Not Just a Medical Matter

IN 1961, Sir Mac Farlane Burnett, the Nobel laureate biologist, wrole in the epilogue to his influential book, "where disease is con veyed by an insect earner and the process of transmission is clearly understood it is virtually always possible to eliminate the disease" And he went on to describe how malaria had been "banished from continental United States". In the 35 years since then knowledge about insect carriers, disease patterns and modes of transmission has grown by quantum leaps and almost every vector-borne disease, trumpeted as having been eliminated, is making a comeback, even in parts of the US. Recently, the WHO has drawn attention not only to new and rapidly spreading infectious diseases but to the more complicated issue of the resurgence of old, once-eliminated diseases all over the world. If the beginning of this century saw the triumph of humankind over devastating pestilence, at least in the industrial countries, its end is about to see a reversal which is of far more serious consequence, because in a very real sense science is at the end of its tether Of course, infectious diseases had never disappeared from the poor countries of Asia, Africa and Latin America. Up to the first half of the century the focus of colonial governments in the colonies was on containing epidemics among the native populations, lest they spread to the colonial enclaves or even to the home countries themselves. With the colonies gaining independence, disease control programmes provided an expanding market for new technologies and products of the nascent pharmaceutical industry in the US and Europe. In India, for instance, vertical disease control programmes, planned with military thoroughness, with an array of curative drugs, preventive chemicals and immunisation, look precedence over the creation of sustainable health care infrastructure.