Plague in Madagascar: Is Our Approach to Outbreaks Fundamentally Flawed?
One hundred people reported dead, countless others infected. Madagascar is in the midst of its most deadly plague outbreak in recent memory. Schools, universities and public buildings have closed. The government has forbidden public gatherings. The WHO has already shipped 1.5 million doses of antibiotics, as well as designated US $1.5 million from its emergency funds to contain the disease. However, the real tragedy of this outbreak, and many others like it, is that it is almost inevitable to occur yet again.
Yersinia pestis is the bacteria that is responsible for causing the plague. It most commonly manifests itself in fleas, which in turn feed on rodents and typically render them as the first victims of the bubonic plague. Fleas can occasionally feed on humans in close proximity to these rodents, thus transmitting the bubonic plague to humans. While this most recent outbreak in Madagascar has been caused by the slightly rare and more dangerous pneumonic plague (caused by the same bacteria in the lungs and capable of airborne transmission), the country experiences close to 400 cases of the bubonic plague each year. With the plague bacteria actively circulating in humans, it should come as no surprise then that similar to a dormant volcano, a plague outbreak is simply waiting to erupt. While it is encouraging to see the response from the world community regarding this outbreak, it is an unfortunate trend that resources of this capacity only become available once tragedy strikes. The plague is not a unique case by any means, as similar trends of neglect followed by rapid mobilization in response to crisis can be observed with outbreaks of malaria, yellow fever, cholera and many other infectious diseases.
While this is much easier said than done, perhaps a better approach lies in increased mobilization while the volcano is still dormant, not as it’s erupting. It is important for all stakeholders to realize that the plague is just as much a public health issue as it is a socio-economic one. Avoiding close proximity to rodents is often not a choice for the poor and disadvantaged in Madagascar, and as such, the bubonic plague is always knocking on their doors until it finds a way in. As difficult as this challenge is, it can perhaps be argued that lifting people out of poverty will do more to curb the effects of the bubonic plague than spending millions of dollars on resources in order to treat an infected population. While developing new drugs and diagnostic tools are essential as we currently continue to deal with infectious diseases, maybe what really deserves increased priority in the long term is coming up with solutions that work to minimize or even eliminate the spread of these diseases in the first place.