By Frank Rando
From socioeconomic disparities to population management in an epidemiological emergency, Frank Rando discusses the greatest challenges facing global health security in the 21st century.
For centuries, microbial life has proven itself a stealthy and deadly enemy of humanity. From the Black Death in the 14th century to present-day HIV, from the 1918 influenza pandemic to our most recent encounters with Ebola, and not forgetting COVID-19, both bacteria and viruses have dealt devastating blows to humanity.
The great chemist and bacteriologist Louis Pasteur stated, “the microbe is nothing, the terrain everything.” The great scientist also once stated that “chance favors the prepared mind”. In both statements, Pasteur has succinctly summarized, in part, our current predicament in developing an evolving framework of biodefense and global health security to address exotic and emerging infectious disease threats.
The terrain that Pasteur alluded to essentially relates to the global environment and its various components. As we have discovered, the evolution of emerging infectious diseases can be intimately associated with human activities and environmental modifications. As human populations encroach on remote areas and disrupt natural systems, animal species that serve as reservoirs for a variety of infectious diseases become displaced and in the process of establishing newer habitats may cross-infect other species. These trans-species jumps may also lead to genetic assortments and viral mutations that may occur in the new host animal. This has been well established in novel strains of influenza, where pigs and even domesticated pets serve as “bioreactors” harboring novel pathogens.
Critical Shortages and Socioeconomic Disparities
Climate change influences meteorological patterns and conditions. Shifts in the jet stream or other weather phenomena can cause excessive rainfall and have led to an explosion of mosquitoes, which serve as vectors for transmitting vector-borne illnesses. Researchers have conducted “hot spot analysis” to identify conditions such as the presence of vectors, land use, and climate to identify where particular types of disease, such as vector-borne illnesses, may occur.
Many regions of the world are also affected by critical shortages of healthcare personnel and tend to have the least developed healthcare infrastructure. Understaffing, a lack of resources, and overpopulation are three common denominators that contribute to the spread of emerging and re-emerging infectious diseases.
Agricultural practices in crowded conditions may serve as potential breeding grounds for novel pathogens, such as lethal strains of highly pathogenic avian influenza. Excessive use of antibacterial soaps and both human and veterinary antibiotics have initiated leaps in antibiotic resistance and the creation of super strains of pathogenic bacteria that are extremely difficult to treat. Widespread poverty, illiteracy, and diverse cultural practices are often commonly associated with the propagation of infectious diseases and the morbidity and mortality that follow in their wake.
Health and socioeconomic disparities, such as lack of access to health services, lack of robust public health infrastructure, malnutrition, inadequate sanitation, low income, and other such factors add to the proliferation of epidemics that can lead to pandemics affecting global health and security. Globalization, population displacement, complex humanitarian crises, movements of animals and goods, rapid urbanization, changing human behaviors, ethnic and racial customs, and land use all can influence the emergence of infectious diseases.
Much is said about “global health security “, but what does this mean in the context of emerging pathogens and a natural world that is out of balance?
Health Security in the Age of COVID
The World Health Organization (WHO) defines health security as the activities that are necessary to “minimize vulnerability to acute public health events that endanger the collective health of populations”. The WHO also adds that health security can impact “economic or political stability, trade, tourism, access to goods and services, and demographic stability”. In other words, the health of a population directly impacts the security of a nation.
This definition has been vividly portrayed on the international stage as we collectively experienced the COVID-19 pandemic that spread to almost every country around the world and threatened entire continents. In the U.S., a national health security strategy and implementation plan, integrated with a variety of other plans, policies, presidential directives, and acts that address homeland security, national security, and public health preparedness and response were activated, setting into motion an aggressive national effort to combat the adverse effects of the public health emergency in all sectors of society. The U.S. President declared a state of national emergency and invoked both the Stafford Act which addresses national disasters, and the Defense Production Act, along with strategic public-private sector alliances.
Similarly, other nations invoked emergency powers and took wartime-like stances to meet the daunting challenges of this epidemiological emergency. In terms of global security impacts, the potential spread of contagion among the world’s armed forces would also be a critical event as it affects defense operational readiness. Infectious diseases have altered the outcomes of conflicts and wars and affected the balance of power among nation-states. Until World War II, more combatant deaths were due to infectious diseases than from direct combat injuries.
Population Management in an Epidemiological Emergency
In today’s battlespace, military exposures to endemic infectious diseases and emerging biothreats continue to affect the fighting strength of our armed forces. As a result, the U.S. military has invested significant resources in infectious disease research, building sophisticated diagnostic laboratory capacity around the world, disease surveillance infrastructure, vaccine, and other biomedical countermeasure development.
As the morbidity and mortality of COVID-19 rose exponentially, global military forces and their medical and public health assets were enlisted into the domestic assistance realm. The U.S. military, alongside the National Guard, reserve, and active forces can be mobilized to assist with consequence-management during a bio-emergency.
In any high consequence epidemiological emergency, such as the Ebola outbreaks, H1N1 pandemic, or COVID-19, loss of critical and essential services, and disruptions in supply and distribution chains, are inherent during the crisis. Fear of the disease, as well as the disease itself, can lead to social disruption, which can culminate in civil disorder, political unrest, and ultimately social destabilization; the long-term deterioration of economic viability and societal breakdown is also possible.
Fear, uncertainty, and panic may prevail, and measures must be instituted to allay fears and instill hope and confidence as the psychological footprint of an epidemiologic emergency may prove to be larger and last longer than the physical ravages of the disease itself. Therefore, much effort has to be placed into the behavioral health of affected populations. Much remains to be done in biodefense and public health preparedness, and experience with our COVID-19 nemesis has already rendered sheaves of lessons learned and after-action reports.
When the outspoken Pasteur mentioned that “chance favors the prepared mind”, it is certain that he meant mental preparation for scientific discovery. Perhaps, in the context of emerging biohazardous threats in our modern society, we can also look upon those words as a way to avert disaster. Pasteur himself would probably approve of this interpretation of his legacy to humanity.
Frank Rando currently serves as an allied health programs educator, lead instructor, healthcare emergency preparedness, medical readiness, public health preparedness and tactical, operational, disaster medicine and homeland security subject matter expert, educator, instructor, and curriculum designer. He has served in instructional, guest speaker, and consultative roles for DHS-FEMA, various components of the National Domestic Preparedness Consortium, Department of Defense, industry, academia, health, safety and regulatory entities, emergency services organizations, and healthcare.
