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A Single Microbial Sea

is a worldwide disease that could eventually affect them and their friends. It's that AIDS in Africa creates enormous instability that could affect our national security.

"That's because social and political instability can lead to internal strife within a country," he explains, "and then spread into a conflict that may suck us in militarily."

As civil order breaks down, so, too, does the health-care system, and this breakdown opens the door to wider outbreaks of disease, which can all too easily spread to the U.S. "If we allow health to break down in other countries, and political turmoil results, we may get pulled into armed conflict," agrees the Global Health Council's Daulaire. "But as their health systems break down, we may also be victimized by the pathogens that get out of hand as global trade and travel bring them here."

"If we allow health to break down in other countries, and political turmoil results," explains DMS Overseer Nils Daulaire, president of the Global Health Council, "we may also be victimized by the pathogens that get out of hand as global trade and travel bring them here."

There are three wild cards on the global disease scene. One is global warming, which many scientists blame on emissions from factories and automobiles of so-called greenhouse gases. Some scientists believe that even incrementally warmer temperatures could make the upper latitudes of the Northern Hemisphere more hospitable to the diseases of the Tropics, such as malaria and dengue fever. But other scientists


Global tourism (right) means disease anywhere can travel to anyone. Dartmouth's Ford von Reyn (left) helps open an AIDS clinic in Tanzania.

argue that the conditions for some of these diseases—standing water, warm summers, and mosquitoes—already exist and that public-health initiatives have kept them at bay and can continue to do so.

There is also the chance that a new pathogen might be unwittingly generated in one of the industrial world's laboratories and spread through global travel. "There are mutations everywhere," says D.A. Henderson. "The question is when does it take off and become a problem to man? We compound this problem by the fact that we've now taught a lot of people how to manipulate bacteria and viruses. These techniques are being taught at the high school level. There are a lot of situations in which we might accidentally create a new bug."

Bioterrorism is the third wild card. A bioweapon released in any major city could quickly spread around the globe. There is a danger, for example, that terrorists could obtain smallpox virus from one of the bioweapons centers that retained samples in case they were needed to combat a future outbreak. (Smallpox has been considered eradicated worldwide since 1977.) Or terrorists could engineer their own pathogen. "You can do it in a small amount of space, and it can be done

much easier than creating chemical weapons, which require a lot of equipment and supplies," says Henderson, who is senior advisor of the Center for Biosecurity at the University of Pittsburgh.

Even if none of the wild cards play out, there are still ample threats from bugs already out there. "Lots of Americans are coming back from overseas with malaria," says DMS's Strickler. "We run the risk of people bringing back drug-resistant tuberculosis. The other example that's timely is the whole flu business. We are constantly worried about a pandemic caused by a new mutant flu virus. I read that if there is a pandemic, about one percent of the people who get it will die."


Cargo containers (right) can carry germs as well as goods, so disease knows no borders. DMS's James Strickler (left) delivers care in Cambodia.

That's the same as the 1 in 100 chance that a person living in New Hampshire in 1901 would die of TB within five years. A century of advances may have put us right back where we were. The dream of someday eradicating infectious disease has given way to the realization that evolution will forevermore create new pathogens. We can try to flee from them as the people of 14th-century Europe fled from the plague, but in the end we have nowhere to hide. "Thanks to globalization," says Daulaire, "we all paddle in a single microbial sea."

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McInnis is a freelance writer based in Casper, Wyo., who specializes in science, agriculture, and business. His work has appeared in publications ranging from the New York Times to the Corn and Soybean Digest, from Harvard Magazine to the alumni magazine of Oberlin College, his alma mater.

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