How should countries protect citizens from deadly diseases? The most promising solution is often not the most popular, explains author Sonia Shah.
In her forthcoming book, The Next Great Migration: The Beauty and Terror of Life on the Move, Shah explores whether, in a world of disruptive and deadly biota on the move, there is any lasting solace in closed borders and isolated societies—or whether our survival depends on just the opposite.
On April 23, 2020, Shah joined the Pulitzer Center for a discussion of her past and present reporting as part of the Talks @ Pulitzer Science and Health Series. Her latest book grew out of a Pulitzer Center-supported investigation into contagions facing Syrian and Afghan refugees trapped in Greece.
The following is an edited transcript of the Question & Answer segment of Shah's Talks @ Pulitzer, moderated by Ann Peters, the Center's university and community outreach director. Also included are several audience questions that were not presented during the 45-minute webinar due to time constraints, but were answered by Shah after the session via email communication.
The post-session answers are indicated by an asterisk*. Portions of this text have been revised for clarity and/or length.
Question: You said that flight paths affect the spread of pathogens. If nations across the world would have shut down traveling faster, do you think the coronavirus would not have become such a large pandemic?
Answer: I don't think that there's been any respiratory pathogen that we've been able to contain as such in the history of pandemics. Look at the seasonal flu virus, for example: We have that every year, and even though we have some degree of herd immunity that we've acquired at a great cost to our health, even though we have a scientific establishment that creates a cool new flu vaccine every year, we still lose billions and billions of dollars to sickness and we lose half a million people every year to flu. Given that example, I think the idea of containing a respiratory pathogen that spreads just from people moving around and talking to each other, the social contacts that happen, is really difficult. We've never been able to do it even though we've had lots of opportunity to try and lots of incentive to try.
Q: What has your research shown in terms of migration harming a country's health care system?
A: It's exactly the opposite. A lot of political leaders think migrants are coming into their societies because they're attracted by some special benefits that they'll get from getting there. 'They're coming to steal our jobs, they're coming to get our healthcare,' there's all these attractives that pull them in, and so when they don't want them to come policies of deprivation get put into place. And we see that across countries—the ordinary health care that's available to citizens is not available to newly arrived people and migrants, whether they're documented or not documented. Even things that would protect all of us better like vaccination programs [are not available]. Undocumented children across Europe don't get the routine vaccinations in a lot of countries that residents do. I think it comes out of this idea about migration as being this negative phenomenon that we have to deter. Also, that if we don't give them any 'goodies' and deprive them then they're going to stop coming, which is not what I've found at all. It's exactly the opposite.
Q: Is there a solution to create equity across the world so that migration can be reduced and made less risky? Does not access to natural resources often drive migration?*
A: Migration is shaped by many factors, not just the availability of resources or even jobs, which is why poor countries situated next to wealthier ones with porous borders are not depopulated. In fact most international migration in the world occurs between poor countries. Still, migration can be made a lot more orderly, safe, and humane. The UN's Global Compact on Safe, Orderly and Regular Migration provides a roadmap.
Q: Did you come across any interesting research about vaccines for animals? If so, do they make a difference (positive or negative) in preventing disease outbreaks?
A: One point to clarify is that these microbes that become pathogens in humans are not pathogenic in animal reservoirs—they're harmless to the animals. So there wouldn't be any role of vaccination because the animal already has the immunity. The bats are not falling sick with Ebola, they're the reservoir of Ebola. In terms of antibiotic consumption in agriculture, it's a huge driver of antibiotic-resistant pathogens. Here in the United States, about 80 percent of the antibiotics that we consume as a country are used in commercial applications in agriculture. And we know that in countries where that practice is not allowed, that they don't have problems with antibiotic-resistant bacteria the way we do here in the United States. It's really something that scientists realized in the very beginning—if you use them in ways that are not medically necessary, you will provoke the evolution of antibiotic-resistant bacteria. That's basically what we have been doing here in the United States over the past decades. I think it's a ticking bomb, really.
Q: Are CAFOs (concentrated animal feeding operations) in the U.S. part of this current contagion?*
A: Industrial livestock farming is a known driver of pathogens with pandemic potential. The use of antibiotics for growth promotion in livestock contributes to the spread of antibiotic-resistant bacterial pathogens, for example; poultry farms where thousands of captive chickens are crammed together allow avian influenza viruses to replicate, amplify, and become more virulent. Here in the U.S., about half of all cattle on feedlots are infected with Shiga-toxin producing E. Coli (STEC). Because cattle waste so often contaminates our food and water, hundreds of thousands of American fall ill with STEC every year.
Q: Can you explain the positive migration benefits in the context of invasive species? Especially in vulnerable areas?*
A: There's no doubt that migration is disruptive and in some cases, such as for invasive species, the costs might outweigh the benefits. But these are a tiny fraction of introduced species. There's no reason to make the problem of invasives the centerpiece of our policies toward species on the move. They should be managed as outliers, and dealt with on a case-by-case basis.
Q: Could you describe your research and reporting processes?
A: In a nutshell, my process is to do a ton of background research before I go into any of these places. I do all of the background reading and to talk to all the experts I can on the phone in the places that I'm going to before so I have established my background level of understanding of the communities and what their own priorities are. I've also established social contact with the leaders in those communities so that when I go there I can concentrate once I'm on the ground. The other part is just making enough time to really listen. It's not the most efficient thing to do, but if you go to, say, a hurricane shelter where you have traumatized people who have lost everything and you just need information about one part of their experience, you can't just extract that. You have to sit down and establish trust and really listen to what people want to say because people want to be listened to but they dont wanna just give you the one piece of information you want. So, you have to have the patience to sit there and really listen to all of it and absorb it and respond in a humane way. That's how you get a more complete picture of what's going on, even if you're just looking at one angle of the experience.
Q: Can you share some policies or advocacy that offer some hope for tackling these issues?
A: I do see hopeful signs everywhere and the one thing I keep in mind is that history doesn't progress in a linear fashion. There's always unexpected outcomes and little things that can have outside effects in ways you can't imagine. We've seen backlash against science around the world with right-wing populist leaders coming into power saying 'we don't need to do vaccines, we don't need to listen to the science, we don't need experts, we don't need all these environmental regulations,' or whatever it is, and I think it grows in part out of the elitism that is inherent in the scientific establishment. The establishment itself is complicit, to some extent, in trying to elevate its authority and saying 'we're going to speak in lingo that none of you people can understand and you have to study for years and years to even know what we're talking about,' and I think that dynamic is not helpful for us as a society. I'm very hopeful about the fact that that's starting to change. I think scientists themselves are starting to get involved in the political process—we've seen scientists running for office and they're speaking out more. On the other side, we're seeing the democratization of science. This is coming out of the climate movement, I think, where people are learning about atmospheric chemistry, and how energy works, and thermodynamics—now that's all stuff we have to know about. We're seeing that now with public health: We're all getting a crash course in epidemiology right now which I think just a few years ago would have been considered a very obscure part of the scientific establishment that we didn't have to think about. And I think what my work has always been about is that civil society has to be part of the scientific process—it shouldn't be two separate things. So the fact that these things are colliding and starting to meld a little more, I think that's a hopeful movement that's happening right now.