|SocialismToday Socialist Party magazine|
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