February 08, 1998|By Sara Engram
IN THIS country, major medical news usually consists of high-technology advances in treating big killers like cancer or heart disease. In many parts of the world, it takes far less sophistication to have lifesaving results.
"Dear Sir," writes Victoria. "I have a problem on my right leg which started swelling with pains over 24 years ago. This time it has grown worse, [and] with all the tireless efforts to get this undesirable situation off my nerves, so much money spent has made me go down the drain as poverty has set in. The swelling of the leg has become rather enormous with much pains day in and out."
Raising hopes
Victoria is one of 120 million people around the world infected by lymphatic filarial parasites. For her -- and for 1.1 billion people at risk of that infection -- the recent World Health Organization (WHO) announcement of a new effort to treat and possibly to eliminate this mosquito-borne infection is as earthshaking as a cure for cancer.
The joint initiative between WHO and the pharmaceutical company SmithKline Beecham will involve donating a 10-cent dose of medication once each year to kill the parasites in an infected person's bloodstream, breaking the cycle of infection. The program will continue for up to 20 years, at a projected cost to the company of about $500 million.
In 73 countries, spreading from Africa to India to Southeast Asia, the Western Pacific and parts of the Americas, some 120 million people are infected by lymphatic filarial parasites. The rapid and uncontrolled growth of cities has given these parasites an enormous boost by providing ample breeding sites for the mosquitoes that transmit them.
In areas where the parasite is prevalent, it is not uncommon to find children as young as 1 already infected. Typically people in such areas never fully recover from the illness because they are repeatedly re-infected by the bountiful supply of parasite-carrying mosquitoes.
For some people, few visible symptoms exist. But scientists are now learning that the parasites can damage the lymphatic system and kidneys, even in cases where people appear healthy, leading to premature death.
Some 43 million sufferers
Not all victims are fortunate enough to appear asymptomatic. Victoria is one of 43 million people who suffer from the visible symptoms of this disease -- the sometimes-grotesque swelling of legs, arms, breasts or genitals that gives rise to the name elephantiasis.
The costs of this disease are immense. In addition to the pain described by Victoria, victims carry a psychological and social stigma.
Young women afflicted with this swelling will probably never be able to marry, because it can make it difficult to have children. Married men and women with the disease may well find themselves rejected by their spouses.
In India, home to one-third of the people affected by this disease, the annual economic losses caused by lymphatic filariasis have been estimated at $1.5 billion. But until recent years, few countries had the resources or knowledge to mount control efforts that were broad enough to be effective.
Now, with significant advances in the ability to test for the parasite and to administer inexpensive treatments, the cost of controlling the disease has dropped dramatically. As for India, WHO estimates that the cost of administering annual, communitywide doses of medication is less than 1 percent of the economic burden lymphatic filariasis imposes on the country.
Lymphatic filariasis, a disease long ago eliminated in this country, has been cited as one of the world's leading causes of permanent and long-term disability. But thanks to medical research, it is now one of six infectious diseases that has been identified as eradicable or potentially eradicable.
SmithKline Beecham's agreement to donate billions of doses of one of the drugs essential to this effort can help make that a reality. In the meantime, however, researchers such as Dr. Alan Scott at the Johns Hopkins School of Hygiene and Public Health will continue their search for a vaccine against the infection.
A little means a lot
It is possible that the programs to administer annual doses of medication will in fact succeed in wiping out the infection in many parts of the world. But those efforts must continue over several years, perhaps for as long as two decades. That is plenty of time for political or economic disruptions that could wipe out several years of progress.
In public health campaigns, it is always good to have more than one weapon in the arsenal against any disease. But, for people like Victoria, the miraculous thing about public health campaigns is that it takes so little to achieve so much. Imagine what it must be like to know, firsthand, what a difference a single, yearly dose of medicine can make.
Sara Engram is deputy editorial page editor of The Sun.
Pub Date: 2/08/98
