DISEASES WITHOUT BORDERS24 May 2016
Outbreak after outbreak, from Ebola to Zika to Swine Flu, the media highlights groundbreaking biomedical innovations as the solution to our global health concerns. Mosquitoes for mosquito-borne disease, genetic modification, development of antimicrobial vaccines – these are the marquee solutions when it comes to combating modern-day disease.
But are these really the solutions that we need? Or do we already have the means to solve these issues at hand?
Prior to the advent of modern medicine, when there was little understanding of the biological basis of disease, major Western cities tackled illness through preventative strategies. Before the discovery of biological cures, there was no alternative but to do so. In 19th Century London, cholera and tuberculosis were rampant and there was no way of treating them, much like our current predicament with infectious diseases such as Zika, Ebola and HIV/AIDS.
The 1854 Soho outbreak of cholera was devastating, killing 500 people in just 10 days. Whilst no biological cause for cholera was known, physician John Snow came to the conclusion that it originated and spread through a shared water pump. He did so by meticulously mapping each case and monitoring the progress of the outbreak. These conclusions were met with scepticism but, in time, Snow’s discovery led government officials to invest in sewage and sanitation systems to protect a rapidly growing urban population.
This snippet of history illuminates how urbanisation and population growth can lead to the spread of disease, and the importance of political intervention and non-biological prevention in combating such diseases. Just one of his many contributions to the field of public health, John Snow was able to show the effectiveness of epidemiological studies in combating disease.
The importance of data surveillance has been made evident more recently in the West African Ebola outbreak. The areas which suffered most were those which lacked infrastructure and surveillance systems. As a result, the World Health Organisation (WHO) was slow to recognise and declare Ebola a public health emergency and afterwards it was difficult to direct resources to where they were most needed. This tragically illustrates the importance of data surveillance and also reflects the inability of international organisations such as the WHO to adequately respond to and manage global emergencies.
As stated in the report, ‘Combating Emerging Infectious Diseases’, the WHO recognises the “importance of strengthening global surveillance mechanisms”. However, as Chairman of the Review on Antimicrobal Resistance, Jim O’Neill, notes, the lack of a universal surveillance system, especially in developing nations “deprives us of the key insights and early warnings that we need to mount an effective response”.
Consequently, whilst biomedical fixes are important, they are band-aid solutions. The causative agents of these diseases can be identified and we can statistically monitor their prevalence in mortality rates, disability-adjusted life years and incidence rates. Apart from these biological causative agents – parasites, infections or whatever it may be – there are important (perhaps even more important) non-biological agents at play.
Shockingly high prevalences of preventable diseases in the developing world are proof enough that biomedical solutions alone are not effective.
Take diarrhoea as an example.
According to the WHO, diarrhoea is the second leading cause of death in children under five globally and kills more children than AIDS, malaria and measles combined. As UNICEF Executive Director Ann M. Veneman stated, “it is a tragedy that diarrhoea, which is little more than an inconvenience in the developed world, kills an estimated 1.5 million children each year”. What’s more shocking is that standard diarrhoea treatment – oral rehydration therapy – is simple, inexpensive and life-saving. But despite this, only 39 per cent of children in need of this treatment receive it and there has been little progress since 2000.
However, perhaps rather than treating the symptoms of such diseases, more focus should be placed on tackling the causes. The causes of diarrhoeal deaths can be superficially laid down to the biological causative agents – to rotavirus, shigella virus or E. Coli bacterium. But ultimately, the causes of these deaths stem far beyond the biological agents, down to issues of poverty and inequity, manifested in the forms of malnutrition, lack of sanitation and poor access to healthcare.
A 2009 WHO/UNICEF Report, Diarrhoea: Why Children Are Still Dying And What Can Be Done outlines seven recommendations for combating diarrhoea – five of which are preventative. These measures include: providing access to potable water, improved sanitation, hand-washing with soap, exclusive breastfeeding for the first six months of life, good personal and food hygiene, health education and rotavirus vaccinations.
The same report suggests that such disheartening statistics are partly due to other global health emergencies taking precedence. As UNICEF Chief of Water, Sanitation and Hygiene, Clarissa Brocklehust stated, “Other diseases have come in and caught the spotlight. What [this] means is that spending on the ways to reduce diarrhoeal diseases is completely disproportionate to its impact”.
This brings about the question of how we should equitably allocate resources and funding. Should we operate within a purely economic framework and monetise lives? Should we invest our money in that which brings us the greatest marginal return in terms of lives saved, and quality of lives improved? Or should we allocate our resources to the areas of greatest need? And if so, how and where we should direct our attention, resources and money?
It needs be understood that diseases manifest from social conditions – poverty and inequity – and so our solutions must address both the biological and non-biological causes. Any biomedical solutions to global health issues must operate alongside sociopolitical interventions. And by tackling disease through tackling issues of infrastructure, data, sanitation and equity – we can systematically combat a whole host of diseases without having to direct our effort to any one specific disease.
Of course, it’s much easier said than done, and such changes are slow and difficult to enact. But when it comes to our global health, by no means is there a quick-fix.