A review of THE COMING PLAGUE: NEWLY EMERGING DISEASES IN A WORLD OUT OF BALANCE by Laurie Garrett, published in 1994. CHAPTER 7: N’ZARA: LASSA, EBOLA, AND THE DEVELOPING WORLD’S ECONOMIC AND SOCIAL POLICIES
A startling increase in their incidence over the last decade
Similar dam-related epidemics of Rift Valley fever would occur during the 1980s in Mauritania, Senegal, and Madagascar, and in the 1990s the disease would revisit Aswan, causing a severe epidemic. By the mid-1980s major donor groups, particularly the World Bank, instructed applicants for major water project funding to submit disease impact studies as part of their project proposal. By 1980 the World Bank would conclude that the worldwide malaria eradication campaign had failed, noting that cases of the disease had increased an astonishing 230% on the Indian subcontinent during the period 1972-76. Most other vector-borne diseases, just a decade earlier considered easy to eliminate, had experienced a “startling increase in their incidence over the last decade.” Sleeping sickness, bilharzia, river blindness, and Chagas’ disease were all increasing in frequency, often in the very countries that had been recipients over the period of billions of donated and loaned U.S. dollars.
Spend more on primary health care and disease prevention
By the end of the 1970s the World Bank’s solution was to urge poor nations to spend more on primary health care and disease prevention. Reaching U.S. health care expenditure levels, even as a function of per capita annual spending, would, however, represent an extraordinary feat for most of the world’s poor nations. In 1976 in the United States there was a 1:600 ratio of physicians to the general population; virtually 100% of drinking water supplies were considered free from infectious disease; people consumed, on average, 133% of their minimum caloric need every day; 99% of adults were literate; 3.3% of the federal GNP was directed toward health care spending for a per capita spending rate of $259. Tanzania had one physician for every 18,490 citizens; safe drinking water was available to less than 40% of the population; the average citizen consumed only 86% of the minimum caloric need; 34% of the population was illiterate; and the government spent 1.9% of its GNP on health care for a total of $3 annually per capita. Between 1967 and 1976, the Tanzanian village health care campaigns increased the numbers of maternal/child health clinics by 610%, rural paramedics by 470%, and built 110 new medical facilities (for a total of 152 clinic structures nationwide by 1976. Life expectancy over that time increased seven years, reaching 47 (compared to 70 in Europe in 1976). Infant mortality also showed modest improvement, decreasing to 152:1,000 babies, compared to a 1967 level of 161:1,000 (with 1976 European infant mortality at 20:1,000).
Problems were particularly acute in Africa because of its severe political and military instability
Though problems plagued all the poor nations on the planet, they were particularly acute in Africa because of its severe political and military instability. Nowhere else in the world were governments so recently freed from centuries of European colonialism. The Portuguese colonies of Guinea-Bissau, Angola, Mozambique, and Cape Verde only gained independence in the mid-1970’s, after more than a decade of bloody civil war. In the southern part of the continent, warfare and instability would persist until the fates of Rhodesia, South Africa, Angola, and Southwest Africa were decided. Mobutu brutally smashed all dissent within Zaire. Self-appointed Emperor Bokassa ruled the Central African Republic with such brutality that he would be overthrown by French paratroopers. Junior elements of the military violently seized power in Ghana. Civil unrest due to religious and tribal disputes raged through Sudan, Morocco, Ethiopia, Mauritania, Angola, and Rwanda. Much of the warfare stemmed from the artificial national boundaries created by colonial powers in the 17th and 18th centuries, dividing ancient tribal lands, extended families, and traditional power structures.
Hoping to align African governments with either the United States, the U.S.S.R., or China
The superpowers, as well as the People’s Republic of China, sought to manipulate these seemingly endless battles, hoping to align African governments with either the United States, the U.S.S.R., or China. As a result, obscene amounts of money were spent on the military and police forces of impoverished countries, squandered by dictators who made ‘gifts’ to their nation’s power elites in exchange for support, wired to the bank accounts of arms dealers worldwide.
Microbes exploited the war-ravaged ecologies, surging into periodic epidemics
Between 1975 and 1980, Uganda, its entire health infrastructure devastated, experienced epidemics of malaria, leprosy, tuberculosis, cholera, visceral leishmaniasis (kala-azar), and virtually every vector-borne ailment known to the continent. A French team found evidence of more exotic diseases as well, when they took blood surveys of villagers in western Uganda. Ebola, Marburg, Lassa, West Nile fever, Crimean-Congo hemorrhagic fever, and Chikungunya were among the viruses found in the blood of the region’s populace. Between 1971 and 1977, Uganda had its worst measles epidemic in over forty years, with high death rates among children. So great was the country’s chaos that no agency kept count of the death toll. Routine vaccination for such diseases as whooping cough and tetanus came to a halt, and the incidence of these diseases rose dramatically. Starving, sick refugees poured by the tens of thousands across borders to Zaire and Sudan, taking their diseases with them. Makerere University, which had been the primary medical training center for East Africa’s doctors, was looted right down to its electrical sockets and bathroom tiles. Rumors of strange disease outbreaks were rampant, but there was nobody left to investigate these claims. Such tragic events, with the resultant epidemics and health crises, were mirrored all over the world. And the microbes exploited the war-ravaged ecologies, surging into periodic epidemics. The World Health Organization, with a staff of only 1,300 people and a budget smaller than that spent on street cleaning by the city of New York, tried to combat such seemingly intractable public health problems with donated vaccines, technical assistance, and policy statements.