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Garrett on Global Health - August 18, 2016

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Garrett on Global Health

August 18, 2016

Dear Friends and Colleagues,

Greetings from sweltering New York, which has been united with the rest of the eastern United States in weeks of heat and humidity, often above a heat index of 100 degrees Fahrenheit (37–38 degrees Celsius). Along the Mississippi Delta and throughout Louisiana, this heat wave has brought record-breaking rains, flooding, at least eleven deaths, and tens of thousands of evacuations. Parts of Thailand and Moscow have been inundated this summer with record floods. Out west, the heat, coupled with a record-breaking drought, has brought wildfires of unprecedented frequency and severity. On Wednesday, for example, tens of thousands of Californians were evacuated from San Bernardino as a massive fire devoured homes and businesses. Thanks to the fires and hot air capped over southern California, air pollution has reached near-Beijing levels of smog, ozone, and fine particulate matter. A new study out of the University of Southern California finds that Los Angeles air is worsening the outcomes of treatment for lung cancer and other respiratory diseases.

Heat, floods, fire—three great threats to human health. 

Welcome to the Anthropocene, the permanently altered world Homo sapiens created. 

Climate scientists at the National Aeronautics and Space Administration (NASA) have warned for at least three decades that this time was coming, but the global health community has been slow to adopt non-rhetorical positions about links between human and planetary health. That is beginning to change, but far too slowly.

The trends are inescapable, however. Average heat indices and extreme anomalies have increased steadily since 1880, when serious record-keeping commenced in some parts of the world.

It has become a cliché to note, month after month, that world average surface temperatures hit new records. The trajectory remains unaltered, soaring.

Sea levels are rising, and the oceans are churning more, with heat convection cycles racing around the planet.

As the world warms, a cruise liner company is offering customers the chance to be the first tourists to sail through the newly melted Northwest Passage across the Canadian Arctic, from Pacific to Atlantic. Here is the pitch for your next summer holiday, as described by National Geographic:

The “ultimate expedition for the true explorer,” the thirty-two day trip on the Crystal Serenity departs from Anchorage, traveling north through the Bering Strait and across the Canadian Arctic, then making stops in Greenland and the northeastern United States before docking in New York City. Prices for the sold-out excursion ranged from $22,000 to $120,000, plus required insurance coverage of at least $50,000 for emergency evacuation.

In the Russian tundra, and in other places across the Arctic, the permafrost is melting, releasing surprises long locked in icy hiding. Outside the northern town of Salekhard, reindeer started to die off by the hundreds in July when temperatures soared into the nineties (above 30 to 35 Celsius daily). The carcass of a long-ago frozen reindeer anthrax victim thawed, releasing live Bacillus anthracis that sickened not only wild reindeer, but also at least forty people, including a twelve-year-old boy who died of the disease in early August. Nine months before, the area was shaken by enormous explosions in the tundra producing massive sinkholes—the result of ancient stores of frozen methane melting. CO2 is a nasty greenhouse gas that is forming a layer around the planet that, like Saran Wrap, is holding heat and moisture in, but its chemical cousin methane is at least thirty times worse; methane is so stable in the atmosphere that its impact will be felt for decades. Russian scientists have filmed tundra that has become so warm that the landscape “bounces” under their feet, as they walk on an Earth balloon filled with freshly thawed methane. Canadian officials now worry that similar microbial surprises may greet the nation’s caribou herds, Inuit and other indigenous peoples, and natural gas operations. In Russia, Sergei Netsov, the deputy director of Vector, Russia’s former bioweapons facility now used for high security infectious diseases work, warned the nation that smallpox might lurk in frozen animal and human carcasses across Siberia, noting:

“Stories about corpses with smallpox thawed from the permafrost first appeared in our country. The first bodies with traces of smallpox were excavated here, in Yakutia. It was 1993–94, at the mouth of the Kolyma River. I went there in winter, and in summer our virologists had really found bodies with traces of smallpox. . . . The live virus itself was not found. But the signs, some of its markers, were found in the samples.”

Virologists debate the likelihood that viruses can survive decades, or centuries, of freezing in environmental conditions, but the anthrax bacterial thaw is a shot across the Anthropocene bow.

Scientists are also debating the relative contributions of the 2015 El Niño event and general climate change to the emergence of mosquito populations that are spreading yellow fever in equatorial Africa and Zika across the Western Hemisphere and into Asia and West Africa.

On August 17, the World Health Organization (WHO), Gavi, UNICEF, and dozens of other global health partners launched a huge yellow fever immunization campaign in Angola and the Democratic Republic of Congo. The region has been battling the mosquito-borne virus since the end of 2015, amid a terrible combination of urbanization of the Aedes mosquitoes and a near-collapse of routine vaccination against the disease. A global shortage of vaccines, exacerbated by gross mismanagement of supplies and logistics on the ground, has forced use of five-fold diluted vaccines to stop further geographic spread of the disease. The real concern is urban invasion by the Aedes mosquitoes, which has created patterns of transmission never previously seen with yellow fever and challenged norms for outbreak control.

Patterns of the Aedes spread and emergence reflect a combination of climate factors and human behavior. The various species of Aedes are strongly adapted to human beings, residing inside homes, gardens, garbage heaps, and the discarded detritus of people’s lives. The mosquitoes thrive in areas with high heat and moisture, a band of the planet that is expanding with climate change.

The Aedes species—especially aegypti and albopictus—are of great concern because they can carry and spread not only yellow fever, but also the dengue, chikungunya, and Zika viruses. For centuries, these diseases have been concentrated in rural areas; the mosquitoes found breeding sites in farming villages and watery delta regions. But all over the world, the epidemiology of the diseases has been shifting over the last two decades, gaining ground in cities, especially in perimeter areas inhabited by poorer, more recent arrivals to the urban areas. A hallmark of these ecological settings is the paucity of essential urban infrastructures: drainage systems, sewers, piped water supplies, fully enclosed housing, transportation systems, and energy supplies. In these conditions, the mosquitoes are able to breed by laying their eggs in drinking water stored in open containers, undrained rainwater, open sewers, and piles of refuse abandoned to empty lots and roadsides. Where people have no electricity, air conditioning, or window screens, the insects easily reside inside homes, feeding on households day and night. The absence of transport systems compels children to walk long distances to school, and adults to trek outdoors to work and shop, creating further feeding opportunities for hungry mosquitoes.

These factors certainly contributed to the emergence of dengue, chikungunya, and now Zika in the Americas. We have been working hard to explain the unfolding Zika epidemic in the Americas, and its threat to the United States and Puerto Rico. Most recently I have written the following articles:

“The Zika Threat Moves North” on CFR.org. The piece was coauthored with Dr. Larry Brilliant of Skoll Global Threats. Larry, by the way, has a book coming out soon, Almost Brilliant, a memoir of his battles to eradicate smallpox.

“Could Zika Be the Next HIV?” on CNN.com.

Dear Washington: The Time to Prepare for Zika Has Come and Gone” on Foreign Policy.com.

“Act One of ‘Zika Hits the USA’ has begun” on CNN.com.

I have also spoken about the Zika situation on the public radio show To the Point in a segment entitled, “As Zika Invades the US, Congress Dithers,” as well as in a Council on Foreign Relations session, “Teetering at the Precipice: Brazil and the 2016 Summer Olympics” (CFR meeting video).

In the United States, the Zika situation is playing out against a deeply partisan political background, during a national election year. Not surprisingly, it is a thorough mess.

Two other elections also have our attention.

I recently had the honor of participating in the EuroScience Open Forum (ESOF2016) in Manchester, England, where the United Kingdom’s Brexit election decision overwhelmed proceedings. I spoke on a pandemics and outbreaks panel, alongside Sir Andrew Witty (chief executive officer of GlaxoSmithKline) and Dr. Paul Stoffels (chief scientific officer for Johnson & Johnson). Though our focus was Ebola, the future of cross-European scientific cooperation and UK foreign assistance were also discussed. In every session I attended, from astrophysics to Arctic science, the deleterious impact of Brexit on European science was at issue. And conversations with the directors of massive multinational scientific programs, involving everything from space telescopes to neutrino-hunting, bemoaned the horrors of Brexit and likely damage to science.

The other election of concern is proceeding with near invisibility: the selection of the next director-general (DG) of the World Health Organization. Candidates have only days remaining to put their hats in the ring, and so far, just three individuals have come forward. I wrote extensively about this election previously and will not repeat details here. However, it is worth noting that one important candidate, Dr. Tedros Adhanom, is currently serving as foreign minister of Ethiopia, which has been wracked with violence of late. Critics argue that a massive crackdown to supress political dissidents is underway. How this situation may effect Adhanom’s run for the DG job is not clear.

Two final notes are worth mentioning.

First, sadly, polio has reemerged in northern Nigeria, where two paralyzed children were recently discovered. Last year, the WHO declared polio eradicated from Africa, but these Nigerian cases demonstrate the opposite is true. The children had gone unvaccinated and live in an area contested by Boko Haram that is rife with danger. In 2013, nine polio workers were murdered in northern Nigeria, and few government officials enter the area. Boko Haram has declared polio vaccination taboo—along with hundreds of other activities, such as girls’ education—and is blamed for this setback. Despite the peril, public health authorities in Nigeria have vowed to stop polio and vaccinate every child in the Borno state.

On a hopefully more positive note, on September 21the UN General Assembly will convene a special session on antimicrobial resistance and preserving the utility of antibiotics. This session has been in the works for years, and it is hoped that delegates will approve an agenda to greatly limit inappropriate use of the vital medicines, eliminate production of substandard products, and roll back their use in livestock as growth promoters. Stay tuned.

Enjoy the remainder of your summer in the northern hemisphere and enjoy the Rio Olympic Games.

 

Laurie Garrett
Senior Fellow for Global Health
Council on Foreign Relations

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