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Tuesday, October 03, 2017

Review: The Health of Nations

The Health of Nations is a book about the history (and present) of disease eradication programs. I’d heard of the eradication of smallpox, of course, and remember when Google hired Larry Brilliant to help it’s non-profit arm. (As far as I can tell, nothing happened from that effort worth noting) My impression was that after smallpox, efforts on disease eradication basically stopped or were stymied either from lack of will, lack of funding, or the difficulty of working in the tropics. 

To my surprise, this book disabused me of that! It acknowledges that polio eradication had stalled but recently, donors such as the Bill and Melinda Gates foundation have stepped up and revived and refunded effort into tropical diseases like Malaria and Polio. The current hope is that in 2016, we’ll have seen the last case of polio anywhere in the world, and by 2019, the WHO would have identified the last child in the world to have caught the disease. Wow. 

The history of disease eradication has been intense and to a large extent controversial. Apparently, because the efforts usually originated from wealthy countries, particularly the US, these efforts have also been driven by the ideological needs of the countries. That meant that the approaches were largely technological, and worked very hard to avoid trying to improve the health infrastructures of the countries involved. The author points out that this is a mistake, since many situations (such as the Ebola outbreak of 2014) can derail your eradication efforts if the existing health infrastructure isn’t improved. 

Yes, there’s plenty of description of gory and scary tropical diseases, including Ebola. There’s also some hand-wringing about the successor to polio eradication, assuming it succeeds (there’s a statement in the book from a health worker that polio eradication will never happen because too many health workers are making way above the prevailing wages of their native countries because of the funding behind it). Much of the hard work of disease eradication, for instance, is focused around reaching difficult to reach children in order to vaccinate them against the disease, and without sustaining funding, it’s quite possible to imagine that the expertise and networks of health workers that have been built up will disappear. 

The book also covers the history of vaccination and the anti-vaccine movement (which are as old as the history of vaccination, not surprisingly). The author is surprisingly sympathetic to the anti-vaccine movement, pointing out that in the past, shared needles and people-to-people transmission of the attenuated vaccine caused serious problems. The fact that one of the two polio vaccines in common use utilized the live virus also increased the danger of the vaccine causing the disease. Nevertheless, she points out that the disneyland measles outbreak wasn’t caused by a vaccine, but by having large pockets of unvaccinated children in a fairly crowded environment. 

This book covers a huge amount of ground, and provides great insight into the various issues around vaccination, disease eradication, as well as, “Why do we not have a cure for these nasty tropical diseases yet?!” Highly recommended. It was well worth my time.

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