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'Rash' Predictions on Global Health
At the May 1 Town Hall Seattle event on global health and journalism, "Reporting Across Divides: Bringing Global Health Home," guest speaker Donald G. McNeil, Jr., with The New York Times, offered the following predictions on global health. Due to popular demand, the predictions are being reprinted here with his permission:
“I'm going to be rash and do something no journalist should do: make some predictions for the future.
I suspect that AIDS is not going to be solved in the lifetime of anyone in this room. A vaccine is now looking farther and farther off. I fear a cure cannot be found either, because the virus can hide in cells even better than the chickenpox virus, which can cause shingles 75 years after the initial infection. The drugs we have to suppress the virus are very complicated: three a day, every day, for life. And you have to keep changing them as resistance develops. On a continent where many people don't even get a once-a-year de-worming pill, that's a tall order. Right now, we don't even have a plan to get extra food to people on antiretrovirals that's a major issue. People whose immune systems are recovering, whose appetites are returning, are hungry.
AIDS, I believe, will do exactly what it has been threatening to do for 20 years kill 25 percent of the populations of some countries. I think it will become a chronic fatal infection we learn to live with, sort of like syphilis was in the West between the 16th century and the invention of antibiotics in the 20th.
Tuberculosis, I expect, will go the same path, since it rides the same horse - a weakened immune system. I'm more confident of an eventual cure, because it's a bacterium, not a virus. And because a vaccine - a variant of an existing one - looks promising. However, in the meanwhile, it will keep evolving XDR-TB superstrains, which are virtually untreatable. This is a threat that the West has not even begun to come to grips with. I suspect there will be repeated outbreaks in the West - and the public health measures to contain them will be harsh. In South Africa, they are already literally jailing patients for months or years in hospitals surrounded by barbed wire (and at Christmastime and Easter, they break out to visit family, spreading the disease.)
Malaria, on the other hand, I'm somewhat optimistic about. Sir Richard Feachem, the first head of the Global Fund, has called it "the low-hanging fruit."
I don't believe for a minute that it will be eradicated in my lifetime - or that of Bill Gates, who is one year younger than me. And possibly not in those of our children.
But, with enough money to pay for artemisinin combination drugs, mosquito nets, larvicides, DDT and new rapid tests it can be crunched down to a much smaller problem.
However, it is a highly political disease. In Sri Lanka, for example, it went from 1 million cases in 1955 to 18 cases in 1963. Then spraying stopped. A civil war broke out. Cases shot up into the hundreds of thousands. Malaria goes up whenever war divides a country or even when just tribalism does.
Other big killers are solvable, given enough money. In many cases, the solutions already exist, and are relatively cheap. In these I include many causes of diarrhea and pneumonia, as well as measles, polio, diphtheria, whooping cough, tetanus, worm diseases, iodine deficiency, iron deficiency and vitamin deficiency.
And, despite the Global Fund, despite PEPFAR, despite the Malaria Initiatives, the number one, most-needed public health measure in the world is still what it was in ancient Rome, Egypt and China: clean water.
Digging wells and building dams and aqueducts are still the most crucial things the world can do to save lives. But they're prohibitively expensive. As an alternative, cheap water filters are getting better all the time. Distributing them and the people who can explain how to use them may be the most cost-effective health measure the world can take.”
( Material left out of speech but part of his notes.) Also, to my mind, the most crucial thing you can fund is education. A major problem in Africa, one that doesn't get talked about nearly enough, is that too many people believe that disease is caused by witchcraft. Moreover, there is always suspicion, not only of solutions offered by white people, but of solutions offered by central government, which is often run by a rival tribe. The more public health workers you can train, like China's "barefoot doctors," the more lives you can save. It may take only a few months of inexpensive education. People who live in the villages, speak the local dialect, and can explain why clean water is important, why digging latrines is worth it, and who can dispense immunizations, vitamin pills, rehydration packets, iodized salt, deworming pills, antibiotics - those are the ones who make the biggest difference.
It's a lot of money we're talking about and it will take a lot of pressure on third world governments to make sure they use that money honestly. If that doesn't happen, the sources will simply dry up. The donors will back off again, as they had until a few years ago. And then, because diseases move faster than governments do, we're soon back where we started.
-Donald G. McNeil, Jr., The New York Times, Town Hall, Seattle, May 1, 2008
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