At the time of writing, (November 2014) ebola is still an incurable disease causing fewer than 6,000 deaths from about 14,000 infections. It is a gruesome disease. Potentially, but not certainly, it may mutate into a mega-disease. Mega-diseases, such as malaria and TB, have millions of victims and cause hundreds of thousands of deaths annually. These diseases are endemic, crush human potential and are entirely preventable. However in a media driven, sensation- seeking world, hundreds of thousands of preventable deaths are insufficient to attract global political attention. ebola therefore has the ‘advantage’ of being a new disease with an unknown trajectory, or, as Donald Rumsfeld would put it, it is a known unknown. This permits hysterical ‘analysis’ of global outcomes such as transformation into a pandemic regardless of the evidence from Nigeria.
Combating malaria-infected mosquitoes is cheap and effective. A simple $10 long lasting insecticide-treated bed net protects for up to three years. It also kills mosquitoes. Nets can be used in all malaria zones and need no maintenance, the only imperative is reliable replacement and distribution. This is cheap, low tech, accessible in all regions and demonstrably effective. So why did 627,000 people (1,718 per day) die from malaria in 2012? Malaria isn’t media friendly lacking drama and embracing the mundane. UK warships, with dramatically clothed medics, aren’t needed to distribute nets to protect men, women and children. And celebrity stars couldn’t be attracted to perform for free to raise funds to combat a prosaic, dull, disease.
TB has nine million victims worldwide, killing about 1.2 million annually (3,288 per day: a 9/11 massacre every 26 hours)**. There is no quick-fire way of preventing TB. TB is a geo-social disease endemic in regions, which are poverty stricken. In many ways, it is even more an environmental disease than malaria. Over- crowding, poverty, HIV, malnutrition and a ‘herd’ pool of infection create prime conditions for TB. Post infection drugs can, and do, heal. However, the conditions, which ‘cause’ TB prevent treatment***. Death from these avoidable, curable diseases is the price of poverty. Discovering ebola as a new shocking disease is newsworthy. Discussing age-old diseases is for medical anoraks. And cure is the wrong route. These three diseases are preventable simply by improving living conditions of the affected peoples. Ah! But who pays and why should they?
Prevention is cost effective and humane. Why suffer pain, debilitating illnesses and early death when the route to avoidance is readily available? The Bill and Melinda Gates Foundation invested about $2bn in the fight against malaria. Should a charity have to lead the world in investing significant capital to prevent entirely preventable disease? The 1980 Brandt Report correctly identified the geo-social implications of the widening gulf between rich and poor regions. Pathetic politicians bleating about immigration should read Brandt’s prescient report and wonder if their hapless policies have created their nightmare.
Ebola, malaria and TB are competing horrors where the competition is for the amoeba attention span of politicians. Ebola has succeeded because it has the wonderful benefit of being new. Lurid possibilities are described and made more lurid by the gruesome nature of the deaths caused. This has unleashed government purse- strings, emergency hospital (and mortuary) building. Meanwhile…
*TB is the universal shorthand for tuberculosis
**Malaria and TB together have the same number of deaths each day as have died from ebola so far.
***TB drugs have to be meticulously taken over extended periods of time and be kept in hygienic conditions. They also have severe side- effects. So, even if available they have built in tensions as to their actual efficiency.