Many months into a raging global pandemic, which so far has killed over a million worldwide and pushed more than 3.5 crore people into seeking some sort of medical intervention, the world is not clear when will this public health crisis eventually blow over.

Many farsighted public health experts have been warning for long that the world is ill-prepared for an assault by an invisible enemy such as deadly viruses and other microbes. As in the past, since the turn of the current millennium there were at least few such epidemics that were potential pandemics. As luck would have it, the impact of epidemics like SARS in 2003, bird flu in 2005 and swine flu in 2009 was limited as these viruses “lacked” the potential for more deadly human-to-human transmission. These lethal viruses are still around. Some are just a mutation away from unleashing yet another global health crisis.

One expert, who has constantly been cautioning us about the killer germs that can cause deadly infectious diseases leading to untold miseries, is renowned epidemiologist Michael Osterholm. Very outspoken, Osterholm, the founding director of the Center for Infectious Disease Research and Policy at the University of Minnesota, US, has seen the devastating impact of such lethal pathogens up close as he has been involved in investigations into numerous global outbreaks in the past. He is the go-to man for US government institutions, including the Centers for Disease Control and Prevention.

It is this first-hand experience and his insightful understanding of the workings of these deadly enemies from the biological world that make it important for the world to listen to him.

Fortunately, Osterholm has been able to voice these concerns through a lucidly written book that he penned together with master storyteller Mark Olshaker : Deadliest Enemy . Though it was first published in 2017, the authors decided to revise it further to include a chapter on Covid-19 as preface. Significantly, whatever the first edition tried to forewarn played out too soon when the Covid-19 struck in Wuhan in the latter part of 2019 and quickly spread to all over the world.

A new paradigm

The book seeks to give readers a new paradigm for considering the threats posed by infectious diseases in the 21st century. Even though it covers a broad range of communicable diseases, the focus is specifically on maladies that have the potential to disrupt the social, political, economic, emotional and existential well-being of large regions, or even the entire planet.

The authors argue that nations, which spend billions of dollars on national security and defence, do not often realise that the greatest threats come from such microbes. They say that the world is woefully under-prepared to fight a war against disease-causing microbes because of inadequate investments in disease surveillance. As a result, once the threat recedes, everybody forgets about it until yet another one comes along.

Citing the examples of how Osterholm warned the world about outbreaks of Zika in the Americas and MERS (Middle East Respiratory Syndrome), the book explains how foreseeing potential threats should emerge as a standard practice in public health.

Interestingly, the authors invoke two metaphors for disease throughout the book: one is crime and the other war. Just as we will never eliminate either crime or war, we will never eliminate disease. But just like crime and war, a battle needs to be constantly waged against diseases.

The authors also pose a pertinent question: whether we would have been better able to fight Covid-19 had we taken the earlier 2003 SARS epidemic a little more seriously. They think that if the world had put in more serious effort into developing a vaccine for SARS1, then there could have been gains. Probably that vaccine may or may not have worked on the novel coronavirus, or SARS-Cov2, but it may have given us a head-start in basic research helping develop a coronavirus vaccine platform, they argue.

Indeed, serious attempts were made to work on a SARS vaccine in 2003, but the interest of government organisations and philanthropic groups dissipated soon after the outbreak ended in mid-2003. Pharma companies, which spent millions of dollars in the early stages of SARS vaccine development, had to underwrite those losses. The corporate ‘memory’ about losses is a major concern going forward for vaccine-related investment.

The book devotes a chapter to talk about the importance of vaccines in human life. It says since corporates cannot ignore economic realities, governments and philanthropic organisations should come forward.

The authors cite the example of the Coalition for Epidemic Preparedness Innovations, an international initiative that came into being to stimulate and accelerate the development of vaccines against emerging infectious diseases and ensure equitable access to these vaccines.

On the Covid-19 pandemic, the authors puncture the optimism that the world would be in a position to deal it better as compared to the 1918 Spanish flu, which is said to have killed 50-100 million people. While the mortality rate seems to be much less than the 1918 pandemic, the impact of Covid-19 is said to be much more severe all if all things are taken into account.

The book has a piece of advice for leadership in affected countries. It is the first responsibility of the head of any nation to offer accurate and up-to-date information. If the leader sacrifices his credibility, the public will not know where, or whom, to turn to. Citing studies in the past, the book says if the public is given honest, forthright information, panic almost never ensues.

Michael Osterhol’s message is loud and clear: This pandemic will not be the last one to haunt us. Such deadly enemies will keep coming and one of them could be even bigger and one or more orders magnitude more serious than Covid-19.

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