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An Epidemic of Globalization?
December 1, 2003 1:43 PM   Subscribe

Haunted by a truly global epidemic, perhaps it is time to consider the effects of globalization on the spread of diseases like AIDS. In addition to making it easier for disease to achieve global prevalence, global economics reduce funding for public health by placing treatment emphasis on those who can pay for their drugs, and, in the case of AIDS, may also encourage pharmaceutical companies to pursue expensive life-long 'treatments' rather than cures. Furthermore, younger, economically depressed members of the global economy are wholly dependent on the whim of richer nations for their well-being in the face of devastating epidemics. In this case, it seems that the global marketplace has failed to be the holy grail it is so often presented as.
posted by kaibutsu (17 comments total)

 
You want to blame globalization for the poor health of the third world? Certainly the picture is not a pretty one, but do you believe that Malawi's AIDS epidemic would be receiving better research and medical care without globalization? Your first link makes the point that globalization brings diseases that originate in the third world into the first world. Consequently, industrialized nations take some notice and divert some of their considerable research resources to developing treatments.

If globalization had not brought AIDS out of Africa, there would be no AIDS drugs available to anybody today. You contend that "younger, economically depressed members of the global economy are wholly dependent on the whim of richer nations for their well-being in the face of devastating epidemics." Without globalization, however, they would simply be dying in silence.
posted by shinnin at 1:58 PM on December 1, 2003


"If globalization had not brought AIDS out of Africa, there would be no AIDS drugs available to anybody today."

And therein lies the most essential point: Without globalization, AIDS would not have been brought out of Africa, and noone would NEED AIDS drugs today.

Ebola is the text-book example of a massively deadly disease that spreads too fast for it to be carried to a global scale, and, as such, is a good example of what a deadly contageous disease might look like in a world with less global connectivity - hitting a pocket of human population, but really very limited in scope. We can also look to diseases like malaria, which affect a geographic region over a long period of time, but due to the rate of expansion, give us plenty of time to react biologically to the disease. In other words, our current system of waiting for a global outbreak and then funnelling billions of dollars into stopping it isn't the only way to deal with the outbreak of disease. Biology and geography are two natural control methods that we've decided in recent times to give up on.
posted by kaibutsu at 2:25 PM on December 1, 2003


Biology and geography are two natural control methods that we've decided in recent times to give up on

Are you suggesting that travel across borders should be stopped in order to avoid the spread of disease? A little overprotective no? Maybe we'd do better to all wear white overalls and respirators all the time.
posted by dness2 at 2:36 PM on December 1, 2003


Without globalization, AIDS would not have been brought out of Africa, and noone would NEED AIDS drugs today.

Dude, I'm going to presume you don't really mean "fuck the Africans (who have been dying from this disease en masse for decades)" 34.3 million people in the world have AIDS and 24.5 million of them (71%) of them are in sub-Saharan Africa. That's 71% of the people who need AIDS drugs...in Africa...not due to global trade and not due to global air travel.

In financial year 2001, $2.24 billion of the NIH's total $19 billion budget was devoted to HIV/AIDS research. That's 12%. Meanwhile only about 0.03% of the US population has AIDS and is responsible for less than 0.01% of deaths in the US (and falling). It looks to me like globalization is doing wonders for research spending on AIDS.
posted by shinnin at 2:37 PM on December 1, 2003


"Without globalization, AIDS would not have been brought out of Africa, and noone would NEED AIDS drugs today."

Except people living in Africa, of course. But they don't count, perhaps?

Besides, what's the point of this post? Are you arguing that no-one should travel more than a day's journey on foot from their birthplace in order to stop the spread of disease, or somesuch?
Or is it multinational corporations that are somehow to blame for this?
posted by spazzm at 2:40 PM on December 1, 2003


I agree with shinnin. Contrast the amount of research money going into treatments for AIDS to that going into treatments for exclusively third-world diseases, such as malaria, cholera, sleeping sickness, etc. The dichotomy is not, as posed above, between a cheap vaccine and expensive long-term treatments. It's between expensive long-term treatments and absolutely nothing. Not to defend this situation as ideal, or in any way morally right; I just fail to see how globalization has made things worse with respect to AIDS in Africa.

Without globalization, AIDS would not have been brought out of Africa, and noone would NEED AIDS drugs today.

Except, of course, the Africans. Or is that who you meant when you wrote "noone"?

We can also look to diseases like malaria, which affect a geographic region over a long period of time, but due to the rate of expansion, give us plenty of time to react biologically to the disease.

There's no cure or vaccine for malaria; people with access to first-world heath care rarely die from the disease, however. Over two million people do die each year from malaria, about a million of them African children (PDF link). The rarity of malaria fatalities in the first world makes it a second-class target for treatment. Treatments are pursued by some academics, but neglected almost entirely by drug companies. Again, contrast with AIDS,
posted by mr_roboto at 2:42 PM on December 1, 2003


I agree with shinnin. Contrast the amount of research money going into treatments for AIDS to that going into treatments for exclusively third-world diseases, such as malaria, cholera, sleeping sickness, etc. The dichotomy is not, as posed above, between a cheap vaccine and expensive long-term treatments. It's between expensive long-term treatments and absolutely nothing. Not to defend this situation as ideal, or in any way morally right; I just fail to see how globalization has made things worse with respect to AIDS in Africa.

Without globalization, AIDS would not have been brought out of Africa, and noone would NEED AIDS drugs today.

Except, of course, the Africans. Or is that who you meant when you wrote "noone"?

We can also look to diseases like malaria, which affect a geographic region over a long period of time, but due to the rate of expansion, give us plenty of time to react biologically to the disease.

There's no cure or vaccine for malaria; people with access to first-world heath care rarely die from the disease, however. Over two million people do die each year from malaria, about a million of them African children (PDF link). The rarity of malaria fatalities in the first world makes it a second-class target for treatment. Treatments are pursued by some academics, but neglected almost entirely by drug companies. Again, contrast with AIDS.
posted by mr_roboto at 2:42 PM on December 1, 2003


Sorry about that.
posted by mr_roboto at 2:42 PM on December 1, 2003


"In other words, our current system of waiting for a global outbreak and then funnelling billions of dollars into stopping it isn't the only way to deal with the outbreak of disease. Biology and geography are two natural control methods that we've decided in recent times to give up on."

The "geography" method has been discussed above, let me just point out that the "biology" (i.e. evolutionary) method means letting anyone not immune die, let the survivors reproduce and repeat for a number of generations.
It's quite effective - there's a higher rate of malaria-resistance in Africa than elsewhere - if you don't mind waiting a few thousand years.
posted by spazzm at 2:47 PM on December 1, 2003


Way to co-opt the suffering and death of millions to promote your ignorantly held anti-globo beliefs!
posted by Mick at 3:24 PM on December 1, 2003


Kaibatsu, it's not true that drug companies are ignoring the vaccine market. The problem is that no one has been successful yet. Vaxgen, for instance, which was spun off from Genentech (majority owned by Roche), and has spent well over $100M on its candidate vaccine. Sadly, the Phase II trials here and in Thailand failed earlier this year. And they're not the only company in the hunt; last I looked there were over a dozen other legitimate corporat efforts.
posted by billsaysthis at 3:32 PM on December 1, 2003


And therein lies the most essential point: Without globalization, AIDS would not have been brought out of Africa, and noone would NEED AIDS drugs today.

Because, everyone in africa would be dead?

Seriously, unless by "globalisation" you mean "international trade", which has been going on for milenia aids still could have made it out of africa. Many tarrifs were still in place in the 50s-70s when aids spread.

As far as "thrid world" diseases go, they can be 'cured' or at least taken care of simply by improving the conditions in those places. People used to die of cholera here as well. Thats what most relif work goes do.
posted by delmoi at 5:46 PM on December 1, 2003


Dude, I'm going to presume you don't really mean "fuck the Africans (who have been dying from this disease en masse for decades)"

and/ or

Because, everyone in africa would be dead?


Not at all. What I'm trying to say is that in the case of outbreaks in areas with low global connectivity, thanks to barriers such as oceans - but also rain forests, tribal grazing limits, or deseerts like the Sahara - a deadly, fast-spreading outbreak will do a bit of damage and then fizzle itself out.* This doesn't at all equate to saying 'fuck all the Africans.' While it is unfortunate that some would die in such a situation, I fail to see how the present scheme of things is so much more beneficial with regards to the spread and control of disease - as has been well and clearly pointed out, and as we are all aware, millions are dying and suffering.

*(As an interesting ethical question, if we had an Ebola treatment which helped someone with the diesease live a few extra years, but left them alive as a passive carrier of the disease, would you give it to someone with the disease? Are there cases in which 'treatments' can make a disease worse?)

Way to co-opt the suffering and death of millions to promote your ignorantly held anti-globo beliefs!

Ultimately, I am just trying to point out that AIDS is a global epidemic, and it is quite feasible that our high level of global connectivity - largely thanks to the endeavors of global economics - has played a major role in its spread. Furthermore, because treatment of global epidemics like AIDS are neccesarily tied to our extremely expensive science and pharmaceutical industries, the fate of entire nations rely on the whim of the nations and industries with the money and the drugs. As has been shown, such whim often comes with strings attached, which could pose a major threat to the sovreignity of third world nations.

I say these things not to push my 'ignorantly held anti-globo beliefs,' but rather to suggest that our present situation has been brought about and extenuated by a fundamental disrespect for cultural and geographic boundaries, and to suggest that there are other ways to think about the spread of disease than as an occasion to make and sell a lot of drugs, and get all teary-eyed about the natural cycles of life, which neccesarily include factors of death and often very ugly disease. Which isn't to say that I have no sympathy for those who have fallen victim to AIDS or its after effects - I wouldn't be bothering to write this if I had no such concern.

If I've offended your fine sensibilities, I certainly don't apologize, though I do realize in retrospect that the Metafilter post probably isn't the best format to try out new and maybe offensive ideas, ideas which I have in no way claimed represent deep-held or infallible beliefs. I'm no ideolouge. But if such ideas aren't tried, and can't be tried for fear of being laughed down, then we've got some things to worry about.

(I am sorry, though, if I've inadvertently posted a thread in which I'll be the sole presenter of one side of the argument.)

There's no cure or vaccine for malaria...

Very true, but what I was referring to was the way that many people in regions affected by particular strains of malaria (or many other nasty diseases) have with time built up natural resistances to the disease. I don't mean to claim that malaria isn't a major problem in the third world.

As spazzm said, "It's quite effective - there's a higher rate of malaria-resistance in Africa than elsewhere - if you don't mind waiting a few thousand years." I wonder, though, if we measure the cost in lives and time spent suffering, whether more damage is done by waiting for an immunity to arise, or by letting the disease loose on a population of 6 billion and then scrambling over the course of decades to find a cure. Many have to suffer before we'll ever bother to look for a cure, just as many would have to suffer before a natural immunity could arise. It would probably be pretty difficult or impossible to quantitatively guess which method would win out in the long term...
posted by kaibutsu at 10:39 PM on December 1, 2003


kaibatsu:
I just want to point out, again, that "waiting for immunity to arise" is not free of suffering - for evolution to take it's course and produce immunity those not immune must die or otherwise be rendered incapable of reproducing.

This is what's happening in Africa now, so if you think the "biological" option is a good thing, you should be happy.

And if you still think our modern ways are the cause of global outbreaks, you might want to read up on the plague, which spread from Africa to the rest of the known world in the 6th century (possibly before) - and let me remind you that there were no jetliners or global corporations in the 6th century. The plague killed off half of europe at one time, if I'm not mistaken.

So your belief that "a deadly, fast-spreading outbreak will do a bit of damage and then fizzle itself out" is demonstrably false.

Plague has now been brought under control thanks to (not in spite of) technology and free exchange of knowledge and knowledgeable persons among the nations of the world.


"disrespect for cultural and geographic boundaries" - sure, whatever.
posted by spazzm at 7:05 AM on December 2, 2003


No, but the plague did rely on things like merchant vessels under the flags of the 'global' empires of the time to move about, and it was the highly population density of Europe at the time that allowed it to kill so many. It's worth noting in this example that the Northern shore of Africa was highly developed, thanks to colonization from the old Roman Empire, and still trading heavily with Europe, thereby creating a migrant population of diseased rats. The plague did fizzle itself out, it's just that thanks to the scale of the population involved, it took half of Europe with it, without ever having a chance to hit the Americas, Oceania, or Asia.

When we choose to live in dense population centers and regularly cross geographic boundaries, creating a situation ideal for massive deadly outbreak, we shouldn't be too surprised when such an outbreak actually occurs. With regards to the spread of disease, a decentralized population is an evolutionary advantage.

"disrespect for cultural and geographic boundaries" - sure, whatever.

Yeah, exactly. I think we're so used to the idea of world trade and travel as inherently good things that we out-of-hand dismiss the idea that they could cause us harm, or that cultural and geographic boundaries might in some way be useful. We're looking at a situation in which an entire continent of cultures are threatened, and I refuse to accept that a germ is the sole cause, when other factors are so obvious.

FWIW, you are right on one thing - that we are far past the point where 'waiting for immunity' would be a happy solution. We have to fight AIDS on a global scale because it has become a global problem. But we should also learn from the mistakes that allowed it to get this bad.
posted by kaibutsu at 10:34 AM on December 2, 2003


Are you seriously arguing that we should stop inter-continental trade and travel?
posted by spazzm at 5:50 PM on December 2, 2003


No, only that it be cut back. At our present levels of connectivity and centralization, we can expect at least one or two massive global outbreaks of Asian-born influenzas a year. When we have new outbreaks, like SARS, it takes a massive expenditure of resources and a near grinding halt to the economy to stop it, assuming we detect the outbreak early enough. There's got to be a happier middle ground, something short of our present 'global economy,' but also short of sectioning everyone off into absolutely closed nations. A reduction of global trade will have other beneficial effects, mostly stemming from a reduced use of resources, meaning we'll be able to sustain our lifestyles longer. Yeah, a process of 'shrinking' to local economies might be painful, but, if we keep up as we have been, I tihnk we'll see a far more painful transition by neccesity, rather than choice.

There's a lot of related questions here. I'd like to see sciences developed in ways that can directly benefit local communities, by working on 'cheap,' long-lasting technologies based on local resources, instead of relying on resources shipped three times around the world. Housing is an area where such science could do an incredible amount of good, building houses for a particular climate out of local materials instead of assuming everyone should live int he same concrete, air-conditioned centrally-heated box, regardless of their climate. As it is now, our technologies are incredibly wasteful. In a world of local economies, we will probably still need some degree of trade, especially if we want to keep global communication networks like this one. But even then, I'm confident we could develop less wasteful, longer-lasting alternatives to many of our technological mainstays. But that's a whole other topic...
posted by kaibutsu at 8:03 PM on December 3, 2003


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