Plagues & People

I am constantly annoyed to be reminded that there is a world outside my ivory tower. Or rather I am constantly annoyed by the realisation that that world outside my ivory tower does not work the way in which it reasonably should. One of these days I am going to ditch this pervasive naivety, but for now I will just keep being surprised every time I look out the window. I am a scientist. Sure, I had a broad educational background, but pretty much around the time I went into grad school I put on the science goggles and rarely look back. Over the past few months with my study of the history of disease I am realising that this is a mistake. One that is made far too often.

Half or less of the work done in dealing with any epidemic happens in the laboratory or hospital/clinic. That shouldn’t be the case, but it is. The rest happens in the hands of the individual sufferers of the epidemic, and people (as a whole) are not rational actors. The hard part should be developing the cures and protocols. The hard part should be fundamentally re-jiggering things at a molecular level. The hard part should be the 605 compounds you have to go to before you succeed with 606. The hard part should not be convincing people that there is a problem when they are surrounded by suffering, convincing people to actually use their medication properly, or trying to convince HIV+ men that rape is bad. Yet all these continually hang around our necks and weigh us down even after the lab work is over and done with.

We now have two highly effective forms of HIV prophylaxis: condoms and PrEP regimens (and even more in the pipeline as we look at the microbicidal gels everyone is taking about these days). But the problems of compliance, cost, and aberrant behaviour seem dedicated to stymieing these solutions. HPV provides another excellent window into this problem. A safe, effective HPV vaccine exists. And yet, rather than universal support for working to eliminate infection by the single greatest cause of cervical cancer we are confronted with politicians who squawk about “legitimising immorality”. Notably, these are the very same words put forward to attack the use of Salvarson a century ago. The laundry list of things that the U.S. govornment did or did not due contrary to the advice of its own appointed experts during both the 1918 influenza epidemic and the early days of the HIV epidemic is staggering in its size. One of the greatest tragedies of the diabetes crisis is the non-compliant patient who is supplied with everything he or she needs and yet still fails to properly medicate. And let’s not even get started on the modern anti-vax movement.

The above is only a small sampling of these cases, and it should be sufficient to establish an unsettling trend. In many cases, for as many people who work valiantly to cure a disease, there are as many people (either through wilful action, ignorance, or inaction) working directly towards its propagation. It seems that a complete understanding of and basis for addressing epidemics, relies on both an understanding of the plague itself and of the people involved. For it is becoming clear to me that the former may be far easier to deal with than the latter.