Epidemics past
and future

I HADN'T realized last Tuesday was the 100th death anniversary of Apolinario Mabini, and that he was a victim of one of the many cholera epidemics that afflicted the Philippines.

Whether local or global, these epidemics are indeed Grim Reapers, with very high death tolls. In the late 18th century, some 400,000 Europeans were dying each year from smallpox. History books tell us, too, that while the rich tended to have better survival chances during these epidemics, they were not totally safe, with emperors and popes among the victims.

Epidemics often lead to irrational social responses. We see the current panic over SARS (Severe Acute Respiratory Syndrome), with religious zealots warning that the end of the world is near and calling on people to return to religion, preferably of course the ones they preach.

Sometimes, plagues led people to turn from old religions to new ones. During the Plague of Cyprian in Rome from 251 to 270, an epidemic that probably involved measles and smallpox, there were mass conversions to Christianity. Similarly during a smallpox epidemic in Japan in the 8th century, people turned to Buddhism.

In some cases, religious fervor complicated the control of disease. During the cholera epidemic in the Philippines that killed Mabini, public health authorities found their hands full as Filipinos turned to drinking "holy water" from Manila Bay. The water turned out to be contaminated and helped spread the disease through several parts of Manila.

Epidemics also triggered off scapegoating and xenophobia or a fear of foreigners. In the 15th century when syphilis spread through Europe, the Italians called it the Spanish disease or the French disease. The French called it the Italian disease, while it was the Polish disease for the Russians. The Arabs, well, they called it the Christian disease.

In many cases, the conspiracy theories, scapegoating and xenophobia that accompanied epidemics were intentionally instigated. Anti-Semitism, always strong in Europe, took a violent turn during the bubonic plague in the Middle Ages, with Jews being blamed for the epidemic, and massacred.

In the SARS outbreak, we see how mass media have contributed to fear and panic. I asked older people if they remember what it was like during the flu pandemics of 1957-1958 and 1968-1969, which killed thousands of people. None of them could even remember there was an epidemic. Mass media were more limited in their scope then: television was still fairly new and there was no CNN, no Internet, no cell phones and texting. Today, all these new forms of media feed into each other, amplifying people's anxieties and instantly spreading rumors and misconceptions.

Amid all the fear and despair that epidemics create, history tells us that these epidemics also showed how humans could rise above adversity. Rather than accept the epidemics with fatalism, there were men and women who often risked their own lives to probe into the causes and look for solutions.

There is the famous story about the 19th century microbiologist Robert Koch, who had to convince a cynical medical establishment that cholera was caused by germs in drinking water. To prove this, he drank water with the cholera bacteria. Many doctors remained unconvinced because Koch only got mild diarrhea from the drink.

The control of epidemics depends less on medicines than on the coordinated work of huge public health teams, including epidemiologists who trace the spread of diseases, health educators giving out correct information and a host of other workers, not necessarily from the health sector. Much too little has been said, for example, of the role our airport quarantine personnel have played in keeping SARS out of the Philippines.

SARS has revived the language and imagery of war, with descriptions of doctors, nurses and other medical professionals as frontline soldiers. In the current SARS outbreak, we have the example of the World Health Organization's Dr. Carlo Urbani, who recognized the grave threat posed by a new disease when he was called in by a hospital in Hanoi to treat patients with "atypical pneumonia." He alerted the WHO to this new disease even as he worked with Vietnamese doctors to find ways to control the disease. In the end, he himself died from SARS.

May 13th isn't just the death anniversary of Mabini, it is also International Nurses' Day, a day to reflect on how, among the frontline workers, it is nurses who face the greatest hardships and risks. Last week in Hong Kong, nurse Lau Wing Kai, who died while caring for patients with SARS, was given a hero's burial in Gallant Gardens, a cemetery usually reserved for exemplary public servants.

And while we fret about globalization as a factor in spreading disease, we forget that globalization too has been tapped in the battle against diseases and epidemics. The same mass media that sometimes cause panic have also been helpful in alerting health authorities to new disease outbreaks, and in educating the public on prevention measures.

History shows us globalization is not new in the fight against disease. On Nov. 30, 1803, the ship Maria Pita left Spain with a "vaccination expedition" that had been constituted by a royal order from Charles IV of Spain. On board were two medics, Francisco Xavier Balmis and Jose Salvary Lleopart, as well as 21 children from orphanages, who were to be living vessels for a crude form of smallpox vaccine. The expedition vaccinated thousands of people in central and south America, and eventually the Philippines and China.

Epidemics spark not just fear and despair but hope and courage. I couldn't agree more with what Prof. Felipe Miranda wrote in a recent column in the Philippine Star:

"SARS eventually will be checked, as the black plague, the Spanish flu, cholera, smallpox and malaria were. In all of these cases, functional science, community understanding, uncompromising and timely collective action--perhaps also some prayers--jointly worked to neutralize formidable threats to our species.