Can disease be conquered? The struggle continues......

Sohrab Arora

FOREWORD: Avian influenza... commonly called the bird flu... having reached india, it has awakened myself from a deep slumber, and made me fish out for an article i had written about 4 years ago in the health tribune, in which i had mentioned H5N1 virus as a "new" disease with a potential to become a major health problem!!! so, in the beginning im posting the same article in ditto just to put in perspective the situation as it existed 4 years back (though a lot of it was edited and my additions on the SARS virus were totally deleted from the matter. I will update this in my later posts)


The world stands on the threshold of a new era in which hundreds of millions of people will be safe from some of the most terrible diseases. Soon, polio, neonatal tetanus, leprosy and Chaga's Disease will join smallpox as diseases of the past. But still, a basic question needs to be answered: can the world be disease-free? Can disease be conquered, ever?
Within the last decade there has been an ever increasing awareness of the Darwinian struggle with which the human species is engaged. Some infectious diseases once thought to be all but conquered have returned with a vengeance. The new and the so called "mysterious" diseases continue to emerge. We have seen the global ravages of the human immunodeficiency virus (HIV) - one of the simplest of viral constructs - which still evades cure or even true understanding. Unknown till as late as 1985, AIDS has grown exponentially to become a worldwide problem. Together, these trends amount to a crisis for today and a challenge for the future.

Emerging diseases

These present a peculiar and alarmingly dangerous situation as they do not have any cure or vaccine, and the possibility of preventing or controlling them is limited. Finding answers becomes urgent as they can spread rapidly. Currently, we are experiencing the epidemic potential of HIV, but the next epidemic of human disease may be entirely different!!
A new breed of deadly, haemorrhagic fevers, of which Ebola is the most notorious, has struck in Africa, Asia, the USA, and Latin America. Hantavirus infection, first recognized in 1993, has been detected in more than 20 states in the USA. In India too, a completely new strain of cholera, called cholera 0139 appeared in the South which later spread to China, Thailand and other parts of South-East Asia. Without doubt, diseases as yet unknown, but with the potential to be the AIDS of tomorrow lurk in the shadows. An outbreak anywhere must now be seen as a threat to all the countries. Some of the other emerging diseases have been listed below:

Re-emerging diseases

Anthrax threat shook America recently. The sheer dread of a disease striking back or, striking in a big way is immense. Following decades of general complacency in the antibiotic era, a startling turning point has been reached. The last two years have been accentuated by several striking episodes of disease emergence, such as multidrug resistant tuberculosis and acute coccal infections. The increasing use of antimicrobials worldwide, especially in counterfeit form indicates that this problem will increase in the foreseeable future.
Why this happens is easy to understand. When an effort is made to eradicate a particular disease with a particular drug on a mass scale, some strong organisms of the species survive because they are resistant. It seems that we have "conquered" the disease but it is still lurking somewhere. The resistant ones breed, and soon, we have an entire next generation of "disease resistant" microbes. The drug earlier thought to be very effective, becomes good for nothing and we say that "the disease has struck back!"It is history that malaria was thought to be eradicated and it struck back. It still remains a challenge for everybody especially because it presents a double resistance problem, one being for the plasmodium, and the other for the mosquito anopheles.
There has been uncontrolled and inappropriate use of antibiotics. They are used by too many people to treat the wrong kind of infection, in the wrong dosage and for the wrong period of time. The implications are awesome. Drugs that cost a huge amount of money to produce, and take perhaps 10 years to reach the market, have only a limited life-span in which they are effective. As resistance spreads, the life span shrinks, and the vicious circle goes on. The ready availability of "over the counter drugs" allow the patient to treat himself, either with the wrong drug or in a quantity too small to be effective (just right for the microbe to become resistant, though).

What can be done?

There is a need to understand the source of transmission and stop the spread of disease at an early stage. Research on the evolution of disease agents, vaccine and drug development is important. It is often a neglected subject. There is also need for everybody to remain vigilant and report to the doctor early. For re-emerging diseases, early diagnosis and prompt treatment are the keys. Drugs should be used judiciously so that the chances of the microbe becoming resistant are minimised.

New diseases

1977 Ebola virus: Ebola haemorrhagic fever. 1977 Hantaan virus: Haemorrhagic fever with renal syndrome. 1980 HTLV-I T-cell lymphoma-leukaemia. 1982 HTLV-II Hairy cell leukaemia. 1983 HIV AIDS. 1988 Hepatitis E virus — enterically transmitted non-A, non-B liver hepatitis. 1989 Hepetitis C virus — parentally transmitted non-A, non-B liver hepatitis. 1992 Vibrio cholrae 0139: new strain associated with epidemic cholera. 1993 Sir Nambre virus: Hantavirus pulmonary syndrome. 1995 Human herpes virus: 8 Kaposi's sarcoma in AIDS patients. 1997 H5N1 Avian flu.