[Reprinted Article] How to Diminish Fear? The International Problems that Pandemics Give Rise to
Author: Katow Shigetaka Ph.D.
Former Team Leader of the National Institute of Infectious Diseases
Former Visiting Researcher at Centers for Disease Control and Prevention, USA
(Originally published in Japanese in the INTERNATIONAL AFFAIRS No.698 - January & February, 2021 (Combined Issue). Translated by APIC. Permitted to reprint.)
INTERNATIONAL AFFAIRS No.698 - January & February, 2021 (Combined Issue)
◎巻頭エッセイ◎どう不安を減らすか？ 感染症対策こそ、国際問題 / 加藤茂孝
(◎Opening Essay◎"How to Diminish Fear? The International Problems that Pandemics Give Rise to" written by Katow Shigetaka)(Japanese)
What History has Taught Us
Looking back on the history of infectious diseases and the human being, there is a common cause-which is that “humans spread diseases”. During each migration of humans, contagious diseases have been spread around the world. The Black Death in the 14th century was triggered by the invasion of the Mongolian Army into Europe in the 13th century and afterwards the trade between East and West. The bacteria “plague bacillus” carried by the Black Rat lived in Central Asia found its way into Europe through the routes travelled by humans, causing a horrendous calamity. The Pope lost his authority when priests were unable to cure afflicted believers of the Plague with therapy and prayer, followed by the Reformation; this was followed by the start of the Renaissance, and the persecution of Jews due to accusations of spreading poison. These enormous changes brought about a liberation for humanity coming from the darkness of the Middle Ages into early-modern times. Also in the 15th century, Christopher Columbus’ landing on the American continents brought with syphilis to the European continent, spreading it around the world in the blink of an eye. As the American scholar Jared Diamond cleverly pointed out, what moves the world is “Guns, Germs, and Steel”, and there is no other period in time where the power of the influence of germs has drawn as much attention as now. COVID-19 can be summed up in a quote from Mark Twain, “History doesn’t repeat itself, but it rhymes”(though the original is not identified). History keeps changing its figure and reappearing throughout different occasions.
A revolutionary countermeasure to containing the Black Death in the 14th century was the idea of quarantine, which first commenced in the city of Dubrovnik, Croatia in 1377. Venice also took up this measure; they would hold the crew of ships coming into Venice outside of the port for 40 days, and would only allow those who were not infected with the plague onto land. This is where the English word “quarantine” comes from- meaning “forty” in Italian. The foreign-registered cruise ship “Diamond Princess” that docked in Yokohama last year during the start of the COVID-19 pandemic which caused a huge problem due to the lack of international rules regarding quarantine.
21st Century-style Pandemic: Unprecedented Simultaneous World-wide Fear
The year 2020 which future generations would picture should have been the year when the 2020 Tokyo Olympics and Paralympics took place. It took a 180° turn and became the year of COVID-19, postponing the olympic games until 2021.
In the 20 years of the 21st century, four newly emerging infectious diseases have spread around the world. SARS in 2002 with a 10% mortality, the Swine-origin Flu Pandemic in 2009, MERS in 2012 with a 35% mortality, and COVID-19 in 2020. At the beginning of the COVID-19 pandemic, the mechanism of the disease was unknown well, and even with the discovery of it, the lack of treatment and high mortality drove people into fear and anxiety.
Compared to other coronaviruses which cause pneumonia such as SARS and MERS, COVID-19’s mortality is only 2.3%, much lower than others. Despite this fact, the world unprecedentedly fell into a spell of terror and unease simultaneously, causing a 21st century-style pandemic. The context of this lies in the rapid and massive volume shift of globalized people, goods, and money; furthermore, information was added into the equation. With the lockdowns of major cities worldwide, such as Wuhan, Venice, Paris, Madrid, New York, etc. photos of empty streets where people had just once been coming out of every corner were sent around the world in an instant, sending the world into fear that almost seemed to be synchronized. The shock produced from this fear is the first in epidemic history.
As of December 8th, 2020, COVID-19 cases have been confirmed in 192 countries, with an accumulated 67,590,000 infections, and 1,540,000 total deaths. The number of cases in Japan stands at 160,000 infections, and a total of 2,300 deaths (all information based on Johns Hopkins University Coronavirus Research Center), with no hints of slowing down. However, contrary to the increase of infections, the number of deaths is starting to slowly decline; the worldwide mortality was once at 8%, but as of December 8th, it has decreased to 2.2%, and down to 1.3% in Japan. It is projected that it will further decline. In the background of this decline in mortality is firstly the incremental rise in PCR tests, and the confirmed number of patients who have mild cases and those who are asymptomatic. Secondly, the increase of information-sharing with medical professions relating to medicinal remedies and treatments allowed diagnoses and treatments to efficiently take place in the early phase of the pandemic, reducing the number of severe patients and deaths.
In addition to COVID-19 countermeasures (or, even more so), economic problems have weighed down the reality of citizens’ lifestyles. As the government has been earnestly trying to revive the economy, efforts to curb the disease have weakened, and we are in another wave of COVID-19 which is still progressing. It is not a choice of either protecting lives (or health) or either reviving the economy; the government must make the decision choosing the wise measures which will protect lives while skillfully turning the economy around. The people demand such ingenious and meaningful responses from the government under the pandemic where situations are more complicated than ever before.
Fortunately, there is the possibility that the spread of COVID-19 in Africa, which many experts worried about due to its weak medical system, can be held back.
Making a personal speculation, even if the number of infections in 2020 keeps rising, the number of deaths will decline, and psychologically people will start to relax. In 2021 and 2022 a smaller wave of the virus will reappear, but measures to combat COVID-19 will gradually come to light, and a stable social life will soon return. As soon as 2023 and later, COVID-19 will have made its place as a common cold-type infection (or a slightly heavier common cold). Even if COVID-19 were to end in a few year’s time, it will not be possible to return to life pre-pandemic. We are entering a new phase in history.
Proceeding Carefully with COVID-19 Vaccine
Nations, as well as pharmaceutical companies are competing against each other to develop a COVID-19 vaccine; there is no doubt that trial vaccines will come out in 2020, but the efficacy and side effects of the vaccines need to be tested with prudence. Many of the current leading candidates target the viral spike protein as the antigen, which is considered to be less effective than live-attenuated vaccines and inactivated whole-virion vaccines. The ability for the human body to maintain its immunity to the virus after the shot is also unknown. Thus, I think we should wait until the results of a phase III clinical trial are released before making any decisions.
Watching the race to develop a COVID-19 vaccine and the accompanying media reporting, I cannot help but feel like it is a recreation of the 1950s-60s Space Race between the USA and USSR. There is a sense of unreasonableness as research organizations, drug companies, and nations race to be the first to develop the vaccine, even if it means leaving out a few necessary tests and clinical trials. An enormous development budget and each nation’s pride were at stake during the Space Race, but this time with the COVID-19 vaccine race, citizens’ health and lives are in danger, adding a different element this time around. There are examples of previous vaccines that were developed at a record speed either being suspended or called off altogether. One example (of a failed vaccine) is the Swine Flu Vaccine. When the outbreak of the 1976 Swine Flu was reported in the United States, then-president Ford was up for re-election that year. His administration pushed for the swift development of a vaccine, and embarked on an ambitious goal of rapidly vaccinating the American population. Those who were vaccinated showed symptoms of Guillain-Barré Syndrome, and the inoculation of the vaccine was terminated. Luckily the 1976 Swine Flu never became a pandemic; Ford lost his race for another term. Another example of a failed vaccine is the Dengue Fever vaccine. The vaccine was approved for use in Mexico in 2015, and in 2016 in the Philippines. In the case of Mexico, a presidential candidate that year recommended the use of the vaccine. The Dengue Fever vaccine was a particularly difficult disease to create a vaccine for, as there were four different serotypes, and it was known that in the event of a second infection, new serotypes would increase the severity of the disease. In the patients who had been vaccinated, their symptoms became more severe upon a second infection of Dengue Fever, and the plug was pulled on the vaccine in both countries. These are two examples of vaccines which were OK’d after phase III clinical trials on a small group of people; this is pointing to the possibility of other unexpected problems with the inoculation of the masses with the new COVID-19 vaccine.
Infection prevention measures is the field in which international cooperation is needed.
When SARS struck and WHO asked China to inspect the origin of the outbreak in Guangzhou, the Chinese government declined their request (possibly because they thought they could carry out the investigation on their own, or because they were afraid an inspection of an emerging infectious disease outbreak would have a negative impact on their economy?). During this period, SARS traveled from Guangzhou into Hong Kong, spreading throughout the world. According to an estimate from the Asian Development Bank, the economic impact in Asia of the SARS outbreak is approximated at $32 billion USD. Since the SARS outbreak, the importance of early discovery and early information-sharing on emerging infections diseases has been widely recognized by the world. Information on the COVID-19 outbreak was politically suppressed by the city of Wuhan and Hubei province, resulting in a subsequent delay of information being provided to the international community. If this information had been relayed more rapidly, COVID-19 could have been kept to a smaller scale or could have been regionally confined. On the other hand, scientists’ reactions were quick, and as early as January 10th, all of COVID-19’s genetic code had been recorded, and reported to WHO on January 11th, allowing any country to create a PCR kit.
The onset of COVID-19 made various problems already in existence come to light. Worldwide nationalism was revealed; doctors and scientists around the world must come together and cooperate in order to shed light on and propose disease infection prevention measures. If countries are in economic and political conflict, containment will be delayed, and a gap in health of citizens between regions and nations will appear. This is why disease infection prevention measures are an international problem.
Why have so many emerging infectious diseases appeared, and why has the scale of infections increased? There are two reasons. The first reason is the population explosion and the search for natural resources which has led the human race to enter places that we had previously been unable to, increasing contact with the animal world. Scientists are aware that over 75% of human infectious diseases originated from animals. For instance, all coronaviruses induced human severe pneumonia originated in bats. The second reason for the increase in infections and scale is due to the large amount of and rapid speed that people and goods migrate has enabled infectious diseases to travel from one side of the world to the opposite in just one day.
Taking into further consideration the background of these pandemics, (1) by the climate change the habitat of bacilli and mosquito-borne pathogens has increased, and (2) the changes in animal habitats brought upon by environmental destruction are also factors. These long-term and widespread problems can be solved by nothing other than international cooperation. Despite realizing the importance of this, crucial international relations are being thrown into further chaos due to COVID-19. In fact, human being is not facing the problem of controlling the simple infectious disease of COVID-19, but is facing even more enormous problems not previously seen; this is the frame of mind we must begin with. COVID-19 has made us realize that we are living in times that are even more difficult than we imagined.
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