COVID-19: Gobbling Up Funding for Fatal Epidemics Such as Malaria, TB and AIDS

Coronavirus or Malaria, Tuberculosis and HIV?

Al Jazeera (2020)

Film Review

Why is a Low Mortality Illness Like COVID-19 Crowding out Treatment for the World’s Most Dangerous Illnesses?

This documentary reports on urgent concerns that COVID 19 “pandemic” management is crowding out prevention, diagnosis and treatment for far more serious illnesses, such as malaria, tuberculosis and AIDS.

Epidemiologists assert that low cost interventions such as bednets and “residual spraying” (presumably with insecticides?) are extremely effective in preventing malaria in African and Asian countries that experience malaria epidemics during the rainy season. Where the disease is diagnosed early, artemisinin-based combination therapy (ACT) has an extremely high response rate. Unfortunately due to diversion of Red Cross and other international funding to COVID management,  Africa’s anti-malaria programs have suffered significantly. India, however, is still making good progress in reducing disease prevalence.

Diagnosis and treatment of tuberculosis has been similarly affected in the developing world, where, at present approximately 25% of patients diagnosed with HIV are unable to access life-saving anti-retroviral treatment.

 

Doctoring LA’s Homeless

Street Medicine

Jonny Kahleyn-Dieb and Tomi Hinkannen (2008)

Film Review

Street Medicine is an extremely inspiring documentary about a medical outreach program in Los Angeles Country that sends doctors out to assist uninsured homeless patient whose illnesses prevent them from attended Venice Outpatient Clinic.

The most common medical problems the encounter are TB and other chest infections and severe skin infections and abscesses. Owing to severe mental health cutbacks, many also have mental illnesses.

The clinic receives one-third of its funding from Hollywood celebrities and the rest from federal-state Medicaid funding.

The Anti-Tuberculosis Vaccine Americans Never Heard Of

TB Ward

One side of the vaccine controversy Americans are extremely unlikely to hear about concerns the safest, cheapest and most widely used vaccine in the world – against tuberculosis (TB). Every country in the world, except the US and the Netherlands (where TB is extremely rare), uses or has used the TB vaccine (known as Bacillus Calmette Guerin or BCG) in public vaccination programs. The BCG controversy was my first introduction (in 1971) to the US government propensity to engage in conspiracies and cover-ups. This happened during my second year of medical school, in the TB module taught by University of Wisconsin infectious disease researcher Dr Donald Smith. Smith had grave concerns about disadvantaged US communities with high rates of tuberculosis infection, as well as the nurses and doctors who looked after them.

Prior to World War II, TB epidemics infected industrialized countries at levels comparable to the current rate of clinical depression. Roughly one out of three families had at least one family member who had died of TB or been sent to a TB sanatorium. Once a leading cause of death in the US, TB is very much a disease of poverty. Healthy subjects can carry the tubercular bacillus for years and only develop active illness if poor nutrition – or stress – lowers their natural immune state (see

With the post World War II boom and vastly improved nutrition and living standards, the incidence of TB declined drastically in industrialized countries. However in the large disadvantaged urban centers that characterize US society, rates of TB infection continue at pre-World War II rates. This is of particular concern with the emergence of “drug resistant” TB, related to a surge of new cases in AIDS and other immune-compromised patients.

History of the BCG

Albert Calmette and Camille Guerin first began work on the BCG vaccine at the Pasteur Institute in 1908. They developed their vaccine from the bacillus that produces bovine tuberculosis, based on Edward Jenner’s discovery that vaccinating people with “cowpox” produced immunity against smallpox, a far more virulent disease. The BCG was first used in humans in 1921. In 1928 the Health Committee of the League of Nations (precursor to WHO) recommended its use in mass immunization campaigns to prevent TB.

There was strong opposition to the vaccine, particularly in the US and Britain, which delayed global acceptance till after World War II. It was first widely used in Eastern Europe between 1945 and 1948. The vaccination of eight million babies with BCG prevented the anticipated TB epidemic, which always accompanies the massive poverty and deprivation that occurs when a society’s economic and social infrastructure is destroyed by war. The BCG’s success in war torn Eastern Europe led Britain to begin using it in 1953. Between 1956-63, they enrolled 54,239 children in a randomized controlled study, in which BCG proved 84% effective in preventing TB.

More recent studies show that BCG is much less effective in preventing pulmonary (lung) tuberculosis in the third world, where patients are often too malnourished to develop sufficient antibodies to give them full protection. However the BCG is still widely used in India and other third world countries, owing to its efficacy in preventing fatal complications of TB, when it spreads to the brain, liver, spleen and other vital organs

How the US “Prevents” TB

Sadly the vast majority of Americans – including many doctors – are unaware there is a safe, effective and inexpensive vaccine, called BCG, that greatly reduces the rate and severity of new tuberculosis cases. Unlike most other countries in the world, the US continues to resist the use of BCG to check spread of TB in our inner cities. Instead the CDC recommends routine skin testing (known as the Mantoux or PPD) of high risk groups. A patient who has been exposed to the tubercular bacillus (mycobacterium tuberculosis) has a positive reaction. They are then given four to nine months of drug treatment.

Most African American health providers over fifty are well aware of the benefits BCG. TB, more than any other chronic illness, is linked with poverty and poor nutrition. African American nurses I worked with in Seattle community clinics used to bootleg BCG from Canada to immunize high risk African American children.

As I mention above, I first learned about BCG at the University of Wisconsin Medical School, from infectious disease researcher, Dr Donald Smith.. Owing to massive bureaucratic bungling (combined with an unclear amount of sleaze, graft and cover-up), American health professionals have always had great difficulty accessing effective BCG vaccine. As of 1971, the only really effective vaccines were made in Denmark and Prague and had to be imported. Smith was so concerned about our risk of contracting TB from patients that he ordered BCG from Denmark, offering it to all 107 of us for $2 apiece.

According to Smith, the American vaccine, known as BCG-Tice, was notoriously ineffective in preventing TB in both animals and humans (see Why Not Vaccinate, Three Different BCGs, Differences in Biological Activity, and Efficacy and Applicability). It was a story I was to hear often about researchers and drug company CEOs with powerful friends in Washington. Rather than acknowledging the Tice vaccine was useless and importing Danish or Prague BCG, the Centers for Disease Control gave their blessing to the use of Tice in their two largest American trials (in Georgia and Alabama), trumpeting the abysmal results as “proof” that BCG is useless in preventing tuberculosis.

The Influence of Big Pharma

In The People’s Health: Public Health in Australia, 1950 to the Present, Milton James Lewis (The Peoples’ Health) also blames the growing influence of powerful pharmaceutical companies in US resistance to BCG. Thanks to Big Pharma’s aggressive marketing efforts, the US saw a major shift in the mid-1950s away from public health to “curative” medicine based on drug treatment.

As a long time single payer advocate, I also see a more sinister racial and class bias underlying this shift. In the US, which has consistently opposed publicly funded medical care, curative medicine is only an option for patients with the financial means to pay for it. Meanwhile public (i.e. government-funded) health measures, aimed at the poor and disadvantaged, are always the first on the chopping block at budget cutting time.