TCS Daily

The Healthy Society
and Its Enemies

By Roger Bate - April 28, 2003 12:00 AM

China has finally admitted the scale of its problem with the pneumonia-like SARS (Severe Acute Respiratory Syndrome). Denial has been replaced by a crack-down, when on Friday Beijing officials ordered 4,000 people to stay at home and they closed a hospital to prevent the spread of the disease. And on Sunday the officials shut down what the official news agency called "all entertainment businesses involving mass public gatherings" - cinemas, theatres, and internet cafes as well as schools.

Nearly 300 people worldwide have now died from this deadly threat and Asian health officials were meeting over the weekend in Malaysia to discuss how to prevent its proliferation.

While resolving the immediate threat must be the top priority (and it is a threat that soon may spread from Toronto to the United States), the long-term problem is not simply one of Chinese cover-ups, but of misinformation in the health sector. This lack of openness, both oriental and occidental, borders on criminal behaviour, especially with diseases like AIDS, which kill millions.

If any disease is associated most with America it is AIDS. Much of the research into the disease is American and its first major cases were noticed in San Francisco. Thankfully AIDS has been brought under control in America and Europe but it is killing millions in Africa. Recently in "False Truths" I pointed out that the assumption that African AIDS was primarily caused by unprotected sexual intercourse was thrown into doubt when research showed that its major cause was probably the sharing, or other misuse, of needles, and from blood transfusions. The AIDS establishment, which had been claiming that sex was the main cause of AIDS, and had embarked on a billion-dollar finger-wagging sex education campaign, was embarrassed. But now a new report claims, once again, that sex is the main cause.

The resolution of this debate is critical because if it is unearthed that the AIDS community misled the media in the late 1980s and early 1990s, and is once again trying to obfuscate the truth, it will show that it cannot be trusted much more than China's medical community.

Researchers, led by Dr Edward Holmes of the University of Oxford, compared the changing rate of HIV infection with that of hepatitis C. Astonishingly, there are more than 50 million people with Hepatitis C around the world, even more than with AIDS (43 million). Hepatitis C is spread very easily by intravenous exchanges (needle misuse and blood transfusions), more so than AIDS.

The researchers found that Hepatitis C was less prevalent than HIV in Africa and claim that suggests that the cause of AIDS transmission is primarily sexual in nature. The reasoning is that if AIDS transmission was primarily through needles and transfusions then Hepatitis C rates would be far higher than AIDS in Africa, as it is in other parts of the world.

This report has been welcomed by the AIDS community since it reduces the recent criticism. But it is not off the hook yet. Even Dr Holmes admits that while sex 'is clearly the key factor... there are clearly a variety of socio-economic factors' affecting transmission. While there is certainly no blame attached to Dr Holmes, it would have been helpful if the AIDS community had acknowledged - preferably emphasised - these other factors earlier when plans for Africa were being developed. At that time moralising sex education was the main, sometimes only, topic of discussion, and greater attention to needle policy would have been useful.

Openness in medical discussions is absolutely vital because without it millions of lives, and economic growth, are put at risk. Airlines are already reeling from the war in Iraq and the recent recession, travel to the Far East has dropped by a third in the past few weeks because of SARS. French businessmen, never ones to miss a junket, were noticeably absent from last week's Beijing good will visit by French Prime Minister Jean-Pierre Raffarin. Many said it wasn't SARS, just 'business reasons' that had made them change their plans.

Confidence is vital for a business recovery in Asia, and at least there is some good news about SARS. The head of the World Health Organisation, Dr Gro Harlem Brundtland, believes that the SARS epidemic can be contained in Asia. Vietnam has apparently not reported a new case in 18 days, and Taiwan has now instituted mandatory 10 day quarantine for visitors and natives who have been in a country that has reported SARS cases. These kind of drastic measures are likely to work and restore confidence further.

And it can't happen too soon. SARS is a new member of a well-known viral family called coronaviruses, which cause the cold amongst other ailments. Experts, such as Peter Openshaw, a respiratory disease specialist at Imperial College, London, say that rapid mutations will complicate efforts to develop a quick and reliable test for the virus and then, in the long run, a vaccine. The result is that a vaccine is unlikely to be available for 12 years at least.

But 12 years is probably very optimistic since there is still no cure or vaccine for AIDS, which was identified in the 1980s. Until there are cures any study that increases our understanding of how these diseases are spread should be welcomed. Political embarrassment and political correctness are not good enough reasons for preventing openness.

Dr Roger Bate is a Director of Africa Fighting Malaria and a columnist for TCS.

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