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Malaria, AIDS, Avian Flu, and MRSA-will we survive?
2006-01-20 08:20:52
By Christopher Elkington
What is the biggest health scare on our radar screens at the moment? Well, we quite obviously have two, both of such magnitude, and so here to stay, that we seemed to have developed a remarkable complacency towards both of them.
Malaria kills a child somewhere in the world every 30 seconds! This statistic is provided by UNICEF. In any one year, there are 400 million cases of malaria, and 1.1 million deaths.
The economies of many countries, including those of East Africa are seriously affected. Yet, paradoxically, many Tanzanians, who survive their childhood, develop a formidable immunity to malaria. Many people regard an attack as hardly more serious than a common cold.
A couple of days off work, some Fansidar, Mefloquin, Artemisin, and back to work as usual.
I suppose also, the time frame must have some effect.
If Tanzanians have been suffering from malaria since our first ancestor climbed his way out of Olduvai Gorge, then obviously we are going to regard this disease as something which, whether we like it or not, is an inescapable part of our lives.
It would seem to me that we are also becoming complacent about HIV/AIDS. The most convincing evidence of this lethal complacency is that in spite of the millions of US Dollars, mostly provided by international donors, spent on education, and ’sensitization’ campaigns, the countrywide efforts of some seemingly very committed NGOs, and the establishment of a high powered national agency, TACAIDS, infection rates do not seem to be going down.
However, we should remember this complacency has been with us for a long time. Do you remember those Swahili aphorisms, seemingly founded in abrasive ignorance such as-’Ukimwi ni ajali kazini,’ and the anti-condom folk saying ’ Utakulaje pipi na kasha yake?’
Maybe a certain amount of fatalism embedded in Swahili culture has also played its part.
Aren’t we all familiar with such comments, mostly made when somebody dies (not necessarily from AIDS). ’Ilikuwa tarehe yake, ’ ’Mungu alipenda,’ ’Kazi ya Mungu.’
Such comments always seem to me evidence that too many people are too ready to put an impossible burden of responsibility on the back of God.
If the Almighty created us with enough intelligence to engineer that impressive list of life saving drugs in the human medical arsenal, including antibiotics, and anti-malarials, why should we continue to blame God for all the many unnecessary deaths that surround us all on an almost daily basis?
The most obvious new health threat now threatening us , as members of the human race, is obviously bird flu.
Earlier this week, an international conference was held, at only a week’s notice, in the capital city, Beijing, of the country where this ominous disease first reared its head, the People’s Republic of China.
The Washington based World Bank, however controversial an institution in political terms, has probably the most extensive, accurate, up-to-date data bank in the world.
On Monday, the World Bank announced to the conference delegates that its target figure for dealing with the threat of bird flu, was 1.5 billion dollars! Quite a large sum of money, and apparently needed urgently.
Surprisingly, maybe assuringly, but in another sense, maybe disconcertingly, the response has been impressive and rapid, with The European Community on Tuesday immediately making a contribution of 250 million dollars, and the USA 334 million dollars!
Why are all these powerful rich world institutions so afraid of a disease which has so far afflicted only the developing countries? The simple answer to this question is that this disease does not recognize national borders.
One might have wrongly guessed that international air travel was to blame, but its not.
If every singly international airport was shut down tomorrow, the disease would continue to spread worldwide because it is carried by international carriers who have been traveling since before the first human being climbed out of Olduvai Gorge-migrant birds.
These birds are great travellers, and very resourceful. When it gets too cold for them in the European winter, they set off for Africa. When the European spring arrives, they fly back to a more welcoming Europe.
They have been doing this for tens of thousands of years, and even today scientists are not quite sure how they do it.
Unfortunately for homo sapiens(that’s us), although many of them have such tough immune systems, maybe evolved through all this extensive world travel, that they do not get sick from avian flu, they carry the infection.
This disease has already inflicted economic disaster on thousands of small farmers in such countries as China, Viet Nam, Indonesia, and most recently in Turkey, where chickens, turkeys, ducks and geese have been culled in their millions. Actually there have been very few human fatalities world wide.
Earlier this week, the astonishingly low world wide cumulative figure of 79 deaths was issued by the WHO.
So, why is everybody including Kofi Annan, the World Bank, the European Union, the People’s Republic of China, WHO, so shit scared?
The answer is that all the relevant experts say that is no longer a question of if, but when this disease mutates into a form that can be directly transmitted from human to human.
It has been estimated that when this happens there may be as many as 50 million deaths world wide, with, of course, a consequent implosion of the world economy.
The World Bank itself estimates that an avian/human flu pandemic would cost the world economy some 800 billion US dollars. In face of a predicted economic disaster of such proportions, the World Bank’s demand for only 1.5 billion dollars comes into stark perspective!
What can we do in the face of this seemingly unavoidable human apocalypse? Not very much, I suppose. Maybe all we can do is just sit and wait, while watching our chickens and ducks wandering happily round our backyards looking for scraps under Dar es Salaam’s generous January sun.
To give you all some cold comfort after all this depressing news, let me tell you of one horrific health threat which does not yet threaten us.
This growing threat is a bacterial infection known as ’Methicillin-resistant staphylococcus aureus-MRSA-, commonly known as the ’superbug,’ which over the last few years has succeeded in killing a large number of hospital patients in the UK, and is now ominously starting to affect people outside hospitals- where it is known as ’community MRSA.
The worrying thing about this’ superbug,’ is not only that it is becoming an untreatable, life threatening infection, but that it may, in a way, be heralding the end of the antibiotics era, which started in the late thirties when Sir Alexander Fleming accidentally discovered in a petri dish left overnight by an open window in his laboratory, the bacteria killing powers of a mould, which he called penicillin.
One man very concerned about this threat is Professor Richard James, Head of the School of Molecular Medical Sciences at the University of Nottingham in the UK.
He says: ’They say that if bird flu transfers to humans, we’d get 50,000 deaths in the UK. Well, if we had an outbreak of vancomycin resistant community MRSA, millions would die. Millions. We’d be returning to the era when the treatment for TB was fresh air.’
Vancomycin is, at the moment, the only antibiotic that can treat MRSA, but there have already appeared strains that are vancomycin resistant. Professor James believes that unless new antibiotics are discovered, ’we may have to close all our hospitals in the next five years or so.’
However, the era of those super drugs, the antibiotics, may be over.
In Tanzania, for several decades, you could buy capsules of Tetracycline, Ampicillin, Chloramphenicol, etc, in almost any market in the country, even in the most remote areas.
Simple people, suffering from a variety of infections would decide to self-diagnose, and self-treat themselves.
They would tell the man at the market stall:’Nipe rangi mbili tatu.’
(The most common, and popular rangi mbili capsules were orange and yellow, Tetracycline, red and black, Ampicillin, and green and white, Chloramphenicol respectively). Of course, this kind of self diagnosis, and self dosage, was, in fact a training course for the antibiotic to become drug resistant.
Professor James says: ’Between 1940, and 1970, the golden age of antibiotics, we developed thousands of these drugs, and then we squandered them. We fed antibiotics to chicken and cattle. We handed them out to people with a cold.
Each time you try to kill bacteria, you’re forcing them to select for survival. Now we’ve basically bred bugs that thrive in a hospital environment, and they’re just waiting to bite.’
Another reason behind the possible end of the era of antibiotics is economic.
It is extremely expensive for any drug company to develop a new antibiotic. In the year 2000, $800 million was spent developing the last new antibiotic, Linezolid.
Within only twelve months it was discovered that resistance to this drug was developing, so any financial return on the million dollar investment became highly unlikely.
People ask Professor James if he is an optimist or a pessimist.
He replies that he is somewhere in between, verging on the pessimist:’ If I were betting on the race between superbugs, and us developing the drugs… well, right now, I’d be betting on the drugs.’
I hope I haven’t ruined your day. We continue to be battered by malaria, and decimated by AIDS.
However, we seem to have found some kind of philosophical acceptance of these evils, whose bad side is complacency. As for avian flu, all we can do is sit and wait, and pray.
However, next time you take one of your children to one of our smart, private, expensive hospitals, with a minor ailment, and the young doctor prescribes an extremely expensive, and extremely powerful antibiotic, don’t accept it.
If you do, you are basically weakening your own child’s precious immune system, and joining those millions of innocent people all over the world, who have, unknowingly, contributed to the evolution of the superbugs, which apart from becoming a serious health threat to the human race, are at the moment causing lethal chaos in the UK’s once much vaunted National Health Service.
They may also, more ominously, be heralding the end of the era of antibiotics, those wonder drugs that cured so effortlessly, such a wide range of both minor and major infections.
A Happy New Year to you all!
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