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A future of infectious disease

By Peter Curson - posted Friday, 8 January 2021


Since the first decade of the 21st century public health specialists and the WHO have warned us about the possible outbreak and spread of a new virulent infectious disease once referred to as Disease X by the WHO.

Despite what we might believe and despite the many advances in medicine and public health, epidemics and pandemics of infectious disease continue to remain a critical threat to our health.

Before the advent of Coronavirus many believed that we had won the battle against bacterial and viral infections and had little to fear. As Coronavirus has demonstrated, nothing could be further from the truth.

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But more than that, over the last 20 or so years we have tended to overlook major outbreaks of infectious disease such as Ebola and Dengue as well as the resurgence of a raft of childhood infections such as measles.

So why have we been so confident that infectious disease is no longer a global threat particularly when bacteria and viruses have been an important part of our world for millions of years much longer than we have been around?

In all of this we continue to overlook the role of the biophysical environment in our lives and how infections are often nurtured in animal hosts of which perhaps 40% possess the ability to spread to humans. Unfortunately, we have only identified around 1% of these viruses and remain largely ignorant of how they form an important part of animal life and they can spread to involve us.

We should also be aware that we are all infected by between 8 and 12 viruses without showing any symptoms.

For many years I have written much about how we live in an epidemic and pandemic age and how poorly prepared we are to handle such outbreaks. But many believe that we have nothing to worry about and that we can easily handle any infectious disease outbreak that confronts us.

If nothing else Coronavirus has forced us to reconsider such beliefs. But what apart from our ignorance is encouraging the emergence of infectious disease outbreaks?

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Well, like it or lump it, climate change plays an important part in changing the distribution and range of animals and insects such as mosquitoes and ticks which harbour a number of infections. Extreme weather events, such as floods and droughts play a major role in this.

Dengue, a disease which has been a significant issue in Australia for the last 140 years is a good example. Changing patterns of rainfall encourages new breeding grounds for the mosquitoes which carry the infective agent.

But it is perhaps our behaviour which plays an important role in the emergence and spread of infectious diseases.

Deforestation, the spread of farms and livestock as well as the continued human intrusion on remote rural areas all play an important part.

There is nothing new about this process. 

Sweating Sickness that killed more than 20,000 people in England in the late 15th early 16th century was closely tied to the mass destruction of woodland in parts of England liberating a zoonotic virus from its animal host. Or more recently reforestation in the north-eastern part of the USA led to Lyme Disease when reforestation schemes provided a fertile environment for people, deer and a deer-borne tick to interact.

In addition, as the re-emergence of childhood infections demonstrates our reluctance to vaccinate plays a critical role.

Ever since SARS we were repeatedly told that another pandemic was coming.

Australia has a long history of pandemics ranging from childhood infections like measles and scarlet fever to diseases such as smallpox, plague, influenza, polio and HIV/AIDS. Many have been long forgotten. Who for example remembers the pandemic of Encephalitis Lethargica which swept the world after 1917 and which impacted strongly on Australia?

Most of these past pandemics were defining moments in Australia’s history. But how quickly we forget our past and how little we seem to have learnt from such experience. Has Coronavirus produced any change and have we learnt new lessons? I very much doubt it.

There is little doubt that the microbial world remains an important threat to our health and wellbeing. As I have said on numerous occasions, we continue to ignore the importance of the biophysical environment and realise that it is an ever-changing force which continues to play a critical role in our lives.

What we seem to forget is that we are just one of a series of competing species in a world where many processes are cyclical or waxing and waning. We also continue to ignore the fact that the microbial world exhibits a dynamism and resilience that confirms the importance of evolution in the natural world.

In addition, we continue to believe that not only are we the dominant species in our world but also that we can deal quickly and efficiently with any bacterial or viral threat that emerges by simply instituting a policy of quarantine and isolation before developing a magic bullet or vaccine. But at what price?

How many cases and deaths will have occurred from Coronavirus before a vaccine becomes widely available and manages to avoid anti-vaccinators? In the end our efforts to control or eradicate infectious disease is utopian. Microbes are selected for survival and mutate and change in accordance with changes in their host and environment. Will we ever come to fully recognise such things and adapt our lives accordingly? I wonder.

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About the Author

Peter Curson is Emeritus Professor of Population and Health in the Faculty of Medicine and Health Sciences at Macquarie University.

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