Chapter 3 summary
New health threats in the 21st century
Chapter 3 examines three new health threats that have emerged in the 21st century – bioterrorism in the form of the anthrax letters in the United States in 2001, the emergence of SARS in 2003, and the large-scale dumping of toxic chemical waste in Côte d’Ivoire in 2006.
Coming only days after the terrorist events of 11 September 2001, the deliberate dissemination of potentially lethal anthrax spores in letters sent through the United States Postal Service added bioterrorism to the realities of life in modern society. In addition to the human toll − five died out of a total of 22 people affected − the anthrax attack had huge economic, public health and security consequences. It prompted renewed international concerns about bioterrorism, provoking countermeasures in many countries and requests for a greater advisory role by WHO led to the updating of the publication Public health response to biological and chemical weapons: WHO guidance.
The anthrax letters showed the potential of bioterrorism to cause not just death and disability, but enormous social and economic disruption. A simultaneous worry was that smallpox – eradicated as a human disease in 1979 – could be used over 20 years later to deadly effect in deliberate acts of violence. Mass smallpox vaccination had been discontinued after eradication, thus leaving unimmunized populations susceptible and a new generation of public health practitioners without clinical experience of the disease.
Since then, WHO has taken part in international discussions and bioterrorism desktop exercises arguing that the surest way to detect a deliberately caused outbreak is by strengthening the systems used for detecting and responding to natural outbreaks, as the epidemiological and laboratory principles are fundamentally the same. Expert discussions on the appropriate response to a biological attack, especially with the smallpox virus, served to test – on a global scale – the outbreak alert and response mechanisms already introduced by WHO.
In 2003, SARS – the first severe new disease of this century – confirmed fears, generated by the bioterrorism threat, that a new or unfamiliar pathogen might have profound national and international implications for public health and economic security. SARS defined the features that would give a disease international significance as a global public health security threat: it spread from person to person, required no vector, displayed no particular geographical affinity, incubated silently for more than a week, mimicked the symptoms of many other diseases, took its heaviest toll on hospital staff, and killed around 10% of those infected. These features meant that it spread easily along the routes of international air travel, placing every city with an international airport at risk of imported cases.
New, deadly and – initially – poorly understood, SARS incited a degree of public anxiety that virtually halted travel to affected areas and drained billions of dollars from economies across entire regions. It challenged public and political perceptions of the risks associated with emerging and epidemic-prone diseases and raised the profile of public health to new heights. Not every country felt threatened by the prospect of bioterrorism, but every country was concerned by the arrival of a disease like SARS.
It showed that the danger arising from emerging diseases is universal. No country, rich or poor, is adequately protected from either the arrival of a new disease on its territory or the subsequent disruption this can cause. The spread of SARS was halted less than four months after it was first recognized as an international threat – an unprecedented achievement for public health on a global scale. If SARS had become permanently established as yet another indigenous epidemic threat, it is not difficult to imagine the consequences for global public health security in a world still struggling to cope with HIV/AIDS.
As well as the international mobility of people, the global movement of products can have serious health consequences. The potentially deadly risks of the international movement and disposal of hazardous wastes as an element of global trade were vividly illustrated in Côte d’Ivoire in August 2006. Over 500 tons of chemical waste were unloaded from a cargo ship and illegally dumped by trucks at different sites in and around Abidjan. As a result, almost 90 000 people sought medical treatment in the following days and weeks. Although less than 100 people were hospitalized and far fewer deaths could be attributed to the event, it was a public health crisis of both national and international dimensions. One of the main international concerns was that the cargo ship had sailed from northern Europe and had called at a number of ports, including some others in western Africa, on its way to Côte d’Ivoire. It was unclear in the aftermath of the incident whether it had taken on, or discharged, chemical waste at any of those ports of call.