Thursday, July 23, 2015

Postmodernity and global polio eradication

Polio is getting closer to being eradicated. If it happens, it would join (along with smallpox among humans and rinderpest among cattle) that very rare class of pathogens that have been taken literally out of circulation by conscious human efforts.  That sounds good, but in the case of polio it also shows just how long it takes medical advances to deeply penetrate resource-limited and politically volatile settings: a safe and effective vaccine has already been around for half a century. In any case, due to the collective efforts by charitable organizations, civil society, government and religious leaders, Nigeria is getting nearer to being rid of polio, and tomorrow will mark a year since a case of polio has been diagnosed there. The remaining holdouts are Pakistan and Afghanistan. But potential threats to polio eradication may lie elsewhere, where you rationally would expect it less.

Like California. According to the California Department of Public Health, over 60% of children in the state have not received the full suite of vaccinations. This is partly a case of being victims of their own success: Americans have little experience of what it is like to be prey to infectious agents precisely because vaccines have worked so well on so many of them. It is a stance you have the luxury of taking from a position of relative privilege. But it is partly due also to a culture of gossip, suspicion and kneejerk mistrust of medical authority, and hence also from a position of ignorance. If vaccines are the product of Enlightenment faith in reason and science to improve society, rejection of vaccines -- when not itself based on sound reasoning and evidence -- is regression into a pre-scientific state where life was nasty, brutish and short. Privilege and ignorance is a toxic combination, and some people have to (re-)learn the hard way.

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Tuesday, July 21, 2015

The bioethics of austerity

One of the more depressing aspects of the crisis in Greece is the cartoonish way the plight of the Greek people has been portrayed. It is as if ordinary Greeks had all taken out massive and reckless loans, and when asked to pay them back, they stubbornly refused. The nerve of such people! Do they want money for nothing? Can't they pay off their debts like us, i.e. hard-working sensible people? How lazy and irresponsible of them.

Africans may view all this with a sense of dรจja vu. In the years after independence, the ruling class of African countries brought their economies into debt, while rulers enriched themselves from revenue generated by the selling off of their natural resources to the developed countries in the North. In the 1980's and 1990's, the collection agencies of the international creditor community (i.e. the World Bank and the IMF) imposed 'structural adjustment programs' that involved reducing expenditures by the public sectors -- especially education and health -- opening up markets to foreign investment and establishing debt repayment schemes. This was austerity avant la lettre, whose effects in Africa were largely catastrophic and are still felt right up to this day. In this way, Africa was a laboratory for a new, 'bloodless' way of dominating and exploiting other countries, not by armed conquest, but by debt. Debt in this geopolitical context is not like the debt you incur when you voluntarily take out a loan to buy (say) a car. No ordinary African citizen voluntarily asked for despots and kleptocrats to siphon off national resources, run their country deep into the red, and then agree to repayment terms and conditions that gut their schools and hospitals. Africans are familiar with European powers doing this to them, and accusing them of laziness in the process.  Europeans doing it to one of their own: now that is new.

Just like the African case, the Greeks are getting hit ... right in the health sector. Crumbling infrastructure, doctor and nurse burnout and brain drain, use of cheap but unsafe materials, shortages of medical supplies, increasing inability of patients to pay for services: all the classic symptoms of austerity health care. The imposition of austerity will be predictably associated with avoidable morbidity and mortality -- and it is avoidable because austerity is a political construct, not a natural event. If the more powerful countries want to bail out or provide debt relief to certain countries or institutions, they can and they have. So they are at least partly responsbility for those consequences when they decide not to, both in the old African case and the new Greek one.

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