One of my favorite books of all time is Camus' The Plauge. Its a story about how people react when they are thrown into a crisis that they can't escape. Doctors spring into action treating the dying, a priest preaches about God's judgment, people try to escape the protective quarantine. There are many engaging aspects of the book, but I was really drawn to, of all things, the bureaucracy of it all. The grinding, homogenizing power of the state arises at the edge of Camus work frequently, but in this case it feels a bit more like Kafka, who was as interested in the conflict between society and the individual.
But this is a policy blog, why, you might ask, am I talking about mid-century French literature? Well, it turns out there isn't just one, but two, plagues in the news this month and I've finally gotten motivated to look into them a little further.
First, there has been a bubbling up of interest in an old scourge, Smallpox. The virus, which is estimated to have killed at least 300 million people in the 20th century alone (three times more than the First and Second World Wars combined), was officially eradicated in 1980 in what may be the greatest public health victory in human history. There are only two awknowledged stores of the virus remaining, held by the CDC in the United States and the Vector Institute in Russia, both under the auspices of the World Health Organization.
Eradication was an incredible international achievement, especially because it has stuck for more than three decades. As far as I know there haven't been scares or stories about weapons labs with secret stores. It really does seem to be a victory for international cooperation, a well-executed plan, and, maybe, a bit of luck.
There have been two lingering matters that have remained since eradication, though. The first is whether the two official stocks should be destroyed and the second is how to deal with other caches of the virus should when they are discovered. Both of these issue have made it into the news in recent months. Most recently, an old set of samples was discovered in storage at an NIH lab in Maryland. Apparently this is the first time that a forgotten laboratory sample has been found and its seem like the CDC was able to retrieve the virus without incident. In this case the virus was probably long dead, but scientists take no chances, when mummies are discovered to have smallpox sores special teams are brought in to ensure that their is no live virus.
People will react two different ways to this, some will be nervous that the samples were undiscovered for so long, others will be glad that we have the capability to deal with such situations. I think the later group has it right, its prudent to assume that the virus might have survived somewhere and plan accordingly.
The tricker question is what should be done with the known stores of the virus. This is a longstanding debate with no clear right answer. The WHO decided earlier this year not to destroy the remaining samples. Each time this decision is made scientists and policy-makers must balance the risk that these samples will somehow reignite the disease versus their usefulness to scientists should it return from another source. With incomplete information its hard to know which course is safer and you can't know that you've made the wrong choice until its to let to undo it. Its a textbook wicked problem and its especially instructive because most of the ancillary issues have been cut away. No even the most ardent hawks advocate for government weaponization of the virus and there are no Smallpox politics to divide decision-makers. In other words everything about the policy turns on the question of risk. People might disagree about which risk is worse.
The second virus inspires a lot more fear today than Smallpox. Ebola is the closest we have to a modern day Bubonic Plague. West Africa is currently in the middle of the worst outbreak of the disease ever recorded, and it has already killed over a thousand people including at least one doctor treating victims in Liberia and an airline passenger who carried the disease from Sierra Leone to Lagos, Nigeria.
This is a whole different kind of problem, but its still wicked. In this case everyone scrambling to combat an acute crisis and attempting to prevent those exposed to the virus from carrying it to new areas. Again, there is little room for disagreement on the end goal for the medical professionals and government officials, but they have been left with a task that may ultimately prove to be too great. The goal (quelling the outbreak) is clear and the means of doing so are well understood, but the margin for error is so small that executing that plan perfectly is basically impossible.
Humans have a traumatic history with infectious diseases and there are few things that causes more concern among scientists and policy-makers than the risk of a catastrophic outbreak. Worse yet, we are faced with difficult, or even impossible choices every step along the way. The best thing we can do is stay focused and not let our policy responses be interrupted by any consideration other than what the scientists tell us is the best way to keep such threats in check.
No comments:
Post a Comment