For centuries, microbial life has proved to be a stealthy and deadly enemy of the people.
From the Black Death (bubonic plague) in the 14th-century to the influenza pandemic which
which killed up to 50 million from 1918 to 1920, and now, in our century, the coronavirus
pandemic – bacteria and viruses have dealt devastating blows against humanity
Pasteur has succinctly stated, in part, where we find ourselves today in developing an evolving framework of biodefence 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.
Humans are the problem
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. In the process of establishing newer habitats, they cross-infect other species.
These trans-species jumps may also lead to genetic assortments and viral mutations that occur in the new host animal. This has been well established in novel strains of influenza – where pigs and even domesticated pets such as dogs serve as ‘bioreactors’ harbouring novel pathogens.
The influence of climate change on meteorological patterns and conditions where shifts in the jet stream and other weather phenomena can result in excessive rainfall has also resulted in an explosion of mosquitoes which serve as vectors for transmitting vector-borne illnesses.
Researchers have conducted hot-spot analyses 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 will occur.
Many regions of the world are also affected by critical shortages of healthcare personnel and tend to have the least developed healthcare infrastructure. This is also affecting advanced industrial societies as well. Understaffing, underresourced health services and overpopulation are three common denominators that contribute to the spread of emerging and re-emerging infectious diseases.
Globalisation, population displacement, humanitarian crises, movements of animals and goods, rapid urbanisation, changing human behaviours, ethnic and racial customs, especially with regard to food and animal husbandry, and land use all influence the emergence and spread of infectious diseases.
Agricultural practices where crowded conditions prevail to heighten productivity also serve as potential breeding grounds for novel zoonotic pathogens, such as lethal strains of highly pathogenic avian influenza. Added to the zoonotic pandemic phenomenon, excessive or improper use of human and veterinary antibiotics has initiated leaps in antibiotic resistance. This has led to 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 the inability to access health services, lack of a robust public health infrastructure, malnutrition, inadequate sanitation, low income and other factors add to the proliferation of epidemics that can lead to pandemics affecting global health and security.
Life out of balance
What is meant by global health security in the context of emerging pathogens in the natural world, in a time when life is out of balance?
The World Health Organisation (WHO) defines health security as activities that are necessary to “minimise 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 is being vividly portrayed on the international stage as we collectively experience the presentday Coronavirus COVID-19 pandemic which has spread to many countries and threatens entire continents.
In the US, 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 have become activated. They have set into motion an aggressive national effort to combat the adverse effects of the Coronavirus public health emergency in all sectors of society.
The President has declared a state of national emergency and has invoked the Stafford Act, which addresses national disasters and the Defense Production Act along with strategic public-private sector alliances. Similarly, other nations have invoked emergency powers and taken wartime-like stances to meet the daunting challenges of this epidemiological emergency.
In terms of global security impacts, the potential infective spread of contagion among the world’s armed forces would also be a critical event as it affects defence operational readiness.
Impact on our Forces
Infectious diseases have altered the outcomes of conflicts and wars and have affected the balance of power among nation states. Prior to World War II, more combatants died due to infectious diseases than from direct combat injuries.
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 US military has invested significant resources in infectious disease research, building sophisticated diagnostic laboratory capacity around the world, disease surveillance infrastructure, and vaccine and other biomedical countermeasure development.
As the morbidity and mortality of the ongoing Coronavirus rises exponentially, the military forces of the world and their medical and public health components will be enlisted into the domestic assistance realm. This is already in progress within the US as National Guard, Reserve and Active components of the military mobilise to intervene to assist with consequence management during this global bio-emergency.
Loss of services
In any high-consequence epidemiological emergency, such as the Ebola viral haemorrhagic disease outbreaks, H1N1 pandemic or our current Coronaviris pandemic, 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, destabilisation, with longterm deterioration of economic viability and possible societal breakdown.
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 epidemiological emergency may prove to be larger and last longer than the physical ravages of the disease itself. Therefore, much effort must be put into maintaing the behavioural health of affected populations.
The conditions under COVID-19 are unprecedented in modern times and most people, grown accustomed over decades to a civilianised consumer society, find the draconian measures unbearable or untenable with regard to their jobs, families and social contact.
Much still remains to be done in biodefence and public health preparedness. Our Coronavirus nemesis will undoubtedly render sheaves of the inevitable ‘lessons learned’ and afteraction reports. Meantime, at no other time since both World Wars, millions of people face unprecedented privations while healthcare experts and workers face up to a long-predicted global threat to public health.