WCSJ: Maybe The Biggest Disease Threat Isn't Infectious At All

I’ve been away the past week at the World Conference of Science Journalists, a biannual gathering that brought 726 writers and broadcasters from 87 countries to Doha, Qatar. I was there to give a presentation about blogging, and also because I organized two panels on under-reported epidemics and on food and farming issues in the developing world. My panelists’ testimony was so powerful that I wanted to share some of the details.

Going into the conference, the epidemics panel was my favorite. That’s not because I cheated and made myself one of the speakers, but because it brought into public view so many of the disease-control issues that we talk about here. When I say hidden epidemics, what I mean is this: The diseases that routinely grab headlines are almost never the ones that cost society the most in illness and deaths, and also in money to control and repair them.

Think of Ebola, for instance. There has never been a case of human Ebola in the United States. And as I’ve written before, viral hemorrhagic fevers repeatedly have been imported to North America without ever starting an outbreak. Yet whenever Ebola sparks in Africa, it earns scare-font headlines here, as though it were about to rampage across the continent — even though, in all its known engagements with humans, Ebola has killed less than one-tenth of the 19,000 that MRSA, for instance, kills in the US in a single year.

I asked a set of distinguished health journalists, all friends, to come to Doha to talk about diseases that deserve headlines, but never get them. Here’s what they said:

Helen Branswell of the Canadian Press, on the continuing threat of pandemic influenza: Even though much of the world considers the 2009 H1N1 “swine” flu epidemic to be a non-event, no one can predict when a serious or devastating pandemic will arrive. From 2009 to the last pandemic in 1968, the span was 41 years; it was 11 years to the last epidemic before that, 1957, and 39 to the one before that, the devastating pandemic of 1918 that killed possibly 100 million people around the world. But at least three times since pandemic recording began in 1729, there has been a lag of only 3 years between worldwide epidemics.

Helen pointed out that, when a serious pandemic does arrive, we are likely still to completely lack the ability to stop its spread. That’s because a vaccine is still the only effective way to defuse a pandemic, but flu vaccine production still depends on 60-year-old technology that requires at least 6 months to produce a vaccine batch. Moreover, most of the countries in the world still lack any domestic flu-vaccine manufacturing capacity.

Thomas Abraham, director of the Public Health Media Programme at Hong Kong University and former editor of the South China Morning Post, talked about polio, which he’s writing a book about. (And which Constant Readers will know is a longtime passion with me.) Speaking about the World Health Organization’s goal of ending transmission of wild polio virus by the end of next year (after postponements from 2000, 2002 and 2005), he said “it is increasingly difficult to see this happening” — and not just because there is currently a funding shortfall of $665 million.

Thomas said that the global eradication effort has not faced up to the profound difficulty of the polio endgame, in which cases caused by weakened vaccine virus that has mutated back to virulence are burgeoning even as the wild virus is eliminated by the vaccine. That threat can only be eliminated by switching to the more expensive injectible polio vaccine, and vaccinating with that for at least 5 years after polio has been declared eradicated — even though the purpose of eradication is to be able to stop vaccination, which currently costs about $1 billion per year. Official communications from the WHO and the eradication effort focus on “advocacy and spin” and don’t admit to this complex, costly reality, he warned.

Of the three (plus me, talking about antibiotic resistance), I was most struck by the story told by Shan Juan, who is senior health reporter and social-issues group leader for China Daily, the only national English-language newspaper in China. What she had to say made me wonder whether, in our focus on emerging infectious diseases, we’ve missed the point of what the biggest threats are likely to be. Here’s what she said:

  • In 1995, China’s Ministry of health counted 20 million people with lifestyle-related diabetes (that’s the Type 2, adult-onset kind, almost always related to obesity).
  • That trend has risen rapidly: In 2007-2008, another national survey found 92.4 million people with diabetes and 148.2 million with pre-diabetes. An average 10 percent of the population has diabetes, with another 15 percent in the pre-diabetic stage.
  • Diabetes and its complications are extremely expensive: Current costs to treat diabetes in China are more than 497 billion RMB per year, divided between insurance costs and direct medical care. At 6.46 RMB to the US dollar, that’s about $77 billion.
  • Much of the diabetes occurring in China now is going untreated because it has not been diagnosed: It is estimated that 60 percent of Chinese diabetes patients have not been identified or counted, meaning the true prevalence is about twice the official numbers.
  • Diabetes is being driven by inexorable economic development: China is moving away from rural small-scale farming, with its vast population migrating into cities and becoming more wealthy. To become urban and middle class means to eat costlier, fattier foods. Between 1982 and 2002, consumption of meat went up 57 percent in China, and consumption of eggs went up 69 percent.
  • And the trend will only get worse: In 2002, according to the WHO, 23 percent of Chinese were overweight; by 2015, 57 percent of Chinese men and 46 percent of Chinese women will be.

I thought I knew a lot about global health challenges, but the scope, scale and almost inevitable cost of diabetes that Shan Juan describes — a chronic disease, remember, not an infectious one that can be cured by antibiotics or prevented by a vaccine — took my breath away.

Coming up: An equally troubling report on agriculture in the developing world.



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