Two news items caught my notice this last week, because they were the kind of news that I would normally expect to read in medical thrillers. The first related to an alert relating to a small pox alert in India’s North East based on reports reaching India about possible cases of small pox in Myanmar and Bangladesh. Officially , the disease has been eradicated in one of the most successful of public health interventions and in whose footsteps , the polio eradication program, stuttering and sputtering has been trying to follow. The second item pertained to the US authorities quarantining an Atlanta based lawyer , who was having tuberculosis and nevertheless boarded a trans Atlantic flight to Greece, potentially infecting hundreds of people in the process.
In my school days , the visit of the small pox vaccinator was a dreaded affair. The class teacher would line up all the students , and one by one , we would be called forward to receive a jab on our fore arm , that would artificially induce a small pox sore. Unlike other vaccinations we received , where the pain of the injection lasted only a moment , the small vaccination was an enduring agony
That one tiny sore would over days swell and redden and then as it would begin to dry up and form a scab , it would led to an unendurable itch. The torture was in waiting for the scab to fall off without scratching and in learning to have baths and showers with the arm extended , so as to prevent the sore from getting wet. The consolation was that if we coped with that one sore, we would never experience the real agony of small pox. What that might mean, came through to me in a much milder form when in adult life , I suffered from chicken pox which most contract as children but which some how had escaped me.
Today’s children have never experienced the small pox vaccinator and of course small pox is eradicated or so we think. And in America , Tuberculosis is as good as eradicated and their society is unfamiliar with what it is even though TB kills about 1.6 million people a year worldwide, including more than 1 million in Asia, 400,000 in Africa and 100,000 in the Americas and Europe. India incidentally has the world’s highest TB toll.
One can barely imagine the devastating effect that small pox will cause , if it has really come back to haunt us. Consider this: While vaccination for small pox was in full force , Smallpox was responsible for an estimated 300–500 million deaths in the 20th century. Smallpox epidemics could involve scores, hundreds or thousands of cases – the highly contagious nature of variola and its gruesome possibilities made number crunching relatively unimportant. Indeed, in colonial South Asia the discovery of a few cases was often considered to represent a prelude to the unraveling of a crisis that would inevitably result in further infections and innumerable deaths; while large-scale mortality was usually considered to be an affirmation of the dangers expected of variola, a less dramatic toll on human life was generally celebrated as an instance of good fortune.
The news about the occurrence of small pox is still not confirmed but the story of the Atlanta lawyer who had a virulent form of tuberculosis is true. While typically in India , we worry about “multi drug-resistant'’ TB, which can withstand the mainline antibiotics isoniazid and rifampin, the quarantined man was infected with something even worse - “extensively drug-resistant'’ TB, also called XDR-TB, which resists many drugs used to treat the infection.
Rich nations have typically ignored diseases like tuberculosis as diseases of the developing world and little funding has typically been made available to the “diseases of the poor”.Government funding for public health campaigns (TB, AIDS prevention, sexually transmitted diseases and obesity) pales by comparison with the billions spent by pharmaceutical companies on disease mongering intended to increase the markets for their products like Viagra. As the developed world discovers that in a border less world , no society is ever fully insulated and grapples with a case of XDR-TB for which there is no treatment because the existing antibiotics don’t work and no new antibiotics exist because no research has been done in what was always considered a poor man’s disease , it can only be hoped that rich and prosperous nations will be forced to visit and take into account the poor man’s world.
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