(I’ve adapted this piece’s title from Dr. Gena Gorlin’s excellent essay arguing that for human beings, death is the default.)
Recently, I was listening to psychologist Steven Pinker discuss the Second Law of Thermodynamics on a panel. Entropy, in its broadest sense, describes the tendency of systems toward disorder. Pinker noted that human agency acts as a countervailing force, creating pockets of order in a universe that naturally trends in the opposite direction.
I’ve been thinking about that idea a great deal lately, particularly in the context of what I see as the role of infectious disease physicians, nurses, physician assistants, nurse practicioners, epidemiologists, virologists, microbiologists, infection control practitioners, as defenders of civilization.
Transposed into the realm of infectious disease, entropy means that death, disability, and disruption caused by infectious agents are the norm. Human beings altered that trajectory through reason. Germ theory, sanitation, antisepsis, vaccination, antibiotics, antiviral drugs, and modern public health infrastructure are all products of human intelligence directed toward a specific purpose: creating order where nature provided none. Left unattended, the natural trajectory is not toward health but toward recurring outbreaks, epidemics, and premature death.
Measles is the default.
For most of human history, measles infected everyone. Measles elimination was not the natural state of the world. It is an achievement.
And like all achievements, it requires maintenance.
Civilization itself is not automatic. It must be continuously maintained and advanced. Societies can and do backslide. The Dark Ages remain the most famous example. I often think of the Antikythera mechanism—a sophisticated ancient Greek device whose purpose was lost for centuries. Imagine discovering such an object in the Dark Ages, possessing the artifact but lacking the intellectual framework necessary to understand it because people jettisoned that framework.
History offers many examples of achievements that were abandoned, forgotten, or allowed to deteriorate. The Concorde disappeared. Human moon missions ceased for decades. Today, vaccines are following a similar trajectory. A nightmare scenario is some future human finding a vial of an mRNA vaccine the way we first held the Antikythera mechanism—possessing the artifact but having lost the intellectual culture that made it possible.
Human flourishing consists of creating islands of order against a backdrop of entropy.
This is why the return of measles in the United States is not primarily a biological event. It is a cultural and intellectual one.
The measles virus has not become more virulent. The vaccine has not become less effective. What has changed is humans’ willingness to support the technology that made elimination possible.
The ultimate resource is not a vaccine, an antibiotic, an antiviral, or a hospital.
It is the human mind.
The same force that drained swamps, built sewers, created vaccines, developed antibiotics, eradicated smallpox, and eliminated measles is the force that keeps entropy at bay.
Measles elimination was not humanity’s inheritance. It was humanity’s achievement.
The state of nature is not measles elimination but measles endemicity.