Pandemics: Prescription for Prediction and Prevention

Over the natural history of zoonoses and their emergence or re-emergence in the early 21st century, the general causes have been a mixture of humans' creation of new urban or agricultural ecosystems in the ruins of older, non-human dominated ecosystems; economies of scale and monocultures in agriculture; fast global travel and unfettered free trade; loss of land and sea biodiversity; social inequities; marginalization of poor people; rapid sprawl of slums; and human-induced climate change. These modifying factors contribute to the destabilization of ecosystems, the dispersal of animals and microbes into new areas, and the creation of a single interconnected world - a giant microbial mixing vessel for infectious agents that previously stayed separate and stayed put. This convergence altered forever the way in which we will experience epidemics and ushered us into a new pandemic age. All these issues must be encompassed in the context of globalization, climate change, ecological collapse, species extinctions, human overpopulation, huge economic and political disparities, and unintended consequences of well-meaning interventions. Unfortunately, our world remains underprepared to predict, detect, respond to, and, even less, prevent infectious disease outbreaks and a fortiori pandemics, whether naturally occurring, accidental, or deliberately released. These threats endanger lives, disrupt families and societies, and wreck havoc on economies. They do not respect national boundaries; do not discriminate between different ethnicities, religions, social or economic status or even age; and can spread rapidly, jeopardizing the health, security, and prosperity of all countries. Yet, the cost of failing to control outbreaks, ruining and losing lives, destabilizing the social fabric, and decimating economies is considerably greater than the cost of prevention. It is therefore in each country's security interest to strengthen global health security and manage the risk of infectious disease outbreaks that might further develop into full-blown pandemics. In this treatise, I offer a tentative prescription for predicting and preventing pandemics, and hopefully arresting this infernal merry-go-round.