A review of THE COMING PLAGUE: NEWLY EMERGING DISEASES IN A WORLD OUT OF BALANCE by Laurie Garrett, published in 1994. CHAPTER 14: THIRDWORLDIZATION
Representatives of 148 nations
“We are entering a new era,” Mann had assured an international press corps. “We will make 1988 the year we turn the tide against the AIDS virus.” He looked over the largest gathering of Ministers of Health ever assembled. Of the representatives of 148 nations who now sat before him in the vast Queen Elizabeth II Conference Center in London, 117 were Ministers of Health or their country’s equivalent. Every key nation, save one, was represented by the most politically powerful health official in their land: Mann was ashamed to say that the exception was his own country. Still not wishing to give AIDS a priority status, the Reagan administration sent Dr. Robert Windom, who ranked two notches down the power ladder from the Secretary of Health and Human Services. Never in history had the majority of the world’s top health officials gathered to discuss an epidemic. Some 700 delegates and 400 journalists were also present in the London hall on this January morning in 1988 to witness the World Summit of Ministers of Health on Programs for AIDS Prevention. Mann felt that it was a coup for his program, for WHO, and for millions of powerless people with AIDS.
If it hasn’t yet emerged in your country, it will
Mann urgently hoped to drive home a message to the world’s health leadership: AIDS is spreading; if it hasn’t yet emerged in your country, it will, unless you plan now, follow our recommendations, educate your populations, and embrace condom-based programs as a prevention strategy. As of January 26, 1988, some 75,392 cases of AIDS had officially been reported to the World Health Organization. But this figure was a gross understatement of the true dimensions of the pandemic: most nations lacked genuine systems for amassing and recording such health statistics. Many nations were deliberately covering up their epidemic for political or economic reasons.
Silence, exclusion, and isolation creates a danger for us all
It was Pattern III nations that most concerned Mann. Asia, the communist bloc, the largely Muslim Middle East, and much of the Pacific region had only tiny outbreaks of AIDS. Some of these countries were truthfully reporting no cases of the disease, and several more were accurately stating that the handful of cases in their countries all involved foreigners or citizens who had acquired HIV while living overseas. In those Pattern III countries, the relative handfuls of cases were equally likely to have resulted from heterosexual, homosexual, needle, or blood exposure. Pattern III, in other words, represented the potential future of the world-wide AIDS epidemic. There was still a window of opportunity for public health action that might successfully prevent HIV from emerging in the majority of the world’s populations. “The global AIDS problem speaks eloquently of the need for communication, for sharing of information and experience, and for mutual support; AIDS shows us once again that silence, exclusion, and isolation – of individuals, groups, or nations – creates a danger for us all.” Though his words were received with thunderous applause and a standing ovation, Mann knew that many were, back home, promoting policies of mandatory quarantine of HIV-positive individuals, escalated repression against homosexuals, even public execution of AIDS sufferers. Mann knew their modi operandi were less those of the laboratory or hospital than those of the maneuvering, backstabbing, and power plays seen in parliaments and presidential circles.
Denial was all too easy a response to AIDS
HIV surfaced almost simultaneously on three continents and was quickly a feature on the health horizons of at least twenty different nations. Not only was there no sign that AIDS might burn out on its own; scientists could see no evidence of the famous bell-shaped curve of infection and disease. Far from causing immediate disease and death, HIV was a slow burner that hid deep inside people’s lymph nodes, often for over a decade, before producing detectable infections. As a result, a society could already have thousands of infected citizens before any sound of alarm was rung, and even when the first AIDS cases appeared, their numbers were small enough to allow governments to feel comfortable about ignoring the seemingly trifling problem. Denial was all too easy a response to AIDS. Further more, no facile measures could be taken by a government to bring AIDS to a halt. Unlike Ebola, Marburg, drug resistant cerebral malaria, or Lassa, HIV hit specific social targets. It was a sexual disease. It was associated with homosexuality, promiscuity, and drug abuse. It pitted public health against organized religion and the moral pillars of society. “Discrimination simply drives AIDS underground. If you drive it underground, you guarantee its spread.”
Marginalization could be a risk factor every bit as crucial as a contaminated syringe
In the 1960s, René Dubos wrote extensively about the special vulnerability to the microbes among people who lived lives of poverty. History demonstrated repeatedly that, with rare exceptions, the microbes exploited the weak points of economically bereft lives: chronic malnutrition, prostitution, alcoholism, dense housing, poor hygiene, and egregious working conditions. Carballo and his colleagues recognized that there was more to microbial vulnerability than the social-class arguments put forward by Dubos. When information was the key to self-protection, there were gradations of Homo sapiens vulnerability that could be rooted in economic class, but could also stem from social alienation. People who were treated as outcasts from the dominant culture in which they lived could be denied vital life-protecting information or public health tools. If the larger society reviled a particular subgroup, its marginalization could be a risk factor every bit as crucial as a contaminated syringe. Carballo saw a confluence of social factors at play in the emergence of HIV in societies: marginalization, social alienation, poverty, and discrimination. In his mind, they united to form a social bridge across which HIV traveled into one society after another.
The pandemic spread relentlessly
On January 28, 1988, the London Summit endorsed the GPA’s fifteen point declaration that called for openness and candor between governments and scientists, opposed AIDS-related discrimination, gave primacy to national education programs as a means to limit the spread of AIDS, and reaffirmed the GPA’s role in international leadership. But even as they smiled for the cameras and signed the declaration, the seeds of failure were being sown. Despite the efforts of the GPA, the pandemic spread relentlessly, always emerging first in communities that were on the outer periphery of societies’ margins.