Chasing Cures for Deadly Scourges, and Getting in Our Own Way - The New York Times

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infectious disease, disease eradication, CIA, Trust, public health

> https://www.nytimes.com/2017/05/14/us/retro-report-disease-eradication.html?_r=0 <https://www.nytimes.com/2017/05/14/us/retro-report-disease-eradication.html?_r=0>
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> Chasing Cures for Deadly Scourges, and Getting in Our Own Way
> By CLYDE HABERMAN <https://www.nytimes.com/by/clyde-haberman>MAY 14, 2017
> What do the C.I.A. and Nigerian imams have to do with the fight to end polio? Retro Report examines how the worlds of politics and public health can collide.
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> By RETRO REPORT on May 14, 2017. Photo by Irfan/Xinhua, via Alamy Live News. Watch in Times Video » <https://www.nytimes.com/video/us/politics/100000005091538/politics-and-plagues.html?action=click&contentCollection=us&module=lede&region=caption&pgtype=article>
> Most Americans, it seems safe to say, derived a healthy measure of satisfaction from the news in 2011 that a team of Navy SEALs had killed Osama bin Laden <http://www.nytimes.com/2011/05/02/world/asia/osama-bin-laden-is-killed.html>. The cheers faded soon enough, however, for one group: public health professionals. That’s because killing the archterrorist had the unintended consequence of undermining their campaign to finally wipe polio <http://health.nytimes.com/health/guides/disease/poliomyelitis/overview.html?inline=nyt-classifier> off the face of the earth.
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> This offering from Retro Report <https://www.nytimes.com/column/retro-report> recalls how the damage was acute for a while in Pakistan, where Bin Laden had holed up in the northern town of Abbottabad. To confirm his presence there, American intelligence agents took advantage of an anti-hepatitis <http://health.nytimes.com/health/guides/disease/hepatitis/overview.html?inline=nyt-classifier> program being run by a Pakistani doctor, Shakil Afridi. As part of this collaboration, Dr. Afridi collected DNA samples in Abbottabad and tried, without luck, to do so at the compound where Bin Laden was hiding. The Americans satisfied themselves through other means that they had the right target.
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> But they also inadvertently delivered a serious blow to the anti-polio drive in Pakistan, which some imams had already denounced as a plot to sterilize Muslims. With suspicions about their true intentions running high, vaccinators suffered. Eventually, the extreme distrust receded, but the damage had been done. It underlined the frustrations often endured by public health specialists in their attempts to conquer certain infectious diseases <http://health.nytimes.com/health/guides/specialtopic/travelers-guide-to-avoiding-infectious-diseases/overview.html?inline=nyt-classifier> once and for all. Just when they seem within reach of the goal line, events have a way of stopping them short.
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> Retro Report, a series of video documentaries exploring major news stories of the past and their lasting repercussions, examines this issue through the prism of one of humankind’s greatest achievements: the eradication of smallpox <https://timesmachine.nytimes.com/timesmachine/1980/05/08/111240784.html?pageNumber=21> four decades ago. That awe-inspiring triumph has long begged to be duplicated. Yet it stands alone. Smallpox <http://health.nytimes.com/health/guides/disease/smallpox/overview.html?inline=nyt-classifier> remains the only infectious disease to have been globally extinguished.
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> As recently as the 1950s, it had struck an estimated 50 million people a year, killing two million of them and permanently scarring millions more. But under the guidance of the World Health Organization, an eradication campaign greatly picked up steam in the 1960s.
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> Larry Brilliant was part of the effort. An American doctor, he observed Rahima Banu, a 2-year-old Bangladeshi girl who in 1975 became the last person to have been infected with Variola major, the most common and deadliest smallpox-causing virus. Dr. Brilliant recalled for Retro Report a pivotal moment “when her scabs fell off, and she coughed out whatever viruses were still in her lungs, and they landed on the ground in Bangladesh and the sun baked them.” It was the end of that strain of the disease.
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> On Oct. 26, 1979, W.H.O. declared smallpox to have been banished for good, a pronouncement formally affirmed the following May 8 by its decision-making body, the World Health Assembly.
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> What produced that victory? Nothing short of a worldwide spirit of cooperation. Halfdan Mahler <http://www.nytimes.com/2016/12/15/science/halfdan-mahler-who-director-general-dies.html>, a Danish doctor who was then director general of W.H.O., described it as “reaffirmation of the achievement possible when peoples everywhere band together, without regard to politics or national glory, in pursuit of a common goal.”
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> It helped that smallpox could be readily contained if a strong effort were made. Face-to-face contact was required to spread it, and surviving patients acquired permanent immunity. Also, the smallpox vaccine was inexpensive, with only a single injection required.
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> Comparable attempts to vanquish other diseases have repeatedly run into obstacles, many of them human-made. Local wars, corruption, poor transportation networks, wariness of outsiders, religious fears of various stripes — all have contributed to the snatching of defeat from the jaws of victory.
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> The polio campaign is a prime example, as evidenced by the backlash after the Bin Laden killing. As recently as the 1980s, the disease paralyzed an estimated 350,000 people a year in 125 countries. Today it is corralled in just three nations: Afghanistan, Nigeria and Pakistan. Last year, W.H.O. reports, the worldwide total was a mere 32 cases <http://www.who.int/mediacentre/factsheets/fs114/en/>. Still, getting to zero has proved elusive.
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> Much the same may be said about other infectious diseases that are candidates for eradication, notably measles <http://health.nytimes.com/health/guides/disease/measles/overview.html?inline=nyt-classifier> and rubella <http://health.nytimes.com/health/guides/disease/rubella/overview.html?inline=nyt-classifier>. People keep getting in the way. “Lack of sufficient political will is probably the greatest impediment to global measles eradication,” the National Center for Biotechnology Information <https://www.ncbi.nlm.nih.gov/books/NBK98117/> said in 2002.
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> In this country, resistance to vaccinating children has emerged even among some who are well educated and affluent. But inaction can have consequences, like an outbreak of measles that struck Disneyland <https://www.nytimes.com/2015/01/22/us/measles-cases-linked-to-disneyland-rise-and-debate-over-vaccinations-intensifies.html> in Southern California two years ago and spread across the state and beyond.
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> Some Somali immigrants in Minnesota <https://www.washingtonpost.com/national/health-science/anti-vaccine-activists-spark-a-states-worst-measles-outbreak-in-decades/2017/05/04/a1fac952-2f39-11e7-9dec-764dc781686f_story.html?utm_term=.2871ff73152d>, having bought into the widely discredited theory that the vaccine causes autism <http://health.nytimes.com/health/guides/disease/autism/overview.html?inline=nyt-classifier>, refused to have their children inoculated against measles, mumps <http://health.nytimes.com/health/guides/disease/mumps/overview.html?inline=nyt-classifier> and rubella. The result has been Minnesota’s most severe flare-up of measles in several decades. Likewise, vaccine skepticism has taken a toll among Europeans, notably in Romania and Italy, both of which are experiencing an explosion of measles cases.
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> An outbreak of Ebola that killed more than 11,000 people in West Africa in 2014 illustrated the good that can be done if political will does exist. While Sierra Leone, Liberia and Guinea were hit hard, Nigeria emerged relatively unscathed <https://www.theguardian.com/global-development-professionals-network/2014/oct/31/ebola-nigeria-state-public-sector-calestous-juma>. That’s because the authorities there adopted an aggressive approach in cooperation with agencies like W.H.O., Doctors Without Borders, Unicef and the United States Centers for Disease Control and Prevention.
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> Health professionals intensively tracked anyone who might have had contact with infected patients, starting with the first known case in that country, a Liberian-American who had flown into Lagos. Nearly 900 such people were identified, and each was visited an average of 20 times. Suspected cases were thus isolated. As a result, the Nigerian death toll from Ebola was held to single digits.
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> New threats keep coming. The C.D.C. has monitored more than 300 outbreaks of various diseases in 160 countries. Infectious illnesses are believed to cause 15 percent of all deaths worldwide.
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> In President Trump, the United States may well have its most prominent germaphobe, but his commitment to public health seems thin. His proposed budget for the current fiscal year included sharp reductions in domestic spending on medical research, and in aid for public health projects overseas. Congress was unimpressed. It not only rejected most of his desired cuts, it also set aside an extra $2 billion for the National Institutes of Health. There is no guarantee, though, that the president won’t try slicing the research budget yet again in 2018.
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> For his part, Dr. Brilliant emphasizes that the key to beating back an infectious disease is “early detection, early response.” He utters the phrase as if it is a mantra. But in a strife-prone world, translating those words into action is as big a challenge as ever.