We need to be budgeting to defend against the next pandemic.
@nytopinion: Trump will increase funding for defense. But our real security risk is disease.
While the Trump administration is proposing significantly increased military spending to enhance our national security, it seems to have lost sight of the greatest national security threat of all: our fight against infectious disease.
We already spend far more on our military than any other country in the world. To help pay for the increases, President Trump wants to cut back many federal programs, including those that prepare us to wage war against microbes, the greatest and most lethal enemy we are ever likely to face. This is where “defense spending” needs to increase, significantly.
President Trump’s budget would cut funding for the National Institutes of Health by 18 percent. It would cut the State Department and the United States Agency for International Development, a key vehicle for preventing and responding to outbreaks before they reach our shores, by 28 percent. And the repeal of the Affordable Care Act would kill the billion-dollar Prevention and Public Health Fund, which provides funding for the Centers for Disease Control and Prevention to fight outbreaks of infectious disease. (While the budget also calls for the creation of an emergency fund to respond to outbreaks, there is no indication that it would offset the other cuts, or where the money would come from.)
Those cuts will not protect American citizens. They will diminish research and vaccine development and our ability to respond to the growing threats of antibiotic resistance and new infectious diseases.
Those agencies are already falling short, as we saw last year, when they couldn’t effectively respond to the Zika threat. What will they do when we face a real pandemic? With 7.4 billion people, 20 billion chickens and 400 million pigs now sharing the earth, we have created the ideal scenario for creating and spreading dangerous microbes. Trade and travel have connected most points on the globe in a matter of hours. More and more people are living in the microbe-rich megacity slums of the developing world.
By some estimates, the 1918-19 “Spanish” influenza killed more people than all the wars of the 20th century combined. Today, an influenza pandemic could be more devastating than an atom bomb. We are already witnessing an outbreak of influenza in birds — the H7N9 strain, in China — that could be the source for the next human pandemic. Since October, over 500 people have been infected; more than 34 percent have died. Most victims had contact with infected poultry, yet three recent clusters appear to be from person-to-person transmission. Will H7N9 mutate to become easily transmitted between humans? We don’t know. But without sufficient supplies of a vaccine, we are not prepared to stop it.
The spread of antibiotic-resistant microbes also continues at an ever faster rate. Last year a comprehensive review predicted that, if left unchecked, drug-resistant infections will kill more people worldwide by 2050 than cancer and diabetes combined. Without a global effort led by the United States to halt the spread of this resistance and support for development of new antibiotics, we are in danger of returning to a pre-antibiotic world in which a cut could prove deadly and surgery would not be worth the risk of infection.
Yellow fever, a mosquito-borne disease that can kill up to 50 percent of those who get seriously sick, is on the cusp of a major outbreak in some of Brazil’s largest cities, while MERS — Middle East Respiratory Syndrome — continues to infect people on the Arabian Peninsula. If an effective vaccine is not developed, it will continue to be transmitted around the world and cause fatal outbreaks like the one that closed Samsung Medical Center in Seoul to new patients for weeks. A similar outbreak could occur at the Mayo Clinic or Johns Hopkins Hospital.
And three years after the 2014 Ebola crisis, we still have no licensed vaccine or a plan for how to deploy one to prevent future outbreaks.
Finally, there is the danger of diseases deliberately spread by terrorists. Bill Gates, who has put much of his sizable financial resources as well as his brainpower into public health, wrote in the New England Journal of Medicine in 2015: “Of all the things that could kill more than 10 million people around the world, the most likely is an epidemic stemming from either natural causes or bioterrorism.” More recently, at this year’s Munich Security Conference, on the possibility of terrorist-engineered viruses he noted: “They are probably the only thing that can kill a billion.” For example, the science exists to reconstruct the smallpox genome from readily available lab materials, with the added possibility of altering the virus just enough that our existing vaccine would be ineffective.
The military has figured out how to convince congressional funders that the only way to maintain defense is to appropriate money before a crisis. You don’t start building the weapons and training all the soldiers after the first shot has been fired. The only way we can win the inevitable microbe wars is to do the same — to have new vaccines and antibiotics and trained personnel ready before the crisis hits. We cannot rely on pharmaceutical companies to create drugs and vaccines for markets that do not yet exist. Only the government can do this. The additional expenditures would be truly economical in terms of lives saved.
We are talking about national security on the most existential level.