Lessons From the SARS Epidemic

The current hysteria over the severe acute respiratory syndrome (SARS) epidemic recalls Harry Truman's observation that "there is nothing new in the world except the history you don't know." Although a recent phenomenon, SARS has more in common with epidemics of the past than most people realize. These shared aspects include: the seemingly sudden rise from nowhere; the easy transmission from person-to-person; the dragnet of cases inhibited by one country or social group attempting to obscure the outbreak; the scapegoating of a particular social group perceived to carry the infection in question; the virus's spread abetted by a thirst for worldwide travel; intense media coverage; calls for quarantines; and disproportionate levels of panic.

In fact, all of these elements have been essential aspects of epidemics throughout history, ranging from the Black Plague of the 14th century and the cholera epidemics of the 19th century to the stunningly lethal influenza pandemic of 1918 and the early years of AIDS. A more recent plot twist has been the perverse threat of terrorists inflicting infection, as we saw with the anthrax and smallpox scares.

But, perhaps the most troubling paradox of epidemics is the dichotomy between the brief, ubiquitous, and panic-stricken attention we pay to the new infections that kill few in spectacular fashion, like SARS, and our apathetic responses to familiar scourges that literally plague humankind everyday. Compare the level of attention we have given the roughly 300 people who have died of SARS since November 2002 to the attention we have given to the 300 who died of AIDS during the past hour. Our responses to the alarming rates of fatalities caused by older, less fashionable epidemics such as tuberculosis, malaria, and measles are equally phlegmatic.

What distinguishes the complex dance between humans and microbes today has much to do with the remarkable advances science has made in the understanding and amelioration of infectious diseases. SARS is a striking example of this trend. Several months ago, no one had ever heard of it. Already, scientists have not only identified its cause, they have even dissected out the virus's genetic structure, and before long will have developed diagnostic tests and, hopefully, means of treatment.

Yet even these strides in the science of public health have had unintended consequences. The quick detection and containment of a contagious threat, followed by premature declarations of victory, often give rise to a collective underestimation of the unpredictable and remarkable power of infectious diseases. These successes engender a false confidence that the eternal struggle between human and microbe has been won rather than temporarily stayed. Ironically, just when public health departments are working at their best, there is a strong temptation to cut their budgets.

In reality, only the global community can make inroads in responding rapidly to new epidemic crises such as SARS and containing older ones such as AIDS, malaria, and tuberculosis. All of us must accept that the public's health is everyone's problem and responsibility, no matter where today's infectious "hot zones" happen to be. We must back that acceptance with a constant stream of financial and social support even in times of relative infectious quiet.

The good news is that many of the world's truly significant infectious killers are preventable or, at least, treatable. We could prevent some 30 million cases of measles (and the 1 million deaths it causes each year) by vaccinating every child in the world against it. We could prevent nearly 2 million deaths a year from diarrheal diseases (most of these occur in children) by making sure that everyone in the world has daily access to clean water; at present, more than 1.5 billion people do not. With adequate mosquito control, we could significantly reduce the millions of deaths caused each year by malaria, yellow fever, dengue fever, and West Nile virus.

Economists have estimated that if every citizen of every wealthy nation of the world donated approximately 10 dollars per year to preventing and treating epidemics in the world's poorest nations, 21,000 lives would be saved, not to mention millions of dollars in lost productivity, every day.

History teaches us that epidemics are a fact of life, with recognizable patterns and pitfalls. Although the World Health Organization has made tremendous strides in containing the SARS epidemic, it is largely a voluntary organization without police powers or real authority, as demonstrated by China's reluctance to announce cases of the infection as early as last November. For countries struggling under immense poverty, public health surveillance and other preventive measures against the many contagious ailments that kill on a daily basis simply cannot be attended to without real and lasting help from the wealthier nations of the world.

Before SARS joins the growing list of once feared and now ignored epidemics, we should seize the opportunity to develop permanent and accountable global public health mechanisms to prevent the contagious crises that are certain to arise and linger in the future.

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