Asia’s viral resistance marketing

I’m reading , a book by former Times Asia Managing Editor Karl Taro Greenfeld that tries to piece together the story of how Severe Acute Respiratory Syndrome (SARS), the 21st century’s first documented new disease, almost became a global pandemic of catastrophic proportions.

Today we tend to think of SARS as a historical outlier, a freak genetic accident that got a few people sick in Hong Kong, China, and Toronto. It was a disease that both struck and disappeared within an eight month period between November 2002 and June 2003. Case closed , right?

We tend to forget that the SARS was extremely contagious, extremely hard to detect due to the fact that it was caused by a virus, and that the case-fatality rate was nearly 10% on average, with older people being more severely impacted. By comparison it was very similar the Spanish Flu which infected an estimated 500 million people and killed, or 3% of the world’s population, between 1918 and 1920.

In China Syndrome, Karl Taro Greenfeld makes clear his views that the Chinese government was no help in curtailing the disease. To be clear, China’s health personnel were worried about the disease from the outset, but it was the health system’s subservience to the state’s political considerations that prevented the health personnel from speaking out. Health information about disease outbreaks is categorized as a state secret because of the potential that health scares have to destabilize governments. If a health professional releases any information to a domestic journalist or an international organization like the WHO without explicit permission,he risks being tried for treason, which holds a mandatory penalty of death if convicted.

If it hadn’t been for the heroic efforts of scientists, health personnel, government health ministries and public health experts from around the world, SARS could have very well spiraled out of control.

The truth of the matter is that SARS is no historical outlier. It is the product of a century in which the developing world is urbanizing and getting richer, where some 6.69 billion people consume each year close to 300 million tons of animal, and where the supply of healthcare services is not keeping up with demand. China’s health surveillance system is not much better than it was in 2003, and other countries in Southeast Asia, where population density is greatest, are in worse shape. India’s health surveillance apparatus had a pitiful showing last summer when there were great delays in the reporting of swine flu cases.  Vietnam barely has enough doctors to staff its hospitals. Myanmar… well, it’s in the middle of the avian flu red zone and I’m no sure that people there have ever seen a modern hospital room.

This is important because pathogens thrive in dense populations, and in situations where sanitation standards are low and contact between many species of animals and humans is high. And, with how quickly today’s pathogens can travel across oceans it is critical that all nations have a strong surveillance network in place to observe the bugs that are infecting its population.

Moreover, where healthcare system’s are underregulated there is overuse of antibiotics and antivirals. Currently, it is quite easy and in some places quite legal to obtain common antibiotics in most Southeast Asian countries. This encourages develop drug resistant pathogens. Moreover, when there are dense populations of animals living in proximity to humans, where sanitation and species containment standards are low, pathogens can gain further resistance to drugs by mutating within various species populations and then crossing back over into the human population.

A good friend shared this Lancet Article, Incidence of adamantane resistance among influenza A (H3N2) viruses isolated worldwide from 1994 to 2005: a cause for concern, which shows that when one region starts breeding more resistant viruses, then the global incidence of resistant viruses goes up.  I’ve added in where some estimate the resistance frequency of H3N2 viruses, in America, stands today.

Certainly food for thought when trying to formulate good reasons for why we should be advocating for greater openness in China and, indeed, the rest of Southeast Asia. In the new world, there are few health matters that can be considered internal issues.