by Sean Martin
Aside from its rapid international spread, SARS became a red alert because scientists have long been expecting another influenza pandemic, and have been expecting that pandemic to possibly start in pigs (as the Spanish Flu might have done in 1918) or birds. SARS is now known to have originated in bats, which then spread to birds and then to humans via intensively-reared poultry sold in Chinese markets. Something similar had happened in China only a few years earlier, in fact. A new strain of flu, H5N1, had appeared in Guangdong province only in 1996, when it affected geese. This avian influenza (bird flu) then spread to Hong Kong, where it made the species jump in the city’s poultry markets and killed six people (out of a total of eighteen infected). The authorities reacted quickly and drastically, killing all the city’s poultry – over a million and a half birds – and closing the markets down while large-scale disinfecting operations took place.
The appearance of H5N1 in 1996 was only the latest in a line of influenza mutations stretching back to the Spanish Lady herself. That pandemic had been a variant of the H1N1 strain, and scientists have long wanted to find this exact strain in order to try and work out why it was so lethal. Whenever well-preserved tissue from 1918 victims has been found – sometimes in the permafrost of Arctic or Alaskan graves – they have put the samples under the microscope hoping for some clue into why the Spanish Flu was the deadliest pandemic in history, well aware that the influenza virus continually mutates. There have been further flu pandemics: the Asian Flu in 1957, which was the H2N2 strain; the 1968 Hong Kong flu, another new variant, H3N2 (the strain currently circulating in humans); and then in 1977, there was a brief re-emergence of H1N1. (The previous year in the USA, H1N1 had also reappeared in Fort Dix, New Jersey. Although it only killed one soldier, it was similar enough to the 1918 strain to spark a mass immunisation programme; even President Ford got himself vaccinated.)
Part of the problem with the 1996–7 outbreak of H5N1 had been the growth of the Chinese poultry market. Not only were there more birds than ever before, but they had been intensively reared in factory farm conditions, meaning that they had been pumped full of chemicals to make them bigger, and therefore more profitable. In the quest for profit, the birds are kept in tiny spaces, and are injected with cheap vaccines. The result is ‘another unadvertised by-product of globalization’, as Andrew Nikiforuk has dubbed it.498 The principal cause of bird flu outbreaks has been
our gluttonous appetite for cheap, industrially produced meat. Crowded bird factories, rampant bird smuggling, bad vaccines, and duplicitous governments have all played a role in fouling the proverbial nest. Medical professionals may not like to admit it, but avian flu is a fairly predictable man-made plague or what scientists cryptically call a “deliberately emerging microbe”. Even the UN Food and Agriculture Organization has repeatedly concluded that avian flu owes its global reach to “the intensification and concentration of livestock production in areas of high density human populations.”499
Factory farming and globalisation both, it could be argued, fall under William McNeill’s definition of macroparasitism.500 The simplest analogy for this is taxation: governments tax their populations, but leave them just enough money to continue subsisting. (Microbes behave the same way with their hosts: if they are too virulent, they will kill their host and in doing so, probably also themselves.) In globalisation, the desire for profit pushes all else aside, including public health concerns. It happened in Sunderland in 1831, when the Marquis of Londonderry didn’t want quarantine restrictions against cholera imposed so that he could continue making money; quarantine opponents in the USA cited the same reasons whenever yellow fever threatened to dent their pocketbooks; it happened in India in 1883, when the British sent a team of ‘experts’ to tackle cholera, knowing that their results would not hamper trade; the British knew their Indian canals would exacerbate malaria, but that didn’t stop their irrigation programme. The list could go on. In sucking up every last cent and penny, capitalism behaves as the most blatant form of macroparasitism. Indeed, if war is a mass psychosis, as Cartwright and Biddiss suggest in their survey of the effect of disease on history, then it is probably not wishful thinking to suggest that capitalism is also a disease that has reached pandemic proportions.
The Return of Pandora’s Box
In addition to new diseases, numerous diseases that were once controlled or limited through drugs or containment strategies are now making a comeback. Among them: cholera, diphtheria, genital herpes, giardiasis, viral hepatitis, malaria, measles, pertussis, pneumonic plague, syphilis, tuberculosis and viral encephalitis.501
In many cases, these diseases are making a comeback because they have outsmarted the vaccines that were developed to control them. Tuberculosis is a case in point. After effective treatments were developed in the early 1950s, TB had been on the decline. The so-called Edinburgh Method, pioneered by John Crofton and his team, in which the patient was treated with three drugs simultaneously, was seen as one of the great miracle cures in an age of miracle cures. With further developments in treatment over the next few decades, tuberculosis seemed to have been beaten.
But then TB began to fight back. Since the late 1980s, there has been a worldwide increase in the number of new cases. The rise is linked to several factors. After the development of anti-TB drugs, research into the disease became less of a priority in the developed world, as it was thought to have been conquered. But TB was evolving all the time, becoming resistant to the existing treatments. The AIDS epidemic also played a part in TB’s renaissance: people with HIV are more susceptible to TB. In Africa, the incidence of TB has tripled or quadrupled since the 80s, while in some countries, as many as 70 to 80 per cent of their TB patients are also HIV positive. In the former Soviet Union, the collapse of communism was accompanied by a rise in TB, as living standards fell and healthcare systems made the faltering transition to western, market-led models. Cases of tuberculosis also rose in affluent countries. In New York City alone, cases of TB almost tripled between 1978 and 1992, particularly among the homeless (who did not have access to free medical care). The worldwide resurgence of the disease led the WHO to declare tuberculosis a global emergency in 1993. The emergency is still ongoing, with around 60 per cent of the cases of multidrug resistant TB occurring in Brazil, China, India, Russian Federation and South Africa.502
Microbial evolution has also led to the appearance of the so-called ‘superbugs’, of which MRSA is perhaps the most widespread and best known. When Alexander Fleming discovered penicillin he had been working on a bacteria called Staphylococcus aureus, a common cause of skin complaints, respiratory diseases and food poisoning. It also became resistant to penicillin in the 1950s, forcing the development of a new class of antimicrobial drugs called methicillin, introduced in the 1960s. The bacteria, however, evolved quickly and soon became resistant to methicillin also. The first outbreak of MRSA – methicillin resistant Staphylococcus aureus – occurred at Queen Mary’s Hospital for Children at Carshalton in Surrey, spreading to eight of the 48 wards, infecting 37 patients and killing one. It quickly went global, favouring hospitals. As Michael Shnayerson and Mark Plotkin put it, MRSA ‘was like a feasting hyena that saw no need to range beyond the watering hole where its most vulnerable prey gathered.’503 It is, in some ways, a twenty first century equivalent of typhus, which preferred jails and the courtrooms of the Black Assizes. There are now at least eleven different strains of MRSA504, and the disease has now spread to nursing homes, day-care centres, schools, sports centres and fitness clubs, military bases and jails.
MRSA is a bacterium that can live on any surface and ‘is almost as hardy as anthrax’.505 Around 30 per cent of people carry the bacterium in their nostrils (its main home in the human body), or on their skin, in their armpits or perineum. It is thought that about 20 per cent of the population are lifelong carriers of MRSA, with 60 per cent doing so intermittently, and 20 per cent never. MRSA skin infections can cause painful, pus-filled boils and conditions like cellulitis; so
metimes a pus-filled lump can form under the skin. If the bacteria get into the bloodstream via a break in the skin – a surgical incision, for instance – they can cause life-threatening infections such as blood poisoning, heart problems, pneumonia, urinary tract infection, septic arthritis, osteomyelitis and septic bursitis (an inflammation of the bursa, small fluid-filled sacs that lie under the skin and in joints). If it penetrates the bone, MRSA may ultimately require the amputation of the affected limb. MRSA can also cause toxic shock syndrome, itself a relative newcomer to the disease canon (the first case being reported in 1978).
Outbreaks of MRSA in the UK in the 1990s, verging on an epidemic, highlighted the problems faced in combatting the disease. It broke out in three hospitals in Kettering, Northamptonshire, in April 1992, infecting 400 patients and 27 staff. It quickly spread to 15 hospitals and 845 patients in neighbouring counties, and then to London and other parts of the UK. By September 1994 it had infected 21 London hospitals, and four others. MRSA had spread via a combination of patient and staff transfers between hospitals, and by the year 2000, ‘was common everywhere in Britain.’506 Part of the reason hospitals have become MRSA’s favoured hunting ground is related to the ‘Five Cs’, posited by the CDC as greatly increasing the risk of MRSA: crowding, contact, cleanliness, compromised skin and contaminated personal care items. If a hospital is overcrowded or dirty, and also does not have enough to staff to either care for patients or clean the place, then MRSA will thrive. Cuts to the funding of the UK National Health Service by succeeding governments, leading to chronic shortages of beds, nurses, and also contracting cleaning duties out to poorly-regulated private sector companies, have all been manna from heaven as far as MRSA is concerned.
While evolution has played an undoubted part in the resurgence of some diseases, another factor has been the over-prescribing of medication, antibiotics in particular. We are simply popping too many pills. As Sally Davies, the Chief Medical Officer of England, notes, ‘We have taken antibacterial and other anti-microbial drugs for granted for too long. We have misused them through overuse and false prescription, and as a result, the bugs are growing in resistance and fighting back.’507 Repeated use of antimicrobial drugs can reduce the number of good bacteria in the body, weakening the immune system. In taking a pill for everything, we might be keeping the bad bacteria at bay, but we are often killing the good ones off, as well. We are collectively suffering from the proverbial ‘too much of a good thing’. The overuse of antibiotics might also be linked to the lifestyle diseases we looked at in the last chapter. Microbiologist Martin J Blaser believes that overuse of antibiotics has also played a part in what he calls our modern plagues: the rise of obesity, asthma, allergies, diabetes, and certain cancers.508
It’s not just in over-prescription that antibiotics present a danger, but also through their overuse in agriculture and the food industry; they are used, for instance, to fatten animals up, and in pesticides. Macroparasitic capitalism and Big Pharma are not without blame here. Indeed, as James Le Fanu has written that drug companies ‘have orchestrated this massive upswing in drug prescribing to their advantage’.509 The upshot of this limitless greed could have disastrous consequences. Sally Davies warns that:
if we do not change the course of history, and if we allow resistance to increase, in a few decades we may start dying from the most commonplace of ailments that can today be treated easily. We will regress to the point where, in twenty years’ time, when I need a hip replacement, the operation may be deemed too dangerous to even attempt due to the risk of catching an untreatable infection.510
Some diseases have been helped through human intervention of a different kind. Fearing that certain vaccines might lead to conditions like autism, many parents have refused to get their children vaccinated, and an anti-vaccination movement has grown up in the United States and elsewhere. While a concern for side-effects and an aversion to corporate big bucks might be understandable (also fuelled by the fear that vaccines cause conditions like autism), it has also contributed to the needless rise of preventable diseases like measles.511 If we’re going to count capitalism as a disease for the sake of argument, then we should probably also label stupidity as one.
Climate change could also bring old diseases back, and introduce new ones. As Jolyon M Medlock and Steve A Leach note in a paper published in The Lancet in March 2015, ‘the early part of the twentyfirst century [has seen] an unprecedented change in the status of vectorborne disease in Europe’.512 Although malaria has been absent from the UK since 1911, warmer temperatures could tempt the disease-carrying mosquitoes back; the early twenty first century has seen malaria reappear in Greece. West Nile virus, which also has the mosquito as a vector, could also make an appearance. West Nile has already been confirmed in parts of Eastern Europe, and tick-borne diseases such as Lyme Disease continue to increase. As Medlock and Leach point out, ‘These changes are in part due to increased globalisation, with intercontinental air travel and global shipping transport creating new opportunities for invasive vectors and pathogens. However, changes in vector distributions are being driven by climatic changes and changes in land use, infrastructure, and the environment.’513
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Speaking of infrastructure and the environment, before we go, biological warfare and bioterrorism deserve a mention. Biological warfare is certainly not new: one theory suggests that the ancient Hittites deliberately set rams infested with tularemia, a devastating bacterial infection that remains deadly even today, on their enemies.514 If this were true, then it would mark the first time humans had deliberately used disease as a weapon. And when a plague-infested Tatar army attacked the city of Kaffa in the Crimea in 1346, the corpses of the dead soldiers were catapulted over the walls into the city. Plague broke out in Kaffa, and when Genoese merchants in the city decided that the coast was clear, they returned home, and brought the Black Death with them.
In 1942, the small Scottish island of Gruinard was infected with anthrax. It was part of a test to see how well the disease might work as a biological weapon against Nazi Germany. The anthrax proved so virulent – all the sheep on Gruinard were dead within days – it was decided that if it was used against Germany, millions of innocent Germans might die. Furthermore, large swathes of the German countryside might be out of bounds for years. Having such an apocalyptic wasteland in the heart of post-war Europe would, it was felt, hamper reconstruction and de-Nazification efforts, and the plan was scrapped. Pyres were lit on Gruinard for the dead sheep, and the island was left under strict quarantine for forty-five years. It was finally declared safe in 1990. (Although it had become something of a tourist attraction in the meantime, with local boat owners offering tours around – but not landing on – ‘anthrax island’.)
In 2001, just after the 9/11 attacks, anthrax spores were sent in the post to several US media companies as well as two Democratic senators. Five people died, and seventeen others were taken ill. A disaffected former government scientist was thought to be behind the attacks, although some doubt has been cast on this.515 The anthrax attacks highlight the continual security threat posed by deadly diseases stored in research facilities, and the blurred lines between bioweapons and public health. USAMRIID, which cleaned up the Reston incident in 1989, was founded as a bioweapons lab, but was rebranded to fight disease. And when the next pandemic strikes – be it SARS, bird flu, or an act of terrorism – it may well need coordinated might the size of the US military to defeat it.
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SARS, as Thomas Abraham argues, offered valuable lessons on how to fight the threat of global disease in the twenty first century:
It demonstrated the importance of early, transparent disease reporting, without which a new disease can spread rapidly across the world. It showed us that global cooperation on many levels is required to control a disease. Scientists and doctors need to share information and collaborate to find the best ways of treating a new disease and preventing its spread. Governments have to recognize that a disease i
n any one part of the world is a threat to every other part of the world, and work together to fight common threats. The test of how well these lessons have been learned will be when the next new disease emerges in the not too distant future.516
But, Abraham cautions, politicians need to get their priorities right. ‘If SARS has helped to awaken people and governments across the world, particularly in Asia, of the devastation that a new disease can cause, then at least some small good would have come out of the epidemic. But it is not apparent that this has happened.517
Andrew Nikiforuk ends Pandemonium, his study of emerging twenty first century diseases, by noting that ‘waiting for governments to do the right thing can be a hazardous enterprise and a test of patience.’518 He suggests that we can do something useful while we wait, by changing how we eat, buy and live. ‘If unrestrained global trade in all living things has created unparalleled biological mayhem, then maybe it’s time to act and think more locally… to return to personal and local virtues that question bigness and power. Maybe it’s time to learn a new canticle for creation that encourages, as Saint Francis did, humility.’519 Nikiforuk’s ‘Canticle for Local Living’ suggests buying locally grown, organic food, and in doing so, he harks back to the Hippocratic ideal that ‘food shall be our medicine’. Both Nikiforuk and Sally Davies remind us that we can all take a stand in the fight against disease, simply by washing our hands regularly and taking fewer antibiotics.520
