Power in Numbers

IN 1994, in a hospital in Côte d’Ivoire, forty children lay dying in a cramped hospital ward. Black flies circled the room, landing with impunity on the bodies of the tiny human beings so beaten down by disease that they could do nothing to shoo them away. The hospital offered no treatment to lessen the agony of the children’s death throes. When a doctor was asked why no one attended to the children, he said, “They have AIDS, leave them.” The children were being left to die. There was no medicine to treat them, so the doctors had abandoned them to their fate. Within months, all forty lives would be lost.

These children did nothing to deserve this destiny. The simple fact of their birth in a poor country, overwhelmed by a seemingly uncontrollable disease, doomed them to this early and undignified end. Their deaths would go unnoticed by much of the world; they were nothing more than a sad side effect of an epidemic that was taking on surreal proportions in a faraway land.

Yet that epidemic — and indeed rampant disease of any kind — is not a remote event, even when it pervades a country that is very far away. The effects are real and can be felt around the world. A sick country cannot be a successful country, either socially or economically. Disease breaks down the family, stealing mothers and fathers or burdening them with the sorrow of losing a child. It carves the heart out of the workforce, cutting down able-bodied men and women in their prime of life. It foments instability as citizens react against helpless governments and countries look across their borders to replace the crops they could not harvest, the minerals they could not mine, and even the soldiers they could not recruit.

The epidemics that rage across the world’s tropical zones have not just robbed the worst-affected countries of their future. They have also taken new markets away from businesses in wealthier nations and fuelled regional crises that threaten to pull those nations’ governments into crucibles of conflict. Nor is disease a one-off event or a containable catastrophe; if disease takes root, it can be an ongoing scourge, dwarfing the devastating effects of other disasters. Consider the death tolls of these humanitarian tragedies in recent history:

Clearly, all of these were horrible catastrophes. But unlike earthquakes and tsunamis, the deaths from the three major epidemics are preventable. In wealthy countries, HIV/AIDS has virtually become a chronic disease; patients can expect to live for decades after their diagnosis. Tuberculosis and malaria are completely curable in the vast majority of cases. Saving the millions of lives lost to these epidemics doesn’t require troop deployments, economic sanctions, or difficult diplomacy. Yet while we rush to the aid of people hit by natural disasters and loudly lament genocides, we still allow those millions of lives lost to epidemics — those millions of people like us — to vanish forever.

The epidemics have laid down the gauntlet for the citizens of the world. Because the diseases are treatable, it is a failure of human will that we do not yet treat all the people who suffer from them. We could, but we don’t. Why should those children doomed to die among the flies be less deserving than any others? At the heart of the notion of human solidarity is a question of equality: Will we stand by and leave more children to die, or will we stand up for their rights as human beings the way we stand up to protect those in our own country?

When that magnanimity tries to cross borders, however, it can peter out quickly. Budgets for foreign aid are notoriously contentious in the political arena, and even the wealthiest nations give just a tiny fraction of their incomes to help the poor in other countries. Since 1970, the United Nations has asked wealthy countries to raise their annual development aid to 0.7 percent of gross domestic product — a minuscule percentage, but an enormous increase with respect to current levels for most of them. Even in 2005, when the European Union agreed to a timetable to reach the 0.7 percent goal, the world’s three biggest economies — then the United States, Japan, and Germany — gave only 0.22, 0.28, and 0.35 percent, respectively. And today, the world’s wealthy countries still give far more so that other countries can buy guns than they do so that other countries can buy medicines.

And today, many of the world’s wealthy countries, and even rich citizens of poor countries, might shy away from further aid for many reasons. The problems of the poor may seem distant, and it is not easy to figure out which kind of aid is appropriate. It is difficult to argue that a Spaniard should pay to make sure that a Laotian has a decent house to live in. How poor should the Laotian be to deserve the house? How rich should the Spaniard be to feel an obligation to pay? How nice should the house be? The argument about the principle — whether the Spaniard feels any solidarity with the Laotian — can easily get lost in the details.

In the case of epidemics, however, the argument becomes clearer: Disease is often a matter of life and death. Without treatment, the sick will die. In most cases, they became infected through no fault of their own; ignorance, poor public health, environmental conditions, and even the climate in which they live can contribute to their illness. To declare that they should be left to suffer the consequences of these factors, virtually all of which were beyond their control, is close to saying that they should never have been born in the first place. Anyone who possesses the merest feeling of solidarity with his or her fellow human beings will find that idea detestable.

But feeling sympathetic and being able to express that sympathy in a way that is measured and targeted are not the same thing. Some of us are simply overwhelmed by the scale of the challenge. Who, individually, can imagine bringing the effects of malaria to a halt? The problem seems too big for a single person’s actions to make any difference. Indeed, the problem is so huge that no one country affected by disease can solve it on its own, given the political and economic realities that the world now faces. That is exactly why the mobilization of individuals around the world is so vitally important. There is power in numbers.

Now we have a mechanism, and a choice. Every time each of us buys an airline ticket from a website such as Orbitz or Opodo, and soon every time we stay in one of thousands of hotels such as Accor’s Sofitel or Novotel, or when we book a vacation with American Express, we can participate directly in the fight against the big three infectious diseases. When we pay for our travel, we have the option to make a small donation — a voluntary contribution of as little as two dollars — to show our solidarity and save lives in the developing world. In an instant, each of us can make a small but significant gesture of support and participate in the biggest global campaign ever to bring people out of the misery and poverty inflicted by disease.

Moreover, the three diseases interact. Cases of latent tuberculosis, where the germ remains inactive in the body, are common in areas where people are infected with the disease. The overall prevalence rate could be as high as 21 percent in China, for example, compared with about 4 percent in the United States. Many of these cases may never become active. But in people with HIV, latent tuberculosis is much more likely to explode into a full-blown infection, and those infections tend to be much more severe than in people without HIV. Full-blown tuberculosis is more infectious, meaning that one epidemic can directly feed into another one. And people without latent tuberculosis are also much more susceptible to being infected if they already have HIV.

The suppression of the immune system caused by HIV/AIDS also makes it harder for people to fight off malaria. Malaria may also make HIV worse. Patients with both diseases tend to have more HIV in their bloodstreams than those with HIV alone. Medical research suggests that when the body creates antigens to fight malaria, it actually helps HIV to replicate.

Not surprisingly, patients in the developing world — especially in the tropical zones of Latin America, the Caribbean, Africa, and Southeast Asia — are often diagnosed with combinations of all three of the diseases, which may all be present in varying strengths. Because of their interactions and the fact that the infected populations overlap so much, it makes sense to fight the three diseases together.

HIV/AIDS, tuberculosis, and malaria don’t kill as many people around the world as heart disease and cancer. Worldwide, the mortality rate for heart disease and cancer is five times higher than the rate for AIDS, tuberculosis, and malaria. But heart disease and cancers are not infectious, like HIV and tuberculosis, and their victims are rarely children. By contrast, AIDS, tuberculosis, and malaria kill millions of young adults, children, and babies every year — people who haven’t had the chance to live long or full lives. Stopping AIDS, tuberculosis, and malaria doesn’t just add a few years of life; it adds a lifetime.