What we could do to slow down the next outbreak

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Responses to outbreaks and epidemics are often described in war metaphors such as ‘fighting’ the diseases and pathogens. In that process, we often forget that these ‘wars’ are partly our own creations and, to a large extent, preventable too. With the monkeypox disease being declared as Public Health Emergency of International Concern (PHEIC) by the World Health Organization, the discussion has again centered around ways to ‘defeat the virus’ and response strategies of case detection, isolation, contact tracing, containment, vaccines and therapies. Each of these are important; However, this is akin to sweeping the flooded floor without repairing the broken water pipe.

Every time you take antibiotics when it’s not needed, you could be making a pathogen more resistant

The emergence of the monkeypox outbreak — when the world is still in the midst of the Covid-19 pandemic — is another reminder that with every passing day, the probability of the next epidemic and pandemic is greater than yesterday. Newer diseases are emerging (ie Covid-19) and older diseases (ie monkeypox) are re-emerging. In the last 50 years, around 1,500 new potentially disease-causing agents (pathogens — viruses, bacteria and others) capable of causing diseases in humans have been detected. Between 1940 and 2004, an estimated 330 diseases had emerged, of which around 200 had jumped from animals to humans (humanzoonotic diseases in public health terminology) and 70% pathogens were from wildlife.

Let’s look at six major reasons which raise the probability of outbreaks and epidemics.

1. Every time a forest is cut in the name of urbanisation or development in any part of the world, new microbes which till then were hidden in the wilds come into contact with humans. Deforestation is a major cause of emergence of new pathogens.

2. Every human action and government inaction which results in global warming creates a conducive situation for microbes to adapt and survive in conditions and places that were earlier not favorable for them. A study published in the journal Nature in April estimated that in the next 50 years, if the Earth’s temperature rises by 2 degree Celsius, it would force wild animal species to settle in new areas and closer to human settlements. In that scenario, by 2070, about 10,000 to 15,000 new pathogens (bacteria and viruses) previously confined to wild animals and forests would come into human contact. Majority of these would emerge from countries in Africa and Asia, which then are likely to be the most impacted. Considering a majority of these microbes will be new with no prior immunity in humans, it will increase the likelihood of disease spread and epidemics.

3. Large-scale intensive ‘factory’ farms where tens of thousands of animals are crammed together in indoor settings creating a fertile ground for multiplication and mutations of pathogens, increasing the probability of emergence of new and ‘potentially harmful’ variants. This is not a theoretical assumption. The 2009 swine flu (H1N1) pandemic started from a locality in Mexico, which was just a few kilometers away from a ‘factory’ pig farm.

4. Every time you pop antibiotics for conditions in which these are not needed (ie common cold, wrongly believing it will result in faster recovery) or when antibiotics are used in poultry farms and the agriculture industry to increase the weight of chickens and inflate profit margins, it contributes to pathogens becoming resistant and surviving longer to cause newer and more severe disease in humans. These are human actions with grave consequences for generations.

5. Increased wildlife trade through “wet” markets and demand for rare meats provide a perfect environment for the spread of undocumented pathogens. The initial cases of Covid-19 were detected in people who had visited a wet market in Wuhan, China. The first outbreak of monkeypox outside Africa was an outcome of wildlife trade in the US.

6. Finally, unplanned urbanisation and crowded living conditions mean that the newer pathogens can spread faster and infect more people well before detection by any disease surveillance system. And in the era of fast transport where humans can travel to any part of the world in less than 24 hours, these pathogens are not restricted by any geographical or political boundaries.

‘Elementary, my dear Watson’ as Sherlock Holmes would have said to all this. But we can’t seem to understand that an infectious disease risk in any part of the world is a risk to every part of the world. The ongoing monkeypox outbreak is a time to pause and reflect: Are we actually helpless or can each one of us do something to slow down the next outbreak and epidemic? You know the answer.



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Disclaimer

Views expressed above are the author’s own.



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