The next war
It turns out a worldwide plague is a lot like a world war. Not a new observation. It requires expansion and training of the health workforce and mass mobilization of industrial resources for drugs, diagnostics, and medical equipment. It requires a strategy. Maybe more than one.
And the fight is costly, in blood and treasure.
Wars never truly end, and neither will this fight. Just as the denouement of one war seeds the imbalances, and incentives for the next, the diaspora of SARS-CoV-2 is linked with the defeat of SARS-CoV-1, and will define how we think about emerging disease for decades to come.
So let’s think about the decades to come. We have a choice. We can wait around for the next disease, or we can get ready. Historically, “getting ready” for pandemics has been an exercise in planning. Plans are great, but they don’t win wars.
Armed forces do. Big, well armed, well trained, standing armies win wars. (Not always. Usually. Usually is better than ¯\_(ツ)_/¯.) If we want to be able to rapidly respond to epidemics, we need a force that is in the habit of responding to epidemics.
A fighting force needs weapons and intelligence. What if we set aside enough funds to develop vaccines, therapies, and diagnostics for every newly discovered disease, anywhere in the world? What if we deployed the surveillance infrastructure to identify the majority of new diseases each year, not just in humans but in the animals from which the deadliest pandemics emerge? (If you’re wondering, we’ve probably discovered and catalogued about 0.1% of viruses.)
Meanwhile, our military personnel are professional and effective because they fight all around the world, all the time. During the 2015 Ebola outbreak, the military deployed to the Democratic Republic of Congo, where their response was apparently effective, but not without room for improvement. Small wonder: it was a job our military was not built to address. We should fix that.
What if we responded to emerging infectious diseases the way we respond to paramilitary drug cartels or terrorist training grounds? What would it mean to always have boots on the ground and eyes in the sky? We accept without question that it’s better to fight a threat “over there” than “over here.” Our military is designed to project American influence into the furthest corners of the world. We could take the same approach to fighting infectious disease. If we don’t want epidemics here, we’d better build an organization that is in the habit of responding to epidemics overseas.
Having developed all of these vaccines and diagnostics, we could put them to use. Run drug trials and administer vaccines. Test whole villages and provide care. Take samples to catalogue the existence and spread of disease. Stand up hospitals and train field nurses from among the local population.
If this sounds hard and expensive, that’s because it is. But so is maintaining a standing army, an expense that in living memory we’ve always been willing to bear. Building a force to fight disease overseas also builds the expertise to fight disease here. If we were routinely engaged in outbreak response, we’d have better expertise for how to set up field clinics, triage and treat patients with limited staff in rapidly changing conditions, and educate a scared and skeptical population. Plus, we’d probably already have specific experience with the disease in question, because we would have already been responding to it in the country of origin.
Finally, to say the quiet part loud: infectious disease will not always be a random, evolutionarily driven threat. Anyone paying attention to the rapidly expanding toolkit for biological manipulation can imagine a future in which a bad actor engineers a deadly pathogen and deliberately sets it loose. God forbid that future. But if God does not, it would be good to know what in Hell we can do about it.
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