Pestilence in the 20th Century
THE Black Death of 14th-century Europe did not lead to the end of the world, as many were predicting. But what about our time? Do the epidemics and diseases of our day suggest that we are living in what the Bible calls “the last days”?—2 Timothy 3:1.
‘Surely not,’ you may think. Medical and scientific advancements have done more to help us understand and fight disease now than at any time in human history. Medical scientists have developed a wide range of antibiotics and vaccines—powerful weapons against diseases and the microbes that cause them. Improvements in hospital care as well as in water treatment, sanitation, and food preparation have also helped in the battle against infectious diseases.
A few decades ago, many thought that the struggle was nearly over. Smallpox had been eradicated, and other diseases were targeted for eradication. Drugs effectively subdued countless maladies. Health professionals surveyed the future with optimism. Infectious disease would be defeated; conquest would follow conquest. Medical science would prevail.
But it did not prevail. Today infectious disease remains the world’s leading cause of death, killing over 50 million people in 1996 alone. The optimism of the past is being replaced by a growing concern for the future. The World Health Report 1996, produced by the World Health Organization (WHO), warns: “Much of the progress achieved in recent decades towards improving human health is now at risk. We stand on the brink of a global crisis in infectious diseases. No country is safe.”
Old Diseases Become More Deadly
One reason for concern is that well-known diseases, once thought conquered, are making a comeback in forms more lethal and more difficult to cure. An example is tuberculosis, a disease once regarded as virtually under control in the developed world. But tuberculosis did not disappear; it now kills about three million people a year. If control measures are not improved, about 90 million people are expected to develop the disease during the 1990’s. Drug-resistant tuberculosis is spreading in many countries.
Another example of a reemerging disease is malaria. Forty years ago doctors had hopes of quickly eradicating malaria. Today the disease kills about two million people every year. Malaria is endemic, or always present, in over 90 countries and threatens 40 percent of the world’s population. Mosquitoes that carry the malaria parasites have become resistant to pesticides, and the parasites themselves have become so resistant to drugs that doctors fear that some strains of malaria may soon be incurable.
Disease and Poverty
Other diseases relentlessly kill despite the existence of effective weapons to combat them. Consider, for example, spinal meningitis. There are vaccines to prevent meningitis and drugs to cure it. An outbreak raged in sub-Saharan Africa early in 1996. You likely heard little about it; yet, it killed more than 15,000 people—mostly poor people, mostly children.
Lower respiratory infections, including pneumonia, kill four million people each year, most of them children. Measles kills one million children yearly, and whooping cough a further 355,000. Many of these deaths too could be prevented by inexpensive vaccines.
Some eight thousand children die each day from diarrheic dehydration. Almost all these deaths could be prevented by good sanitation or clean drinking water or by the administration of oral rehydration solution.
Most of these deaths take place in the developing world, where poverty is abundant. About 800 million people—a sizable part of the world’s population—have no access to health care. Stated The World Health Report 1995: “The world’s biggest killer and the greatest cause of ill-health and suffering across the globe is listed almost at the end of the International Classification of Diseases. It is given the code Z59.5—extreme poverty.”
Newly Recognized Diseases
Still other diseases are newcomers, only recently identified. WHO stated recently: “During the past 20 years, at least 30 new diseases have emerged to threaten the health of hundreds of millions of people. For many of these diseases there is no treatment, cure or vaccine and the possibility of preventing or controlling them is limited.”
Consider, for example, HIV and AIDS. Unknown only 15 years or so ago, they now afflict people on every continent. Presently, about 20 million adults are infected with HIV, and more than 4.5 million have developed AIDS. According to the Human Development Report 1996, AIDS is now the leading cause of death for adults under 45 in Europe and North America. Worldwide, some 6,000 people are infected each day—one every 15 seconds. Projections suggest that the number of AIDS cases will continue to rise steeply. By the year 2010, life expectancy in African and Asian nations hit hardest by AIDS is expected to drop to 25 years, according to one U.S. agency.
Is AIDS a unique, one-of-a-kind, disease, or could epidemics of other diseases emerge to create similar or even worse havoc? WHO answers: “Without doubt, diseases as yet unknown but with the potential to be the AIDS of tomorrow lurk in the shadows.”
Factors That Favor the Microbe
Why do health experts worry about future disease epidemics? One reason is the growth of cities. One hundred years ago, only about 15 percent of the world’s population lived in cities. Forecasts estimate, however, that by the year 2010, over half the world’s people will live in urban areas, notably in the megacities of less-developed countries.
Infectious agents flourish in densely populated areas. If a city has good housing as well as adequate sewage and water systems and good health care, the risk of epidemics is reduced. But the cities that are growing fastest are those in poor countries. Some cities have only one toilet for every 750 or more people. Many urban areas also lack good housing and safe drinking water as well as medical facilities. Where hundreds of thousands of people live jammed together in squalid conditions, the likelihood of disease transmission is greatly increased.
Does this mean that the epidemics of the future will be limited to overcrowded, poverty-stricken megacities? The journal Archives of Internal Medicine answers: “We must truly understand that pockets of abject poverty, economic hopelessness, and their consequences provide the most fertile fields to sow infection and overwhelm the technology of the rest of humankind.”
It is not easy to confine disease to one area. Huge numbers of people are on the move. Each day about one million people cross international borders. Each week one million travel between rich and poor countries. As people move, deadly microbes tag along with them. The Journal of the American Medical Association observes: “An outbreak of disease anywhere must now be perceived as a threat to most countries, and especially those that serve as major hubs of international travel.”
Thus, despite the medical advances of the 20th century, pestilences continue to reap a harvest of human lives, and many fear the worst is yet to come. But what does the Bible say about the future?
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Infectious disease remains the world’s leading cause of death, killing over 50 million people in 1996 alone
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Many infectious diseases are becoming harder to cure because they have become resistant to antibiotics. This is what happens: When bacteria infect a person, they constantly multiply, passing on their genetic traits to their offspring. With the production of each new bacterium, there is a chance of a mutation—a slight copying error that will give the new bacterium a new trait. The probability that a bacterium will mutate in a way that makes it able to resist an antibiotic is extremely small. But bacteria reproduce by the billions, sometimes producing three generations of offspring in an hour. Thus, the unlikely does happen—every once in a while, a bacterium occurs that is difficult to kill with an antibiotic.
So when the infected person takes an antibiotic, the nonresistant bacteria are wiped out, and the person probably feels better. However, the resistant bacteria survive. But now they no longer must compete for nutrients and territory with fellow microbes. They are free to reproduce unchecked. Since a single bacterium can multiply into over 16 million bacteria within a single day, it does not take long before the person again becomes ill. Now, however, he or she is infected by a strain of bacteria resistant to the drug that was supposed to kill it. These bacteria can also infect other people and in time mutate again to become resistant to other antibiotics.
States an editorial in the journal Archives of Internal Medicine: “The rapid development of bacterial, viral, fungal, and parasitic resistance to our present therapeutic armamentarium makes one wonder not if, but when we will lose this war of man against the microbial world.”—Italics ours.
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Some New Infectious Diseases Since 1976
Year First Appeared
Identified Name of Disease or Were Identified
1976 Legionnaires’ disease United States
1976 Cryptosporidiosis United States
1976 Ebola hemorrhagic fever Zaire
1977 Hantaan virus Korea
1980 Hepatitis D (Delta) Italy
1980 Human T-cell lymphotropic virus 1 Japan
1981 AIDS United States
1982 E. coli O157:H7 United States
1986 Bovine spongiform encephalopathy* United Kingdom
1988 Salmonella enteritidis PT4 United Kingdom
1989 Hepatitis C United States
1991 Venezuelan hemorrhagic fever Venezuela
1992 Vibrio cholerae O139 India
1994 Brazilian hemorrhagic fever Brazil
1994 Human and equine morbillivirus Australia
*Animal cases only
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Old Diseases Make a Comeback
Tuberculosis: Over 30 million people are expected to die of tuberculosis during this decade. Because of inefficient treatment of the disease in the past, drug-resistant tuberculosis is now a global threat. Some strains are presently immune to drugs that once destroyed the bacteria without fail.
Malaria: This disease afflicts up to 500 million people yearly, killing 2 million. Control has been hindered by lack of or misuse of drugs. As a result, malaria parasites have become resistant to the drugs that once killed them. Complicating the problem is mosquito resistance to insecticides.
Cholera: Cholera kills 120,000 people per year, mostly in Africa, where epidemics have become more widespread and more frequent. Unknown in South America for decades, cholera struck Peru in 1991 and has since spread throughout the continent.
Dengue: This mosquito-borne virus afflicts an estimated 20 million people each year. During 1995 the worst dengue epidemic in Latin America and the Caribbean in 15 years struck at least 14 countries there. Dengue epidemics are increasing because of growing cities, the spread of dengue-carrying mosquitoes, and the mass movement of infected people.
Diphtheria: Mass immunization programs that began 50 years ago made this disease extremely rare in industrialized countries. Since 1990, however, diphtheria epidemics have raged in 15 countries in Eastern Europe and the former Soviet Union. Up to 1 in 4 people who contracted the disease died. During the first half of 1995, about 25,000 cases were reported.
Bubonic plague: During 1995, at least 1,400 cases of human plague were reported to the World Health Organization (WHO). In the United States and elsewhere, the disease has spread to areas that had been plague free for decades.
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Despite improvements in health care, medical science has been unable to stop the spread of infectious diseases
WHO photo by J. Abcede
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Diseases spread easily when people live jammed together in squalid conditions
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About 800 million people in the developing world have no access to health care