Coronavirus: Pandemic Prevention

A synopsis of work by Dr. Rodrick Wallace and colleagues, prepared by Robert Fullilove and Mindy Thompson Fullilove, March 27, 2020.  This is for those who want to strengthen their minds.  

We are public health researchers who started studying epidemics in 1986, looking at the AIDS epidemic among Black and Hispanic people in the US.  One of the most important articles to shape the work we have done in public health is A Synergism of Plagues by Rodrick Wallace. This 1988 opus is widely cited in the annals of public health because it demonstrated with careful logic that the HIV/AIDS epidemic in the Bronx was largely driven by public policy decisions and actions. Wallace demonstrates that the decision made by city leaders in 1972  to close 32 fire houses in poor neighborhoods of color in New York City crippled efforts to effectively battle the decade-long epidemic of apartment building fires that followed on the heels of that decision. The city’s inability to mount successful efforts to confront apartment fires in communities such as the South Bronx and Harlem, resulted in a substantial loss of housing and the repeated forced displacement of residents who lost their dwellings in these conflagrations. This loss of housing impacted many members in networks of drug users in these neighborhoods. As network members were constantly forced to move from one dwelling to another, they also formed and reformed syringe-sharing networks where the transmission of HIV infection was substantially facilitated. Dr. Wallace points out that this public policy decision ultimately initiated a chain of events whose end result was an efficient engine for the spreading of AIDS in these communities.

Fire in Harlem.  Photo by Rodrick Wallace 

Similarly, in his current research into the key factors driving the current COVID-19, Dr. Wallace has identified the subtle but significant role that political and economic support of international agrobusiness may have played in our current pandemic. These enterprises rely on techniques to deforest landscapes to make grazing lands for cattle, or to use the same crops on the same soil year after year, thus limiting biodiversity. The loss of biodiversity makes crops in these settings vulnerable to pests and pathogens. To combat these intruders, more and more pesticides and more and more fertilizer must be used to make the land productive. Having usurped Mother Nature’s ability to maintain ecological equilibrium, we have crippled the planet’s ability to create the necessary barriers that can prevent the emergence of a species-ending pathogen. The critical line of defense that biodiversity provides has been substantially weakened.

COVID-19, it is sometimes said tongue in cheek, represents the next step in planet Earth’s efforts to save itself. This virus exploits a number of the most important components of 21^st century life. COVID-19 exploits our love of being in large crowds and in the densely populated urban environments we have constructed. It exploits our transportation hubs which move large groups of humans from one part of the planet to another in a matter of hours.  A novel pathogen like this coronavirus leapfrogs from one host to another in a densely populated urban center like New York or New Orleans and can subsequently take its act on the road via the enormous transportation webs of the 21^st century. With a significant delay in infected people showing outward signs of infection, the virus moves silently and efficiently, defying screening efforts and producing a long period of time during which infection can be transmitted silently from one to another.

What is to be done? We are left with downstream solutions. If we cannot prevent the generation of such pathogens, the only options open to us will be to do our best to treat those infected. Dr. Wallace suggests that there are other possibilities. An upstream strategy that targets the source of the problem is needed.  Asymmetric warfare, he notes, is the strategy that must be adopted if the forces of public health are to defeat – or at least limit the power of – agrobusiness interests.

In asymmetric warfare, two armies with very different resources and capabilities are pitted against each other. Given that they are not equals on the battlefield, who wins the war? Students of asymmetric warfare are fond of citing Henry Kissinger, the secretary of state under Richard Nixon, who noted that in guerilla warfare, the guerilla wins as long as he/she does not lose, while the modern army loses if it does not win. Losing for the guerilla army means they can fight no more; similarly, if the modern army cannot win and end the conflict, the prospect of endless engagement and battle is the same as a loss. There is no withdrawal, there is only the prospect of interminable battle, which ultimately makes the war a costly, worthless enterprise.

What are the asymmetric warfare lessons that can be applied to our need to successfully confront this viral pandemic and prevent, if possible, the emergence of the next one? Public health institutions lack the resources to take on agrobusiness directly in the world of finance and have few tools to limit the power that such corporations exercise over legislators, the courts, and the marketplace.

Nonetheless, the aftermath of this pandemic will take place in a world that will have been fundamentally altered by the steps that will have been taken to defeat this threat. There will be an inevitable series of post-mortem investigations into the whys and wherefores of this unprecedented series of tragic events. The inevitable question that will be posed is, “Why did this happen and what can we do to prevent a recurrence? Dr. Wallace asserts that the prevention question will take on particular urgency because, “…in the USA, emergence of a pandemic human analog to African Swine Fever, with a fatality rate of some 50%, seems inevitable.”

The asymmetric strategy here might well be to use the recollection of the terror of this pandemic to force dramatic changes in the way our treatment of Mother Earth has primed the planet for outbreaks such as this. If human activity in the form of agrobusiness has created this threat, the moment may be soon here to create the political will to resist and to enact the strategies that will reduce the threats it poses. The horrors that we are yet to endure with this pandemic will be more than enough motivation for us all to ask the key questions: how did things get out of control and what must be done to insure that this never happens again?

[For even more exercise for your mind: Here's important paper analysis from Dr. Wallace and his colleagues.]