Diatribes of Jay

This is a blog of essays on public policy. It shuns ideology and applies facts, logic and math to economic, social and political problems. It has a subject-matter index, a list of recent posts, and permalinks at the ends of posts. Comments are moderated and may take time to appear. Note: Profile updated 4/7/12

10 October 2014

The War We Really Have to Win

[For an essay and table of our nation’s eleven biggest unsolved problems, up only two days, click here. Believe it or not, this post is more important. For why and how we should be ready for the next war we must win, click here.]

It’s easy to get depressed reading the news today. The Islamic State, or IS, is busy chopping off heads and conquering towns and territory. Russia is making inroads into Ukraine. Or at least the separatists are. Russia exploits them but may not be able to control them.

China continues to threaten its much smaller neighbors, including powerhouse Japan, raising the specter of a catastrophic new war in Asia. Despite apparently sensible leadership on both sides, Pakistan and India are fighting again in Kashmir. The teenage mutant tyrant of North Korea still has nuclear weapons. And Iran is still bargaining hard to get as close as possible to having them without having its economic ostracism continue, and without having to go to war.

With all this bad news, even an optimist could begin to despair for our species. About the only good news in global politics today is that North and South Korea appear to be making tentative steps toward beginning the long and difficult process of reunification. Godspeed.

We have so many international crises to pick from. So it’s odd to see us Yanks and our allies picking the fight with IS as the one we must win.

It’s true, of course, that IS now wages the world’s most active war. It’s also true that, owing to its medieval ideology, governance, and atrocities, IS is the most repulsive of all the globe’s troublemakers. It’s easy to hate brutal thugs who say, in effect, “Do what I command or die!” and then justify their medieval butchery with self-evident perversions of one of the world’s great religions.

But look at a map. IS is only in Iraq and Syria. It’s hemmed in. To the north and east, respectively, are Turkey and Iran. Apart from Israel, they are the Middle East’s two principal powers. They aren’t going anywhere, and they aren’t going to suffer invasion or subversion, not the least because each has a big buffer of Kurds willing and able to fight for their land and their culture.

To the south are Kuwait—virtually a huge American military base—and Saudi Arabia. That particular part of Saudi Arabia is mostly hundreds of miles of empty desert. It’s ideal territory to stop any invasion with air power alone, and its nomadic and traditional population is hardly the stuff of jihadi recruitment.

To the west are Israel, Jordan and Lebanon. Israel has nuclear weapons and the most advanced military technology in the whole Middle East. So the only things worth saving that might need saving, besides Syria and Iraq themselves, are Jordan and Lebanon. And Lebanon, or part of it, has the strong support of a major regional power: Iran.

Equally important is history. Outside powers have done this region no favors, none at all. We Yanks may have begun the current problem by invading Iraq for no good reason and managing the invasion’s aftermath with inexpressible ineptness. But Russia dug the hole deeper—much deeper—by encouraging its ally Iran to back Assad. And it was Assad’s tyranny, brutality, atrocities and near-genocide that created IS, as surely as if he had grown IS in a petri dish and released it. Now he’s using IS as a convenient excuse to continue his butchery. Lesser culprits include Saudi princes and the various Gulf monarchs, all of whom made their own Faustian bargain with Islamic extremists to maintain their thrones.

From this brief analysis, two things are crystal clear. First, this is not our fight. It doesn’t threaten us Yanks directly. The notion of IS jihadis putting serious effort into terrorizing us and Europe, when they have a new caliphate to run, secure, govern and expand, is (to use Mark Twain’s understatement about this death) greatly exaggerated. And with all the new Orwellian surveillance, it’s not too hard to keep track of Western natives who go to these countries and return. Airlines and border entry points keep records, and boats are slow.

Anyway, the leaders of IS may be brutal, but they have a sort of base cunning. They appear to have learned the lesson of Osama bin Laden, who took on the world’s most powerful nation and is now part of the fish who ate his corpse.

The way to create a viable caliphate is not to terrorize the world’s most powerful nations, but to do exactly what IS has been doing: attacking the vulnerable Middle East at its most vulnerable point—the part that Russia and Iran and, yes, we Yanks messed up with misguided policies and even more misguided action. Yet IS’ leaders are not above trying to terrorize the West with a few random beheadings, just for fun, because we are so easily scared.

The notion of IS jihadis swarming our Western cities is a dangerous paranoid fantasy, much like the one that drove the Cold War or Robert S. McNamara’s “domino theory,” which served us so well in Vietnam. It’s a knee-jerk fear reaction and bit of pro-militarist propaganda foisted on us by people who don’t understand the history or the situation but think we should “do something” and don’t know quite what.

Second, we Yanks are not primarily responsible for the mess today. Nor is Europe. True, we Yanks did invade Iraq stupidly and for no good reason. But we spent a decade there, well over 4,000 lives, tens of thousands wounded, and around two trillion dollars trying to fix Iraq after deposing Saddam.

And what would have happened if we had never invaded and the brutal and capricious Saddam had lived to rule? Likely, the wind of Arab/Islamic liberation that has swept the Middle East would have done exactly as it has done in Syria. Iraqis (especially Shiites) would have risen up; there would have been a brutal crackdown like Assad’s, or like Saddam’s own slaughter of the Marsh Arabs; and the jihadis and extremists would have swarmed in, just as in Syria.

Extremism breeds extremism, as Assad has proven so well and so brutally. Saddam was an extremist tyrant/butcher just like Assad. The chances that his butchery would have morphed peacefully into something unlike Syria today were never very great.

So IS is not our problem or really our creation. Therefore it’s not primarily our fight. It’s part of the Middle East growing up—a process that misguided outside intervention has delayed for several centuries and is still retarding.

Don’t get me wrong. I support the President’s limited intervention. Providing only air support, logistics, weapons and intelligence makes sense. All these things, in essence, support the indigenous people in their fight against brutal extremists.

No leader or pol in the West would ever admit it, but that’s what’s going on. Our Yankee might is being applied at the behest of locals to solve their own problems in their own way. We are serving others; and that’s how it should be.

Anyway, we Yanks simply can’t do more. If our leaders don’t fully understand the history, cultures, and über-complex politics of the region, you think our grunts do? Do we want our own adolescent kids to be facing a mysterious bearded fighter with a Kalashnikov or stolen AK-47 and asking “Hey, dude, which side are you on?”

Didn’t we already try that in Iraq, with such Pyrrhic “success,” despite our superior technology and training? And didn’t Einstein define insanity as repeatedly trying the same thing and expecting different results?

So the assertion that the fight against IS is one we Yanks must win is false. We can help, but it’s not our fight.

And it won’t go global because Iran, Israel, Saudi Arabia and Turkey won’t let it. Sooner or later, all these major Middle-Eastern powers will figure out that it’s their fight. They will combine to stop it, whether or not they ally to do so. If Turkey frustrates us as we wait for it to intervene, we should recall the patience of our European and (then) Soviet allies, as they waited years for us Yanks to enter World War II and years more for us to open a new front in northern Europe. Maybe all our present allies are waiting for their own FDRs.

While we feel all the misguided panic about IS, we are neglecting a much more powerful enemy.

Already it has occupied far more territory than Islamic extremists have taken since the fifteenth century. Already it has killed more people in a few months than died in 9/11.

This enemy is absolutely brutal and relentless. It kills without remorse or a hint of mercy, cutting down pregnant women, children, strong men, and innocent seniors with one scythe. Unlike IS, it is already global, or in the process of becoming so.

This enemy should be far more terrifying than IS because it isn’t human. It isn’t even alive.

By now you may have guessed: it’s ebola.

A must-see report produced by the PBS feature Nova explained how ebola works to kill. The virus is a long string-like rope of proteins that wraps around our bodies’ cells. Its surface has a myriad of protein spikes. When the virus hits a human cell, these spikes attach to the cell’s wall and trick the wall into letting the virus inside. There it reproduces copies of itself, which kill the cell and escape to search and destroy.

No writer of fiction has ever imagined such an automaton of death. Ebola surpasses the ancient Greek myth of armed soldiers springing up from seeds planted in the ground, for it does something similar inside our bodies. It’s worse than the Athenians at Troy, whose spies inside the Trojan Horse let the invading army in. Every single ebola virus has its own Trojan Horse.

Unlike myths, ebola is real. It’s among us. We can’t negotiate with it because it’s not intelligent. It’s a non-sentient genetic killing machine. It will not stop killing us until we stop it. We must defeat it, the sooner the better.

How can we do that? The Nova feature shows how.

After decoding the human genome, our species got a lot smarter. We no longer search at random for chemicals that can kill or disable a disease agent without doing our bodies too much harm. For viruses at least, we look at antidotes at the molecular level, called “antibodies.” We look for proteins that lock into the weapon-proteins of the virus and disable them.

There are three ways to do this. The first is to let our own bodies do the job. People whose immune systems are strong can fight off the virus on their own, as long as we give them proper hospital care. Their immune systems fight it off by creating and reproducing antibodies.

We know all this from molecular studies. We also know that blood transfusions from people who survived ebola often help those fighting it, because of the antibodies in the survivor’s blood.

But blood transfusions from survivors are an imprecise weapon. Different survivors create different kinds of antibodies. And the donor’s blood type must be compatible with the recipient’s, else the recipient will die. If there’s no compatible blood available and properly stored (blood is perishable!), this defense can’t be used. The need for cold storage makes this method problematic in hot Africa.

The second method of fighting ebola is similar but more precise: vaccines. A vaccine stimulates the recipient’s own immune system to make antibodies against the virus, as best his or her body can. Because the recipient’s own immune system does the work, there’s little risk of unintended consequences, as long as the vaccine is tested for safety.

To make a good vaccine, we have to introduce all or part of the virus into the subject and let his or her own immune system go to work. But we first have to be sure that the virus is disabled from causing disease, or that the part of it we use does not itself cause disease.

The most obvious target for any vaccine against ebola is those Trojan-Horse protein spikes that let the ebola virus trick its way into our cells. It would be nice if we could just cut off the spikes, multiply them artificially and use them as a vaccine. But apparently that has been tried and didn’t work. Perhaps our immune systems don’t respond to the spikes alone, without some other (and perhaps more dangerous) part of the virus.

This brings us to the third, and so far most promising, method of fighting ebola. Suppose we could find a protein “cap” for those Trojan-Horse spikes and find a way to reproduce it artificially. Then wouldn’t we have a powerful drug to fight ebola?

That’s precisely what ZMapp is. It’s a cocktail of several monoclonal antibodies, all of which purportedly cap ebola’s Trojan-Horse protein spikes and render them harmless.

I write “purportedly” only because we’ve not observed the exact molecular mechanism in action. But we have lots of evidence that ZMapp works. A 2014 paper describes an experiment with 21 rhesus macaque primates. Three formed the control group and were given a non-functional antibody after being infected. The other eighteen were divided into groups of six, each of which had ZMapp treatment beginning on the third, fourth or fifth day after being infected. All the control primates died, and all the treated primates survived. Later experiments showed that ZMapp inhibited a Guinean strain of the virus in cell cultures.

More recently, three American medical workers contracted ebola and returned to the US for treatment. Two received Zmapp; the third received blood transfusions from ebola survivors. All survived.

Antibodies work, whether artificial or natural. Natural ones are the product of millions of years of evolution of our immune systems. By copying natural ones artificially (which is what ZMapp’s producers do), we can improve on nature and save ourselves.

The question now is how we make antibodies artificially on a war footing. For our war against ebola is our species’ most desperate war against disease since the Black Plague and the Spanish flu epidemic of the early twentieth century.

War requires an effective, immediate and emergent response. That’s why we have military forces. The President was right to send Army troops to West Africa to construct hospitals and treatment facilities. Our military forces are the only assets we have that we can deploy in days, not weeks or months.

Yet military forces alone are not enough. When we Yanks began fighting the Nazis and Imperial Japan, nuclear physics was a science just under development. Apart from a very few Yanks, its practitioners were all foreigners who spoke English with accents. Prominent among them were Jews and Italians—not exactly the most respected people among us at that time. And nuclear theory and science were so raw that, the night before the first experimental atomic blast at Alamogordo, a scientist stayed up calculating whether it would engulf our atmosphere in nuclear fire and destroy our biosphere and our species.

When we started the Manhattan Project, we had far less evidence that atomic weapons would work than we do that ZMapp works today. Yet we started the Project, put it under the no-nonsense command of the military, and gave it authority to commandeer the nation’s resources, which it did. At one time it commandeered about 10% of the entire nation’s electric power for running centrifuges to purify uranium.

We should do the same thing with ZMapp and ebola vaccines now. The development of ZMapp required, and its production depends on, collaboration among three private companies (two American and one Canadian) and several agencies of the Canadian and US governments. It also requires tobacco plants to express the right proteins; that’s why one of the collaborators is affiliated with a tobacco company. No doubt there are complex contractual relationships among all these collaborators, designed in part to assure that the private companies earn a reasonable profit and that the Canadian and US governments have necessary rights in emergencies.

This is an emergency. How much more emergent can it get than three African nations enduring epidemics and fear, random cases of infection popping up in the developed world, and the people who have to care for infected patients and clean up possibly infected blood, vomit and feces demonstrating and even rioting? We need governments to put practical, no-nonsense leaders in charge and put production of ZMapp and further development and production of drugs and vaccines on a war footing. We can sort out compensation and private profit later.

Our own Yankee patent laws provide for the commandeering or even the sequestering of patents in the name of national security and letting courts decide compensation later, after the emergency or need for keeping patents secret has passed. We should use those laws, none the less because our Defense Department funded part of ZMapp’s development and apparently all of the development of its tobacco-plant production process.

During World War II, FDR put an army general named Leslie Groves in charge of the Manhattan Project. He was smart, good with people, a good judge of character, and tough as nails. Without his leadership, we Yanks might never have developed nuclear weapons. The part of World War II in the Pacific might have dragged on a year or two more, with much higher total casualties and much greater destruction and devastation of the Japanese mainland.

Now we need a Leslie Groves for ebola. What we have now is total war against an alien species. It takes over our cells and uses them to reproduce itself. In the process, it kills us. It’s not intelligent or even sentient. It’s just a relentless biological machine of death.

But it’s the toughest enemy of its kind our species has faced since the Black Plague. Why? An epidemic’s threat is proportional to its latency (incubation) period and its mortality. Ebola’s three-week latency period is much longer than the Spanish flu’s, and its mortality rate is much higher. The only thing that so far has saved us from possible species decimation or extinction is that ebola is not airborne and therefore not easily transmissible.

Viruses are not like bacteria. They’re not alive, and they can’t exchange genes as can bacteria. But they can mutate. We just don’t know how fast, or even by what precise mechanism. So we’d better have lots of ZMapp and some good vaccines on hand, just in case ebola goes airborne.

The President has the Executive power to make all this happen for our national security. He should use it before things get out of hand. The 3,000 troops he sent to build medical infrastructure in Africa are a good start, but they are only a start.

For all the President’s time in office, the opposition has harassed him and sought to stymie him at every turn. But God help them if they oppose him this time. Just look at the videos of the protests in Dallas and the near-riots in Madrid. And this is with only one death each inside the US and Spain! This could be the beginning of a rapid decline of global civilization, unless we realize we’re in a war we have to win.

Eight Reasons Why We Need to Make ZMapp and Vaccines in Bulk Now, and How We Can

If you listen carefully to our medical leaders as they talk about ebola, you will notice something odd. They downplay the value of the anti-ebola drug ZMapp. They call it “experimental.” They say it’s not been proven effective. So far they’ve refused (to my knowledge) to give it to anyone in Africa.

But all reported experiments with it, as well as known uses in two American patients, have been successful. Not only that: the two people who got the drug and survived ebola were American medical personnel.

It doesn’t take more than a moment’s thought to understand that ZMapp is both safe and effective, and that our doctors know it. At least it’s the best anti-ebola drug we’ve got. The problem is that it takes time to make and we’re running out of it. Or we already have.

At the same time, we’ve got a vaccine against ebola that has passed preliminary safety trials. It, too, is not available in large quantities.

So let’s pretend we’re all engineers. Pretend we’re practical people who don’t “spin” facts but accept them in straightforward ways. Pretend we try to solve real problems not with ideology or “canned” solutions, but with facts, logic and math. What reasons can we find for putting ZMapp and the already-safety-tested vaccine into production on a war footing now, and how could we best go about doing so?

1. More Than a Maginot Line. Right now, our war strategy against ebola is containment. Find the victims, identify and quarantine or observe their contacts, put the sick in hospital, and treat them as best we can until they die or recover.

Remember the Maginot Line? It was an expensive, static line of entrenched fortifications that the French built after World War I. Its idea was to give the French time to mobilize if the Germans attacked again. But when World War II came, the Nazis drove their tanks right around it, and France fell in weeks.

Our “containment” strategy of field hospitals and treatment centers in West Africa is a bit like the Maginot Line. Of course we need field hospitals and treatment centers to fight any serious disease. But like the Maginot Line, they are static.

In contrast, people are mobile. They can move far and wide during ebola’s three-week incubation period, before they present any symptoms at all. They can even move from Liberia to Dallas.

If they can move as far as Dallas, they can certainly move to the next town or region. They—and the virus they carry—can skirt the Maginot Line of hospitals and treatments centers just as Nazi Panzer tanks skirted the French Maginot Line in World War II. That’s why we now have a whole region of West Africa marked red on our epidemic maps.

We need more than a Maginot Line for ebola. We need mobile defenses, which don’t take days or weeks to build. Doesn’t that mean ZMapp and the already-safety-tested vaccine?

2. Fear. Fear is ebola’s strongest ally. It’s hardly confined to West Africa. We’ve already seen it in the protests of cleanup workers in Dallas and the near-riots in Madrid. Besides the virus itself, fear is the toughest enemy we face.

Perhaps the most important impact of having enough ZMapp and an already-safety-tested vaccine will be on fear. The fear now reaching levels of panic around the globe will subside to the normal caution and timidity that accompanies other controlled diseases.

Imagine that ebola had broken out in Iowa and that Africans, not we Yanks, had the best medical technology. Imagine yourself a white Iowan stricken with ebola in a small village in Iowa.

Black folk come in hazmat suits to take you away to a treatment center. Almost everyone there is black, dressed in a yellow hazmat suit, and speaking a language that you can’t understand. The medical workers give you help and seem well-meaning, but they are far too busy with other patients to attend to your emotional needs. They ask you about your family and other contacts, give you some water to drink, and let you lie on your bed and worry.

For days on end, you see no one you know, let alone your loved ones. You get medical care, but as you begin to feel worse and worse, you get little or no emotional support. Pretty soon it dawns on you that you are going to die miserably in this awful place, surrounded by strangers from another race in hazmat suits, without seeing anyone you love ever again.

Don’t you think you might feel a little uncomfortable and fearful? Do you think your friends and loved ones, seeing you go into that awful place—and knowing that over 50% or more of those who go in come out in body bags—might be reluctant to stick around, give contact information and volunteer for treatment if they feel bad?

Now imagine a different scenario. As you go into the hazmat hospital, a nurse gives you some pills. You are told that you need to identify all your family and contacts so they can be given the pills and vaccinated. The doctors explain to you that it’s too late to vaccinate you because you have already fallen ill.

Once vaccinated (and given pills for good measure), your loved ones can visit you in a special room, or outdoors, sitting at a safe distance. You can speak with them and receive and give love, just without touching, hugging or kissing. The presence of your loved ones gives you courage, hope, and the will to live. Their seeing you well cared for, and their getting the medication and vaccines, gives them confidence and hope. So they tell all their friends who have had contact with ebola patients to come in, before they feel sick, to get the pills and vaccinations.

Night and day, you say? Well, if you think so, let’s get to work manufacturing those pills and vaccines.

3. “Boots on the Ground.” As we know so well from the war with IS, no war gets won without “boots on the ground.” The same is true of the war against ebola. That’s why the President is sending over 3,000 troops from our Army Corps of Engineers to build hospitals and treatment centers in West Africa.

The Engineers have to go as ordered because they are in the Army. But our war against ebola needs a lot more people still. It depends mostly on trained medical personnel and their helpers, not just engineers.

Nearly all medical personnel now in West Africa are volunteers, with the French organization Médecins Sans Frontières (Doctors Without Borders) and the World Health Organization in the lead. So the “army” fighting ebola is nearly all-volunteer.

Right now, volunteers face both great risk and great hardship. They must wear thick, bulky, clumsy hazmat suits while they work. It takes half an hour to put the suits on and another half hour to take them off. Volunteers must be meticulously careful when doing either, at the risk of infecting themselves. One infected nurse thought she might have infected herself merely by touching her face while taking her suit off.

Add the heat to that. Hazmat suits trap the body’s heat and add it to the stifling heat of West Africa. Volunteers sweat like pigs. Sometimes they can barely see for the fogging of their goggles. Sometimes the heat makes them lightheaded or dizzy. Most can work only two hours at a time in this condition. But they soldier on.

ZMapp and a vaccine won’t change this sorry picture entirely. No drug or vaccine is 100% effective. So volunteers will still have to wear hazmat suits in caring for seriously ill patients.

But a drug and vaccine will vastly reduce the fear that volunteers must face. It will also reduce the inconvenience: volunteers will be able to do intake interviews of not-so-sick patients and do contact tracing without hazmat suits, as long as they keep a safe distance from people presenting symptoms and their bodily fluids.

Best of all, volunteers will feel some relief from the constant fear that a single mistake may endanger a patient’s life or their own. Work will get easier and safer—much easier and safer. So there will be more volunteers.

4. Encircling the enemy. Our “containment” strategy self-evidently isn’t working, at least in West Africa. The red epidemic map is spreading like a stain. It continues to grow.

The primary reason is that the virus can travel as far and as fast as people do. And with no cure or preventative available, people have every incentive to travel as far and as fast as they can from areas of infection, even if they might be infected themselves.

ZMapp and a vaccine could change this dynamic by encircling the enemy. If an outbreak occurs in a town, the surrounding area can be protected with drugs, vaccination, or both. At the same time, people can be reassured, so they don’t leave if they become sick or think they might have been infected. The age-old military strategy of encircling the enemy can work with ebola, too.

5. Engineers for the job. It’s no coincidence that the troops the President has sent to build up West Africa’s health-care infrastructure are engineers, from the Army Corps of Engineers.

Engineers are highly educated people, accustomed to using facts, logic and math to solve real problems. They work well with scientists, including medical doctors. They are practical people.

When you think about it, you can see that most of the jobs that need doing are engineering, not medicine. Building hospitals and treatment centers is engineering. Building factories to scale up production of ZMapp and vaccines requires engineering, albeit in close cooperation with scientists and medical doctors.

Even designing ZMapp and the vaccines themselves could be considered a new kind of engineering: bimolecular engineering. The task is to build antibodies that can cap or block those Trojan-Horse protein spikes on the ebola virus. This is engineering at the molecular level.

Accordingly, it may be appropriate to put an engineer from the Corps of Engineers in charge of the whole process, or at least the building of care centers and factories to make ZMapp and vaccines. An engineer/general like the legendary Leslie Groves, who led the Manhattan Project, would do just fine.

6. A new life for tobacco companies? An oddity of ZMapp is that tobacco plants are the best molecular “factories” for the monoclonal antibodies in its “cocktail.” That’s why one of the collaborators in the production of ZMapp is Kentucky BioProcessing, a biotech firm in the heart of tobacco country.

Right now, tobacco growers are facing medical opprobrium, heavy regulation, higher taxes on their products and a declining customer base. No wonder! Their tobacco fields are killing fields for their primary customers: smokers.

To say that producing ZMapp and other monoclonal-antibody products offers tobacco growers a new lease on life would be an understatement. Instead of being factories of addiction, death and suffering, they could become producers of life, hope and health. If I were a tobacco-company executive, I would jump on this opportunity with both feet and put some serious money into it.

7. From complacency to wartime efficiency. Our nation’s leading medical doctors are extraordinary men. Dr. Anthony Fauci is head of the National Institute of Allergy and Infectious Diseases within our National Institutes of Health (NIH). More than any other human being, he is responsible for discovering and taming the virus (HIV) that causes AIDS. Dr. Tom Frieden is head of our Centers for Disease Control and Prevention (CDC).

Both men are doctors and scientists who have navigated the halls of politics and made extraordinary contributions to discovering and fighting the causes of ever-nascent plagues. And they have fought—successfully—various incipient or real epidemics, including AIDS, SARS, swine flu, bird flu, and the pathogenic variety of E. coli that appears occasionally in improperly prepared or packaged food. So they have have reasons to be confident in their own and their institutions’ ability to handle any new plague that comes along.

Of course part of their job is also to reassure the public and tamp down fear. But as you listen to them speak about ebola, you cannot escape the feeling that they share a dangerous complacency.

So far, our species has been lucky. Nature has not yet thrown her worst at us. AIDS has killed some 39 million people. It took decades before we could control it. But AIDS takes years to kill. In contrast, ebola kills in twelve days. AIDS also takes years to incubate into full clinical disease. Ebola incubates in three weeks. Finally, AIDS requires sexual intimacy or an exchange of body fluids for transmission; ebola requires only much more casual contact.

So we can’t let ebola get loose now. We just don’t have the same kind of time we had with AIDS.

SARS is similar. Although a respiratory virus, it is nowhere near as easy to transmit as the common cold. That’s why we could control it with only a few hundred deaths worldwide.

So far, Nature has been kind to us in tossing us only softballs. Some day, it will throw us a hardball. We had better be ready.

8. Future wars. This brings me to my final point. We don’t really know yet how these various new plagues develop. Since the early 1970s, we have discovered at least a half-dozen new viral ones: ebola, AIDS, Marburg, swine flu, SARS, and bird flu. So far, we’ve been able to defeat them all with vaccines or drugs, or with public-health measures such as isolation, quarantine, contact tracing, containment and the elimination or culling of animal vectors.

Although challenging and deadly, none of these plagues has yet presented the worst possible combination of factors: long incubation period, short mortality period, easy transmissibility, and high mortality. A plague like that could rip through our highly mobile, interdependent global society. It could wound, if not destroy, our global civilization in months.

Unfortunately, we have no reason to believe that some future plague won’t do exactly that. We can’t even estimate the risk because we don’t know exactly how these previous plagues arose. All we know is that most arose from some chance interaction between microbes, people, and animals—whether domesticated, as in China, or undomesticated, as in Africa.

And even if we knew the precise past mechanisms of combination, we have no theory for predicting new ones. If we did, we would probably have to take into account myriads of viruses and bacteria in our environment that we don’t study because they are not pathogenic to humans.

So as good planners, we have to be prepared for anything. Our chief doctors are probably right: we probably can keep ebola mostly out of developed nations with careful public-health precautions like contact tracing and quarantining. But we’re almost certain to have additional isolated cases, and perhaps a small outbreak or two along the way.

Wouldn’t it be more than nice if we had enough ZMapp and vaccine to put this particular plague entirely behind us, just as we’ve done with smallpox and polio? It would certainly do no harm to our badly damaged national prestige and standing if we Yanks could give West Africa a new lease on life and new hope for a better future after its recent civil wars.

But this is far from all. To be ready for the next plague—whose source, strength and peril we cannot even begin to guess—we have to have large-scale laboratories and factories for the rapid development and bulk production of safe and effective monoclonal antibodies. We must develop a national “immune system” at industrial scale.

That will require unprecedented cooperation among scientists, private companies, and government agencies that fund, manage and supervise all activities. We cannot depend on private profit to finance this effort for a simple reason: there is no possibility of profit before a new plague arises, and after it arises it’s too late.

Ebola is unlikely to become a species-threatening plague unless it goes airborne and its transmissibility increases dramatically. Although not impossible, that terrible combination is unlikely.

So we ought to consider ebola a practice case—a “drill” if you will. Just as we’ve developed a military-industrial complex to fight off future human enemies, we need a medical-industrial complex to fight off future plagues. Only then can we be ready when the next plague comes, as it most surely will.

Mild Erratum: While I was thinking about this post, it occurred to me that ZMapp (and any anti-ebola drug counterpart) likely has to be administered in the form of injections, not pills. The reason is that its active ingredients are monoclonal antibodies, which are proteins or parts or them. In general, there is too much risk that digestion will destroy or modify the antibodies, or otherwise reduce their effectiveness, to use pills. So they have to be administered directly into the bloodstream or tissues, by injection.

Injecting a fluid on a public-health scale of course requires more infrastructure than giving people pills. Liquids are harder to preserve, store, transport and administer. Often they must be refrigerated to prevent degradation. And giving injections requires basic nursing skills, whereas administering pills just requires sentience.

So giving injections will be a bit harder and more costly than giving pills. But nothing else in the reasoning or analysis of this post changes. Giving injections still beats building emergency field hospitals and treatment centers, or donning and doffing hazmat suits, let alone the cost of having to sterilize the suits reliably or wear a new one for every working session.

Anyway, most vaccines require injection, if only subcutaneous. So the physical and human infrastructure and method of administration will not differ as between ZMapp (or other monoclonal-antibody drugs) and vaccines. The only difference is that drugs work as cures, or immediate preventatives, whereas vaccines work to prevent disease longer term and tamp fear. I regret the error, but it doesn’t change the thrust or validity of this post one whit.

BTW, this minor error helps justify my penchant for fully-reasoned posts. Without complete reasoning, how could anyone tell how much, or whether, an error like this minor one affects my conclusions? One strong impetus for our nation’s rather precipitous decline is our modern inclination to substitute bumper stickers for complete and careful reasoning.



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