04/05/2008 - 14:35

An interview with Laura H. Kahn

Laura H. Kahn

Laura H. Kahn

A general internist who began her career in health care as a registered nurse, Kahn works on the research staff of Princeton University's ...

More

How does global health affect global security?

From an infectious disease perspective, microbes such as bacteria, fungi, and viruses don’t recognize political borders. So an infectious disease outbreak such as SARS, HIV/AIDS, or avian influenza that begins in one country can spread to its neighbors. For diseases in which there is neither a vaccine nor effective treatment, the risk for global spread is high, particularly if the microbe is highly communicable such as a novel pandemic influenza virus. And a deadly pandemic is effective at stopping global trade and travel. The SARS outbreak is a good example, as it badly hurt the Chinese economy. If a pandemic were severe, the global economy would be adversely affected, which in turn, could impact global security.

What constitutes a strong biodefense?

People. Nations must have well-educated, well-trained specialists in medicine, veterinary medicine, bacteriology, virology, entomology, plant pathology, ecology, and of course, public health and epidemiology. There needs to be enough of these scientists to form a network of expertise to conduct disease surveillance, identify outbreaks, and direct an effective response.

In addition, countries that provide health care to all of their citizens have an advantage. People without health insurance delay seeking medical care, which could result in disaster in the case of a highly communicable infectious disease. Successful outbreak containment depends on early recognition and response, which is less likely to occur in a country without universal health-care coverage.

Is bioterrorism a risk?

Bioterrorism is a risk for two reasons. First, if we consider that bioterrorism is just as likely to come from Mother Nature as from humans, then it poses a considerable risk. We’ve seen many novel, deadly infectious diseases emerge from wildlife. This trend won’t stop, as larger human populations contribute to deforestation, intensive agriculture, and bushmeat consumption--all of which increases the risk for pathogens to emerge.

Second, if history is any guide, then bioterrorism is a risk because people have been devising clever ways to kill each other for centuries. Indeed, there are a number of historical examples of bioterrorism and biowarfare. In the fourteenth century, Mongols catapulted plague-infected corpses over the city walls of Caffa in Crimea to harm their enemies. In 1763, the commanding general of the British forces during the French and Indian Wars authorized using smallpox-infested blankets to kill Native Americans. During World War II, the Japanese conducted biological warfare experiments against the Chinese. Sadly, this list isn’t inclusive. People have carried out acts of bioterrorism before, and they will do so again.

How does animal health relate to the well-being of humans?

Many examples demonstrate how they’re inextricably linked. The introduction of West Nile virus, a zoonotic disease, in North America emphasized the need to coordinate human, veterinary, and wildlife disease disciplines in an effective public-health response. In Africa, wildlife outbreaks of Ebola virus (a potential bioterrorism agent) have preceded human outbreaks. In an outbreak of methylmercury poisoning in Japan, a neurologic disease in cats that ate fish (“dancing cat disease”) helped health authorities make the connection between sick humans and exposure to mercury-contaminated fish.

Therefore, it would be prudent to break down the barriers between those working in human and animal health. Fortunately, a “One Health” movement, which promotes closer ties between the disparate communities, has gained momentum. On June 24, 2007, the American Medical Association passed a “One Health” resolution endorsing closer ties with the veterinary medical community. And the American Veterinary Medical Association has established a “One Health” Initiative Task Force to determine how “One Health” could be implemented more widely. These are steps in the right direction, but the “One Health” movement will need additional political and public support to succeed.

Predict the state of global health in 2040.

It will depend on the political leadership around the world. For example, South Africa’s President Thabo Mbeki has shown disastrous leadership in confronting his nation’s AIDS epidemic. In the United States, a growing call for universal health care is receiving political attention, but it will take strong, committed leadership to stand up to special interests and meaningfully change a dysfunctional health-care system.

Scientists can develop the best vaccines in the world, but it’s up to political leaders to decide whether they’re widely used. For example, the measles vaccine has existed for decades and is incredibly cheap, but there are some nations in which the vaccination rates aren’t high enough to prevent outbreaks. Japan is a top exporter of measles to other countries. In 1994, after several severe adverse reactions to the measles vaccine, the Japanese government changed vaccination requirements from mandatory to voluntary. In 2000, the total measles cases in Japan ranged from 180,000-200,000, with 88 deaths.

All political leaders must work together to ensure global health; otherwise, they’ll be forever doomed to deal with each other’s health-care failures.