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Out of Order: Out of the Mayan pan
January 2013
by Randall Willis  |  Email the author

Congratulations. If you are reading this commentary, the Mayans were wrong, and the world did not end on Dec. 21 as foretold in the records. (I'm more inclined to believe we've misinterpreted the records, but that's another story.) Yet again, the human race has escaped apocalypse. Put the four horses back in their stables.
But before we get too complacent in the narcoleptic afterglow of way too many turkey leftovers, and in the spirit of the new year, I think it's important to take a look over our shoulders and see what might be coming up behind us.
Over the last couple of months, I have been watching reports out of the Middle East that don't alarm me, so much as make my skin prickle a little. Aside from the usual strife in this region, there is a more insidious enemy that is making its presence known—a microbial presence that has killed five people in the region (as of this writing).
While five people don't sound like much (aside from the personal devastation to their families and friends), it is the name associated with this microbial presence that has me wary—SARS—and the location of this outbreak.
As a Torontonian, I remember reading daily reports about what the SARS epidemic was doing to my community (I lived in the Washington, D.C., area at the time); how it left scars that were not just physical, but emotional, psychological and economic. Toronto didn't suffer the worst of the SARS epidemic, but it was the highest profile city and served in some respects as a beacon of Western vulnerability to emerging disease coming from elsewhere.
And therein lays the second component of my tingling Spidey sense. The SARS that hit Toronto arrived from Southeast Asia, much like the bird flu and swine flu before it. Ebola, which luckily (for us) did not spread to the Western world, arose from Central Africa.
This new SARS-like microbe, however, is raising its head in the Middle East, a major economic hub, center of international travel and frighteningly close to Europe. All this to say that emerging diseases emerge from anywhere and when global travel is as easy as logging into a website, the world becomes an increasingly smaller place.
Case in point, the West Nile Virus that routinely makes the evening news throughout the United States was not named for the city of Niles, Ohio. Furthermore, as global economies become more intertwined, Western capitals can no longer sit back from their imperial thrones and take an "us-versus-them" attitude, because morally and economically, they are us.
At the end of November, The Lancet published a special series on zoonoses—pathogens shared by humans and animal species—that looked not just at the natural history of the microbes, but also at the socioeconomic impact of the diseases arising from these organisms. In a podcast about the series, Princeton University professor of ecology and evolutionary biology Andy Dobson echoed the sentiments on global vulnerability and unity in crisis.
"We're coming out of a period of forgetting about zoonotic diseases," Dobson said in the podcast. "We've tended to focus on diseases that are purely human diseases, and then we're realizing as we massively develop the rest of the world, our exposure to zoonotic diseases, diseases we share with wild animals, has begun to increase."
What happens in Central or South America very much impacts what happens in Baltimore. Pathogenic events in Southeast Asia or Central Africa represent very real threats to San Francisco and Madrid.
Elsewhere in this issue, I recount a conversation I had with Jim Tartaglia, Sanofi Pasteur's vice president and head of North American new vaccines, on the challenges and opportunities of vaccine development (see "No vaccine is an island," page 27), which included lengthy discussions about work going on in the developing world, whether on HIV, dengue fever, tuberculosis or hepatitis.
I raised the question of ROI, and Tartaglia was quite blunt.
"The more we do to bolster public health in these countries bolsters the economies of these countries, and that builds stronger markets around the world for everybody," he explained. "There is also the need to share risk, share investment and share the benefits to be able to effectively develop vaccines in these areas of the world, especially when thinking of our shareholders. We are in business."
To flip Tartaglia's sentiment around, we truly cannot share the benefits until we are ready to share the risks—and more importantly, when we are ready to step up and mitigate them. For everyone's sakes, we have to stay on the ball and be ready to jump in and lend a helping hand at any moment. The microbes don't really care who we are or where we live. And we could find the Mayans were right, just not about how or when.



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