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We need to worry about Africa…..

In this country, and I am sure we are not alone , media frenzy over COVID19 has been quite extraordinary. The only comparison I can think of in terms of daily coverage is the Falklands War in 1982 when people were glued to their TVs to hear what had happened each day . 

I can understand this, it is natural and you could say it is necessary. Perhaps for the sake of transparency and accountability . In theory. 

Not that I believe there has been full transparency , you can pretty much predict that if the T word is used then  the dissembling is about to begin . Nor  for that matter do I believe that the Press has been that good at holding politicians of any administration to account . England appears to be entering a phase  of what seems to be exuberant release from total lockdown and we will need to see what impact, if any that has on what we all now know is the R rate . 

For some this degree of media attention has been helpful, others have been desensitised by it . I have friends who now only watch the TV news once a week because they find it too depressing . One described this as like watching a slow moving car crash, but one where the impact point seems never to end . 

Early in this period of pandemic there was a lot of discussion about around temperature and if the summer months would see a drop in numbers infected. Some people pointed to  low infection rates in Africa as a point of logic  to justify this theory. The reality is that is a poor example to quote; the disease was late arriving there because there are few access points for international travel and thus exposure. Africa’s demographic is such that there are far more young people and while they are less likely to die from this disease we also now know it seems to affect people of colour disproportionately. And we don’t know why . We also know that in the UK it impacts more on those who are poor and Africa has many poor communities. So the picture in Africa is; complex ,confusing and unreliable as a point of reference . 

There are other issues in Africa too. Overall, health systems  have improved out of all proportion, usually through the hard and inspiring work and prioritisation  of their own governments rather than any external support . But some countries  are still in a dire place. COVID 19 in South Sudan for instance is hampered by the fact that they have virtually no respirators, and while the position on ICU beds in South Africa is remarkably good, its neighbours and much of the rest of the continent are nowhere near those standards . 

We heard yesterday that with the identification of one infected person, Lesotho became the last African country to have COVID 19. 

But Africa has other challenges .

We know a lot about: SARS, MERS, Ebola and Zika. We know, that spurred on by media coverage of those diseases, when pressed and  inspired , the World can act fast and have a major impact in controlling them. We know also that as a species we have the capacity to eradicate a disease, Smallpox,  but we are not consistent in focussing on other diseases or repeating that. 

A while back it was fashionable to talk about the 10/90 split, the fact that 10% of research was dedicated to 90% of the world’s disease burden which is primarily in the poorest countries in the world. Diseases such as: leishmaniasis, lymphatic filariasis ,Chagas disease, leprosy, guinea worm, TB, cysticercosis,  schistosomiasis form a legion of endemic diseases that do not, usually, affect us, in the North and the West of this planet. I ran this list past a friend , he recognised 2 , TB and Chagas disease, the former because his grandad had it, the latter because the name sticks in the memory . 

Some diseases that disproportionately  affect Africa and other developing countries have been looked upon for some considerable time now as candidates for eradication, these include;  measles, mumps, rubella, lymphatic filariasis and Cysticercosis .

I know a bit about the last because it was a disease that in the porcine part of its development cycle formed an element of the work plan of an organisation I used to run . 

We were playing our part in extending the work of a brilliant Professor in Australia who had developed a vaccine for pigs.  As a non scientist my exposure to that disease was eye opening and depressing . 

May I suggest you finish your lunch before reading the next bit ?

Cysticercosis is caused by the larvae of the parasite Taenia Solium. 

Now let’s have another go at that last  sentence, move past the Latin into our world. 

We are talking tapeworm .  This disease is associated with places where pigs roam freely and consume human faeces . Pigs pick up the tapeworm eggs from the faeces,  people eat raw or undercooked pork and swallow the eggs, the eggs pass through the stomach and attach to the walls of the small intestine as cysts that then can develop into adult tapeworms . The outcome is that they can transmit to the muscles, rarely to the eyes and sometimes to the brain or spinal cord which can in some cases be fatal.Usually the disease can be treated with anti parasitic and anti inflammatory drugs,  rarely surgery and for some, needs no treatment at all. Sometimes there are no symptoms 

Before I put you off pork forever, I need to say I have just eaten a bacon roll! This disease is not a threat in this country where sanitary standards apply and where we cook our food well. 

But if you look closely there is another story . I mentioned a vaccine for pigs, I mentioned treatment. You may have noticed that the main cause of the spread of the disease is through pigs eating human faeces and this implies that the most basic of sanitary provision that you and I take for granted, is  missing . You may think this is  something; evidently , easily, obviously, we could do something about ?  So why in 2015 did WHO identify that  there could  be between 2.53 and 8.30 million people affected by this and why is there such a disparity in the figures?

The latter is because the cerebral version of the disease mimics epilepsy . If you can identify an area where they eat pork and there is higher than average incidence of ‘epilepsy’ then you are probably seeing this disease. Countries’ politicians  don’t like to admit that because to do so would be to admit to poor sanitary standards, so reporting is skewed. 

But Cysticercosis  cannot be passed from human to human ( unless you eat people of course, which remains , ill advised.) 

So perhaps we should look at another disease which  like COVID 19 is passed human to human – say – TB. 

Figures for neglected diseases are rarely up to date and these are a few years old but WHO then were predicting that 10.4 million cases could be expected with 1.5 million deaths ANNUALLY. 

Compare that with COVID19.

In 2010 I  had a bit of an  argument with the UN Special Envoy for Swine Flu about ‘priorities.’  Why,  other than the fact that Swine flu was affecting the West and the North, were we intending to invest countless billions more in that than in TB where there was a known and cheap  cure ? 90% of TB cases can be cured for an average cost of between $200 and $500, in treatment . 

Two wrongs don’t make a  right, a death from either disease is unacceptable, but all the same . 

There is also  a contradiction here.  It is assessed that if we put our minds to it we could eradicate TB by 2030 but equally we can extrapolate from the statistics above that since I had my little discussion in 2010 , 15 million people in , by and large the poorest countries in the world,  have died from a disease where we have the cure.

An obscenity ? It is if we know about it and do nothing. 

Which brings me to the title of this piece. We should be worried about Africa, but also about other places where we see disproportionate disease burdens associated with grinding poverty that are somehow just over the horizon and away from the media glare.  

We also now  have a choice in why we should be worried. COVID 19 has made that clear. 

We are, graphically reminded of the importance of human life and the personal impact of loss. Nicola Sturgeon daily speaks for other political leaders  in making the point that we are not just seeing statistics here, we are seeing the tragic loss of people who were important as individuals. A tidal wave of; love, intellect, care, potential and uniqueness passing . Each individual counts. 

Wherever we are .

Just over a hundred years ago another unknown disease emerged, Spanish Flu. First reported in Camp Funston in Fort Riley, Kansas, it was “ Spanish “ not because it emerged from there but because  as a neutral country with a free press, Spain reported it significantly when it affected them. The major warring countries didn’t for their army’s morale reasons. It is suggested more USA troops died from this, than from conflict . We have never reliably pinned down where it emerged from, theories still emerge .

For the purpose of future prevention, working  out how a pandemic spreads is important, political posturing during a pandemic to allocate blame on where it spreads from is puerile. The fact is that infectious disease know no borders. 

So perhaps one of the reasons we should be worried  about Africa, is hopefully  to appeal to the basic tenets of human dignity and species solidarity. Lives ,wherever they are, matter. 

But if they are so distant  that it is beyond our capacity to see them as more than statistics then there is another reason  that we are now much  more familiar with . Africa, Asia, China, Europe, South America , wherever we find poverty and poor sanitary and health standards, there is the potential for a disease pool which released and matched with the propensity for international travel, can infect us ,whoever we are , wherever we are . 

I hope that in the understandable and necessary preoccupation with what is immediately affecting us we do not forget others. 

Will this sudden and shocking acquaintance with the fragile transience of our own mortality, make us less or more conscious of the mortality and lost potential of distant others? 

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  1. I’ve been thinking – about the refugee camps, and about countries which don’t have the resources which we, as a more affluent country, have, for dealing with this virus.
    I was thinking – it could sweep through the refugee camps, unhindered. I was thinking about it, and realizing there is nothing whatsoever I can do about it.

    There are some nations which are partly affluent – some folk are very rich, and some are very poor – what happens there? Diseases don’t respect walls or wealth, Victorian Britain found that.

    I risk rambling on – but – what about the others? The ones who aren’t in places with resources? However questionable parts of Britain are, as places to be right now, still, most of us can, if we choose, individually, detach ourselves from those around us.

    What about those who can’t ? The refugee camps come to mind, again and again. I don’t watch much of the news – I watch the beginning of the 6 o’clock news to see the main things, then turn it off. I can only take so much of that stuff, and a lot of it is pointless repetition. But – I don’t remember seeing anything about refugee camps. Even if the media did present folk with what is happening in these places – what could be done? Is anything being done?

    I think too much.

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