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National Geographic : 2002 Feb
Contents
Lake Michigan became contaminated with the intestinal bug Cryptosporidiumin 1993, hun dreds of thousands of residents in Milwaukee were infected. When one U.S. fast-food chain sold undercooked hamburgers tainted with a virulent strain of E. coli bacteria in the same year, hundreds of children fell ill, and several died. And far-flung outbreaks of severe diar rheal disease have been traced to apparently healthful seed sprouts that were grown from contaminated seeds and then widely distrib uted from a single source. In the worst case, white radish was implicated in a Japanese E. coli outbreak that sickened about 10,000 and killed 11 in the summer of 1996. T'S BAD ENOUGH that in today's crowded and interconnected world small out breaks can blossom inadvertently into huge epidemics. Equally worrisome, how ever, is the fact that terrorists can take advantage of that modern vulnerability and intentionally sow the seeds of a devastating disease. A bioterrorism attack, as difficult to counter as almost any act of war, combines the best of microbial lethality and human ingenuity. Bil lions of infectious particles can be stored in a small vial, much easier to smuggle into a coun try than a nuclear device. Computer models have shown that an intentional outbreak of smallpox (public health officials report that some samples of the smallpox virus, stored for research after the disease was eradicated, are now unaccounted for) could spread uncontrol lably almost before officials could take action to contain it. And as the U.S. learned firsthand in October, even a noncontagious disease like anthrax can wreak enormous havoc if it finds its way into the nation's mail system. To a terrorist perhaps the most attractive feature of a plague is its fantastic capacity to create social unrest and political instability. "Infectious agents have the potential to trigger panic and fear like no other weapon," says Michael Osterholm, director of the Center of Infectious Disease Research and Policy at the University of Minnesota-and an epidemi ologist with a worldwide reputation for his disease-sleuthing skills. "It's horrible to be eaten from without by a lion or something, but it's equally horrible to be eaten from the inside out by some terrible bug and to see that going on all around you. It's a very primal fear." Bioterrorism was already a matter of height ened concern when planes crashed into the World Trade Center and the Pentagon on Sep tember 11. The CDC immediately warned U.S. public health agencies to be on the lookout for "unusual disease patterns associated with the events of September 11," a chilling hint of fear that the country might be under biological attack. A biowarfare unit from the CDC and a military team specially trained in disease detection were rushed to New York. As part of the security crackdown that followed the hijack ings, federal officials temporarily grounded the nation's fleet of 3,500 crop duster airplanes, which they feared might be used to release a cloud of deadly microbes. When anthrax attacks did materialize a few weeks later, billions of dollars in resources were quickly redirected to bioterror defense. And yet the recent emphasis on bioterror ism obscures a more pedestrian but equally important truth about infectious diseases: Even without the element of intentional terror, diseases are a huge source of human suffering -and a tremendously destabilizing force. Nearly half of the world's premature deaths (defined as deaths under the age of 45) are caused by infectious diseases. Some 30 mil lion infants in developing countries remain unprotected by the lifesaving childhood vac cines that in the rest of the world are admin istered routinely; a million die each year from measles alone. It may not be obvious in the healthier nations, but from a microbe's point of view the world today-even with modern antibiotics and fancy vaccines-remains a virtual smorgasbord. With the recent reemer gence of some of these diseases in richer nations, there is a growing recognition that no nation is an island. "The lesson of West Nile is that any country is vulnerable," says David Heymann, execu tive director of communicable diseases at the World Health Organization in Geneva. "Coun tries have to realize that infectious diseases, regardless of their origins, can travel widely and affect anyone." No nation, no matter how rich or seemingly protected, can be assured of a healthy and peaceful future as long as any nation is still an active breeding ground for the world's many and varied scourges. Encouragingly, that reality is sinking in. A 1999 CIA report, an (Continuedon page 26) WAR ON DISEASE
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