Life before the rise of modern public health was, to quote philosopher Thomas Hobbes, nasty, short, and brutish. Rooted in antiquity’s attempts to dispose of polluted water and waste to ward off communicable diseases like the plague and leprosy, public health in the 19th century, at the onset of the Industrial Revolution, still concerned itself with providing clean water and building sewers. As more and more people moved to cities in the West and began living in cramped and unsanitary conditions, there was no stopping diseases like cholera, typhoid, and tuberculosis from spreading.
However, advances in public health in the years since have allowed average life expectancy to more than double: people are healthier for a longer time. In 1900, average life expectancy was around 30 years, while the same figure now has passed 70 years everywhere in the world, except sub-Saharan Africa. Even there, average life expectancy now ranges between 40 and 60 years. These advances stand on the success of specific public health programs: vaccination and control of many infectious diseases, effective health and safety policies, and lowering known risks for non-communicable diseases.
In particular, since Edward Jenner discovered the smallpox vaccine in 1796, the fields of microbiology and immunology have produced vaccines against an ever-widening range of diseases, from anthrax to rabies, from hepatitis to meningitis. Thanks to vaccines, we live in a world where smallpox and polio are being consigned to history. Yet, perhaps because of the vaccines’ great success, we also grow more and more aloof to their attendant risks—and we’re not even talking about those opposed to vaccinations.
The dengue vaccine scandal that is unfolding in the Philippines is one such example. Southeast Asians, like others living in the tropics, are intimately familiar with the dangers of dengue, this mosquito-born infectious disease. As a consequence, they would leap at any chance to keep it away, a chance that the Dengvaxia vaccine seemed to promise. However, unlike other vaccines, Dengvaxia may exacerbate the symptoms of dengue fever for those who have never contracted the infection prior to vaccination. Over 700,000 school children in Manila and surrounding areas have received Dengvaxia before the Philippine government stopped the vaccination program.
Whether the scandal resulted from rushed judgment or malgovernance, as this week’s first Spotlight article argues, the vaccination program began with little heed to what risks may accompany Dengvaxia.
In most situations, risks are well worth taking for a vaccine’s efficacy, but as we see in this scandal, the authorities seem to have chosen to look the other way. We may no longer likely witness the scars from smallpox or the bent legs of polio patients, but that happy fact should not blind us to another fact that (effective) vaccines come with (tolerable) risks.
The same nonchalance vis-à-vis attendant risks is also evident in the way we choose to treat antibiotics, the other pillar of modern public health. “For the love of flesh, we put our own flesh at risk,” is how our second Spotlight article this week succinctly describes the issue. The abuse of antibiotics is visible in Southeast Asia: from the misuse of antibiotics in the rearing of chickens to the imprecise and sometimes inappropriate consumption of antibiotics when we are sick. As a result, we’re seeing the rise of ‘superbugs’ resistant to standard antibiotics.
Our carefree approach to vaccines and antibiotics, the mainstays of modern public health, must end because it weakens the very foundations of what keeps us healthy as an international community. The longer we stay this way, the greater the chance of our moving backwards. What would you do if antibiotics don’t work anymore the next time you get sick?
