Dr. Charles Calisher is an epidemiologist who specializes in the evolution of arboviruses, diseases transmitted by insects and other arthropods. He has served as Chairman of the Executive Council of the American Committee on Arthropod-Borne Viruses.

From 1973 to 1992, Dr. Calisher worked as Director of the World Health Organization’s Collaborating Centre for Arboviruses in the Americas, Division of Vector-Borne Viral Diseases. He served as Chief of the W.H.O.’s Arbovirus Reference Branch from 1973-1989 before taking a position as Assistant Director for International Programs at the Centers for Disease Control, Division of Vector-Borne Infectious Diseases, a position he held until 1992. Since 1996, Dr. Calisher has been Moderator for the Program for Monitoring Emerging Diseases (ProMed).

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The following is Part One (there will be three) of an email interview conducted in late February, 1999; questions were asked by Brent Hoff, our science and math person. This interview is real, and is the second in a series of interviews Hoff will be conducting for McSweeney’s. The first, with mathematician Paul DuChateau, appears in the second issue, now available in some cities, including Toronto. Now then:

Q: What happens in such a crisis situation, such as hantavirus or Ebola fever outbreaks? The phone rings, you jump into the white protective suit and it’s off to New Mexico or Africa?

A: It is really quite like this. The phone rings or an e-mail arrives and we go to the lab, decide what we might need (likely the toughest decision of the trip). Pack a series of boxes and take off for the airport. Contacts with locals will have always been made prior to our arrival. One cannot simply pack a box and go bleed people in a foreign country or even in one of the States here; it’s against the law and local authorities tend to get nervous when outside authorities start doing things without their knowledge. This surely is understandable. Anyway, a visa must be obtained for some places (I have sat in airports waiting for couriers to bring me a visa from D.C.). World Health Organization, Pan-American Health Organization, national governments (who already have issued an invitation, in writing), and other organizations have made local arrangements.

As for being afraid of the virus I am investigating, no. If I did not have confidence in my own abilities, in the abilities of the people with whom I was working, and with my supplies, I wouldn’t begin the work. The only time I was afraid was when I was working with Marburg virus, before we new what that was. Many people had died and no one had lived and we didn’t have a clue as to what was what. This insecurity later led to the construction of the high containment facility at Centers for Disease Control and Prevention (CDC). None of the diseases I’ve worked with have frightened me. I have never worked with Ebola virus. Hantaviruses are not at all frightening to me. They are not something from outer space, they are just viruses. One must take care and I do.

One checks into a hotel, unpacks, and goes to see the government authority responsible. Those people usually wear suits and ties and do not really get into the action, so they delegate someone to assist us. I have never been treated with any but the greatest care. Once I was threatened by a soldier with a machine gun in an airport in Africa. He wanted me to give him $200 before he would let me through customs. I told him he should go ahead and shoot me. I didn’t have $200, I had had diarrhea for two days, and he could save me a lousy trip home on a Air-Nauseating. He laughed and took me to dinner: monkey paw soup, roasted pangolin, and excellent beer.

Q: I just saw the “Epidemic! The World of Infectious Diseases” exhibition at New York’s American Museum of Natural History. It was sponsored by Bristol Meyers Squib and portrayed an extremely positive picture of both the history and the future of medicine in fighting disease. It (understandably) downplayed social issues of human rights regarding access to health care and practically ignored the growing emergence of drug resistant diseases and pesticide resistant vectors of infectious disease. Do you share their optimism that we are winning the war against disease?

A: First of all, you would have been better off going to the Metropolitan Museum of Art. Second, no. I do not at all share such optimism. You don’t see the CDC sponsoring exhibitions saying we are winning the war on disease. Everyone has his/her own view, depending on which side s/he is on. We are clearly losing the war on disease and it is getting worse every day.

Q: I gather you’ve seen a lot of crisis situations and various responses to crisis situations. What have you learned about humanity’s response to threatening epidemics? Are we getting better at dealing with them?

A: I can tell you one thing, for certain. When the health and economy of U.S. citizens, including our military personnel, are threatened, the U.S. acts, quickly and usually effectively. It seems reasonable that the federal government responds first to threats against our own direct interests, after that to threats against our indirect interests. In my opinion, the rest of the world also does the best it can but their actions are not always effective. This is not at all to say that we know what we are doing and no one else does. On the contrary, there are superb people in many governmental and non-governmental organizations around the world who have world-class expertise and world-class facilities available to them. The problem lies in some of the places that tourist bureaus would like us to visit. Awful places with no useful health infrastructure. Given the increase in human population densities, I am not at all optimistic that the situation will improve. Indeed, I believe it will get much worse, and not before it gets better.

As for improving our responses to epidemic situations, my view is that is much improved. I attribute this to availability of information on the web and e-mail. A group I work with, ProMED-mail, gets out daily reports of disease occurrences and outbreaks, human, livestock, wildlife, and otherwise. It is not only popular, it has been shown to be quite useful. The reason it is useful, rather than simply the bad news of the day, is that many governments, maybe all governments, are less than completely forthcoming in reporting disease occurrence. Part of the reason for that hesitancy is that governments want complete confirmation of occurrences and determinations of etiologic agents before they publicize the bad news and because certain governments, ours not included, do not tell the truth because they do not want to look bad or do not want their tourist industry hurt. By use of public communications we sometimes can get out the news before it is officially reported. There’s a danger here. We could be reporting an unconfirmable rumor or an untruth (disinformation). We have to work very hard to see that we keep such reports to an absolute minimum.

But, yes. We are getting better at dealing with epidemics.

Q: You once wrote a paper on virus species. Do you think the immune system evolves along a Darwinian path of evolution as some epidemiologists have argued? What about viruses and bacteria? Could Lyme-causing spirochetes really be just mutations of syphilis causing spirochetes? Leprosy of TB?

A: I believe that everything has evolved along Darwinian lines. The greatest misunderstanding about Darwinism is that it occurs randomly. This gives the religious folks all sorts of reasons to not accept this truth. Random occurrence is simply not the case. What is random are the changes. Selection is not at all random. Why believe that immunity is any different than any other biological system?

As for borrelia that cause Lyme disease being mutants of the spirochaetes that cause syphilis, I suggest you stick with what you know. Sure it’s possible. How many things are possible? Is it probable? Sure, with exceedingly low probability. What if it is true that Borrelia burgdorferi evolved from the organism that causes syphilis (or the one that causes TB or the one that causes leprosy)? So what? Everything came from something.

Q: The overprescription/misuse of antibiotics is said to be dangerously increasing drug-resistant bacteria — Strep. A, for instance. Some have claimed we are about to find ourselves right back where we started, i.e., the pre-Koch and Pasteur 1890s. Is this media hype or a real threat?

A: This is not media hype. This is real. As I said above, this is bad. It likely is the end of humanity unless we come up with a third generation antibiotic. That will be done, I am confident, but what then? This ain’t ever going to stop and, ultimately, we will lose the fight. Meanwhile, I’m enjoying myself. It won’t happen tomorrow but we’d better plan as thought that is the case.