interest, interest 2016

Opinion Piece on How the World Handles Infectious Disease

photo credits here

By Tan Qi En

In today’s globalized environment, many things are capable of spreading faster than before. Ideas, people, products. Along with these is the possibility of infectious agents crossing barriers previously impermeable, sparking fears of a global pandemic wiping humanity out to the last man. While this scenario makes for a thrilling plot device for a post-apocalyptic story, what fiction outlines might not be too far from reality. Take for instance the SARS epidemic in 2003, an outbreak that, despite our government’s best efforts, made it to our shores, showing that Singapore is not the safe haven it makes itself out to be. More recently, the Ebola and Zika outbreaks are both of concern as they can cause either death or the formation of deformed, disabled offspring respectively. Neither of these have a vaccine, nor a cure.

So what measures are being taken to prevent such a scenario from occurring? These fall mainly into three classes: prevention, containment, and cure. Prevention, on a national level, would primarily consist of ensuring that infectious agents do not enter their borders. This can consist of deploying infrared cameras to screen inbound traffic for fevers, or subjecting people travelling from countries known to be harbouring an infection to mandatory quarantines. Containment can consist of setting up specialized wards in hospitals specifically for the housing of infected patients, and screening people they have been in contact with for the disease. Curing the disease is an arduous process, with researchers struggling to generate possible solutions and push them to the human trial phase. However, only a small number of potential cures are actually effective, with even fewer actually making it to the market.

Of course, none of these measures are completely effective. Pathogens might lie inactive in the body and people will slip through loose borders. The governments can of course enforce their policies with greater stringency, but this will come at an economical cost. From an average first-world citizen’s perspective, no cost is too great to pay to ensure their personal safety. But governments cannot simply bend to the will of their populace; they have other pressing matters to expend resources on, and the state coffers are only so deep. Most likely, control measures would only be implemented to the extent that it saves money over the alternative of trying to treat infected people.

Meanwhile, less glamourous illnesses exist: those that have been reduced to a mild annoyance in a developed country but a fatal one in the less developed world. Take for instance gastroenteritis, an infection of the gastrointestinal tract. With the primary symptoms being a stomachache and diarrhea, in developed nations this disease is easily treated with antibiotics, painkillers, and proper hydration. In undeveloped countries, on the other hand, access to things oft taken for granted such as basic medical supplies and clean water are limited. As such, the infection is left untreated and allowed to ravage the patient’s body, and diarrhea can lead to severe dehydration, to the point of death. Sometimes the patient continues drinking from the same contaminated water supply he contracted the disease from, in an attempt to ease his insatiable thirst, exacerbating the situation.  This is reflected distinctly in the disparity between the disability-adjusted life year for diarrhea in developed and undeveloped countries. This is a metric of a disease’s impact on a person, based on the number of healthy, productive years lost to the disease. In developed countries, this number is less than 500 years lost in every 100,000. For undeveloped countries, that figure stands at a staggering 50,000. In this scenario, there are two options available to governments and healthcare organisations: control or eradication.

The former entails sufficient measures in place to prevent an epidemic from occurring within a geographical area, while the latter refers to eliminating the disease from the wild on a global scale. While eradication can prove to be a daunting task, it is likely the more economical option in the long run. Containment and treatment plans for the disease can be removed, and inhabitants of previously disease stricken regions can live with one less thing to worry about. In addition, making the sacrifice to contribute to eradication can generate good amounts of political goodwill, not only from the people that benefit directly but the international community in general.

So why don’t we see this happening very often? This is mainly due to the fact that politicians remain in power based on their popularity with their population. In first world countries with the power to make change, its citizens would not appreciate their policymakers spending their tax money on something other than themselves, so anyone brave enough to implement eradication programs would have a hard time staying in office for long enough to see them to fruition.

The situation looks less than favourable, especially for people living in less developed countries. The way ahead looks to be bleak, unless countries begin to be more involved in cooperative efforts; pooling resources to systematically eradicate diseases one by one, or developing and pricing drugs cooperatively rather than competitively. Together, we can make the world great again.