unintended consequences

One hallmark of a complex problem is the phenomenon of 2nd and 3rd order effects – implementing a solution fixes one thing but causes other challenges. Often the best of intentions are swamped by unintended consequences.

Society is in the midst of a highly complex problem, the “once a century” kind of problem. Covid-19 was the biological scourge that many in science and healthcare have expected would eventually pop up, and it has shown gaps in both technology and policy across the globe, as well as shining a light on economic and social disparities. The world has focused unprecedented resources and attention on battling the viral pandemic. But as the NYT notes, there are other diseases lurking that are ignored at the peril of society.

Drug-resistant strains of Tuberculosis have been a concern for years. Over time, most bacteria (and viruses for that matter) can evolve resistance to treatment drugs. These mechanisms happen through a variety of biochemical processes, but one consistent factor is that human misuse of antibiotic drugs typically exacerbates the resistance problem. But even with good patience compliance, mutations happen and bacterial and viral threats are constantly changing.

The current rush to focus all available research and medical resources on battling Covid-19 is understandable, but may have an overall net-negative outcome if other somewhat controlled diseases such as TB, malaria, and HIV flare up globally. Another player is methicillin-resistant Staphylococcus aureus (MRSA), and of course we still have influenza strains that vary each year.

While the scientific community rushes to find a vaccine and therapeutics for Covid-19, we know from experience that those solutions will likely be partial and/or temporary. And working on Covid-19 to the exclusion of other biological threats exposes even more long-term risks – particularly if proven drugs for one disease are largely redirected for unproven treatments. One interesting angle is that personal hygiene is called out as a preventative measure for any of these diseases, and many of them rely on airborne transmission. So perhaps the longer-term solution, in addition to the necessary (and balanced) medical and pharmaceutical research is an evolving set of policies focused on human interactions and how society operates. Physical distancing has been implemented in response to Covid-19, but it may be part of a long-term social change to limit the impact of biological infections.

The problems are complex, and the solutions will need to be comprehensive and include policy and social changes in addition to pharmaceuticals and vaccines. While many view Covid-19 as a “once in a lifetime” event, it may just be part of a new-normal where our ability to remain healthy is tied more to behavior change than medical intervention.

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