We are in the middle of a global pandemic caused by a virus, SARS-CoV-2, that is transmitted in the air we breathe. Especially in the UK it is not going well, with over 1,000 people dying a day. A big part of the problem is political. But it is also true that our knowledge of how diseases that spread in the air we breathe, is very incomplete. This is, I think, contributing to both debates and decision making being poorly done. Examples I can think of include debates and decision making in important areas such as social distancing, mask wearing, and whether in the middle of a pandemic it is a good idea to encourage people to visits restaurants. So why is our knowledge of how diseases such as COVID-19 spread, so incomplete?
Two interwoven reasons: The first is that transmission of diseases across the air is complex. Understanding complex phenomena requires gathering a lot of data, and this costs a lot of money. The second is that we have spent very very little money on understanding transmission of diseases across the air. If you spend very little money on research into a complex phenomenon, then you will not understand it. And, as we are finding out the hard way, we are then faced with a deadly disease spreading in ways we only poorly understand.
Now, I don’t have data on spending on research on disease transmission — I think it is lumped in with spending on treating the diseases. But the number of research papers published on a topic is basically proportional to the money spent on research on that topic, and I can search the Web of Knowledge for papers by topic. Of course, research on COVID-19 did not start until late 2019, so I can’t search for that, but I can search for research into tuberculosis (TB), which is spread in a very similar way to COVID-19, and has been killing us throughout history. Over a million die of TB each year.
In the ten years 2011 to 2020, about 5,000 papers were published that this database reckons had both “tuberculosis” and “transmission” as topics. This is 500 papers a year. This may sound a lot, but to put into perspective, the number of papers published on the gene BRCA1 in the same period is over twice as many, at 12,000 papers, or 1200 papers a year. Mutations in the BRCA1 gene can greatly increase a women’s risk of breast cancer. We are spending huge sums on research in the processes that underlie cancer, and as a result cancer treatments are getting better and better, and so more and more people are surviving cancer. That is wonderful. It is money well spent. And it is a result, in part, of spending billions on cancer research each year.
I think we have spent less on research into transmission of a disease that kills more than a million a year, than we have into a single cancer gene. The consequence is that we have only a poor understanding of how TB is transmitted. TB is rare in wealthy countries like the UK. TB is much more common in poorer countries such as India, so neglecting research into TB transmission makes little difference to most of us in the UK. But now a disease has arisen that is also spread in our breath, and is definitely not restricted to poorer countries. Our decision to neglect research here looks, in hindsight, a poor one. I hope we will learn from this mistake.