Paradise delayed

As we struggle to come to terms with the Coronavirus outbreak there are a number of critical issues regarding public health and our safety that we need to address .The persistence of infectious disease and the regular onset of epidemics and pandemics must be seen as one index of our public health’s failure to come to terms with a series of basic problems inherent in industrialised societies.

In the first place there is the problem of how to change deeply entrenched health attitudes and health behaviour and to fully appreciate that the people most at risk are often those who have the lowest regard for prevention and public health. The recent resurgence of childhood infections such as measles is an example of how personal attitudes to health as well as parenting skills can place many at risk.

Secondly, we need to realise that maintaining our health is a difficult undertaking at the best of times requiring a skilful balancing act of two conflicting forces – individual rights and liberties on one hand, and the overall well-being of all Australians on the other. In times of epidemic or pandemic crisis the often-uneasy equilibrium between these two is easily upset. It remains one of the basic weaknesses of our public health that we have never resolved this basic conflict.

Pandemics such as the present Coronavirus outbreak that we are experiencing force us to consider priorities and choices such as personal freedom versus coercion, and social responsibility versus individual rights. Pandemics also pose the critical question as to who is ultimately responsible for our health. Is it us or the Government or?

There is little doubt that maintaining the health of all Australians requires a deft balancing act – of balancing the overall wellbeing of all Australians against the importance of an individual’s rights and freedoms – an exceedingly difficult undertaking even in the best of times because there is a basic conflict between the two. In normal times this is difficult. In times of epidemics and pandemics it often becomes almost impossible.  

It is interesting how we continue to struggle with this basic dilemma – of how our country committed to the supremacy of civil liberties and sensitive to discrimination, reconciles the conflict between individual rights and the common good. In addition, most people in Australia do not like rules, regulations, restrictions and prohibitions even when imposed in the name of public health. There is little doubt that the dilemma of infectious disease and public health in our world remains unresolved.

As I have often said, we continue to underestimate the power and resilience of the microbial world and continue to show considerable complacency in recognising the importance of infectious disease and the role of the bio-physical environment in our lives. In particular, we continue to ignore the role that the microbial world plays in our lives believing that we are the dominant species and that we can always easily control infectious disease outbreaks. As our pandemic history and now Coronavirus demonstrate, nothing could be further from the truth.

Epidemics and pandemics tend to bring to the fore basic social divisions and conflicts within our society and expose latent tensions and antagonisms. They thus remain an acid test of our behaviour and provide much evidence of individual and group behaviour in times of great stress.

The way we respond to pandemics reveals much about the way our society functions and is structured. The psychological climate pertaining to pandemics such as Coronavirus, particularly the anxiety and fear and the way it manifests in our behaviour tells us something about how particular groups manipulate such disasters for their own ends.

But have we learnt from our past and are we prepared to deal with epidemics and pandemics?

The bad news is that we continue to ignore our past epidemic and pandemic experience and remain poorly prepared for a pandemic outbreak. We still do not have the best disease surveillance system or “surge capacity” in our hospitals and public health system. There are not enough beds, ventilators or health staff and there is worse news. Coronavirus will not be the last pandemic to affect us and there may possibly be even more widespread and virulent infectious disease outbreaks over the next 20 years. We might be entering a Pandemic Age.

An important part of this is how we continue to dismiss infectious disease as a thing of our past. This reminds me of what the US Surgeon-General announced in 1969 to the American Nation. He stated that infectious diseases had been conquered and that the time had come to move on and address a range of chronic diseases like cancer and heart disease.

As many indulged visions of a new anti-infection age  new infections were already on the march. At first, because most appeared in parts of Asia and Africa we could calmly look the other way. But in the 1970s a range of new infections  struck our world and we were suddenly confronted by Hantaan Virus, Lyme Disease, Ebola, Legionnaires Disease, HIV/AIDS, West Nile Virus, SARS, Avian and Swine Flu and now Coronavirus.

The hope of an infection free world quickly evaporated and over the next 40 or so years infectious disease returned to the international agenda. It became very clear that we had severely underestimated the complexity of our environment and the capacity of the microbial world to adapt and evolve and that we had placed too much reliance on the power of anti-bacterial drugs and vaccines to protest us. As well, human vulnerability to infectious disease increased reflecting a variety of factors including ageing populations, the over-use of antibiotics, increasing social marginality, large scale population movements and our increasing modification of our environment.

Threats from infectious disease are not new. Our history is littered with examples of communities being exposed to a wide range of epidemics and pandemics and , if we do not learn from our past experience, if we simply dismiss what happened as part of an earlier less scientific age, then we run the risk of repeating the mistakes made. Let Ashburton-Thompson, possibly Australia’s greatest public health practitioner have the last word. Writing in 1899 he said – “the brilliancy of modern discoveries blinds incautious eyes to old truths and often endangers sound practice”