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
The world’s biggest health lender
The World Bank didn’t begin to view health care as a specific part of its mission until 1975, when its Health Sector successfully argued that trickle-down modernization would never adequately remedy the acute needs of the poorest of the poor. Between 1975 and 1978 the World Bank gave loans or provided technical assistance for seventy health-related projects in forty-four countries, ending up the world’s biggest health lender. During that three-year period, the World Bank loaned poor countries $400 million for primary health care facilities and mosquito control; $160 million for family planning and nutrition projects; and $3.9 billion for water sanitation efforts. At the close of the decade, the World Bank again assessed its efforts, deciding to shift policy further toward provision of financing the development of primary health care infrastructures for, among other things, “promotion of proper nutrition, provision of maternal and child health care, including family planning, prevention and control of endemic and epidemic diseases.”
One out of every four people on earth suffered diseases due to roundworms
As the twentieth century drew to a close, the majority of the world’s population still suffered and died from diseases due to unclean water. During the 1970s one out of every four people on earth suffered diseases due to roundworms, acquired from polluted waters or foods. A World Bank study found that 85% of the residents of Java had hookworm. Some 1.7 billion people annually suffered some additional parasitic infection acquired from polluted water, according to WHO. Sometimes a major water development project could directly increase the incidence of disease by changing the local ecology in ways that were advantageous to the microbes. The most often cited example of this was the Aswan High Dam, with its apparent association with an increased incidence of schistosomiasis. At no stage of the 1950s planning or construction of the dam was the ecology of human disease taken into consideration.
Rift Valley fever epidemics occurred throughout Africa
There was an additional reason to challenge the wisdom of building massive water projects without first assessing their potential health impact. Rift Valley fever epidemics occurred throughout Africa wherever European livestock species, which had no immunity to the virus, were introduced. In nonimmune animals its impact could be devastating: intravenous injections of minute quantities of the virus into laboratory mice produced death within less than six hours in 100% of the test animals. In 1977, six years after completion of the Aswan Dam, it was proved that a widespread epidemic in the Aswan area was due to Rift Valley fever with over 200,000 people ill, 598 died and livestock losses so great that the country experienced severe meat shortages. Scientists concluded that the epidemic began as an isolated outbreak among livestock in northern Sudan, but spread – either via human migration or wind-carried mosquitoes – to Aswan. Once there, the infected mosquitoes thrived in the 800,000 hectares of dam-created floodlands. The disease had never previously been seen in Egypt.