After SARS: Fear and Its Uses

In the mid-twentieth century, antibiotics and modern medicine seemed to be eliminating the threat of infectious diseases. But since the 1980s and the emergence of HIV/AIDS and the subsequent appearances of Ebola, Hanta Fever, West Nile Virus, Lime Disease, SARS, and Monkey Pox, it is clear that the dangers posed by new infectious diseases or by old ones reappearing in drug-resistant forms (or as weapons of bioterrorism), are fearsome and compelling. Among the recent outbreaks, SARS especially caused hysteria around the world and demonstrated how important public health is to global safety. How much should we be alarmed by each new disease? And how might we use our fears to energize public health agencies and force the public generally to confront the issues of equity and liberty raised by infection?

Despite data showing that endemic diseases such as tuberculosis and malaria kill more people worldwide than the emerging diseases (with the important exception of HIV/AIDS, which has become the number three cause of death in the world), it is the new and unknown illnesses that produce anxiety. Anxiety doesn’t grow only from statistical dangers. The sense of personal risk-when disease comes close to our doorstep-seems to be far more important in determining responses than do the numbers and distribution of actual cases. Our worries begin with our lack of knowledge about each new disease, and they grow as a result of media coverage that emphasizes danger and evokes panic even while appealing for calm.

The dangers are real. What the recent disease outbreaks demonstrate is that public health agencies and standards, in the United States and elsewhere too, have fallen prey to their previous successes. In recent years, believing we had conquered infectious disease, we grew complacent and withdrew support from health departments around the country. But now HIV/AIDS, Lyme disease, West Nile Virus, and SARS have shattered our complacency. Actually, it shouldn’t have taken new diseases to do that. Consider that, in 1993, faulty water purity surveillance led four hundred thousand people in Milwaukee to succumb to (very old-fashioned) gastrointestinal illness. The protection we get from state agencies, our collective ability to prevent or deal with health crises, is lower today, in many areas, than it was in the past.

We need to worry about this-more, perhaps, than about any particular disease. The decrease in available resources devoted to public health is a serious political problem. Old diseases such as tuberculosis and malaria continue to kill; new diseases-like SARS-are not taking lives at the same level but serve nonetheless to alert us to the fact that we are not safe. If the fear of SARS, or of bioterrorism, can lead us back to more general support for public health, then this is a time to let our worries be our guide.

A little bit of history can provide some perspective on the issues raised by SARS and other emer...