Season 3, Episode 6: Phantoms
An outbreak of a new strain of antibiotic-resistant C. difficile threatens Joanne’s life – but she’s not the only one in danger. As Wes points out, “if this was to get out in the developing world, it would kill millions.” NorBAC gets to work right away to try and determine the cause of the antibiotic resistance. First task: sequencing the bacterium’s genome…
Emerging Infectious Disease
The emergence of new infectious diseases is hardly science fiction. From antibiotic resistant strains of known bacteria like Mycobacterium tuberculosis to entirely new viruses like the one that causes severe acquired respiratory syndrome, or SARS, novel infectious diseases seem to be popping up all over the place.
No matter where they appear, they present problems for patients and doctors, and new challenges for scientists. But if and when they appear in developing countries as opposed to, say, Canada or the US, they bring with them an inordinately high potential for devastation. Wes wasn’t exaggerating – if antibiotic resistant C. difficile were to appear in or spread to the developing world,it could very well lead to millions of deaths.
Would it have the same impact in North America? Not likely. There’s a message here for scientists and policy makers alike, as Science & Society guest author Dr. Hassan Masum explores below.
Disease, Death...and Hope
Roughly ten million children under the age of five die every year and of these, 99% are outside higher-income countries.
What does that mean in human terms? Living in poorer countries, it means that your younger sibling or child could die of malaria, or your parent could be suffering from AIDS. It means that disability, disease, and death are familiar companions in the developing world - less hidden away in hospitals, more a fact of life.
But not an unalterable fact. Historically, most medical research money has gone into "rich peoples’ diseases" like cardiovascular disease - not to mention treatments for obesity! Fortunately, the last few years have seen an expansion of research into treatments, medicines, and vaccines for diseases like malaria and AIDS that disproportionately impact upon the developing world.
And more money – from private donations, governments, and companies – is being put into getting those vaccines and medicines out to the people who need them. In fact, companies in India, China, Africa, and elsewhere are starting to invest in R&D for local diseases like sickle cell anemia – you might say they are hoping to do well, by doing good.
Tackling the Global Disease Burden: Science, Fairness and Affordability
So what are these “global” diseases? The two big infectious killers are TB (tuberculosis) and HIV / AIDS, but there are many more. Some, like cholera, occur predominantly in the developing world. Others, like measles, meningitis, or influenza – the “flu” – occur around the world, but are more frequent and severe in developing nations.
By now everybody has heard about the danger of a flu pandemic. If and when a pandemic does happen, the big question will be, "Who gets the medicine?" Indonesia focused global attention on this question when it briefly withheld samples of avian flu virus from scientists in developed countries, protesting that vaccines that might be made from their samples could then be sold back to them at prices too expensive for Indonesians to afford. While some might object to such a course of action, the motivation behind it is nonetheless cause for pause and consideration.
Many diseases are not infectious from person to person, but are spread by parasites. Malaria, dengue, leishmaniasis, schistosomiasis, trypanosomiasis - the list goes on…and gets less and less pronounceable! Many of these occur predominantly in hot or tropical climates. Is it fair that a child who happens to be born in Africa or Asia instead of in North America or Europe is much more at risk of infection?
The science of genomics generates new knowledge about how these diseases work, enabling scientists to better understand how bacteria and viruses spread and infect, and to design drugs to stop these processes.
Take pharmacogenomics, for example: Sometimes medicines can be ineffective or have nasty and even fatal side effects. Pharmacogenomics aims to match the effects of particular drugs with specific genetic characteristics, helping doctors and patients to know which medicines would work best for any given person. Countries like Mexico are aiming to understand the genetic characteristics of their populations, so they can develop drugs likely to work better for local people and diseases - similar to how a good teacher understands each student's learning style.
What does all this science mean “on the ground?” To bring these big problems back to a local, human level, one basic question is this: how would you feel if your sibling or child got sick, and you couldn't do anything but hope they got better -- either because there was no cure, or because you couldn't afford the cure?
Put that way, and two main global health goals become clear, goals in which scientists – researching genomics, microbiology, virology, pharmacology – and policy makers will play key roles: to develop cures where none now exist, and to make those cures affordable for all who need them.
-- Hassan Masum, PhD
About the Author
Dr. Hassan Masum earned his doctorate in Computer Science from Carleton University in Ottawa, Ontario. He is a Senior Research Consultant with the McLaughlin-Rotman Centre for Global Health (formerly the Canadian Program on Genomics and Global Health), whose mission is to harness innovative technology and policies for global health advancement.
More food for thought
Q: Many medicines are developed using plants, genetic material, or clinical trials from developing countries. If such a medicine sells well, how important is it to share the benefits with the developing countries that provided the original material or trial subjects?
Q: How much should be spent by developed countries on diseases that mainly affect people in the developing world? What kinds of motivation could generate that funding?
Q: The poor often need basic, and inexpensive, medical interventions, while the rich disproportionately use high-tech, and expensive, health solutions. Given that each country's budget is limited, how should funding be allocated?
Want to read and learn more?
The Disease Control Priorities Project shows what people suffer from around the world:
http://www.dcp2.org/
The Science and Development Network is a great source for developing world perspectives in science and medicine:
http://www.scidev.net/
To read the World Health Organization’s news release on the Indonesia virus-sharing case mentioned above, visit:
http://www.who.int/mediacentre/news/releases/2007/pr09/en/index.html
