ABSTRACT: To live life forwards, we need to understand it backward. In this article, we review the factors that drove us here and now what right things we could do to set things right.
The 5-DRIVERS which drove us to the place we are standing now.
1.Population Growth and Urbanization- New and enlarging cities especially in tropical and sub-tropical regions (Asia, Africa) with rich biological diversity, poor infrastructure, vulnerability to disruption all-ready-made settings for the spread of infections.
2. Travel- The second driver is travel. The time to reach any spot on the globe from any other spot is shorter than the incubation period of many infectious microbes. Mass gatherings the Olympics, world cup, meetings all are a great chance for the microbial exchange among humans with subsequent distribution across the planet.
3. Animals- Especially vastly increased domesticated animals living in close proximity to humans. Three-quarters of infectious diseases originate in animals. The demand for animal protein in the developing world has doubled in the past 30 years. The biomass of humans is 350 million tons. The biomass of domesticated food animals is estimated to be 3 times the biomass of humans.
4. Environmental and Climate change- The rise in global temperature, global warming can disrupt ecological systems and extend a range of vectors like mosquitoes. The increased frequency of weather events feeds into the fifth driver
5.Conflicts and Natural Disasters- In addition to natural disasters(earthquakes) Wars damage infrastructure, displace population, and increase the likelihood of disease spread.
The 5-things to be done
1.Alert-Clinicians who should raise the alarm that something is happening. This is the major way epidemics are identified. Even after the advent of high technology, clinicians play a pivotal role in alerting the higher authorities. Multi-Drug Resistance TB cases were first informed by a clinician, after intensive investigation it came about to be true! That call gave rise to the recognition of a very large outbreak of MDR-TB and its control. And also, it’s really important to have a strong connection between health care and public health system. There is a gap between these two systems, which we have to build up. We have to understand the strengths and limitations of the systems, work hand in hand, and communicate regularly.
2.Effective laboratory system that works from the periphery to the center and must co-ordinate internationally. All too often laboratories have poor relations with health care systems. We must, indeed, all hang together or, most assuredly, we shall all hang separately quoted by Benjamin Franklin is absolutely true. It is extremely essential to have a laboratory network that connects everyone across the globe so that we can progress collectively.
3. Surveillance and tracking system. We need to know the baseline. Unless we know the baseline, we wouldn’t know whether something unusual is happening or not, to take appropriate actions. This is the core principle in stopping and finding epidemics. The surveillance and tracking systems should work day in and day out across the globe. We
just can’t break the glass in case of emergencies, read the guild lines and see if we could prevent epidemics and pandemics.
4. Analyze rigorously- Analyzing the data properly is absolutely important to prevent the occurrence of pandemics. Human intelligence together with artificial intelligence can make wonders. Training staff, deploying robots wherever essential to process the enormous data brings a lot of change.
5.Politics-When there is an economic impact there would be push back. Leaders need to recognize and address the situation timely. It plays a crucial role in curtailment of the pandemic. Political capital and financial capital investment, strengthening public health care systems should be actively taken up by political leaders. Downplay of leaders can pay way to disasters.
OUR ROLE?
Doctors, nurses, pharmacists, clinicians, researchers, epidemiologists should insist the government to invest and stop the diseases to protect us not only from the diseases that are killing us today but also from the diseases that might kill us tomorrow. The importance of civil society is encouraging the government to do the right thing is extremely important. Our role is not just limited to notifying and tracking diseases but we need to be the advocates to ensure the government addresses the threats of today, as well as tomorrow.
History has taught us there would be another epidemic. We can’t predict when, but certainly, we will have to witness many such if we aren’t equipped. There is no escape either we do the right thing or just become the victim of these recurring epidemics.
Joshua Lederberg rightly said “The future of humanity and microbes will likely unfold as episodes of a suspense thriller that could be titled OUR WITS versus their GENES”
“It is inevitable that there will be future outbreaks. It's not inevitable that we will continue to be so underprepared."- Dr. Tom Frieden, ExCDC Chief.
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