Will Byrnes's Reviews > The End of Epidemics: The Looming Threat to Humanity and How to Stop It

What frightened me? Certainly the prediction by Bill Gates and his team that an epidemic like the 1918 influenza pandemic that killed 50 million people could happen again today—and that in the first 200 days it could kill 33 million people. That’s almost as many people as AIDS has killed over four decades. Even scarier was the Bank of America/Merrill Lynch assessment that the threat of a global pandemic could claim more than 300 million lives and cost the global economy as much as US$3.5 trillion.

There are many things to be concerned about in this world, justifiably. Terrorism, global warming, the undermining of democracy by dark forces. (The Patriots winning yet another Super Bowl) I know that we are, or certainly should be, concerned about the potential carnage that might be wrought by some lunatic (you know the one) doing something in a fit of pique over an insulting tweet, and sending considerable supplies of glowing ordnance rocketing about the planet. Millions would perish. Landscapes would be rendered uninhabitable for decades, if not centuries, if not forever. A worldwide engagement in such insanity would slaughter hundreds of millions. We have experienced large-scale human die-offs before, in wars, of course, but there are other sorts of global catastrophes (defined as events that could wipe out 10% of humanity) that could kill even more.

The Spanish influenza pandemic of 1918 may have killed as much as 5% of the world population. Some outbreaks since then infected over a third of the world’s population (e.g., pandemic influenza), whereas others killed over half of people infected (e.g., Ebola or SARS). If a disease were to emerge that was as transmissible as the flu and as lethal as Ebola, the results could be catastrophic. Fortunately, this rarely transpires, but it is possible that it could, for example with the H5N1 influenza virus. - from the Global Catastrophic Risks report

There may not be a lot we can do about deranged leaders, other than vote them out of office, where untampered voting is an option. But there is a lot we can do to take on the growing challenges of potential epidemics and pandemics. Preventing the emergence of a global deadly pandemic afflicting vast swaths of the world’s people can save as many lives, and maybe even more lives, than averting a nuclear war. This is the point of The End of Epidemics.


Jonathan Quick - Image from Scribe Publications

Dr. Jonathan D. Quick, MD, MPH, a family physician, has been working in international health since the 1970s, was Director of Essential Drugs and Medicines Policy at the World Health Organization from 1993 to 2003. He is a fellow at Management Sciences for Health (MSH), a non-profit founded in 1971 to assist local communities in distressed nations establish health care delivery systems. He has authored over a hundred books, articles and book chapters, and is a long-term advisor to health care projects in Afghanistan and Kenya. He has gotten up close and personal with some of the worst threats to human health and decided to put together a plan of action after the West African Ebola epidemic killed over 11,000 people and orphaned more than 16,000 children.

Once the world woke up to the crisis, there was a generous outpouring of assistance. As the response peaked, I was consumed by nagging questions: Where will we be four or five years from now? Will the world have gone back to sleep? What’s needed to protect the world from future outbreaks? To find the answers, I explored the lessons from epidemics over the last century – smallpox, AIDS, SARS, avian flu, swine flu, Ebola, Zika – and I drew on some of the best minds, experienced professionals and committed citizen activists in global health, infectious disease, and pandemic preparedness. - from the MSH site

Influenza victims at Fort Riley, Kan., during the 1918 epidemic - image from the Boston Globe

He lays out a seven-step program for averting future epidemic crises, (lofty goals) then drills down into each of the seven to add flesh to the bones, specifics to the generalities. In doing so, he offers considerable historical perspective. This is what happened here at this point in time. This is what was done to address the medical problem. This is what was done to raise public awareness. This is what was done to use the fuel of that awareness to effect change in laws, resource allocation, and results.

Here are his Seven sets of actions needed for preventing and coping with epidemics
(1) Ensuring bold leadership at all levels
(2) Building resilient health systems
(3) Fortifying three lines of defense against disease (prevention, detection, and response)
(4) Ensuring timely and accurate communications
(5) Investing in smart, new innovation
(6) Spending wisely to prevent disease before an epidemic strikes
(7) Mobilizing citizen activism

If your brain works at all like mine, your first instinct is to engage in a little recreational eye-rolling, accompanied by mutterings such as, “uh huh, and how do you define that?” Or, “Oh, really? And who gets to say what constitutes “timely and accurate”, “smart”, and “wisely?” All seven sound like lofty, and very ill-defined goals. But Quick addresses each of these goals using real-world experience and translates them into examples, offering actions that can be taken. I soon parked the snark and took in what was being offered. While there are plenty of short-sighted, self-serving jerks who will stop at nothing to interfere with making the world a better place (Even today, needle exchanges are banned in almost every state in the southern U.S., where the AIDS epidemic is now concentrated and HIV infection rates are ten times higher than in other parts of the country.), there are also a lot of knowledgeable, committed people, care providers, religious, political and business leaders, eager to identify and implement mechanisms for change, for improving access to health care, for developing new vaccinations and treatments, for organizing distribution networks where few or none now exist, for educating populations on the realities of transmissible disease exposure and for working with local communities to address today’s health challenges and defend against potential horrors.


The AIDS virus – image from Avert.org

There is frightening intel in this book on the sources of new pathogens, from bush meat to factory farms, to unemployed bio-engineers. In addition, there is brain-candy material on how several of the all-star list of epidemic diseases got their start, and how they were brought from their birthplaces to the rest of the world. Fascinating, powerful stuff. One particular bit of important analysis here is on the secondary impact of epidemics. The damage is not just to those immediately afflicted, but to those around them and to entire economies.

As with war, where common illness can take more lives than war injuries, epidemics sometimes take more lives from disruption of primary healthcare than from the epidemic itself. Because health workers are diverted to emergency response centers and health facilities are sometimes closed, epidemics can also disrupt routine public health care needs such as immunization, treatment of acute illness, and facility-based births.

He looks not only at how we manage to put our hands over our ears and rattle out sound-blocking la-la-la-la-la-la noises, but takes it a step further to try to understand why we do that. He also reports on some remarkable success stories, including, over a long-term, the West coming to grips with the HIV crisis to the point where, while still a major life-threatening disease, it is now a manageable long-term condition and not an instant death-sentence. With concentrated and persistent effort progress can be made. Quick cites some other remarkable success stories in Africa that have received scant coverage in Western media. He gets specific on how much money would be needed to undertake the program he proposes, (chicken feed) and compares that with the cost of failing to do so.

New diseases are cropping up at a faster rate than ever before. Since 1971, scientists have discovered at least 25 new pathogens for which we have no vaccine and no treatment. Where do new diseases come from? What is the impact of actions by people on the creation of new diseases? We face threats from bioterror. What would ISIS do with a designer virus? Bio-error presents another risk. I can certainly image a future president (Merkin Muffley?) getting on the phone to a foreign leader to fill him or her in on the oopsy release of an engineered bug, even if it had been intended only for testing and defense purposes. Well, how do you think I feel about it, Dmitri? Hopefully, a sufficient number of forward-looking world leaders will have already established protocols to make that call one that is intended to deliver information, and not induce a retaliatory doomsday panic. And what about unintended consequences from bio-engineered materials that go rogue?


The Ebola virus – image from Wikimedia

If you are a public health policy junkie (it was my first career out of graduate school, and that monkey took up permanent residence on my back), this is mainlining material. The stakes could not be higher, the need for long-term-planning could not be clearer.

We provide considerable funding for the military and charge them with the broad mission of keeping us safe from foreign threats. Given the potential for danger to the lives of citizens, doesn’t it make sense to direct resources toward preventing such losses where the potential for carnage is greatest? And don’t forget that many of the diseases that we fear here have their origins elsewhere, as air travel allows stowaway bugs to cross the globe in a matter of days. So, in our ever-smaller world, resources need to be directed to the sources over there of some of our exposure here at home.


H5N1 Influenza Virus – image from Wikimedia

I have two gripes about the book. Quick calls his program The Power of 7. Sorry, but that sounds like a Sesame Street segment, or yet another group of Marvel superheroes, maybe a vitamin drink. I am sure there is a PR firm somewhere that would be happy to earn some pro-bono brownie points by coming up with something better. Second, and this is a more passing thing, early in the book the author tended to sound like one of those people whose focus is more on himself than his message. Even if the content of what he is saying is true, it’s just poor form. Sentences like I was hosting a videoconference for the global health nonprofit that I led… or it comforts me to know that I’m part of an organization that’s truly committed to saving lives. Thankfully this sort of thing vanishes pretty quickly, and focus on the message proceeds without further such asides.

While I can definitely see this being of particular interest to readers who share my personal addiction, I could see it being used even more productively in colleges and graduate schools. It should be required reading in all MPH (Master of Public Health) programs and in any courses, graduate or undergraduate, that address global health issues. It should certainly find its way to every political leader in a position to impact public health legislation, and to all those charged with managing health care institutions, public and private. It wouldn’t hurt to slip a copy over the transom of every foundation that funds such things. Maybe the Gates Foundation, or a similar entity could see to such a global distribution.


SARS-associated coronavirus- image from ThingLink.com

The End of Epidemics is reality-based, offers fully-informed analyses of existing and projected medical dangers, and presents a well-thought-out program for averting catastrophic loss of life across the planet. It is a significant distillation of current knowledge on how to go about ensuring that we actually have future generations, and for anyone involved in public policy it is a must-read. For the rest of us, it is a readable, worthwhile, informative look at a potentially imminent global danger. I hope the knowledge presented in this book and the optimism of its author, infects readers, and is passed on to many, many others.


Published – 1/30/18

Review first posted - 2/2/18

Added bit on February 2022 reposting - The prescience of Quick’s concerns is impressive, even though his predictions were, in fact, conservative, and based on established science. Thankfully, COVID was not as lethal as Ebola or Marburg. It was, and remains, lethal enough. The importance of this book, looking back from 2022, cannot be overstated. I can only hope that it finds a readership among public health officials and legislators sitting on health-care-related committees.



=============================EXTRA STUFF

Links to the author’s personal, Twitter and FB pages

From This Week in Global Health - a fascinating interview with Dr. Quick

A short video in which Quick talks about his End of Epidemics project

ResearchGate offers a list of Quick’s writings, many of which can be downloaded in their entirety for free.

From Science Alert, a short article on the ranking of potentially horrific events - New Report Officially Ranks All The Catastrophes That Could Wipe Us Out in 2016

The report cited by the above article is from the Global Priorities Project - Global Catastrophic Risks - 2016

Flue Near You is a crowd-sourcing system for early detection of you-know-what. It takes data from participants across the country, anonymously. Check it out.

January 18, 2018 - NY Times - Flu Hospitalization Rates Are the Highest in Years. Here’s Why. - by Donald G. McNeil Jr

in some places — including Southern California, Pennsylvania and central Texas — some hospitals have seen so many flu patients that they had to set up triage tents or turn other patients away. Local shortages of antiviral medications and flu vaccines have been reported, and the C.D.C. said patients may have to call several pharmacies to find shots or to fulfill prescriptions.