The Stockholm Paradigm: Climate Change and Emerging Disease
421
The Stockholm Paradigm: Climate Change and Emerging Disease
421eBook
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Overview
As this book reveals, a new understanding of the evolution of pathogen-host systems, called the Stockholm Paradigm, explains what is happening. The planet is a minefield of pathogens with preexisting capacities to infect susceptible but unexposed hosts, needing only the opportunity for contact. Climate change has always been the major catalyst for such new opportunities, because it disrupts local ecosystem structure and allows pathogens and hosts to move. Once pathogens expand to new hosts, novel variants may emerge, each with new infection capacities. Mathematical models and real-world examples uniformly support these ideas. Emerging disease is thus one of the greatest climate change–related threats confronting humanity.
Even without deadly global catastrophes on the scale of the 1918 Spanish Influenza pandemic, emerging diseases cost humanity more than a trillion dollars per year in treatment and lost productivity. But while time is short, the danger is great, and we are largely unprepared, the Stockholm Paradigm offers hope for managing the crisis. By using the DAMA (document, assess, monitor, act) protocol, we can “anticipate to mitigate” emerging disease, buying time and saving money while we search for more effective ways to cope with this challenge.
Product Details
| ISBN-13: | 9780226632582 |
|---|---|
| Publisher: | University of Chicago Press |
| Publication date: | 07/19/2019 |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 421 |
| File size: | 2 MB |
About the Author
Read an Excerpt
CHAPTER 1
How Bad Is It, Anyway?
The world's a little bit under the weather and I'm not feeling too good myself. — Sign at the Rally and March for Science, Washington, D.C., April 22, 2017
This planet's climate is changing. Inexorably. We now live in a "second-order world" in which change is not simply accumulating, it is accelerating. Projections for the year 2100 made around the turn of the century already seem woefully inadequate. Despite incrementally decreasing birthrates, the human population grows daily; it's on the move, and deep technological footprints mark its passage. We alter landscapes and perturb ecosystems, inserting ourselves and other species into novel regions of the world, contributing to permanent changes in the biosphere. This should surprise no one. More than a century ago the Swedish Nobel Laureate Svante Arrhenius showed that carbon dioxide emissions from industrial sources would increase atmospheric temperatures. Three generations ago Charles Elton, a founder of modern ecology and a bellwether for the disruptive effects of climate change, wrote: "We must make no mistake; we are seeing one of the greatest historical convulsions in the world's fauna and flora." Elton concluded that human civilization was about to experience severe socioeconomic disruptions. Global changes in temperature and rainfall would lead to drought, famine, and disease. These would in turn lead to conflict and disease. And conflict would lead inevitably to migration and more disease. Now each day is a testimony to Elton's insights. Climate change alters the movements and geographic distributions of myriad species. Transporting people and goods brings previously isolated species into sudden contact with one another. Drought and flood create famine and conflict. Two-thirds of humanity risk water shortages, and the rest face the threat of floods. Paradoxically, both drought and flood carry increased risk of disease transmission. Furthermore, they all lead to migration, and not just of humans. Diseases emerge everywhere on a daily basis, affecting us and the species upon which we depend for our survival. Elton would surely not have been surprised that we now find ourselves deeply embedded in the midst of an epidemiological crisis. In these arenas of movement and new contact, a world of pathogens continually encounters suitable hosts with no resistance and no time to evolve any.
This is also not news — maladies rare or unknown half a century ago, like HIV and Ebola, West Nile virus, avian influenza, Zika, dengue, monkeypox, hanta, and Lyme disease — are increasingly commonplace. Some old associates, such as malaria and yellow fever, have resurfaced with a vengeance. We are even seeing a resurgence of polio and tuberculosis, two diseases we thought we had largely vanquished. Yet others lurk in places becoming more accessible to humans. Some, such as bubonic plague in the United States, are expanding their geographic distributions as a result of successful efforts by conservation biologists to reintroduce reservoir hosts into areas with high human traffic. In such a world — this world — events like these are ongoing. The entire range of species upon which humanity depends for socioeconomic reasons is affected.
Scarcely a week passes without news of some freshly discovered strain of pathogen trading up to a human host ... or European cattle ... or Nigerian tomatoes ... or critical pollinator insects ... or sea urchins. News items flashing across our monitors since we began writing this book in mid-2016, in no particular order: temporary cessation of blood transfusions in Greece for fear of malaria; closing of the Yellowstone River to fishing for fears of whirling disease and viral pathogens infecting trout; tourism losses in Florida amid Zika fears; shortages of the yellow fever vaccine in Brazil and in Central African countries amid outbreaks on both their continents; appearance of the South American tomato leaf miner in Nepal; an invasive insect killing trees on which street lights are hung, leading to crime increases associated with the loss of night lighting; an army worm invasion from North America to Africa, putting 10–40 percent of Africa's corn crop at risk; red squirrels in the United Kingdom harboring two different variants of the bacterium that causes leprosy; sudden oak death disease in Hawaii; a rust fungus that is resistant to every known fungicide and is infecting wheat in Eurasia; spruce beetle outbreaks in North America; plagues of locusts in southern Brazil and northern Argentina; filarioid worms in reindeer in Fenno-Scandinavia; blue-tongue virus and anthrax returning to Europe; an anthrax outbreak in eastern Siberia that may have come from anthrax bacteria frozen in permafrost for the past century until it began melting; a yellow fever outbreak giving way to a monkey-pox outbreak, giving way to an Ebola outbreak, giving way to a polio outbreak in the Democratic Republic of Congo in a span of four months; a massive cholera outbreak in Yemen associated with ongoing conflict and a breakdown in the water and sewage treatment infrastructure; plague in Madagascar; malaria in Tuscany, southern France, and southern Switzerland; leptospirosis breaking out in Puerto Rico following Hurricane Maria; a bacterium imported to Europe that threatens garden plants and fruit trees; a large influenza outbreak in North America on the centenary of the Spanish flu pandemic; the threat of measles at Chicago's O'Hare Airport; a Lassa fever outbreak in Nigeria; city parks in São Paulo closed for fears of yellow fever and malaria; Ebola reaching an urban center of two million in Congo; ongoing outbreaks of Crimean-Congo hemorrhagic fever, Zika, Ebola, dengue, chikungunya, Marburg, norovirus, arenavirus, rhinovirus; and on and on ...
This is the new normal, the crisis of emerging infectious disease (EID), caused by pathogens fitting one of the following criteria: (1) something "new," that is, a pathogen previously unknown to science; (2) a known pathogen becoming more pathogenic than before; (3) a known pathogen becoming more pathogenic at the edges of its geographic range; (4) a known pathogen appearing in a geographic location where it had never been reported before; and (5) a known pathogen infecting a host it had never been reported infecting before. This is not a crisis of a few headline-worthy viruses infecting humans in tropical countries. Emerging diseases are caused by viruses, bacteria, fungi, protists, and multicellular animals, all exacting a socioeconomic cost from humans and the plants and animals upon which we depend. They can be found in developed as well as developing countries, and they occur in the wild lands, agricultural lands, and rural, suburban, and urban regions. They are transmitted in soil, water, and food; by eating, drinking, and casual contact with other organisms or surfaces that they touch; and by a constellation of biting, piercing, and sucking arthropods that feed on us and our livestock.
So here we are, plodding prey for a microcosmos of hunters that are finding us with — it seems — increasing ease. Some are ancient associates, but something new pops up on a daily basis. And we are afraid of them — starting in the past century they have been portrayed as the ultimate boogeymen intent on doing us in: "Searchers had not yet, like Pasteur ... begun to challenge God, to shake their fists at the meaningless cruelties of nature toward mankind, her children." Even these insights are not new — such classic books as Microbe Hunters (1926) and Rats, Lice, and History (1935) drew attention to this phenomenon, so humanity should have been ready to accept the same message when it was delivered 60 years later by the microbiologist Laurie Garrett and the geographer Jared Diamond in their seminal books.
If None of This Is New, Why Is It "News"?
You would think that the public health response would be a well-oiled machine by now. But yet again we have been blindsided.
Scientists have been warning for at least a generation about the potential impact of EID in a world experiencing climate change. The global response to those warnings, however, encourages the public to think of EID as isolated events, mostly affecting humans, that can only be dealt with by reacting after the fact and that have nothing to do with climate change. We allocate massive resources to pathogens that have already made themselves known while ignoring the far greater threat posed by those waiting in the wings. The ones we know are the tip of the iceberg — most of the world's pathogens haven't been discovered yet. They're discovering us easily, however; those weekly outbreaks and the endlessly variable strains of recent years are ample evidence of that. The new status quo is a succession of outbreaks battering an increasingly fragile public and agricultural health infrastructure that cannot meet the challenges of global climate change. We rarely have an idea where the next one will pop up because we have done such a poor job of cataloguing the world's pathogens. All we know is that they're far better at finding us than we have been at finding them. This known issue is likely to continue to be reported as "surprising news" lasting only a few days when the real news story, as Laurie Garrett pointed out in 2001, is our continuing failure to cope with the crisis by anticipating and preparing for more outbreaks.
Elements of the Problem
The emerging disease crisis can be best understood in the context of three fundamental realities that will be recurring themes throughout this book.
It's about Us and Climate Change
About three million years ago our African ancestors moved from the forest to the savannah. Gradually changing from scavengers to predators, sharing prey with grassland carnivores, those ancient humans acquired pathogens that had first been found in hyenas, large cats, and African hunting dogs. They carried those pathogens out of Africa, helping them move into native hosts in new environments, while native pathogens residing in nonhumans returned the favor, infecting the newly arrived humans. Over time, agriculture, domestication, and urbanization brought people and animals into even closer contact, expanding the menus of yet more pathogens and making transmission easier than ever.
In the past 100,000 years, human geographic expansion disseminated EID risk on a global scale. If doctors had existed then, they would have remarked on a worrisome surge in the number of EIDs, responding to the crisis as best they could, after the fact, and wondered how to manage the outbreaks. The human ecological footprint has had a disproportionate influence on the distribution of diversity on the planet for the past 12,000 years. By that time at least some humans had adopted sedentary lifestyles, accompanied by the rapid emergence of animal and plant domestication (corn was being domesticated in Mexico between 11,000 and 9,000 years ago) and new diseases as humans inserted themselves more intimately into the lives of their newfound domestic companions. That time period also witnessed an improvement in the physical conditions of life, especially for women, who, narrowing the size gap with males, began having bigger, healthier babies. This was a mixed blessing. The human population began to grow. A lot. By 5000 years ago, humans had established permanent cities, many of which would be destroyed and abandoned, and only rarely rebuilt, as a result of conflict and natural disasters, including climate fluctuations that were relatively mild compared to what is now bearing down on us. The human population continued to grow and expand geographically, building new cities and acquiring more and more new diseases. By 250 years ago, we had created industrial cities and the foundations of modern technological society.
In the past 50 years an exploding human population, rapid transit, and the globalization of economies have produced the real-time crisis that is now part of our daily existence. And the onset of accelerating warming and environmental disruption has intensified that situation. It seems that at least some of the climate change we are experiencing signals the end of the extended run of climate stability that marked the Holocene. But that is not the full extent of the problem. Today human beings drive considerable environmental perturbation and uncertainty. Anthropogenic input, including the injection of carbon dioxide and other greenhouse gases into the atmosphere, has a tremendous influence on the state of the climate, global atmospheric and sea temperatures, patterns of precipitation and drought, and the severity and frequency of the storm systems that sweep the planet.
Temperature and water ultimately mediate the structure of the biosphere and the distribution of diversity over time. Atmospheric carbon dioxide has fluctuated throughout the course of Earth history, directly influencing global temperature and the availability and distribution of water. Relatively small changes in atmospheric carbon can have substantial cascading effects, as is demonstrated by the outcomes of atmospheric forcing from industrialization during the past 250 years. Ironically, the technological component of humanity arose during a period of relative stability in the global climate system, following the termination of the last major glacial advance of the Pleistocene just 12,000 years ago. The inception of industrial development in the 1750s perturbed that stability, accelerating warming and increasing climate fluctuations globally. The trajectory was fairly consistent for more than a century. Unusual temperature increases began in the late 1800s, spurring Arrhenius to make his calculations. The rate increased in the early 1900s, forming the base of the curve in what is called the "hockey stick." There has been considerable and spirited discussion about this hockey-stick model, but it appears to be an inconvenient truth that has been maligned but never disproven. That rate increase produced "anomalous" temperatures throughout the twentieth century, but Arrhenius's calculations and observations of global temperature changes still hold true. Around 1970 there appears to have been another uptick in the rate of warming that was especially pronounced in the northern latitudes.
It's about Complexity
Climate, biology, and human society are all examples of complex systems. One hallmark of complex systems is that they are capable of surprise. This is because they are made up of interacting parts leading to different outcomes, depending both on the proportions of the different parts and on the context in which their interactions take place. Alicia Juarrero laid the conceptual groundwork for understanding complex systems in her groundbreaking book published just before the new millennium. Following her lead, we will remind you at critical junctures in this book that when dealing with climate change and emerging disease:
It is never just one thing, and it always depends.
Some aspects of life can be explained but cannot be made simple. Humans interact in complicated ways with one another, with other members of the biosphere, and with the climate. Better food production has led to more people demanding more food, causing global poverty levels to rise. Improved public health measures allow more people to live longer, leading to more and older people demanding more public health services. Decreasing birth rates hold out hope for reduced population pressure but also diminish revenues coming into public health systems from the young workers who support the older, longer-living members of society. Multiple socioeconomic demands on land use lead to conflicts. Climate change leads to conflicts. An increasing variety of waste products deposited in the very places upon which humans are making increasing demands marks the end of the human production line. These activities are expensive, and soon the expense will be greater than we can bear.
Two manifestations of these complex interactions are critical. The first is tipping points, instances in which changes occur that impact ourselves and the planet irreversibly. Think of them as decisions made through action or inaction. Humans have failed to recognize tipping points that are occurring due to a burgeoning human population; agricultural advances; the ways in which landscapes are occupied, used, and modified; and a deepening reliance on technology driven by nonrenewable power and energy resources. Combined, these effects have transformed humanity's world from the large and slow one of our ancestors to today's small and rapid one. Generation by generation, the transformations have been incremental and thus difficult to discern and identify. They are however, consistent with a world history of dynamic change, and increasing scientific understanding of that history has made it possible to understand that our current conditions of existence are increasingly problematic. Within that world, our massive ignorance about potential pathogens and our indifference to that ignorance has brought us to the brink of a tipping point, beyond which our ability to respond to a crisis will be overwhelmed. Our capacity for responding to disease outbreaks after the fact is already eroding and will continue to decline if we do not find a way to buy time and mitigate the costs of outbreaks.
(Continues…)
Excerpted from "The Stockholm Paradigm"
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Table of Contents
Preface1: How Bad Is It, Anyway?
2: How Did We Get into This Mess?
3: Dawning Awareness
4: Back to the Future
5: Resolving the Parasite Paradox I: Taking Advantage of Opportunities
6: Resolving the Parasite Paradox II: Coping with Changing Opportunities
7: A Paradigm for Pathogens and Hosts
8: Emerging Diseases: The Cost of Human Evolution
9: Taking Action: Evolutionary Triage
10: Time to Own It: It’s Nobody’s Fault but Everyone’s to Blame
Notes
Bibliography
Index