Plague is a pretty reliable stand by for science fiction authors when they need a plausible apocalypse. After all, it's happened before in history, and we don't have to go to ancient history. In our lifetimes, 70 million people have been infected with AIDS, and 35 million people have died.
Go back only a century, and you find 500 million people infected with flu in 1918-1919, with 50 million people dying.
Which is why, on the whole, I don't spend a lot of time worrying about civilization getting wiped out by disease. Nature takes its best shot at us all the time, and for the most part we just shrug it off. This doesn't mean it's not tragic if you or a loved one is one of the millions claimed by a modern plague, only that it hardly qualifies as an apocalypse if the world, for the most part, carries on. Let's say a truly devastating mega-disease breaks out next year that has twice the death toll of the 1918 flu, wiping out 100 million people worldwide in a single year. This sounds devastating, but in a world with 7 billion people, close to 98.5 percent of the population isn't going to be killed by the disease. Subtract 100 million people from 7 billion, then round up to the nearest billion, and you're still at 7 billion. We'll carry on.
Now, there are a few arguments in favor of a deadly plague spreading. First, we're a much more mobile world than we were in 1918. Plague can spread from continent to continent in a matter of hours. Second, our current crop of antibiotics is under great stress due to evolved resistance and there's little reason to think that new antibiotics are going to show up in time and abundance to counter the tide. Third, in the wealthiest, most educated nation on earth, it's become fashionable among a segment of the population not to vaccinate children.
The counter arguments: Disease might be more mobile, but so is information. By the end of the first week of the new plague, everyone on earth will have heard about it and heard how not to contract it. Antibiotic resistance is a genuine problem, but can be countered in part simply by following good hygiene practices. We know more about not contracting these infections than ever before. And, most plagues would be spread by viruses, which aren't affected by antibiotics anyway. As for the vaccination resisters, part if the reason such stupidity can spread is that vaccinations have been so effective that most people have never met anyone with one of the diseases being vaccinated against. It's easy to question whether a polio vaccine is necessary if there are no cases of polio at all in your state for the last fifty years. But let even a handful of cases show up in a modern school system and I predict vaccinations will become all the rage again.
Ultimately, our biggest defense against a modern plague isn't some new vaccine or drug. It's our own biology. Humans have been around a long time on the planet and gotten pretty good at fighting the various microbial threats that lie in wait for us. Just as importantly, a lot of these microbes have gotten good at surviving simply by becoming less lethal. A microbe that kills its host quickly and in massive numbers will have a pretty short run. Our second best defense beyond our own biology is good government. Lord, that's kind of chilling, isn't it? But, seriously, despite my best libertarian, free market instincts, I have to admit that government run water and sewage systems have probably done more to end the spread of disease in the US than any other innovation. The biggest reasons a truly devastating modern plague is unlikely are porcelain toilets and clean tap water.
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