An expert's point of view on a current event.

‘War on Disease’ Is a Self-Fulfilling Prophecy

The mindset that helped fight the current pandemic is what gets us into situations like this in the first place.

By , the executive director of the World Peace Foundation.
A medical worker closes an ambulance’s doors.
A medical worker in personal protective equipment closes the doors of an ambulance after dropping off a patient suspected of having COVID-19 at the Acibadem Altunizade Hospital in Istanbul, Turkey, on April 17, 2020. Chris McGrath/Getty Images

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Most virologists don’t think COVID-19 escaped from a laboratory, but they all understand a pandemic caused by a lab leak is a credible scenario. There have been at least a dozen lab-leaked outbreaks of lethal pathogens over the years, one of which, the 1976 strain of swine flu—luckily a mild strain—spread around the world. It was partly in response to worries from biosecurity experts in 2012 that the U.S. government imposed a moratorium on “gain of function” experiments, where scientists tinker with viruses to explore what makes them more deadly or more transmissible. (The ban was lifted in 2016.)

Most virologists don’t think COVID-19 escaped from a laboratory, but they all understand a pandemic caused by a lab leak is a credible scenario. There have been at least a dozen lab-leaked outbreaks of lethal pathogens over the years, one of which, the 1976 strain of swine flu—luckily a mild strain—spread around the world. It was partly in response to worries from biosecurity experts in 2012 that the U.S. government imposed a moratorium on “gain of function” experiments, where scientists tinker with viruses to explore what makes them more deadly or more transmissible. (The ban was lifted in 2016.)

But alongside the discussion about tightening biosecurity, there’s also a growing awareness among experts that there may be a deeper problem at work—that the entire system that’s been set up for seeking out and neutralizing viral threats may itself be the problem. The danger isn’t just that individual accidents will inevitably occur; it’s that the overall strategy of a forever war with disease agents is fundamentally unsound because it involves escalating a confrontation we cannot realistically expect to win.

Physicians and public health experts tend to use the “war on disease” metaphor casually, thinking of it as an innocuous figure of speech. It seems natural to think we are “at war” with COVID-19. Immunologists speak of the body’s “defense” against invading pathogens. We celebrate doctors and nurses as “front-line heroes.” The book by influential public health expert Michael Osterholm and writer Mark Olshaker is titled Deadliest Enemy: Our War Against Killer Germs.

In fact, this metaphor influences policy in some specific ways. The fight against potential pandemic pathogens is the biological version of the war on terror—a war that can’t be won and causes damage and destruction along the way.

Exactly 20 years ago, on June 22 and 23, 2001, high-level policymakers in Washington participated in one of the most influential—and chilling—simulation exercises. Operation Dark Winter was a war game with a difference. The scenario was an attack on the mainland United States, and ground zero was an outbreak of smallpox in Oklahoma City. The simulation condensed 13 days of a highly infectious airborne virus’s spread into two days of realistically staged updates from the Centers for Disease Control and Prevention (CDC), increasingly desperate meetings of the National Security Council, and media reports.

Operation Dark Winter has been credited with waking up the George W. Bush administration to the threat of pandemic diseases—and not a moment too soon. In the weeks after 9/11, spores of Anthrax, a favored biowarfare pathogen, were mailed to journalists and political leaders. The simulation suddenly looked terrifyingly prescient. Biosecurity was catapulted to the top of Homeland Security’s agenda.

Public health specialists had been clamoring for this kind of attention—and funds—for a decade. Led by molecular biologist Joshua Lederberg among others, they had produced a slew of detailed reports. But a catastrophic scenario with a 1 percent risk rarely grabs sustained White House focus. Everything changed during the summer and fall of 2001.

At the time, officials at the CDC observed that public health consequences of a naturally occurring epidemic would be the same as for a bioterror attack. Now, they had the money and the policy access that made it possible to build a serious biodefense against pandemic threats, natural and human-made. But this came with a twist: The national biosecurity strategy was shaped by the war on terror.

It was the latest expression of the distinctly modern idea of a “war on disease.” Until 150 years ago, military metaphors were occasionally found in medical textbooks, but the idea of organizing science and society to “combat” infections made no more sense than “fighting” bad weather. Seminal military theorist Carl von Clausewitz commanded Prussian army brigades that tried to enforce a cordon sanitaire to keep cholera out of Germany in 1831—but nowhere in his voluminous writings does he consider the military to have a role in “combating” disease. (Clausewitz’s operation failed, and he himself perished of the disease.) This changed with the simultaneous triumphs of germ theory and the zenith of European imperialism.

In April 1884, when German microbiologist Robert Koch returned to Berlin after isolating the bacteria that causes cholera, he was given a military honor—the Order of the Crown, second class—by Kaiser Wilhelm. Seven months later, the kaiser convened the Berlin Conference that carved up Africa among the European colonial powers. The goal of conquering the globe’s territories extended to naming their mountains and forests and classifying their peoples, fauna, flora—and microbes. Conquering disease was part of the same project, making the tropics safe for settlement by the white race. The triumphs of the colonial Pasteur Institute in sub-Saharan Africa and southeast Asia and of the U.S. Army Medical Corps in Cuba and Panama—specifically controlling yellow fever—followed.

Each subsequent generation reshaped the martial metaphor. The post-World War II “campaigns” to control malaria and eradicate smallpox and polio lost much of their colonial associations, and Africa’s fight against HIV and AIDS was presented as a continuation of liberation struggles.

Under both the George W. Bush and Obama administrations, the United States was the world leader in pandemic preparedness, and its explicit template for the United States’ global “war” on these diseases was the war on terror. When President George W. Bush publicly launched bird flu pandemic preparedness plans in a speech at the National Institutes of Health in November 2005, he embraced the comparison: “Our country has been given fair warning of this danger to our homeland—and time to prepare.” The United States developed an institutional overlap between U.S. Homeland Security efforts to defend against bioterrorism and programs to increase public health capacity.

There have also been a similar set of assumptions, usually unstated. In a war, we assume the worst about the threat posed by our adversaries and play down the dangers of our own armaments. The underlying model of today’s war on infectious microbes is this: To sustain our way of life, with its capitalist economy and massive ecological footprint, we designed a defense against dangerous pathogens, which identifies individual candidates that pose a threat and eliminates them as quickly as possible as they emerge.

It’s the highest of high-tech whack-a-mole. Programs such as the U.S.-funded PREDICT hunted down viruses with lethal potential and established surveillance systems to detect outbreaks. Over 10 years (until shut down by then-U.S. President Donald Trump in 2019), PREDICT gathered 140,000 samples and identified several dangerous strains. It merely scratched the surface of the pathogenic reservoir: To do the job properly would require a scientific and surveillance system at a far greater magnitude. It requires virus harvesters going out and seeking microbial candidates with pandemic potential wherever they may lurk, isolating them in laboratories, and working out how they could mutate to infect humans and be transmissible from person to person. This research is worthy, selfless, and dangerous. It requires dedicated individuals, such as the U.S. Agency for International Development’s Dennis Carroll (who set up PREDICT), Peter Daszak of EcoHealth Alliance, and the scientific teams that reconstituted the influenza virus that caused the deadly 1918 pandemic.

Precisely because the pathogens are so dangerous, virological research has an infrastructure of maximum safety, including the biosafety level four laboratories we see in documentaries and movies such as Outbreak. This infrastructure is not infallible.

“Normal accident theory” tells us that in any complex interconnected system, a string of mishaps is possible that can bring about a catastrophic failure. Although engineers can do their utmost to design safe power stations or weapons systems, there’s inevitably some concatenation of events—each one improbable—they overlook. Over time, the improbable becomes more and more likely. When a disaster happens, in retrospect, it is always explicable. “Normal accidents” occur with research into the most lethal pathogens we face—from the 1978 smallpox outbreak in the English city of Birmingham to clusters of coronavirus cases traced back to researchers cutting corners in biosafety protocols.

The “lab leak hypothesis” for the index case of COVID-19 covers a range of possibilities. At the end of the range is the idea that COVID-19 was a specially engineered bioweapon. There’s no evidence for that at all.

But readers of David Quammen’s 2012 book, Spillover: Animal Infections and the Next Human Pandemic, will shudder at his descriptions of virus hunters exploring bat caves, risking a bite or scratch from a frightened bat, kicking up dried bat feces on the floor or touching feces on rocks, usually wearing cumbersome protective suits, sometimes dispensing with them because they make it difficult to clamber through narrow crevices and around rockfalls. We have recently learned there was an outbreak of severe respiratory infection among six miners in Mojiang county in China in 2012. They had been tasked with clearing bat excrement from a mine shaft. Six fell sick and three died. Blood samples from the men were sent to the Wuhan Institute of Virology, where researchers isolated a coronavirus, a very close sibling of COVID-19. It’s not exactly a smoking gun but certainly a whiff of cordite—especially because the institute appears to have been conducting “gain of function” experiments on coronaviruses.

It’s too early to jump to conclusions about what the Biden administration’s investigation into the origins of COVID-19 may find. But we can say with confidence that the lab leak hypothesis is plausible, that lab leaks have happened in the past, and as virus hunting and research into pandemic threats increase, the perils of lab leaks will only grow. In fact, the entire apparatus of pandemic prevention is a risky business.

Is it worth it? For now, we are trapped. We have so disrupted our planet’s ecology that we cannot do without this forward line of defense. We’re trebly at risk. First, we are clearing rainforests and encroaching on the habitats of native species, so we are exposed to zoonotic spillovers at a level never before seen. Second, Homo sapiens and a tiny range of animal species farmed at the industrial scale are now hyper-dominant to a truly perilous extent. We and our livestock are 96 percent of terrestrial mammalian biomass; farmed poultry dominates wild birds by a ratio of 2 to 1. Any pathogen that can make the leap into these massive but genetically narrow species has hit a jackpot. And third, we are connected: Pathogens can travel around the world within a day.

Evolutionary theorists compare our predicament to the Red Queen in Alice Through the Looking Glass: We must run as fast as we can to stay in the same place. This applies to antibiotic resistant bacterial strains as well as viral mutations. Actually, because of the increasing pace of ecological disruptions and microbial mutations, the metaphor is underpowered: We must accelerate as fast as we can.

What is the strategic endgame? For some, the war on pandemic diseases is winnable. Last year, Daszak told CNN, “I’m optimistic about this. I think that in 50 years we will look back on this age and say, ‘we were in the pandemic era but we dealt with it.’” For others, it is a forever war: We will have to be more vigilant and build more sophisticated defenses.

What the plausibility of the lab leak tells us is these defenses are themselves dangerous. Enhanced biosafety can reduce the dangers but not eliminate them. It’s a simple fact that the chances of a normal laboratory accident increase as the number of laboratories and the number of deadly viruses they contain increase.

Twenty years after that dark summer of 2001, the United States has long since drawn back from the idea the homeland could be made safe from terrorism by eliminating terrorists one by one. We haven’t yet reconsidered its cousin: the war on pandemic disease threats; we haven’t started rethinking the wisdom of being in a perpetual war against components of nature.

Alex de Waal is the executive director of the World Peace Foundation. His book, New Pandemics, Old Politics: Two Hundred Years of War on Disease and Its Alternatives is published by Polity this month.

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