Interview with Dr. Marc Siegel on Epidemics
from Global Health Program

Interview with Dr. Marc Siegel on Epidemics

August 17, 2005 5:43 pm (EST)

To help readers better understand the nuances of foreign policy, CFR staff writers and Consulting Editor Bernard Gwertzman conduct in-depth interviews with a wide range of international experts, as well as newsmakers.

Dr. Marc Siegel, a physician and author of False Alarm: The Truth About the Epidemic of Fear, talks about irrational fear of epidemics.


Why is there so much fear around generalized topics, like epidemics?

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Because people personalize about illness, and people are voyeuristic about it. So when you hear that somebody has [an illness], you immediately assume it’s going to be you [next]. And in the information age of Internet, cable TV, and news cycles every five seconds, it’s easier to misuse our voyeuristic tendencies and feel falsely alarmed.

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Public Health Threats and Pandemics

We humans have the ability to inform our fear mechanism with abstract information. So if we’re going to inform it with abstract information, it would best suit [threats] in the offing. We can be smarter than animals, but we’re often not.

You say in your book that the chances are much greater of dying in a car accident than in a terrorist attack or from an epidemic. Why is it so difficult for people to process the odds? Why are they still afraid?

It’s not a rational thing. Cars feel comfortable. Look at them, they’re air-conditioned, they’ve got radios…and terrorists look uncomfortable. They look scary. They look like they’re about to get you. So it’s a matter of processing rational information. That’s the issue.  

But there are real epidemics, like SARS, or bird flu in Asia. Aren’t those real risks to people’s lives?

Let’s start with SARS. [The SARS case] was portrayed based on hypothetical information, which turned out [to be] wrong. Back in 2003, people postulated, “This [SARS] is a cold-like virus, it’s a corona virus, this thing is going to be able to be passed easily by touch. Therefore—a lot of therefores were in the equation—therefore, it can go on planes, it can go from one sector to another, [all] these fancy theories could work. But the problem is that SARS turn[ed] out to be a bug that is not easily transmitted. And nobody bothered to add that to the equation at the end. So basically it’s a problem of not having a memory and not integrating follow-up information into our perspective going forward when the next so-called threat comes along. That’s A.

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B, too many assessments [were made] based on hypotheticals and theories. C, it’s ignoring and taking resources away from already known killer epidemics out there. And I think we’re doing them a disservice. Malaria is a devastating international illness that we don’t pay enough attention to because it’s not really prominent in the United States. AIDS is not dying out worldwide, and we’re not paying enough attention to it. Obesity is certainly an American epidemic we’re not paying enough attention to.

For things like obesity, what can they do besides tell people to eat right and exercise? It doesn’t seem like there’s much more they can do about it. There’s no vaccine.

Well, the vaccine for obesity is information. For example…there’s a huge milk industry in this country. But when we were cavemen we didn’t drink milk. I don’t think the cavemen were walking up to cows. And I also think it was pretty hard to catch beef. So cavemen farmed and ate berries. Turns out berries have aspirin in them! Aspirin-like compounds. No wonder aspirin turns out to be cardio-protective! We make an assumption from childhood on that milk is good for us, but we eat way too much dairy in this country. So what I just did was give you more information than you get when you say, “Let’s all eat right.”

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Public Health Threats and Pandemics

Let’s talk about bird flu.

I see bird flu in the same vein as I see SARS. Bird flu is a potential epidemic that could be very harmful to humans. But here’s what’s often not exercised in the bird flu equation. No. 1, for bird flu to be transmitted easily from human to human, it requires a mutation. No. 2, there’s no way to know if that mutation is going to occur. Saying that you don’t know if something will occur or not is not sexy, so that gets passed over. But you can’t pass over that because it’s the difference between a potential and an actual problem. You’ve never heard public-health officials say they know what the chances of that occurring are. Nobody knows. There are all kinds of theories. The only thing they know is that [flu epidemics] tend to occur once every fifty years or so, and it’s been a while, so it may occur now. But that’s not good enough to be scaring a whole society.

The second point I would make…is that they keep using World War I as an example, 1918 [when a worldwide epidemic of Spanish influenza killed 50 million people]. But in 1918, A, there were no ready vaccines. B, people were huddled together in poor public health conditions. C, there was a world war going on. D, they didn’t have the technology we have now.

The third problem is we’re busy making vaccine for bird flu. Well, this vaccine is expensive, and it only lasts a couple of years. And we’re taking the resources away from other vaccines. We only have a very limited amount of vaccine-making [capacity] in this country, as we learned recently with the [2004-2005] flu. So what are we doing? And then—if the worst-case scenario occurs, and bird flu did mutate—the vaccine might not even cover it, because it would be a different bug.

But don’t public-health officials have some responsibility to prepare for something that devastating, even if it’s only a slight possibility?

I think that’s right. Laboratory work should be ongoing to prepare vaccines for potential disasters. That’s not the same thing, though, as saying 30 million doses ought to be prepared. Right now it’s two million doses. But I don’t know what we’re gearing up for. If we gear up, we send a message that something is in the offing. That’s different from doing public-health, epidemiological, and laboratory preparation for something.

So you think the authorities and governments should still be prepared, but just not make such a big noise about it?

If I thought the noise was conveying perspective [and] information in context, I wouldn’t be so concerned about it. I think the message ends up being conveyed that something is in the offing, which I don’t believe there’s any scientific evidence of. I do believe in preparation. [But] let’s have preparation without all that big noise, and without preparing excess numbers of doses we don’t need. We threw out a lot of smallpox vaccine in 2002. We’re making a lot of anthrax vaccine we don’t need. It’s hard to know where to draw the line here, but I wouldn’t automatically draw the line on the side of excess, because that’s very expensive, and resources are diverted from other places.


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