Dec. 5, 2002

FROM THE AIRWAVES
Connecting Public Health with Geopolitical Stability

Diseases Influence A Country's Economy

"From the Airwaves" is a transcript of “The GW Washington Forum,” the weekly public affairs radio program produced by GW, hosted by Richard Sheehe, and broadcast on WWRC-AM 1260 in Washington Sunday’s at 9 am. This conversation with Peter Hotez, professor of microbiology, comes from a recent program.

Richard Sheehe: In a recent paper you co-wrote, you suggested links between health and economics. How is public health an actual player in global economics and geopolitical stability?

Peter Hotez: It’s a new idea, yet it’s a very old idea. The idea that global infectious diseases can have an impact on developing countries that go beyond simply health, but also have an impact on developing nations’ economic development and geopolitical stability is one that first came to light in the early 1800s. But it was really resurrected in the later part of the 1990s. A number of interesting things started happening at that time. One of them was a very personality-driven event that an international global economist named Jeffrey Sachs, who was at Harvard University and now heads the Earth Institute at Columbia, began to look seriously at infectious diseases such as malaria and HIV and he started to do some calculations. One of the calculations that he did was to directly link the economic development of nations like Spain and Greece shortly after World War II, with the eradication of malaria through spraying with DDT in order to eradicate mosquitoes. He did some remarkable calculations to show a flat line economic growth prior to World War II and then around the middle of World War II in spring, began to show this dramatic increase in economic development with the sole intervention being the eradication of malaria. This has now been extended to a number of other analyses. The most dramatic example is the HIV pandemic which is rampaging through sub-Saharan Africa and numbers coming out that the HIV pandemic in places such as Namibia and other sub-Saharan countries, was having the dramatic impact on the ability of the economy to succeed.

RS: We’ve heard the word epidemic before. What is a pandemic?

PH: There are three terms that are commonly used in epidemiology. One is epidemic, which generally refers to an outbreak of a disease. Another is endemic, which is a disease which is not simply a sporadic epidemic, but rather an ongoing problem. For example, malaria is endemic to many parts of sub-Saharan Africa, whereas an epidemic might be something like fever or ebola virus. Pandemic refers to a global epidemic. The best example of that being the influenza pandemic, which occurred in association with the outbreak of World War I.

RS: What’s the actual linkage? You mentioned Dr. Sachs. I had the chance to hear him speak at GW some years ago, not exactly on this topic, but related. He was a very impassioned speaker.

PH: I think this was a very important development because traditionally, when you talked about global infectious diseases, these were issues that only got the attention of the minister of health. Typically, in developing countries, the minister of health is not a high level official. The real clout, the real firepower in an administration really resides with the minister of finance. Now, that one can make the link between economic growth and infectious diseases, this got the attention of the ministers of finance not only throughout developing countries, but also the G8 powers. When this happened, new attention was brought to bear upon these infectious diseases that, “Hey, we really do need to come about with some interventions.”

RS: What links diseases like malaria to the economy? What did Dr. Sachs see in his calculations?

PH: The short answer is no one knows, but there are some guesses as to why that may be. I should mention that we’re not only talking about impacts on economic development, but also an impact on global security. That’s what I’ve been writing about, which is to look at other social science factors other than economics to account for outbreaks of global infectious diseases, which would include global security and even a fascinating association between endemic infectious diseases and outbreaks of conflict during the 1990s.

RS: I would suspect there are other diseases folks have never heard of that are very important. Talk about some of the diseases we may not be too familiar with.

PH: One of the questions that I always ask my second-year medical students is “what are the 10 leading killers of children in the world?” The 10 leading killers are infectious diseases. It always strikes me as impressive at how wrong the medical students get it. And the public health students don’t do much better. When I talk about leading killers in children, I don’t mean infectious diarrhea and respiratory infections, but what are the microbes associated with death. It turns out that the leading killer of children in the world is still measles. Prior to widespread implementation of the measles vaccine in 1974, eight million children died every year; now it’s down to about one million. Number two is malaria, but not the type recently found in Loudoun County, Virginia. [Among the top 10], HIV is not on the list. HIV gets a lot of attention and it’s an extraordinarily important disease, but among children, there’s still an enormous menagerie of microbes that are responsible for deaths.

RS: Does it frustrate you as a microbiologist that there are certain headline illnesses that people hear about that don’t even come close to rivaling the true killers of people on earth.

PH: Things are much better than they used to be. Until only a few years ago, it was very uncommon to see infectious diseases make press headlines. To bring it back to the impact of infectious diseases on global developing economies and geopolitical security, this has stimulated a number of individuals to throw philanthropy at some of these infectious diseases and it’s had a huge impact.

 

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