The politics of SARS
AN ENTIRELY NEW infectious disease, Severe
Acute Respiratory Syndrome or SARS, has swept large parts of Asia in recent
weeks. The outbreak probably began in China last November and spread to Vietnam
in late February. It appears that the Stalinist bureaucracy in China hid the
extent of the epidemic for as long as they could. On March 12 the World Health
Organisation (WHO) issued a global warning about the new illness, quickly
followed by warnings on international travel.
Up to 7,500 people are thought to have been
infected and nearly 600 have died. Initial hopes of a mortality rate of 4-5%
have been dashed by recent estimates that 8-15% of those infected may die. In
one area the death rate amongst those aged over 60 is 50%. For those under 60 it
is 13%. This is tremendously high. The Spanish flu, which killed over 18 million
people in 1918, had a death rate of about 10%. The Asian flu of 1956 and the
Hong Kong flu of 1968 together killed 4.5 million. Luckily SARS is much less
contagious than the flu.
The vast majority of cases have occurred in
Hong Kong and China. The worst outbreak outside Asia has occurred in Toronto
where twenty-two deaths have been reported. Other cases have been scattered
across the world – with outbreaks in 28 countries. While at present it appears
the epidemic is coming under control, there remains the possibility of a
devastating pandemic either now or in the future.
According to David Heymann of the WHO, SARS
"could become the first severe new disease of the twenty first century with
global epidemic potential". The disease "is emerging in ways that suggest great
potential for rapid international spread under the favourable conditions created
by a highly mobile, closely interconnected world".
Significant progress has already been made in
combating SARS. Its genetic sequence was discovered very quickly. This progress
has been possible through a combined international effort. In Heymann’s words
"these laboratory directors have put aside profit, certainly prestige and
national pride, to work together to help put into the public domain the
information that is so necessary to learn about this disease. And it has been
done in record time". Unfortunately, however, international cooperation is not
always the order of the day. Scientists in Canada, Hong Kong and the US have all
filed for patents in order to gain the rights to information on SARS and, of
course, the right to future profits. Not all scientists agree with this
approach. Marco Marra, the head of the Canadian team who discovered the gene
sequence of the SARS virus, has refused to allow his name to go on a patent
application.
SARS is caused by a virus, as is the common
cold and influenza. Viruses are nearly impossible to treat, hence the importance
of restricting their spread. Anti-viral agents are available but their
effectiveness is extremely limited. Secondary infections, caused by bacteria,
can be treated by antibiotics.
SARS is not the first deadly infection to
appear in recent years. AIDS, caused by the HIV virus, has killed thirteen
million to date. HIV is thought to be a mutated (or changed) virus that crossed
over from a species of monkey to humans. SARS too is thought to have crossed
over from an animal species to humans. It is a form of corona virus, like the
common cold. Like the cold it is generally spread by coughing and sneezing.
Worryingly the SARS virus may have the capacity
to mutate rapidly and may even develop into even more deadly forms. In one local
outbreak 268 people in a Hong Kong apartment complex were infected despite not
being in close contact with each other. The infection may have spread through
the water system. Some people seem to be super carriers, for example the flight
attendant who infected over 100 people in Singapore. The capacity of the SARS
virus to mutate will cause difficulties as scientists try to develop a vaccine
and diagnostic tests. HIV constantly mutates and for this reason it has proved
very difficult to develop a vaccine against it.
Historically it has often been argued that
epidemics are great levellers, carrying off both the rich and the poor. It is
simply not the case that all are at equal risk however. The image of the
Victorian lady dying a slow but romantic death of tuberculosis (TB) is not the
whole story. The ‘White Plague’ was primarily a disease of the poor, and was
associated with overcrowding, over-work and malnutrition. Today TB remains
endemic to large parts of the world and kills two million a year, despite the
availability of effective treatments since the late 1940s. In the advanced
capitalist countries it has made a comeback in the last twenty years, not only
because of its association with AIDS but also because of increasing poverty.
AIDS can be caught by anyone but on a world
scale it is clearly a disease of the poor. It is cutting such swathes through
sub-Saharan Africa that it is contributing to the dramatic falls in economic
output that have been seen in the area. There is no ‘cure’ for AIDS but
life-prolonging treatment is available – at a price. If SARS were to spread to
Africa it would decimate the 30 million Africans who are HIV positive.
Last autumn the Ebola virus infected 135 people
in a remote area of the Congo leaving 123 dead, a mortality rate of 91%. Whilst
Ebola is much more deadly than SARS it is less of a problem in that its effects
develop very rapidly. This means that its victims die before they pass on the
infection. In contrast SARS does not show its effects for two to ten days. In
the modern world of relatively easy international travel SARS has thus spread
rapidly from area to area and country to country.
One British Medical Association (BMA)
representative has claimed that a patient with suspected SARS was treated in an
ambulance at Broomfield Hospital in Chelmsford by staff who were not properly
protected because of a lack of adequate facilities in an A&E department. He
argued that all A&E departments should have access to negative pressure
ventilation rooms, which prevent airborne infection from spreading by using a
vacuum to suck out air safely, because "where hospitals have got it wrong around
the world, staff have died".
SARS has now become an issue in a all-out
strike of 300 public doctors in Ireland. The strike, now in its fifth week,
began over pay and conditions but has now broadened in scope. The health
minister threatened senior doctors with disciplinary action if they did not
respond to the threat of SARS. The striking doctors responded by declaring that
they would not return to work until a proper public health system is in place.
The Irish Medical Organisation (which is affiliated to the Irish Congress of
Trade Unions, unlike the BMA which is not affiliated to the TUC) is escalating
the dispute and general practitioners are set to stop doing public health work,
such as giving vaccinations.
In recent decades public health systems have
been neglected across the globe. In the nineteenth century public health
measures were first taken by developing capitalist nations such as Britain and
Germany in response to epidemics of diseases such as cholera and typhus and
chronic problems such as TB. Whilst these diseases primarily effected the poor
they could and did cross into the richer layers of society, and of course the
ruling class requires a healthy population to work in their factories and to
fill the ranks of their armies. Public health is about preventing disease
gaining a foothold in the first place, often through simple measures such as
improved sanitation.
World health care is increasingly dominated by
huge private companies, especially the multinational pharmaceutical industry.
Their interest is in the lucrative acute care market – selling products for the
treatment of those who are already ill. In other words, for them prevention is
not better than cure. There is little or no money in it.
International privatisation has weakened health
care systems in the advanced capitalist countries but has decimated health care
in the poorer parts of the world. The WHO has been starved of funds especially
by the US which refuses to pay its contribution in full.
SARS may yet make the world pay for this
neglect, or if not SARS another disease, either arising naturally or conceivably
created by humankind. In order to combat disease effectively we need a truly
integrated world public heath care system. We will only really achieve such a
system with the advent of democratic international socialism.
Dr Ciaran Mulholland
A Socialist Party Ireland publication
A Healthy Future?
By Ciaran Mulholland.
Available from the Socialist Party, 36 Victoria Square,
Belfast, BT1 4DQ or online at
www.geocities.com/socialistparty
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