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Plague is stoppable. The next health threat may not be.
The word plague is scary. Centuries ago, the Black Death killed tens of millions of people and changed the course of history. Plague still kills people around the world, and the word still evokes catastrophe. New fears of plague surfaced on October 2, when a lab worker in Irkutsk, Russia, died of pneumonia. Reports suggested that she may have contracted plague through a laboratory exposure. Understandably, people were alarmed. On October 7, the World Health Organization called for the Russian Federation to be transparent about what it knew. WHO issued an update on October 10. Russian authorities told WHO that testing did not identify plague and that investigations found no laboratory release. WHO said confidence in its risk assessment remained limited and that further clinical, epidemiological, and laboratory information was needed. The cause of the woman’s illness remains unknown, and WHO says a laboratory-associated exposure cannot be excluded. As I explained in a recent interview, this incident is very unlikely to lead to a pandemic. Plague is still active, including in the U.S., which sees a handful of cases each year. But it is a disease we can prevent and treat. Plague doesn’t spread readily, and it responds to antibiotics. The standard response—isolate the patient, trace contacts, and administer antibiotics and monitor for symptoms among contacts for seven days—works. We have even planned for antibiotic-resistant plague. At CDC, we developed a playbook for antibiotic-resistant plague and ran exercises on how to find and stop it. CDC guidance anticipates engineered resistance and recommends two different classes of antibiotics if there’s reason to suspect it. There is no evidence that resistance—or even confirmed plague—is involved in this incident. We have thought through how to address plague, but we’re not ready for the next major health threat that emerges from a lab or from animal spillover to humans. What should concern people is how little stands between the world and the next pathogen to get loose. Since peak COVID, epidemic preparedness has fallen off the political agenda, but the risk is greater than ever. More labs handle dangerous pathogens with more ways to make those pathogens deadlier, and more people live and work in close contact with animals. There are actions we can take now: We need better lab safety in every country. The number of labs that work with dangerous pathogens has increased worldwide over two decades, but there’s no enforceable international standard and no inspection regime; the Biological Weapons Convention, fifty years on, still has no verification mechanism. Labs that study dangerous germs need strong safety systems, training, and oversight. We need to reduce spillover events. Three in four emerging human infections start in animals, and there’s a lot we can do to reduce spillover risk, but the world is doing very little of it. Live-animal markets are one place to act. For instance, closing live-bird markets helped control H7N9 influenza in China. Reducing opportunities for people to encounter infected animals can prevent infections before they become outbreaks. In The Formula for Better Health, which is now out in paperback along with the hardcover, Kindle, and audiobook versions, I argue that labs do too many risky experiments with too many dangerous pathogens in too many institutions, and that every experiment should first answer one basic question: Is the likely benefit greater than the risk? Spillover risk can also be reduced: In the book, I discuss how Brazil cut its deforestation rate by 70% from 2004 to 2012 while increasing agricultural production and reducing risky contact between people and forest animals. We need faster detection and response. Delay costs lives. Strong surveillance, good labs, and trained responders can turn a single case into a small cluster of infections instead of an epidemic. Resolve to Save Lives has worked for nearly a decade to help countries find and stop outbreaks faster. The 7-1-7 target, which Resolve to Save Lives developed with partners in Uganda and elsewhere, provides a clear standard: detect within 7 days, notify within 1 day and complete all essential early response actions within 7 days. In Uganda’s Kasese district, for example, a review of a measles outbreak using 7-1-7 identified shortages of accessible funds, fuel, and vehicles that delayed the response. District leaders established funds they could access quickly. When, a few months later, the Crimean-Congo hemorrhagic fever appeared, the district detected it in three days, notified authorities in one, and mounted an effective response in two. Only one case was confirmed, and the patient survived. Because funds were available before the emergency, authorities were prepared and able to act. This kind of preparation can’t wait until the next crisis begins. Plague is an old disease we that know how to stop. The next threat may be harder to recognize, harder to treat, and easier to spread. Safer labs, less risk of spillover, and faster outbreak detection and response need sustained investment now, while we still have time to prevent the next emergency. Share
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