Sunday, March 30, 2003

Here's a quote from a recent article in the Atlanta Journal-Constitution I googled:

Bush's proposed budget would give the CDC $6.5 billion. While the request is a 1 percent increase over the proposal he offered last year, it is about $700 million less than what Congress actually approved, and Bush signed into law, for the current year.

Some of the proposed cuts are sizable. Next year's budget calls for a 26 percent cut for improvements at local public health centers. It also would cut funding for environmental health programs by 18 percent and reduce money for occupational safety and health by 10 percent.

Let's hope for two things. One, this particular disease is cured quickly with the resources the CDC and the WHO already have at their disposal. Two, the issue doesn't go away, and people keep asking what we are doing to prepare for next time.

It was very recently, only a couple of generations ago, that it was common to have more children then you really wanted because you didn't know how many would die of disease. It may have happened to the poor slightly more often than the middle class, but death was indeed the great leveler. When the WHO wiped out smallpox, it was a major triumph for humanity and for America, which played a huge role. This was the height of the war against contageous disease, when it really seemed humanity would hand one obnoxious horseman of the apocalypse his head. Victories in the war did not always come easily or cheaply, but we knew the price and we paid it. Newt Gingrich liked to talk about the values of our parent's generation, but those who paid for the Marshall plan and the eradication of smallpox would have spat on him.

The United States did not help pay for this glorious triumph merely out of philantropy. We knew that smallpox anywhere in the world would come back to us in time - and we wanted it gone. Disease breeds on the margins, but in time affects the heart. Some of the worst places for breeding resistance to HIV therapies are where people may get help enough to start using the drugs, but poor enough that they cannot continue forever. The viruses which survived the drug will increase their numbers, and perhaps this parially resistant strain will be passed on to someone else who will repeat the process.

I don't follow automobile racing, but I have heard that weight is at a premium and they have a saying. If something critical breaks, it must have been too lightly built and needs to be sturdier next time - whether anyone died or not. If it doesn't break, it must be at least a little heavier than necessary. Shave off a tiny bit of weight. I have also heard that NASA kept assuming that if they had gotten away with something last time it must be OK. So they kept taking the same risks, unless they accidently took a new one and won, in which case that could be added to the list of accepted practices.

For a long time, our resources to resist epidemics have been gradually hollowing out. There have been spikes, such as the discovery that tuberculosis was beoming more widespread, but our level of preparedness for something wildly new has been decreasing. In species from rats to humans, increasing population leads to increasing risk of epidemic disease. For rats, the situation has always ended with a massive populations crash, no matter how great the food supply. Then the cycle starts again. For a brief historical moment homo sapiens has interrupted the cycle. Do we have what it takes to break it?

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