Chapter 152
Defeating Infectious Agents — 16
Figure 10.4. How metagenomic sequencing determines a disease-causing pathogen in a patient with sepsis. Adapted from Simon Ye et al., “Benchmarking metagenomics tools for taxonomic classification,” Cell 178, no. 4 (August 2019): 779–94, https://doi.org/10.1016/j.cell.2019.07.010.
Ican’t think of any reason why this technology hasn’t been universally adopted in health systems. It’s a potential lifesaving use of sequencing that is many years overdue to become a standard of care. We need to get over our ritualistic culture and move on.
INFECTION AND AMERICAN LONGEVITY
The average lifespan in the United States in 1900 was forty-eight years, and a dominant reason it has improved to seventy-nine years now is because of our ability to prevent and treat infections. We’re making profound progress in so many ways, and progress is speeding up: fast-tracking potent vaccines against most pathogens, some that we never had a vaccine for before; understanding infections that are a root cause for diseases, as achieved with HPV and perhaps MS in the future; and tackling antimicrobial resistance, with AI, structural biology, and phage therapy. And there are much better ways to deal with sepsis, using AI for prediction and rapid diagnosis, and metagenomics to get to the right treatment quickly. The reduction in deaths and morbidity from infectious disease should drop considerably in the years to come. Commitment to promoting equitable global access for these advances can make such a difference to human health span, yet another lesson we should learn from the COVID pandemic.
Unfortunately, however, we are our own worst enemy. During the pandemic, anti-science and anti-vaccine movements were organized and funded; this has led to far fewer people deriving the net benefit of COVID shots, which has also extended to marked reduction of vaccination in children. As a result, we’ve seen the recrudescence of poliovirus and measles. On the one hand, we’re making phenomenal advances in the science; on the other hand, these are being aggressively countered. To make progress in defeating infectious diseases, it will be vital to develop effective strategies to prebunk and debunk anti-science efforts. That social challenge to our political culture may prove to be our greatest challenge in continuing to add to life expectancy.