In the wake of Ebola and the Zika outbreak, a new book maps out the best, smartest ways to combat man’s greatest killers.
- By Laurie GarrettLaurie Garrett is senior fellow for global health at the Council on Foreign Relations and a Pulitzer Prize winning science writer.
The first time I saw Ali Khan in action, we were both much younger, and perhaps more idealistic. The year was 1995, the place — a remote village down the Kwilu River from the equally remote city of Kikwit, in a nation formerly known as Zaire, now called the Democratic Republic of the Congo. It was sweltering hot, we were atop the equator, and the center of the village was denuded of shade-providing trees. The village elder, shouting in Kikongo, was putting out as much angry heat as the sun boring down upon us: He was enraged that Khan and other foreigners were trying to remove an ailing resident of the village to a quarantine site.
Tempers rise during epidemics. Every culture, whether African or American, has beliefs and taboos that clash with efforts to stop the spread of disease. In my experience, few diseases elevate raw emotions and fear like the hemorrhagic virus Ebola. I sat on the periphery, trying to follow as the Kikongo, Zairois, French, and Parisian patois barked back and forth among the locals and their American, Belgian, and WHO visitors. But I was distracted by Khan, who stood off to the side, pen and paper in hand, wearing no hat or sunglasses and decked out in what I recall as a starched white shirt, dark tie, dark pants and loafers — as if he were in downtown Atlanta, not stifling hot, red-dust-coated central Africa. When a moment allowed, I sidled up and asked whether it was wise for him to wear a tight tie and warm clothing in such conditions.
A bit miffed at a then-reporter’s intrusion into his thoughts, Khan sneered. I smiled, and he condescended to answer, saying: “I must show full respect for the people I encounter. This is respectful attire at the CDC, so I wear it here to honor these people.”
That’s Ali Khan in a nutshell, one of the most valuable and influential disease detectives working at the U.S. Centers for Disease Control and Prevention. He is tough, yet modest; driven by science, yet always aware of the social and cultural events around him. What Khan lacks in humor, he more than makes up for with irony. And no passage in his new book, The Next Pandemic: On the Front Lines Against Humankind’s Gravest Dangers, is more laden with irony than his description (crafted with co-author William Patrick) of heading into the anthrax mess on Capitol Hill, following contamination of the Hart Senate Office Building:
“On October 15, 2001, I was coming back from a conference when I was detained at O’Hare International Airport by the FBI. Special Agent Don Duffy took one look at my brown skin and my passport with stamps from Saudi Arabia, Yemen, Egypt, Pakistan, and must have thought, Uh-oh.”
For several hours, Khan was detained and grilled by the FBI under the watchful eyes of armed Chicago police. Ali is among the most common male names in the Islamic world, and Khan is to Pakistanis what Kim is to Koreans or Smith to the English — so it was perhaps not surprising that “Ali Khan” was on the FBI’s post-9/11 no-fly list. But the FBI ought to have taken note of Khan’s official U.S. government employee passport, badge, and CDC travel documents. They did not, insisting that all of the IDs could be fakes. Khan was allowed to fly home to Atlanta only after many hours of detention: The FBI finally called the CDC’s after-hours line and, by great luck, the person who happened to answer knew physician Ali S. Khan — born and bred in Brooklyn — as “New Yawk” as they come — and verified his identity.
“In my case, the offense was FWM: ‘flying while Muslim.’ In the fifteen years (and counting) since, I’ve gotten used to the ‘Red Muslim’ folder at immigration, and the room off to the side to await my judgment,” Khan writes. He’d barely staggered into his Atlanta home when the CDC called to order him back to the airport, to handle anthrax, released from a mailed letter in the office of Tom Daschle, then the Senate majority leader. He hit the ground running in Washington, trying to figure out how widespread the anthrax exposure was, where it came from, and how best to protect the U.S. Senate and its staff. The brown-skinned Khan worked with CDC microbiologist Sherif Zaki (“with that name, you wonder how long he was detained at airports,” Khan quips) and team leader Rima Khabbaz (“obviously, another ‘real American’ from solid and trustworthy Anglo-Saxon stock,” he writes in sarcasm-laden prose).
Many epidemic fighters from the CDC and other government and academic institutions have written memoirs of their microbial detective days, and a few of the books have proven good reads. The best of the lot manage to take the reader inside the disease detective’s head, learning how the individual processes everything from infection rates of transmission to screaming baby noises, reaching decisions that solve outbreak mysteries and stop microbes’ spread. The Next Pandemic ranks among the best, taking readers to every epidemic Khan has worked in, from SARS to hantavirus, bird flu to Ebola, MERS to salmonella, and offers wonderful insights into the author’s problem-solving skills and even his own personal anxieties. In 1997, for example, Khan returned to the Democratic Republic of the Congo just two years after fighting Ebola in Kikwit to confront another deadly virus, monkeypox. A close genetic cousin to one of humanity’s greatest historic scourges, smallpox, the monkey virus had jumped from rainforest primates to people, presumably through animal hunters, and was then spreading rapidly from one person to another. Smallpox had been eradicated two decades earlier, and vaccination for the virus had long stopped all over the world.
“The real question for us was … had we called it wrong? By discontinuing smallpox vaccination, had we opened the door to monkeypox infection?” Khan writes. To answer that vital question, the American disease detective flew directly into a bloody Congolese civil war and hunted down a pilot willing to take a dilapidated, old cargo plane into the dense rainforest region where the epidemic was unfolding. A few months after Khan’s trip, I also flew into the region, strapped onto a shipping crate in lieu of seats in the back of a 1950s military cargo plane, all the while thinking, “Is any story worth this risk?” Once aboard his similar flying Congolese claptrap, Khan turned to his fellow passenger, and said, “Dying’s not that big of a deal.”
Insisting that he isn’t a courageous sort, Khan added:
“I’m not foolhardy but, at the same time, if you’re going to go out and help in those kinds of situations, you can’t do the job if you’re too concerned about your own safety. How can you tell others not to be scared if you’re too scared to take action? Not fearing death has always given me clarity of thinking about what to do, because I don’t have to deal with my anxiety before getting down to problem solving.”
And often, Khan writes, the most vital problem-solving exercise has little to do with science, and everything to do with social customs. In 2015, Khan was involved in an out-of-control moment in the Ebola epidemic of Sierra Leone. Long after neighboring Liberia had its outbreak down to a handful of cases, the military-run campaign in Sierra Leone was losing the support of the people by imposing mass quarantines, shutting down entire regions of the country for long periods. Out of the discontent over loss of business, food, and trade arose false leaders claiming witchcraft practiced by the foreigners and magic were spreading the Ebola — not intangible things few could comprehend, like “viruses.” Khan realized that arguing scientific principles of germ theory would be pointless, especially in the absence of genuine partnerships between the national disease-control leaders and local communities. “I think it was that lack of partnership that explains why the outbreak went on for so long,” he opines. “The central issue in any environment where there is an outbreak … is fear of the unknown, and this fear remains irrational regardless of anyone’s level of scientific understanding.”
Trust is, then, the key ingredient of success in battling outbreaks. Where corruption leads to hiring family and friends, rather than competent individuals, into key epidemic jobs; where money disappears in outbreaks to fatten political leaders’ bank accounts; where well-educated people decide movie stars have greater credibility in deciding the safety of vaccines than trained physicians and scientists; where incompetence sends the FBI off on a two-year wild goose chase only to realize millions of dollars were wasted identifying the DNA of one of its own agents rather than an anthrax culprit — in such situations, Khan writes, trust is eroded, and outbreaks persist.
I was reminded of several passages of my own book, published 16 years ago, Betrayal of Trust, in which I described episodes all over the world of diseases spreading where the trust between public health leaders and the citizenry had collapsed. Khan tried to engender U.S. citizens’ trust in disease-control leaders by imagining an epidemic of a virus that spread by one person touching another — turning the touched victim into a zombie. His “Zombie Apocalypse” has proven the No. 1 draw to the CDC’s website, and is used by the American Red Cross and other disaster response groups to teach the public how diseases spread, and can be stopped.
In the end, Khan argues — and I fully agree — preparedness is the key to human survival against the microbes. There are no quick-fix technologies, instant cures, or miracle vaccines to use in the equatorial Congolese village, and no smartphone app can stop a lethal virus in its tracks. Every country, every province, every city and town must have strong public health systems in place, ready to spot threats and react swiftly, Khan insists: “The time has come for us to move beyond seeing public health as the ax in the display case, where the sign says, “In Case of Emergency Break Glass,” and into the realm of flame-retardant building materials with fire extinguishers and sprinkler systems. In other words, we need to build preventive measures directly into the infrastructure of our communities and make them resilient.”
Amen to that, Brother Khan. Inshallah.
Photo credit: MOHAMMED ELSHAMY/Anadolu Agency/Gett Images