The world runs on numbers - apart from a growing preoccupation with big data, the obsession with which seems to be propelled by a rapidly expanding digital literacy among the educated classes. I want to focus here just one facet of data. Everyday facts and figures about mortality in an age of pandemics.
Numbers inform our beliefs and shape our expectations in unique and occasionally unexpected ways. Originating in Mesopotamia 4,000-5,000 years ago, introduced into Europe through the writings of Middle Eastern mathematicians, al-Khwarizmi and al-Kindi in the 12th century, Western knowledge has been constrained and symbolized by numbers ever since. We worship at the altar of numerals, captivated by their cryptic qualities yet trusting them to establish and maintain order, calculate probabilities, evaluate progress, and synchronize our activities.
Without numbers we would be lost - segregated from one another. The sciences are all based on numbers. Industrial production, distribution, exchange and mobility are all reliant on them. Value is calculated using numbers, as is wealth and well-being. We interpret demographics through numbers. Numbers enable digital functionality. We even tally our days on this planet by them. Numbers have a fascination and a potency found in no other facet of modern life, with the possible exception of sound.
Over centuries the Western cultural mindset has forged a reality mesmerized by the power of averages, measurements, percentages, estimations, quotas and statistics. Numeracy has become the key literacy for making sense of, and contributing to, our material world-system.
But numbers can also reveal things about our values and attitudes, our hopes and our fears. As I watch the global population clock on my computer desktop ticking over at 7,847,203,620 other numbers revealing information about human nature cause me to pause and wonder. Especially how we think about issues concerned with death - like the costs involved in preserving life in comparison with the amount we are prepared to spend eliminating specific risks – both real and perceived.
To put things into perspective - on any given day this year, around 150,000 people will die. Approximately 30,000 of those people will die from hunger - most unnecessarily given that we produce sufficient food for every person on the planet. Ischaemic heart disease, stroke, lower respiratory infections and chronic obstructive lung disease will claim around 20 million lives. 7.6 million will die from cancer. Over the past 12 months roughly 2.47 million people have died from the SARS-CoV-2 virus. Fatalities from HIV/AIDS were about 1.5 million, and road traffic accidents accounted for 1.3 million.
At the lower end of the scale death from a lightning strike, thought to be so rare that it has become a metaphor for extreme bad luck, still ranges anywhere between 6,000 to 24,000 deaths annually. And over 102,000 people die each year from circus stunts that go wrong – more than those killed from isolated acts of terrorism, if we exclude war zones like Gaza, Iraq and Syria from our calculations.
A much more worrying trend concerns increases in all forms of dementia. There are around 10 million new cases of dementia each year - implying there is a new case of dementia somewhere in the world every four seconds. As of earlier this year there were an estimated 50 million people suffering from dementia worldwide, with 60 per cent of those living in low- and middle-income countries. This number is expected to increase to around 75.6 million in 2030 and 135.5 million by the year 2050 - most in developing countries.
As astonishing as these numbers are, they do not seem to scare or invite our attention nearly as much as other newsworthy events such as plane crashes, shark attacks, roller coaster mishaps, the current pandemic, or acts of terrorism. Because corporate news media are shrewd about, and complicit in, stirring up our fears, we are fed an endless supply of news regarding death that has little to do with how most people actually die.
That presents a crucial issue for us today when actual deaths resulting from the corona-virus pandemic - officially 2,477,457 from today's account, also include the elderly who were dying from some other cause, those who died with (compared to from) COVID-19, and those who were incorrectly diagnosed. Figures like this present us with more than a few anomalies: like the supposed 24 per cent of all deaths occurring in the US, which only has 4 per cent of the global population. Something does not quite add up!
Recent figures from the National Centre for Health Statistics in the US suggest that the lifetime odds of dying in a plane crash are about 1 in 20,000. The odds of being killed on a single trip in a commercial aircraft accident are 52,600,000:1. Those same figures put the chances of dying in a car accident at around 1 in 100 – considerably higher in countries like Thailand, Libya or Venezuela, especially if you are on a motorbike. Yet even seasoned travellers will admit to slight apprehension as their aircraft takes off after nonchalantly getting in their car and making what is, statistically speaking, a far more perilous drive to their local airport.
Perhaps the actual risks and, by extension, the multitude of daily tragedies such risks engender, simply hit too close to home. We do not think much about car accidents, dementia or heart disease, not because we believe they could not happen to us, but because we suspect (or even assume) that they will. Given the high probability, our response is to put it out of our minds entirely.
But all that unlocked mental space leaves plenty of room to obsess about a proverbial lightning strike. As responses to the current pandemic have revealed, the daily lives of ordinary citizens are so casually disrupted. Of far greater concern however is dread of our own shadow. As our deepest fears are exploited by plagues caused by our culture and the way we relate to other species, and anxious regimes try to act as though they know what to do, many freedoms we take for granted are being eroded. We are now brainwashed into looking for terrorists around each corner, keeping a safe distance from mask-wearing neighbours, and crying for help at the sound of a door banging.
Death does not discriminate. But when it comes to the deaths of strangers it is not immune to certain hierarchical precepts. A cursory glance at the events we most pay attention to suggests that grand spectacles rule the day – especially when children are involved. Sinking ferryboats trump bus accidents, for example. But school massacres trump ferries sinking. Plane crashes and large-scale acts of terrorism, with their awful brands of horror, come next. Pandemics are possibly the most riveting of all because we are well aware that any of us could fall victim to them.
We know that an incendiary combination of grief, anger and fear accompany acts of terrorism. We also know that this brand of fear, whether rational or not, invariably leads to increased nationalistic fervour. This is precisely why the mere threat of terrorism has become an astute political stratagem. The actual number of deaths from terrorism is small compared with deaths from other forms of violence, and miniscule compared with deaths from heart disease or lung cancer for example.
Contrary to what is alleged by right-wing bigots and media fear-mongers, no religious group is more inclined to violence than others. Muslims are not more violent than people of other beliefs. In fact murder rates in most of the Muslim world are very low compared to most other countries. Nor is Islam hell-bent on embedding a universal caliphate. That is pure hysteria masquerading as intelligence. As for political violence, people of Christian heritage during the twentieth century polished off tens of millions of people in two world wars and colonial repression – a massive carnage that occurred not because European Christians were worse than, or different from, other human beings, but because they were the first to industrialize war.
The use of terror spreads across a wide variety of groups, ideologies, and targets. Terrorism is cheap. It requires few resources, captures the world’s attention, and gives the weak the ability to terrify the strong. The material cost of a suicide bombing, for example, can be as low as a few dollars. This modest investment could result in an average of 12 deaths and spread panic throughout the targeted population.
In response to this uncertain menace the developed world has resorted to building ever-bigger, ever-better fortifications around key targets. So transit through airports has become a protracted and unpleasant affair, embassies are far more difficult to access, while key landmarks like sports stadia, government buildings, energy utilities and even large shopping malls, for example, are blocked from potential attackers. I cannot help feeling that this kind of response is informed by a prejudice born of obsolete views of patriotism underpinned by a set of flawed logics.
Collective violence occupies a perilous but coherent place in contentious affairs of state. It emerges from the ebb and flow of collective grievances and struggles for power. It interweaves incessantly with non-violent politics, varies systematically with partisan regimes, and morphs as a consequence of the same causes that operate in the non-violent zones of collective political life. Understanding those causes will help us minimize the damage human beings inflict upon each other. In our own violent time, advocates of non-violent political struggle need all the help they can get.
Since 9/11 the economic cost of dealing with terrorism has escalated exponentially. Actually it is not precisely quantifiable, but certainly runs into billions of dollars each year – mostly in the form of counterterrorist activities. Predictably, this has reduced the number of transnational attacks by about 34 per cent. On average, though, terrorism has claimed 67 more deaths each year since that terrible event. This rise in the death toll has occurred because terrorists are responding pragmatically to the higher risks imposed by greater security measures. They have focused on events that create more carnage and that generate greater fear in the hearts of the community.
In an age where comfort, convenience, choice and variety have become commonplace for so many of us, it is easy to forget that life remains brutally tough and unfair for large numbers of our contemporaries who barely eke out a living in conditions we would find intolerable. Why should this be so? Life, so we are led to believe, has never been so good. Major wars have been consigned to the past, rampant poverty is in decline, we travel more frequently and experience the many marvels of what it means to be human on a regular basis. In addition, fewer people are starving and we live longer, healthier lives. We might be forgiven for thinking that our world is perfect for that is what the statistics are telling us.
But for some people struggling through each day is a living nightmare. Furthermore individuals are deciding to end the misery of it all in far greater numbers than ever before. About 800,000 people commit suicide each year – roughly one person every 40 seconds. In the Middle East, North and sub-Saharan Africa, Eastern Europe and the Caribbean more than 5 per cent of the adult population suffer from depression.
Incredibly, given its wealth, the US is one of the most depressed countries in the world, according to the World Health Organization. In terms of quality years of life lost due to disability or death – a widely adopted public health metric gauging the overall burden of disease – the US rated third for unipolar depressive disorders, just after China which was ranked first, and India. India, China and the US are also the countries most affected by anxiety, schizophrenia and bipolar disorder.
Clinical depression leading to suicide has become a blight on our society. Depression is the second-leading cause of disability with registered cases now running at around 6.7 per cent of the population. The taboos against mental health disorders in certain countries, in addition to fewer services for mental illness, makes this a conservative estimate at best.
At this point one can only guess at the root causes for such a global outbreak of mental illness. We do know that conflict, privation, and the presence of serious contagions, all push depression rates up. I have no doubt this scourge betrays the absence of hope in an uncertain future where wealth is enjoyed by far fewer and fewer people in relative terms. Ignoring a few fanatical extremists, a similar sense of hopelessness probably drives most terrorists' rationale for creating havoc.
Our fear of terrorism has waned somewhat over the course of the past year for obvious reasons. Now it is zoonotic pathogens and how we restrict their spread that is on our minds. Pandemics are on the rise primarily as a result of the way we interact with other species, harvesting them for food. There is a need to contain the conditions that drive their development, not just attend to individual diseases when they occur.
New strains of influenza have emerged from livestock farming. Pandemics like Ebola, SARS, MERS and now COVID-19 have all been linked to wildlife - like bats, civets and pangolins - commonly hopping to humans when contact is made with them. Zoonotic transmissions have been increasing exponentially for years as our ecological footprint brings us closer to exotic wildlife in remote areas, and trade in wildlife brings these animals into the wet markets of urban centres, particularly across Asia.
Record road-building, deforestation, land clearing and agricultural development, as well as globalized travel and trade, make us supremely susceptible to pathogens like coronaviruses. Yet our strategy for dealing with pandemics is depressingly inadequate.
Across the board, from politicians to the public and even many health officials, we treat pandemics as a disaster-response issue: waiting for them to happen, then hoping a vaccine or drug can be developed quickly in their aftermath. But even as Covid-19 rages, there still is no vaccine available for the SARS virus of 2002-3, nor for HIV/AIDS or Zika, or a host of emerging pathogens.
The problem is that between outbreaks, the will to spend money on prevention wanes, and the market for vaccines and drugs against sporadic viral diseases is insufficient to fund the necessary research and development.
During its World Health Assembly in 2016, the WHO set up an R&D Blueprint to bridge this gap, announcing a priority list of pathogens that most threaten global health, and for which no vaccines or drugs were in the pipeline. SARS made the list, as did MERS, Nipah, Ebola and other rare but serious diseases caused by prevalent viruses.
The Coalition for Epidemic Preparedness Innovations - a global partnership between public, private, philanthropic and civil society organizations - was launched in 2017 by the World Economic Forum, to source funds for the development of vaccines and therapeutics against some of these viruses.
To escape from this age of pandemics, we will need to treat them as a global public health issue and start working on prevention in addition to responses. Our first goal should be to broaden our resources against potential outbreaks. It is not sufficient to develop vaccines and drugs for known agents when the next big one is likely to be a different pathogen - a virus close to SARS, say, but not close enough that the same vaccine can work against both.
As Covid-19 strikes millions today, and a spate of other pathogens wait in the wings ready to strike in the future, we continue to butt up against nature. Scientists estimate that there are 1.67 million unknown viruses of the type that have previously emerged in people. Discovering and sequencing them should be a priority. In the backwash of SARS, research on coronaviruses originating in bats has discovered more than 50 related viruses, some of which have the potential to infect humans. This information can now be used to test for broad-action drugs - including the new messenger RNA vaccines. Scaling up this effort to cover all viral families, as the Global Virome Project proposes to do, is a logical first step toward prevention.
A radical shift is also needed in the way that tests, vaccines and drugs are designed so that entire groups of pathogens are targeted instead of individual pathogens that are already known to us. The National Institute of Allergy and Infectious Diseases in the US is working on a universal flu vaccine that would cover all known strains of influenza. A pancoronavirus vaccine, an Ebola-virus vaccine, and others will also be needed.
With a much smaller investment, we can also try to get ahead of pandemics by working with communities in hot spots of emerging diseases. Disease surveillance should be focused on farmers, rural communities and anyone who has extensive contact with wildlife, to look for uncommon illnesses, test for novel pathogens, and work with people to develop alternatives to high-risk activities such as the wildlife trade.
Pandemics are similar to terrorist attacks. We know that we can expect them from time to time. We also know where they originate, and what is responsible for them. But we do not know exactly when the next one will occur. They need to be handled in a similar fashion - by identifying all possible sources and dismantling those before the next pandemic strikes. If that is not done, fear will continue to accumulate.
That a sense of despair should hang in the air, invading the psyche of even our most talented people and potentially alienating an entire generation, is surely a valid reason for a massive re-boot of our shared worldview in this regard. This is not simply utopian foolishness. Using our resources for peace rather than conflict, and for public health rather than rapid emergency response, also happen to be among the most economically sane policies we could possibly pursue.