Western bias hampers disease fight Consensus must be reached on human causes and controls

January 11, 1998|By Laurie Garrett

In the wake of Richard Preston's 1994 thriller "The Hot Zone," a best seller in 26 countries, the publishing industry has released a torrent of books about emerging disease threats.

Nearly every major fighter of the Ebola virus has published a memoir. Several scientists have produced warning missives. And fiction writers from Stephen King to Tom Clancy have made microbes prominent plot devices.

Amid the plethora of paranoia-inducing publications, barely a handful offer insights that could help make worldwide public policy.

Yet, chillingly, the only relevant point of view for microbial issues is global. Bacteria, parasites and viruses exploit appropriate ecospheres wherever they find them, regardless of national boundaries.

Despite the chatter on everything from "mad cow disease" to the Hong Kong "bird flu" to mutant strains of the Ebola virus, there are serious causes for concern.

Of late, the Clinton administration has formally designated emerging infectious diseases as a national security issue. That has drawn big political players such as the CIA, the National Security Council, the Defense and State Departments and the U.S. Agency for International Development into an arena that before the mid-1990s was the province of scientists.

The most recent entrants in the debate on emerging diseases are the historian Sheldon Watts of American University in Cairo and the virologist Michael Oldstone of the Scripps Research Institute in La Jolla, Calif.

Watts, the author of "Epidemics and History: Disease, Power, and Imperialism" (New Haven: Yale University Press, 1998), has spent his career in Nigeria and Egypt. He sees humanity's relations with the microbes from the side of the victims of European imperialism.

In his analysis - which is indebted to William McNeill's 1976 landmark "Plagues and Peoples" - most of the scourges of the past millennium are direct results of Christian or European cultural and colonial practices.

On the other hand, Oldstone, a prominent American laboratory scientist - author of "Viruses, Plagues, and History" (New York: Oxford University Press, 1998) - pays little attention to the socio-economic foundations of disease transmission. He focuses, optimistically, on the triumphs of Western science - following the path of Paul De Kruif, author of the popular gem, "Microbe Hunters."

Of the two, Watts sounds the more profound challenge to contemporary health policy. His perspective is stridently anticolonialist, emulating the viewpoint of many African intellectuals.

And as is typical of that body of work, it draws from an awesome trove of historical evidence. Watts' scouring of Europe's and the Islamic world's ancient databases has resulted in a compelling rationale for his pro-Southern Hemisphere argument.

Yet, not surprisingly, most of the world's serious writing on infectious disease, including Oldstone's "Viruses, Plagues, and History," has a highly American or European point of view.

"The obliteration of diseases," Oldstone writes, " ... is a regal yardstick of civilization's success, and those who accomplish that task will be among the true navigators of a brave new world."

The way to reach that world is primarily through development of a broader range of vaccines, he believes, particularly against HIV - his personal area of research. That will require "the best efforts of scientists in medical research ... not inhibited by political or religious interests, but supported by the full resources of governments and industry with conscientious participation by the general public worldwide."

It must be considered that there are enormous economic and legal barriers to vaccine production. With fewer than a dozen companies still in the business, and with the current profits for all vaccine sales combined less than those for a single patented anti-ulcer drug, there is little corporate interest in developing products that target diseases found mainly in poor countries.

Moreover, consumer litigation so envelops the industry in the industrialized nations that budgets must include as much money for legal defense and insurance as for actual vaccine distribution.

Western science, Oldstone argues, has triumphed over the world's biggest infectious killers, and there are only five significant foes left: AIDS, Lassa fever, the diseases caused by the hemorrhagic fever viruses (such as Ebola), mad cow disease and hantaviruses. It's a curious list.

The first four "enemies" are amenable to well-understood preventive measures - in order: condoms and clean syringes, rat control, sterile hospital and funeral procedures, and proper livestock and meat production practices. Further, Lassa can be cured with proper use of the antiviral drug ribavirin.

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