Out of Order: Out of the Mayan pan

Congratulations. If you are reading this commentary, theMayans were wrong, and the world did not end on Dec. 21 as foretold in therecords. (I'm more inclined to believe we've misinterpreted the records, butthat's another story.) Yet again, the human race has escaped apocalypse. Putthe four horses back in their stables.

But before we get too complacent in the narcolepticafterglow 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 becoming up behind us.

Over the last couple of months, I have been watching reportsout of the Middle East that don't alarm me, so much as make my skin prickle alittle. Aside from the usual strife in this region, there is a more insidiousenemy that is making its presence known—a microbial presence that has killedfive people in the region (as of this writing).

While five people don't sound like much (aside from thepersonal devastation to their families and friends), it is the name associatedwith this microbial presence that has me wary—SARS—and the location of thisoutbreak.

As a Torontonian, I remember reading daily reports aboutwhat 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, butemotional, psychological and economic. Toronto didn't suffer the worst of theSARS epidemic, but it was the highest profile city and served in some respectsas a beacon of Western vulnerability to emerging disease coming from elsewhere.

And therein lays the second component of my tingling Spideysense. The SARS that hit Toronto arrived from Southeast Asia, much like thebird flu and swine flu before it. Ebola, which luckily (for us) did not spreadto the Western world, arose from Central Africa.

This new SARS-like microbe, however, is raising its head inthe Middle East, a major economic hub, center of international travel andfrighteningly close to Europe. All this to say that emerging diseases emergefrom anywhere and when global travel is as easy as logging into a website, theworld becomes an increasingly smaller place.

Case in point, the West Nile Virus that routinely makes theevening news throughout the United States was not named for the city of Niles,Ohio. Furthermore, as global economies become more intertwined, Westerncapitals 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, TheLancet published a special series on zoonoses—pathogens shared by humansand animal species—that looked not just at the natural history of the microbes,but also at the socioeconomic impact of the diseases arising from theseorganisms. In a podcast about the series, Princeton University professor ofecology and evolutionary biology Andy Dobson echoed the sentiments on globalvulnerability and unity in crisis.

"We're coming out of a period of forgetting about zoonoticdiseases," Dobson said in the podcast. "We've tended to focus on diseases thatare purely human diseases, and then we're realizing as we massively develop therest of the world, our exposure to zoonotic diseases, diseases we share withwild animals, has begun to increase."

What happens in Central or South America very much impactswhat happens in Baltimore. Pathogenic events in Southeast Asia or CentralAfrica represent very real threats to San Francisco and Madrid.

Elsewhere in this issue, I recount a conversation I had withJim Tartaglia, Sanofi Pasteur's vice president and head of North American newvaccines, on the challenges and opportunities of vaccine development (see "Novaccine is an island," page 27), which included lengthy discussions about workgoing on in the developing world, whether on HIV, dengue fever, tuberculosis orhepatitis.

I raised the question of ROI, and Tartaglia was quite blunt.

"The more we do to bolster public health in these countriesbolsters the economies of these countries, and that builds stronger marketsaround the world for everybody," he explained. "There is also the need to sharerisk, share investment and share the benefits to be able to effectively developvaccines in these areas of the world, especially when thinking of ourshareholders. We are in business."

To flip Tartaglia's sentiment around, we truly cannot sharethe benefits until we are ready to share the risks—and more importantly, whenwe are ready to step up and mitigate them. For everyone's sakes, we have tostay 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 findthe Mayans were right, just not about how or when.