Science and charity by Pablo Picasso depicting tuberculosis disease
May 8, 1980 was an extraordinary date in the history of mankind. In the framework of the thirty-third World Health Assembly, the WHO officially declared that “the world and all its inhabitants have been rid of smallpox.” The advancement of science, perseverance in a vaccination program and international collaboration had managed to eradicate a disease that “had devastated human beings for more than 3,000 years and that, in the 20th century alone, had killed 300 millions of people”.
It was the first time that medicine had managed to eradicate a deadly disease and many thought, with too much optimism, that this milestone was only the first step and that other deadly scourges would follow. However, more than 40 years have passed since that day in May and smallpox remains the only disease that we have managed to completely eradicate.
Obviously we cannot deny that the current medical landscape has improved. Life expectancy continues to rise, especially due to the drop in infant mortality, hygienic conditions are much better and, even so, we continue to witness medical scenarios more typical of the Victorian era than of the 21st century. How is it possible that some diseases, like measles or leprosy, are making a comeback despite the fact that we have a vaccine or an effective treatment?
The question is complex and does not have a single answer. A recent article in Politico analyzes the main causes and highlights key factors such as falling childhood vaccination rates, changes in behavior and eating habits, bacterial resistance to our antibiotics and, of course, the global warming they are creating “a perfect storm in which dangerous diseases, thought to be relegated to bygone eras, have returned to countries that previously had all but eliminated them.”
Doctor Edward Jenner and the first vaccination in James Phipps, an eight-year-old boy on May 14, 1796 | Painting by Ernest Board, Wikipedia CC
Measles outbreaks in Europe
The return of measles is the most inexplicable event of all those listed in this article simply because we have had a safe and highly effective vaccine for decades. A single dose offers an efficacy of around 93% and with two doses it rises to 97%. As with smallpox, having such an effective vaccine made many think that measles would be the next disease to disappear.
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However, measles is a highly contagious airborne virus and requires a very high percentage of the population to be vaccinated to stop its advance… and that has not happened. In fact, vaccination rates are declining and this has important consequences: “in recent years, the United Kingdom, Greece, the Czech Republic and Albania have lost his measles-free statusand in February 2023 , already registered 900 cases of measles in the European region, surpassing the total number of 2022.
Just a week ago the UK Health Security Agency launched an alert warning that London could see tens of thousands of measles cases due to low vaccination levels. These UK measles, mumps and rubella (MMR) vaccination rates are at their lowest level in a decade, with around one in ten children unprotected by the time they start primary school.
Leprosy could once again be endemic in Florida
Leprosy is a serious skin disease caused by a bacterium (Mycobacterium leprae) that mainly affects the skin, peripheral nerves, the mucosa of the upper respiratory tract, and the eyes. Its name reminds us of biblical passages and sordid places belonging to bygone eras that should already be forgotten. In the year 2000 the World Health Organization eliminated leprosy as a public health problem since we managed to reduce its prevalence rate to less than one case per 10,000 inhabitants and, nevertheless, in recent years seems to come back strong surprising with important outbreaks in developed countries that have the resources to deal with it.
Saint Francis embracing a leper, Museo del Prado
In a recent report of the famous CDC (US Centers for Disease Control) warns that Florida has witnessed a high incidence of leprosy cases that contribute to the evidence that “leprosy has become endemic in the southeastern United States ”. The CDC itself admits that the number of cases has doubled in the last decade in those states due to poor management by the health authorities, especially considering that leprosy has a slow but effective treatment. In the past, lepers were sent to isolated places to keep them in quarantine away from the population, but today leprosy is a curable disease. A cocktail of three drugs (dapsone, rifampicin and clofazimine) is used for several months with a treatment that manages to kill the pathogen and cure the patient.
Syphilis spreads in Europe
Syphilis is a sexually transmitted disease caused by a bacterium (Treponema pallidum). Historically it has caused millions of deaths but, currently, can be treated with a single penicillin injection if caught early. If not properly treated, the disease progresses in stages and can seriously damage the heart, brain, or other vital organs.
It is said that, at the end of the 18th century, one in five young Londoners had syphilis, but fortunately the advent of the first antibiotics managed to reduce infection rates. In our days, this ancient disease seems to be making a comeback as the annual epidemiological survey The latest from the European Center for Disease Prevention and Control shows that cases in the European Union are on an upward trajectory. The UK Health Security Agency is recording massive spikes again with 8,692 cases in 2022, the highest annual number since 1948.
The disease of kings is now everyone’s
Gout was traditionally seen as a disease of the rich, nobles, and kings, a painful toll to pay for medieval feasts of red meat, shellfish, and alcohol. In our days the disease of kings has taken a radical turn and affects the less affluent classes. Cases are increasing worldwide but the United States and Canada stand out with the highest increases in gout prevalence estimates between 1990 and 2017.
Gout is no longer the disease of kings | image “Burlesque Feast” by the Flemish painter Jan Mandijn.
If we take into account that the risk factors for gout are obesity, high blood pressure, diabetes, poor diet or alcohol consumption, it does not seem that this disease is going to disappear. On the contrary, reports indicate that is increasing.
Global warming favors the spread of malaria
Nowadays we associate malaria with tropical countries and regions, with low income and poor hygienic conditions, however in the 19th century it was common to find thousands of cases in France, Italy or England. Malaria was curbed in Europe by a powerful postwar program that included insecticide spraying, swamp drainage, and drug therapy. Global warming is playing against us and the mosquitoes of the genus Anopheles that act as vectors of malaria are finding shelter in habitats increasingly to the north.
Tuberculosis is still there… and is even growing
In a report published last year, the World Health Organization warned that “tuberculosis spreads around the world again”. For the first time in two decades, infections increased globally and one of the direct causes of this growth was the COVID pandemic.
In short, we live in a world full of paradoxes. As medicine and treatments advance like never before, we are witnessing an increase in diseases that could be eradicated. We have effective and safe vaccines but they do not reach everyone or are opposed by ridiculous anti-vaccination groups that affect the rest of the population. In economics it is often said that “past successes do not guarantee future successes” and perhaps we should apply that saying to other aspects of our society. Having made important advances in health, medicine or pharmacology does not assure us that, if we neglect ourselves, old problems that we already thought were solved will reappear.
More interesting articles and news about Medicine on Yahoo:
Scientific references and more information:
Ashleigh Furlong “5 Victorian-era diseases that are back in the West” Politico.eu
European Centre for Disease Prevention and Control “Syphilis – Annual Epidemiological Report”
Centers for disease control and prevention CDC “Locally Acquired Malaria Cases Identified in the United States”
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