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Going Viral

When tuning in to radio or television news programmes, or opening a daily paper, you cannot help but be alerted to the Ebola outbreak in West Africa. On 14 October, the World Health Organization (WHO) reported that, by December, the number of new cases of the virus could reach 10,000 per week – with a worst-case scenario of between 537,000 and 1,367,000 cases in Liberia alone by 20 January. As I write, the confirmed number of deaths since the outbreak started approaches 5,000.

Health authorities in the developed world have tried to comfort the public, proclaiming that the disease is hard to contract, and that existing facilities are capable of isolating and treating the individual cases occurring in Western countries. I suspect that the uneasiness with these bland reassurances is rooted in the lack of faith the general public has Going Viral in governmental statements – the case of the bovine spongiform encephalopathy virus is a prime example.

In the spring of 2009, a new flu virus spread quickly across the US, and then across the globe. The first US case of H1N1 (or swine influenza) was diagnosed on 15 April 2009. By 21 April, the Centers for Disease Control and Prevention (CDC) were working to develop a vaccine for the virus. On 26 April, the US government declared H1N1 a public health emergency. The CDC estimated that between 43 million and 89 million people had H1N1 between April 2009 and April 2010; this resulted in up to 18,000 fatalities, equating to a death rate of 0.5-1%. On 10 August 2010, the WHO declared an end to the global H1N1 flu pandemic, having previously predicted millions of deaths.

Let us compare these outbreaks with some from history. The earliest well-documented case of HIV/AIDS was in 1959 in the Congo. As of 2012, 35 million people have contracted HIV, which has caused over two million deaths a year. Another particularly well-known pandemic is the bubonic plague or ‘black death’ which began in the early 1340s, spread through Europe, and killed 20-60% of many countries’ populations – half of Paris’s 100,000 population is thought to have died. The plague has returned to haunt Europe and the Mediterranean region since the 14th century, and even in the 20th century there have been outbreaks in the US and Australasia. Currently, between 5 and 15 people in the US are estimated to catch the disease each year.

A more recent pandemic was, again, an H1N1 influenza outbreak: Spanish flu. This virus infected half a billion people across the world, and killed approximately 50 million to 100 million. A plague in 165AD, the Antonine plague – understood to be smallpox – is estimated to have caused five million fatalities. In the year 541AD, the Eastern Roman Empire was afflicted by a disease – now thought to be bubonic plague – that left around 25 million dead.

Current plagues include cholera, which the WHO estimates affects between three million and fi ve million people a year, killing 120,000; and malaria, with over 200 million cases a year, killing over 600,000. Both of these ongoing outbreaks are preventable and treatable – mainly thanks to investment by the pharmaceutical industry.

The development of a vaccine, let alone a treatment, for viral or bacterial diseases such as those mentioned above is neither minor nor rapid. It is, perhaps, too much to expect that pharma should be altruistic in investing hundreds of millions – if not billions – of dollars in development when economic returns are likely to be trivial, since these diseases are, largely, of developing, economically-challenged countries. Worldwide panic may encourage such investment, but it looks as if we shall be waiting some time before seeing results.


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Graham Hughes, EPC Editor
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