Meanwhile: Echoes of
panic over global disease By Philip Bowring (IHT) Wednesday, February 18, 2004
No sensible policy is possible without assessing risks and the likely
costs of avoiding them. It may be the World Health Organization's duty to
warn of dangers, but societies have broader interests in weighing costs
and risks and a right to subject current scientific wisdom to scrutiny.
Experts fret that globalization is increasing the risk of the spread of
new diseases. In response, societies are being urged to arm themselves
with ever greater precautions. At the official level there has been
culling of animals and quarantining . Unofficially, there has been a more
dramatic response. Travel collapsed last year because of fear of severe
acute respiratory syndrome, or SARS. Countries as far apart as Japan and
Australia were badly hit even though they had no cases of SARS, whose
method of propagation is still little understood. Now, avian flu threatens
a repeat.
But take a look at the history of alarms and responses. Back in 1851,
nervous experts worried that the Great Exhibition of that year could
attract so many travelers to London that new diseases might be brought to
Britain. But professional worriers and self-proclaimed experts did not
always have things their way.
I have a paper delivered by a forebear, John Bowring, then a prominent
liberal political economist and later governor of Hong Kong, published by
the British Association of Science in 1838 entitled “Observations on the
Oriental Plague and on Quarantines as a means of arresting its progress."
The author was not a doctor but he did understand statistics and the
processes of government. He studied the issues firsthand in Turkey and
Egypt.
SARS caused less than 1,000 deaths worldwide. About 200,000 died of the
plague epidemic that hit Egypt in 1834-1835. Lesser outbreaks occurred
spasmodically throughout the Levant. The official response was usually
draconian quarantine rules by which whole cities, such as Alexandria, were
surrounded by military cordons. Officials were given exceptional powers to
limit movements.
The contagiousness of the plague was assumed to justify quarantines but
Bowring concluded that they were largely useless. Officials failed to take
into account that plague was endemic. A Scottish doctor, long resident in
Alexandria, ascribed the zeal for quarantines as due to “superstition and
ignorance."
There was no evidence that quarantines affected the spread of the
disease. Major plague outbreaks - like SARS? - were associated, Bowring
said, with particular weather conditions and were specific to the area
where they prevailed. Death rates were largely a function of overall
living and sanitary standards - overcrowding and poor ventilation being
the main determinants. Quarantine of humans could not stop spread of the
virus by birds and animals. (The WHO now says that wild birds can spread
avian flu across continents.)
Quarantines were anyway impossible to enforce effectively, Bowring
wrote, because of the inefficiency and corruption of government employees
- a sentiment that could be echoed in China and elsewhere today. And, he
asked: “Will the adventurous Khurd, the migratory Turkoman, the fanatical
Pilgrim, the potent Sheikh, be stopped in their peregrinations by the
quarantine?"
Bowring concluded that the net result of the quarantine system was not
to improve health security but to submit travelers to “capricious and
despotic” actions by officials. They inflicted huge losses on commerce and
added to “the miseries which it is their avowed object to modify or to
remove." Support for the quarantine system was partly due to ignorance but
partly to vested interests. Rumors and unsubstantiated claims “were for
the most part from persons connected with boards of health or quarantine
establishments having a pecuniary interest in the question.”
These 1838 remarks might cause us to ask whether in the age of SARS and
bird flu alarms it is not time to subject the statements of certain
virologists, headline writers and health bureaucracies to critical
analysis by those trained in other disciplines. |
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