In 1979, a respiratory anthrax outbreak occurred in Yekaterinburg, in the former U.S.S.R., this disease was met with a shock and panic due to anthrax’s nature to strike “down this person and lets another escape unscathed.” These are the words of Jeanne Guillemin in Anthrax: The Investigation of a Deadly Outbreak. The manner in which the Soviets spoke of the outbreak is noticeably different than the way that Americans discuss epidemic disease. The element of chance is emphasized in the Soviet view of infection. On the other hand, Americans believe disease affects those who have not best prepared their immune system to fight back. These differences are in great part due to the difference in political economic organization. Communism emphasizes the equality of all people and the importance of community. Capitalist societies tend to emphasize the value of competition and individualism. These core beliefs have led to differing reactions to disease.
• Equality and competition. The emphasis of communism on equality encourages viewing disease infection as random, since all people are to an extent equally likely to become ill. The American obsession with competition has introduced the image of fighting into our bodies. Now yoga, smoothies, and vitamins are our weapons to fight diseases. Those who are not properly armed will be unable to beat the illness. Since the majority of Americans are ingrained with a competitive mentality, we expect those who are infected to be “good losers” and accept their illness. Competitive ideals separate the healthy from the ill in America. Those without disease feel that they have “beaten” it; whereas, the sick were not prepared.
• Community and individualism. In the former USSR, community was emphasized. Thus the entire society was affected by an outbreak. This accounts for the fear that anthrax could infect anyone in the city. In the United States, individualism and to be more precise individual responsibility is emphasized. If an individual is sick they were not responsible enough to prepare their immune system to defeat the disease. Many of the macho young men in Martin’s book felt they had super strong immune systems. Since those with strong immune systems felt they were invincible to diseases from colds to AIDS, the sick were separated as weak and irresponsible.
Dissimilarities in the political economic organization of communism and capitalism led to differing beliefs regarding infection. In the former U.S.S.R., anthrax could randomly strike anyone in the community. In the US, the individual will wage war against the disease and win or lose based on personal preparation.
To best comprehend Social Darwinism it is useful to know what Darwinism means. Darwinism is the principle of Charles Darwin’s theory of evolution that animals originate, evolve, and survive through natural selection in response to environmental forces. Social Darwinism is the belief that people of a certain “quality” or “morality” are discernible from others. In terms of the disease, those with the “right” sort of immune system will survive the epidemics of the future. Medical historians imply that the right immune system arises from being challenged by more advanced and powerful germs. The interaction with these more powerful germs tends to kill the poor in greater numbers, since poverty is a comorbidity in itself. Social Darwinism explains this by pointing out that an immune system must be correctly trained. The individual is considered responsible for the strength of their immune system. A healthy young doctor who was interviewed by Martin expressed the idea of having a “buff” immune system and another interviewee talked about training his immune system by camping.
In Venezuela, the concept of Social Darwinism was seen in relation to the cholera epidemic. The poor indigenous peoples of the delta were not the right quality or morality to survive. The concept was reinforced by the limited infection of the criollos in nearby towns. The biological weakness of those infected was discussed in papers on the epidemic. Tauxe and Blake express that “biologic factors may also increase the susceptibility of the affected population.” Type O blood was considered more susceptible to cholera. Since the Peruvian population is over 75% type O they were genetically prone to the disease. In this case, the physiological aspects of the disease were brought forth when the socioeconomic problems and the weak healthcare infrastructure should have been blamed. Social Darwinism created the same divisions in society as sanitary citizenship. Those who have the economic, scientific, and political backing to avoid cholera are “superior” to the infected. Little has been done to help the indigenous people living in the delta since the epidemic. The lack of attention and assistance can be explained by the belief that the Warao were biologically more prone to cholera. The immune system aspect of Social Darwinism allows social and cultural problems to be ignored and blamed on physiology.
“When you hear hoof beats- think of zebras.” Historically, medical professionals were taught to expect logical and common diseases (horses) to be the cause of symptoms (hoof beats). In the new world of globalization, disease eradication, and bioterrorism, it is becoming equally useful to be able to identify the exotic wildlife. Zebras are the diseases which are atypical of a region. For example, Malaria would be considered rare in Minnesota.
Zebras are reemerging in the United States for various social, political, economic, and cultural reasons. Three which have increased the likelihood of a primary care giver to encounter a rare disease are: technological improvements in travel, an increase in refugees from developing countries, and bioterrorism. Technological advances in travel and the inexpensive nature of flying has greatly increased the number of people jumping from country to country. The increase in movement over political, geographical, and cultural borders has allowed a disease like SARS a ride to communities around the world. Although schisto is painfully prevalent in many developing countries, a doctor in the United States would have trouble recognizing the symptoms. Thus knowledge of foreign diseases is needed.
Partially due to increase in travel, refugees from areas around the world have immigrated to the United States. Diseases common in poor countries often are considered eradicated in the US or are unknown to health professionals. Polio or measles still exist in many areas, yet they are zebras in the US. With the immigration of people from many developing nations, disease also immigrates. To be able to best treat groups arriving from countries like Somalia, Cambodia, or Nicaragua, a doctor needs to be able to recognize zebras.
Finally the most overrated of the ways zebras will enter the United States: bioterrorism. Diseases that have been altered (aerosolized anthrax) or are considered extinct (smallpox) could be reintroduced into the population through terrorist activity. Most doctors cannot tell the difference between smallpox and chicken pox. The misdiagnoses of a bioterrorist released disease could endanger many people.
Due to factors like quick global travel, immigration, and bioterrorism, medical practitioners must stay well educated in the identification of both horses and zebras.
The microworld of viruses, bacteria, parasites, and prions is the home of infectious diseases that effect humans. To eradicate an infectious disease requires enormous amounts of dedication and hard work. Three of the major difficulties of disease control are drug resistance, vectors, and poverty. Drug resistant forms of infectious diseases like malaria and tuberculosis are appearing at an alarming rate. Antibiotics are unable to cure diseases that they could fix ten years ago. At the rate that many diseases are mutating to circumvent drugs, a new manner of disease control will have to be found in the near future. Gene therapy is a possibility, but the technology is still years away. Many diseases like onchocerciasis and schistosomiasis have animal vector which will make eradication virtually impossible. As long as a disease can escape annihilation by moving to an animal host it is difficult to eradicate the disease. The final challenge to disease eradication is poverty. The socioeconomic inequalities throughout the world allow illnesses to hide out in poor communities with faulty healthcare and often heightened transmission. Diseases like polio and tuberculosis have been virtually removed from developed countries, but the diseases can still thrive in developing countries, poor communities, and total institutions.
In the war against infectious disease, a major victory was the total eradication of smallpox. Certain characteristics of smallpox have proven an Achilles heel for the disease. Smallpox undergoes only minor mutations, normally between the known strains, and all species bestow immunity to all other variola strains. Smallpox can only exist in humans; therefore, there are no animal reservoirs for the virus to use. Along with the lack of an animal host, the relative inability to mutate has allowed for the extermination of smallpox. Hopefully, polio will join smallpox as a disease of the past. International efforts hope to eradicate polio in the near future.
There are diseases that fall into the opposite end of the spectrum of ease of eradication. These diseases take full advantage of mutation to avoid treatment, spend a part of their life in an animal host, and are thriving in poor areas around the globe. Tuberculosis and malaria are examples of diseases that have evaded eradication by mutating into drug resistant forms. Cholera, malaria, and schisto all exist in animal vector. Since the only way to eradication is to remove the disease from both the human and animal reservoirs, it is unlikely that these diseases will ever be stamped out. All of the diseases listed above are diseases of poverty. Most are easily treated with medical care, but in poor areas the lack of money, resources, transportation, and the comorbidity of malnutrition lead to doubtful eradication.