MEDICINE: The Killers All Around

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Clearly there is no way to prevent human exposure to microbes. But the risks can be reduced. To minimize bacterial resistance, for example, doctors can be stingier with antibiotics. "We've been careless," says Dr. Robert Daum, a University of Chicago pediatrician. "Every childhood fever does not require antibiotics." Nor does a healthy farm animal.

Most important is increased vigilance by public-health authorities. The faster a new microbe can be identified and its transmission slowed, the less likely a small outbreak will turn into an epidemic. Unfortunately, the trend has been in the other direction. "Even in the U.S.," says Thomson Prentice of the World Health Organization in Geneva, "disease-monitoring expertise has been lost, either through cost-cutting or reduced diligence. If some of the edge has been lost in the U.S., just imagine how poorer countries have reacted."

American health officials are convinced that their information-gathering network must be strengthened. That has begun to happen under a new program that will, among other things, increase the surveillance of new microbes and educate both health workers and the public about how to deal with emerging diseases.

An all-out effort to monitor diseases, vaccinate susceptible groups, improve health conditions around the world, develop new drugs and get information to the public would be enormously expensive. But the price of doing nothing may be measured in millions of lost lives. Doctors are still hopeful but no longer overconfident. "I do believe that we're intelligent enough to keep ahead of things," says epidemiologist Shope. Nonetheless, neither he nor any of his colleagues will ever again be foolish enough to declare victory in the war against the microbes.

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CREDIT: [TMFONT 1 d #666666 d {Source: World Health Organization, Harvard School of Public Health, 1990 figures}]CAPTION: The World's Deadliest Scourges