Tag Archives: Pandemics

AIDS-mémoire: The Plague Last Time, Dr. Robert Zuber

13 Jun

Twas doing nothing was his curse. Is there a vice can plague us worse?” Hannah More

Each day the pair would meet at 2pm at the exact halfway point between the villages and stand a hundred yards apart, staring longingly at each other, yearning for the time when the pestilence would pass.  Tom Cox

Plague germs are notorious for their non-observance of class distinctions. Palagummi Sainath

Before coronapocalypse, people were so distracted by items presenting themselves throughout life; items that really do not matter. Noise for the mind. Ways to distract the heart. Now there are no more distractions, noise evaporated. Everyone must face their truth now: their Demons and their Angels.  C. JoyBell C.

I recalled how cruel the plague had made people to each other, and was obliged to concede that there is no disaster which can befall humanity, that we will not fail to make worse by our own hands, for it is fear that makes us cruel.  Sarah Burton

Thus, whereas plague by its impartial ministrations should have promoted equality among our townsfolk, it now had the opposite effect and, thanks to the habitual conflict of cupidities, exacerbated the sense of injustice rankling in our hearts. Albert Camus

The human race settles on terms with every plague in the end, the doctor told her. Or a stalemate, at the least. Emma Donoghue

It is not news to anyone who even occasionally consults these posts that the COVID-19 pandemic has impacted personal and institutional life in ways that were only partially predictable.  At the UN for instance, we are keenly aware of how the pandemic has impacted some of our core, collective commitments, complicating the missions of peacekeepers and humanitarian workers, creating new dangers and levels of urgency for health care workers, exposing inequalities in health care and food access that have only become more difficult to overcome, even intensifying security deficits as movement-related restrictions caused by the pandemic have created fresh opportunities for armed groups and terrorists to expand their physical influence and step up online recruitment. 

Even during a week when an international court rejected an appeal of the convicted Ratko Mladic, the so-called “butcher of Bosnia,” the talk in the Security Council was in large measure about the cases remaining to be tried, the indictments remaining to be honored, and the general difficulty of carrying out the vital work of justice (or conducting investigations of any global importance) in the midst of our current plague.

At a another level, we have a growing sense of the diverse impacts of this pandemic on personal and family life:  the isolation and depression as we struggle to maintain some semblance of sanity and overcome personal distances; the discriminatory acting out of fear and even cruelty on each other; the despair in many places of having to care for loved ones as services further erode and vaccines remain out of reach; the “habitual conflict of cupidities” that has served to inflame a sense of injustice but also dampened the belief that human beings are actually capable of delivering it. For many, thanks in part to COVID-19 and our reactions to its limitations, both our sense of self and our hope for humanity have taken a serious hit.

In this week of genuinely impactful UN events, including a global dialogue on food systems, the selection of a new president for the General Assembly (Maldives) and a farewell message from the extraordinary prosecutor of the International Criminal Court, Fatou Bensouda, reflecting on her long pursuit of justice and accountability for the people of Darfur, it was particularly meaningful for me that the General Assembly devoted much of its week to a discussion on HIV/AIDS, a plague from the past for many in the “developed” world, but one which continues to infect people in many global regions, especially those youth whose limited access to antiretroviral therapies and related health care continues to sicken them in ways that we don’t often encounter any longer here in New York. 

The GA event was a stark reminder of the promises the UN community once made together to eliminate the scourge of HIV/AIDS, to end what is for some in the last stages of HIV infection a horrific death from predatory infections to which their bodies become increasingly vulnerable, a death not dissimilar in its grimness to those many millions –old and young, poorer and richer, people who were loved and cherished –who have literally drowned in their own fluids as their own bodies turned against them due to COVID-19.

HIV moves along a somewhat similar path but with some clear differences, most of which were duly noted by the diplomats and other speakers, including Charlize Theron whose presence graced the hall and who advocated passionately for the creation of “enabling environments,” especially for young people, that can both provide help and communicate hope. In addition to her, I was impressed with the statement of Ghana’s health minister who advocated for an “evidence-based and people-centered” approach to HIV/AIDS caregiving as well as the Minister of France who noted that the point here is “not to replace one health care threat with another” but to build strong and reliable health infrastructure and rebut those who deny the virtues of science-based diagnostics and care. Many delegations, including Ecuador and Netherlands, stressed the importance of “harm reduction” measures for young people, including in the form of reproductive services for female youth, to increase the odds that they can avoid HIV infection altogether and receive prompt care — even from health services ravaged by COVID-19 — when prevention fails.

Perhaps the most impressive voice during this high-level event was that of UNAIDS director Winnie Byanyima, who set an urgent and hopeful tone relevant both to the current pandemic and the one to which we still have unmet responsibilities. She underscored the “bold shifts” we still can and must take, including dramatically improving access to the best medical services and countering the discrimination and stigma that continues to accompany HIV infection in several global regions. She also reminded us that, in its application, “science moves at the speed of political will” while insisting that, as much as we seem to deny it, “we are more than inter-connected; we are inseparable.”

In many ways, this meeting represented the best of the UN: reminding us of unfinished business and tying the promises of the past to the urgencies of the present. And reminding us of our personal responsibilities to ensure services and end stigmas, to resist the temptation to “settle” with our pandemics and then seek to sit out their threats and consequences on the sidelines.

To my mind, it is the depth of stigma which separates HIV from the current COVID plague.  I recall our efforts in the 80s and 90s through East Harlem Interfaith and nearby Saint Cecilia’s Catholic Church, efforts to create safe space for persons living and dying with HIV/AIDS (often young and not even near their prime), a space to mourn and grieve, a space to find accompaniment as infection turned into full-on plague: the loss of weight, the ubiquitous sores, the difficulty breathing, the extreme fatigue, the endless fevers.  And on top of all this were the often-profound emotional impacts: the shifts in mood and cognitive capacity, the depression that came from experiencing a body that was literally turning on itself, a body which seemed determined to cast aside all common and once-dependable functions.

We did our best to mitigate some of the impacts of lives set to end without the comfort of familiar faces, faces which in too many instances had already rejected them, had already abandoned them to live out the final chapter of this “gay plague” in utter isolation from all they once knew.   For many, it was the stigma they faced, often at the hands of those who had once pledged to love and protect them, which was the saddest aspect of a multiply painful journey.  There was little for us to say; at times there was little to be done.  This plague was set to take the dozens of men who had accepted what care we were able to provide, to cover their wounds and listen to their tales of abandonment-related grief, to hear their confessions and offer what little comfort we were able. And to ensure that the end of these lives were duly recognized by the community which had committed to gather around them, members of a community who in too many cases were soon to replicate that mortal path. 

Even in this time of COVID-19, even in this time where we are quicker to judge than to think; even now when, in the US at least, mask wearing has been a symbol of some alleged malevolent government intent that is causing record high gun sales with corresponding discharges of weapons (or fists) often directed at unsuspecting objects of hate; even amidst all of this there is compassion in considerable measure to be found, compassion for those lives have holes in them due to pandemic distancing; compassion for those medical workers and other humanitarians who have risked their own lives to save us from ourselves: compassion which we must find a way to cultivate in even greater measure if we are to put current pandemics to rest and survive pandemics to come. Simply put, we must find the means to reinforce the best of our humanity as plagues here now and around the bend threaten to bring out some of the worst.

The message of this week’s GA event was clear.  HIV/AIDS is not over.  COVID-19 is certainly not over.  And there may be new challenges of this sort to come for us, new “stalemates” to achieve with regard to a new round of deadly viruses. But what is most likely to do us in, what threatens us most deeply, is ourselves, our predispositions to stigma and discrimination, our endless talent for making enemies out of neighbors; our willingness to use crisis as an excuse for selfishness, indifference and even violence.  We have not seen the last of HIV/AIDS; neither have we seen the last of the plagues which are sure to visit our fractured human world, the fear of which will unleash new waves of cruelty and indifference unless we have prepared ourselves to choose a different, kinder, less discriminatory path.

Such preparation must begin together and begin in earnest.

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Forewarned is Forearmed — Thoughts on the Looming Threat of Pandemic and What We Can Do About It

11 Feb

The deadly influenza outbreak of 1918 swept across the globe, claiming tens of millions of lives. The more conservative estimates place the death toll at around fifty million people though the number may have been far greater. My grandmother lost her older sister during that outbreak, but with the advent of more advanced medical technologies and increased understanding of how pandemics spread, my generation has so far experienced these deadly global outbreaks largely through the study of history. However, as the flu virus continues to mutate and scientists push the boundaries of experimental manipulation of pathogens, I wonder if we are adequately prepared to meet the biological security threats of tomorrow.

A recent article in Foreign Affairs by Laurie Garrett, “The Next Pandemic”, offers a comprehensive look at how the evolution of pathogens may shape our future and highlights the lack of governmental capacity for dealing with this urgent security threat. Due to several mergers in the 1990s and the high risk associated with investment in vaccines, there are now only a few companies that produce an influenza vaccine. Furthermore, as of 2003, the entire market for all vaccines accounted for less than two percent of the global pharmaceutical market. Thus if disaster strikes, manufacturers will have trouble ramping up production sufficient to meet dramatically increased demand. Garrett notes that “manufacturers have never produced more than 300 million doses of flu vaccine in a single year”, a disturbing figure given that in order to inoculate the entire population in the event of a global pandemic, the US alone would require roughly 300 million doses.

Should a pandemic strike now, given our current level of preparedness, tragic consequences seem inevitable. The world would be thrown into turmoil – widespread panic and drastically reduced law enforcement make for a bad mix. Peacekeeping operations would be weakened by loss of personnel, leading to a worldwide rise in conflict potential. Inter- and intrastate tensions would be further exacerbated by a severely limited supply of lifesaving vaccines and medication. In addition, a vastly reduced workforce, as well as an almost inevitable global stock market meltdown would lead to major economic troubles throughout the world. The combined effects of these outcomes would lead to global chaos and discord, exactly what security experts around the world spend their lives working to prevent.

In addition to formulating a response to the natural evolution of pathogens, we must also decide how to deal with the challenges that manmade pathogens pose to global security. Laurie Garrett offered some thoughts on this issue in “Biology’s Brave New World: The Promise and Perils of the Synbio Revolution.” She notes that “[i]n May 2010…J. Craig Venter and his private-company team started with DNA and constructed a novel genetic sequence of more than one million coded bits of information known as nucleotides.” This heralded the beginning of a new era where scientists could both manipulate the genetic code of existing organisms and create new ones. This is the age in which my peers and I will experience our adulthoods, and it has the potential to be a time of exciting innovations – everything from “smart” materials to artificially grown organs. However, this new era brings with it the potential for frightening innovations in the realm of biological warfare, as well as warfare triggered by biological catastrophe.

It is vital that we ask ourselves what the boundaries of exploration are and whether there are experiments that simply should not be conducted. In 2011, Ron Fouchier of the Erasmus Medical Center in Rotterdam announced that he had “mutated the hell out of H5N1”, turning it from a disease confined mainly to birds and transmissible only to humans who had direct contact with infected animals, into a possible human-to-human flu. Initially, he created a virus that could infect ferrets – ferret flu susceptibility is similar to that of humans, and thus they are often used as human stand-ins in labs. Fouchier then did what he described as “something really, really stupid” – he swabbed the nose of infected ferrets and then used the gathered virus to infect more of the animals, repeating the process until he had produced a strain of H5N1 that spread through the air. Fouchier defended his actions, arguing that the experiment served to alert that world that H5N1 could become airborne. However, the experiment set off a debate about what should and should not be allowed in the lab, with people raising concerns about what would happen if such a virus fell into the hands of terrorists.

Certainly, one way we can learn about these potential killers is by experimenting with them. However, Garrett raises an interesting point noting: “When HIV emerged in the early 1980s, nobody was sure just how the virus was transmitted…Had it been technically possible to do so, would it have been wise to deliberately alter the virus then, giving it the capacity to spread through the air or through casual contact?” In all fairness, although both are infectious, flu is very different from HIV, and the chance of H5N1 naturally mutating to become airborne and human-to-human transmissible is significantly higher. However, there is also a very real risk that the blueprints of experiments like Fouchier’s could fall into the wrong hands, with catastrophic consequences.

Perhaps the endless predictions of the coming storm have deafened us to the far off thunder. So far we have avoided a pandemic, but it is likely that eventually a highly contagious, deadly strain of influenza will emerge on a large scale. Whether that influenza kills hundreds of millions of people or not depends on how well we prepare for it. Stockpiling enough vaccines to inoculate the global population is not a viable option, but perhaps policymakers can offer companies incentives to enter the vaccine market and increase production capacity. Furthermore, by augmenting controls on and monitoring of scientific experimentation and weapons development, world leaders can help assure that no manmade biological weapon is ever unleashed. Our world is full of threats as well as opportunities. For the moment, we might well be missing the opportunity to proactively prepare for the threat of a pandemic, natural or otherwise. Through conducting a global dialogue on this potential danger to all humanity, we can share ideas on how to prepare and hopefully both prevent the malevolent use of biological agents and also mitigate the effects of a naturally occurring pandemic.

My generation is eager to add our brainpower and our voices to this discussion as we take on the mantle of tomorrow’s innovators. For now we must still rely on those at higher policy and scientific levels to take the lead on such initiatives and protect all our futures. I would urge those in authority to consider the consequences of failure to take proactive action. As Cervantes once noted, “to be prepared is half the victory.”

Carly Millenson, Student and WIIS New York Coordinator

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