Doomed to Repeat History?
“At the beginning of October, in the year of the incarnation of the Son of God 1347, twelve Genoese galleys were fleeing from the vengeance which our Lord was taking on account of their nefarious deeds and entered the harbor of Messina.? In their bones they bore so virulent a disease that anyone who only spoke to them was seized by a mortal illness and in no manner could evade death.”
??????????????? -An early account of the Black Plague
The Black Plague emerged from the eastern provinces of China, where fleas carrying blood from plague-infected rodents attached themselves to merchants traveling down the Silk Road. In this way, the disease journeyed bumpily by caravan through the Middle East and eventually into Europe.??
The symptoms of the plague were easy to recognize.? It started with a fever, vomiting and delirium.? Lumps formed around the groin, neck,?or armpit, turned a blackish color (giving the disease its name), and continued to swell until they burst.? Death followed symptoms by three or four days. The Black Plague decimated Europe, killing approximately 75 million people, roughly one-third of its population. Although the Black Plague still exists, resulting in a few deaths each year in the rural parts of the western United States, it can be easily cured with modern antibiotics.
HIV appears to have first infected humans as early as the late 1800s. Originating in chimpanzees in central Africa, the disease was contracted by hunters who harvested them for food.? It took about one hundred years before the term “AIDS” was defined,?and about a decade later?it?became the number one cause of death in the U.S for men aged between 25 and 44. In total, there have been approximately 40 million deaths from AIDS, and while HIV is still present, it is usually well managed with modern medicine.
Over the period from 1918-1919, the wildly misnamed Spanish flu (the Spanish called it the French flu, but the first case on record was at Fort Riley in Kansas) caused acute illness in over a quarter of the world’s population and resulted in roughly 40 million deaths. The perpetrators were not rodents or primates but instead a mix of domestic and wild birds, as is the case each year when a new version of the flu circulates and we all contemplate whether or not to get an updated shot.????
MERS-CoV emerged from dromedary camels in Saudi Arabia. Pigs, bats, and mosquitoes are all responsible for the widespread infectious disease. In fact, much of the animal kingdom is brewing generations of bugs that will eventually evolve into forms of infection that can leap across species. Consequentially, humans will do what humans do to contract the disease and then, usually impervious to the threat, spread it to the rest of the human population.??While planes were considerably more efficient in spreading Covid-19 than sail-powered ships did the Black Plague, the result was more or less the same.
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The century that tends to pass between truly awful outbreaks explains why we are so disorganized in our response and why it is possible for a new infection to spread so widely before it is recognized.?However, it does not explain why we are doing our best to make matters worse in the meantime. The CDC reports approximately?three million antimicrobial-resistant infections each year in the U.S. alone. These bacterial and fungal infections represent an accelerated version of what is happening in the animal kingdom, except in humans.?One of the primary forces behind this issue is the misuse of antibiotics and antifungals which serves to kill?off our milder infections while allowing more drug-resistant variants to survive and spread.
Despite the escalating number of deaths from drug-resistant bugs and the ever-present zoological threat, there are paltry resources being applied to the development of new treatments. Novel anti-infectives are penalized by cost-conscious hospital systems and rightly held in reserve by conscientious physicians. The result is these life saving therapeutics have very limited economic potential.?The consequences are curtailed investor interest in funding novel approaches, bankruptcies among anti-infective-focused biotechnology companies, and profound disinterest among the larger pharmaceutical companies.?
Legislative solutions have focused on granting exclusivity extensions to companies who advance qualifying anti-infectives.?However, a prolonged period of unprofitable revenues is not actually an incentive.?The Pasteur Act, which came within a hair of passing in 2021, proposed a more thoughtful approach.?Under this proposal, the government would pay meaningful upfront access fees for novel anti-infectives approved by the Food and Drug Administration.?This would ensure nationwide availability of these anti-infectives without the contradictory pressures of an economic system that, on one hand, requires a return and, on the other hand, requires powerful new therapeutics be held in reserve.?
It is true that there is considerable geopolitical strife at present and that is a necessary area of focus for legislators. But, given the death toll from infectious disease easily tops the chart over war and any other disease and the observable decline in efficacy of existing treatments, perhaps now is nonetheless a good time to legislate a fix? We need not be doomed to repeat history again.