We Have Met the Enemy, and He Is Us

What infectious disease says about humanity's penchant for self-destruction!

Jun 1, 2006
Jack Woodall

The title of this column is a quote from Pogo, the philosophical possum of the Okefenokee swamp in Walt Kelly's classic cartoons. Pogo went on to say that to combat environmental pollution, the source - in this case "human beans" - must be eliminated. But the evidence is all around that we humans carry within us the seeds of our own destruction.

In an earlier column I related what had happened when a malicious rumor about polio vaccine circulated in one African country in early 2004, and vaccination was halted. The infection has now spread back to 20 countries from which, at great effort and expense, it had been eradicated.

Look at another crippling disease, tuberculosis. The cure requires daily doses of antibiotics for a number of weeks. But in countries where people have to travel far from home to receive health care, as soon as they start to feel better they head for home, not yet cured, carrying back with them bacteria that have survived the treatment and are now resistant, to be spread again in the community.

Look also at HIV/AIDS, the 25th anniversary of which is the subject of a feature in this issue (see p. 36). Educated people know how it is spread and what to do about it, but nevertheless get carried away and ignore precautions in the heat of passion. As a wise friend of mine likes to say, "Hormones will always trump neurons." A Swiss teenager who was told her drug-addicted boyfriend was HIV-positive said, "I know he loves me and would never do anything to hurt me." In the face of such emotional responses, what chance do precautions have of succeeding?

Some scientists have convinced themselves that AIDS is not caused by HIV but by anti-AIDS drugs. Worse yet, they have succeeded in convincing politically powerful figures, setting back AIDS control programs for years as in the case of South Africa. That country's leaders have changed their views, but the damage has been done.

Turn now to the less-educated majority. When I ran the CDC's dengue lab in San Juan, Puerto Rico, I accompanied sanitary inspectors on their tour of the city to look for mosquito breeding places. We lifted the lid of a rain barrel to find a swarm of mosquito larvae inside. When we showed them to the homeowner, he said, "You gringos all think we are stupid. Don't try to tell me these worms are going to turn into mosquitoes. Get out of my house!"

In Puerto Rico commands like that may be backed up by the barrel of a gun, so we didn't stay around to argue. Beliefs like these not only stop government mosquito control programs from working, but they also prevent any cooperation by the public in keeping their homes and gardens free of the dengue-carrying mosquito. Cuba has shown, twice, that dengue can be eradicated by elimination of vector breeding, in spite of repeated reintroductions of the mosquito by trading vessels. Cuba has been free of dengue for as long as 20 years at a time.

Behold a paradox: People everywhere tend to either not believe a word their government says, or to be skeptical. Yet when governments announce (a) that bird flu is coming, but (b) it's perfectly safe to eat chickens and eggs as long as they are cooked properly, the public believes the first but firmly rejects the second. One wonders if reverse psychology might not work: If the government said bird flu is not coming, but as a precaution we should stop eating poultry and poultry products, would people buy and eat them from sheer contrarianism?

As long as human nature continues to let emotions overrule the evidence, we are on the wide straight road to our own demise. But who among us would want to live in a world ruled by cold intellect? We don't tell the selfless doctors who work in appalling conditions in refugee camps to stop, despite the fact that those they cure go straight back to the miserable conditions that made them sick in the first place. Rather, we applaud them. So let us face our inevitable fate with equanimity.

Jack Woodall is director of the Nucleus for the Investigation of Emerging Infectious Diseases in the Institute of Medical Biochemistry at the Federal University of Rio de Janeiro, Brazil.