Martin Henry

Malaria bruk out! I had already decided to write for this week on the holocaust issue of growing germ resistance to drugs when the malaria story broke.

In 1963, a year after Independence, malaria was declared eradicated in Jamaica. The presence of a growing number of cases here raises the possibility of in-country transmission. The protozoan [amoeba-like] parasite, not 'virus' as the media keeps erroneously referring to it, is transmitted by the anopheles mosquito. Malaria eradication in Jamaica, while the disease remains a scourge across much of the tropics including countries surrounding us, was a public health triumph of vector control. While imported cases will crop up from time to time, if in-country vector transmission can be avoided we are safe.

For years medical people and public commentators like myself have been crying that we cannot soften up on vector control. The scramble by the Government now to close the gate is the usual fire-fighting reaction which we have come to expect from our leaders.

Mosquito control

The mosquito control programmes of the '50s and '60s relied very heavily on the insecticide DDT. DDT has several negative environmental side effects which Rachel Carson carefully documented in 'Silent Spring,' her 1962 book which launched the environmental movement. A decade later, under pressure from environmentalists, DDT began to be banned by country after country.

No less a body than the World Health Organization is now pushing for the reinstitution of the use of DDT specifically for malaria control as the lesser of two evils. Malaria, not AIDS, is the world's biggest infectious disease. More than half of the world's population is at risk. Some 500 million cases of clinical malaria occur each year with 300 million acute cases resulting in a million deaths. Contrary to what is implied in some media reports, malaria does not have high fatality; without treatment it is a long-term debilitating disease, killing mostly children and those with a compromised health status for other reasons, like malnutrition.

People used to be terrified of a nuclear holocaust. Those fears, perhaps unreasonably so, have eased since the end of the Cold War. A new bogeyman out there in the dark is 'global warming'. But not enough people are aware enough - and afraid enough - of the impending germ resistance holocaust. The human triumph of whipping bugs with antibiotics and vectors with insecticide is set to be seriously reversed.

I have been tracking the issue for a while, so my attention was arrested by a Reuters story out of South Africa, the country with the highest number of AIDS sufferers in the world, which The Gleaner carried last week Tuesday [Nov 28], "Hospital struggles with deadly S. Africa TB." Tuberculosis has been bouncing back, riding on AIDS.

The story reported an emerging "public health nightmare" as one hospital in rural KwaZulu-Natal province grapples with a new, highly drug-resistant form of TB which has already killed 74 people, including hospital staff, since January 2005. About 30 new cases of XDR-TB are being reported per month in this one province where as much as 40 per cent of the population may be HIV-positive. The new strain of tuberculosis is resistant to most if not all of the drugs in the drug cocktails used to fight TB.

Discovery of penicillin

Antibiotics have been massively used to treat infectious diseases caused by bacteria since Dr. Alexander Fleming accidentally discovered penicillin in 1928.

Everybody wants to live and strains of bugs which have any resistance at all to the onslaught of antibiotics will survive, multiply and build on that resistance while their comrades in disease get wiped out by Fleming's magic bullet. Bacteria can grow up and reproduce by dividing inside half an hour so resistance to a particular drug can be fairly rapidly selected for.

Humans have been keeping one step ahead of drug-resistance by developing new antibiotics after penicillin. But the bugs have been fighting back; and nobody seriously believes that there can be new antibiotics emerging forever.

Highly drug-resistant disease-causing microbes and insecticide-resistant vectors seem a grim part of the human future, with all the ugly possibilities of a return of pandemics of deadly infectious diseases which were so much a part of the human past.