the bud. Still, 774 people died, and I doubt they thought it was funny. More than three-quarters of what he calls ‘emerging diseases’ are zoonoses — transmitted to us through contact with animals.

SARS goes back to masked palm civets (cat-like mammals), sold as food in a market in Guangdong.

Influenza A starts in migratory waterfowl, yellow fever and dengue are carried by mosquitoes, and for Lassa fever it’s rodents. It’s why, unless you obliterate the carriers, you cannot obliterate the diseases. We could dispose of smallpox because it affects no other animals, only humans.

So the fight never ends, but it’s a good fight, and the people doing the fighting are clearly up to it. In between bashing diseases, Dr Khan frequently finds time to complain about the hotel rooms he’s been put up in, and the dodgy food he’s been served.

But such moaning is oddly reassuring, because it shows that, even in the most extreme circumstances, normal life goes on. As must mine after reading this book. Night night, sleep tight.

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