The handshake that ends the human race

The next pandemic could begin with a handshake - and it might be the one which kills off the human race.

This apocalyptic vision was laid out by one of the world’s leading experts on global health, Sir Richard Feachem, of the University of California. His message at a Canberra seminar was that despite an international spend of $4 trillion every year on health care, we are woefully under-prepared to deal with the outbreak of an aggressive, fast-spreading virus.

Even if this worst case scenario is avoided, pandemics will still be the biggest killers in the 21st century, just as they were in the 20th, Sir Richard said. The Spanish flu outbreak, which occurred immediately after World War I, killed at least 50 million and maybe as many as 100 million.

“HIV-AIDS is the pandemic we all know about - the biggest pandemic in human history -and it continues to spread; we are nowhere near its end,” he said.

“XDR tuberculosis is spreading and there are no drugs that are proof against it. While we are getting on top of H1N1, watch out for N5H1. It is far more virulent and if it finds a way of easy human-to-human transmission, we are in trouble.

“We will be looking at a pandemic at least as serious as Spanish Flu, with no means of coping with it.”

The problem lies in a burgeoning and highly mobile world population. “At the time of the Black Death [which killed an estimated third of the world’s population in the 14th century] there were just 400 million humans on earth; by the time of the Spanish Flu this had risen to 1.8 billion and now there are 6.8 billion with a projected rise to 10 billion,” he said.

In the 16th century a journey from London to China took between 12 and 15 months; by 1900 ocean-going liners had cut this to 10 weeks; in 1950 a propeller-driven plane did the journey in three days while modern jetliners take 13 hours.

“In 1900 almost all journeys were longer than the longest incubation period of any virus,” Sir Richard said. “People became ill in transit, died and their bodies were probably thrown overboard. By 2006 the longest journey on earth was still far shorter than the shortest incubation period.

“Somebody could be infected, travel around the world, still not be picked up by airport scanners and only start to feel unwell in their hotel the next morning, by which time they would have infected hundreds of people, now travelling to other cities all over the planet.

“If you take the case of the H1N1 pandemic, on day one it was in one country, Mexico; 10 weeks later it was in 120 countries.”

The good news is that the methods through which pandemics can be transmitted have narrowed. Cholera outbreaks, which ran unchecked because of the insanitary conditions existing in big cities up to the end of the 19th century, have largely been eliminated in wealthy nations. Now the spread is mostly through respiratory or physical contact.