PESTILENCE

Will It Ever End?

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.

About 800 million people in the developing world have no access to health care

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?