Inevitable Surprises

Inevitable Surprises

By Peter Schwartz


INEVITABLE SURPRISES covers high-level, universal trends — from business to international affairs, from biotechnology to climate change — but presents them in the context of the particular and concrete choices that different people must make.

Plague and Denial

There have been 2 serious global plagues in the last hundred years – influenza in 1918 which killed between 20-50 million people worldwide, AIDS which kill more than 100 million people.

 The history of these 2 disesases give us a sense of the conditions required for another devasting plague.  While reading this section, I was thinking about H1N1 influenza and some of the areas of similiarites that the author had mentioned. The book was published in 2003, there was no H1N1 then.

1. Incubation point : a place where the disease can evolve and develop into its virulent form example AIDS came into the world apparently from a relatively isolated part of Africa, which suddenly come into contact with the rest of the world in 1970s.

2. Long gestation period : This is a period between when an individual is infected and the time symptoms appear. This give the disease an opportunity to spread; human beings unaware that they are sick, continue their lives as usual and take no precaution against infecting others.  This was the pattern with influenza, which we now know, was contacted in some victims as early as 1902, 16 years before the symptoms appeared.

3. A large, uninfected and infectable population – without immunity to the disease : the more unfamiliar the disease, the farther it travels from the original site.

4. A distribution system that brings the disease to the infected population : One reason for the return of epidemics, despite massive improvements in public health since the turn of the century is the availability of inexpensive air travel.  Airplanes carry people, pets and microbes to parts of the globe where they  have never been. In fact, the person who unwittingly brought AIDS to the West was an Air Canada flight attendant, a gay man who later became known as “Patient Zero”.

5. A consistently reliable form of transmission from one person to another : AIDS continues to spread because people exchange fluids – either through transfusions, needle sharing or sexual activity. Influenza was much easier to spread; it merely required breathing in the same room with someone else who had it.

6. Ignorance about the disease : AIDS was originally known as the “gay cancer” and treated as such. Influenza was assumed to be caused by a bacteria and a vaccine was created accordingly. But in fact, it was a virus. This ignorance was one of the factors that prolonged ineffective treatment and allowed the disease to spread.

7. Denial of its seriousness : The longer people refuse to recognize the plague as a public health crisis, probably requiring intensive research, new forms of quarantine and changed behaviour, the more time it has to spread.

Imagine, however if a disease like AIDS mutated into an air- or waterborne form, or a form carried by insects (like malaria). Hundreds of millions of people could be infected by such a disease in a matter of weeks. We don’t know for sure if it will be devasting as that, and we don’t know for sure exactly when it will come. But we do know it is coming.

The author believes that there are 2 things that need to be done. The first is to improve public health facilities, particularly for sanitation and water. The second is to invest in detection systems.  There is also a need for a better network for hospitals to share information and educated people need to be subsized to continually make sense of the information and look for cues that a new disease has emerged – while its population base is still relatively small.


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