Economic Impact of XDR-TB

I don't want to jump the gun on this new XDR-TB outbreak in KZN. The current news is maybe just the way the media reacts to news that is suddenly "hot" and "newsworthy", but have been known to people in the field for over a year. I mean, we have only had 53 confirmed cases over the past 12 months, maybe a bit more in recent weeks. However, 52 of the 53 people have died within 1 month of being diagnosed. The WHO and CDC are worried - and so should we. If one looks a bit deeper at the issue, one sees that its highly effective against AIDS patients and HIV+ people with CD4 counts close to but above 200. Though we don't know how effective person-to-person transmission is for XDR-TB, it will not be too presumptions to assume it spreads as easily as normal TB. My best case scenario is that it afffects only 20% of AIDS sufferers, with a 50% fatality rate (highly optimistic). My worse case scenario, it affects all AIDS sufferers with a 80% fatality rate, all HIV+ people with an average 50% fatality rate, and 25% of non-HIV+ people with a 20% fatality rate. The list of possibilities is endless. People with more facts about this, please inform me. Lets get the discussion started.

The SA govt and other international agencies are rushing research on this - quick action research mostly medical so as to avert a outbreak. However, I feel we definitely need to do research on the potential economic impact it will have on SA and the rest of Southern Africa. I am not a health economist, and have only read a few impact assessments of HIV & AIDS on Southern Africa. My question is: what is the expected impact on the SA, KZN and various local economies of this XDR-TB threat? How will this affect tourism to SA? Some compare it to SARS crisis of East Asia or bird flu, but I expect it may be bigger than both combined. How will it affect the SA health care system, both public & private? How will it impact on socio-economic situation of households and communities affected? How will it impact on social grants, on household structures, on productivity, on markets and industries e.g. health insurers & tourism dependent companies(travel agencies, airlines, accommodation,etc), hospital and healthcare industry, on foreign investment, mental health of the survivors, etc? How will it impact on South Africa's ability to host the 2010 World Cup? the list of potential impacts are endless.

It is necessary to alert our economic policy decision makers to these potential social and economic risks and our need to actively and pre-emptively manage these risks - both reducing the potential impact it will have, as well as increasing our ability to cope when it occurs. We have numerous HIV & AIDS research experience in this country to assist us to do this kind of impact assessments.

I do not want to be seen as a doomsdayer, but we need must not wake up 2/3 years from now and suddenly be confronted by this enormous crisis that will set us back 20 years and keep us down for another 10 years. SA have "slept" too many times when crises have loomed on the horizon, only to wake up and realise it has not disappeared but have ballooned out of control. There are people in SA that is more familiar than me about the potential impact and our ability to manage it effectively. Please think about it and lets get the debate / discussions started. It is something of public interest and not something to be held behind closed doors. We may be unable to avoid it, but we certainly can influence how we manage it and possibly reduce its impact on our economy.

Spread the word and lets start the action that we need.

Support for Traditional Medicine

An idea came to me not too long ago, which is very topical in SA, and possibly in other parts of the world too - the West's perceptive superiority/authority (monopoly even??) on evertything relating to medicine/health treatment. Powerful forces in the west (especially large pharmaceuticals, medical lobby groups, etc.) are using propaganda (e.g. bombarding us with adverts) or their economic/political influence (e.g. opposing medical status to traditional healers) to claim their approach to health treatment/medicine as superior to those developed in other parts of the world, i.e. the so-called traditional medicine. For example, the medical fraternity in SA is resisting efforts that traditional healers (in the African sense) be recognised on par with medical doctors or pharmacists. Nevertheless, the SA government is forging ahead on this issue, with the local medical aids reluctendly following suit. The medical fraternity also indirectly belittle the work of chiropractors, who often uses unorthodox/Eastern medical knowledge, by describing them as "wannabe doctors". In economics, traditional medicine is often seen as an "inferior" good vis-a-vis western medicine, which is a "normal" good. Only in strong traditional societies such as rural SA (and possibly other rural areas in the world) has the influence of the Western medical fraternity not taken root effectively.

Now, before I get a slaughtering about the merits of the West's medical science, I must state that that my sister is a doctor and my mom a pharmacist, and I only use medicine that I can buy at the pharmacy. I am not appose to the approach of the west towards medicine, and I am very sceptical about traditional African medicine in most cases. The issue is not the merits and demerits for me, but nobody has the right to claim the moral high ground wrt health treatment. I am for the right to more competing idealogies about health treatment. Creating a legal and institutional environment where both are considered equal, and both are vigorously tested is much more ideal, and possibly better for the long term health of human kind. If there is some root or leaf that is more effective in dealing with a flu or cold (than what my doctor / pharmacist would prescribe), I would certainly like to know about it.

Not only will it help me, it would certainly help the poor and vulnerable who are trying to make a living from traditional medicine. The informal muti (traditional medicine) market in Durban, estimated to have a turnover of R2bn/year, would be greatly enhanced if traditional medicine is formally recognised, thus assisting many marginalised persons with a more formal means of income. In addition, it would provide the impoverished areas of KZN that supplies this market with much needed stable income opportunities.

Why am I arguing this point? The reason is simply my age-old drive to create a more just economic system. You may have heard about the term "indigenous knowledge", i.e. local knowledge gained over many years through customs or practice by communities. It is not privately owned, but collective knowledge of everyone. What has happend in many cases in the world, is first the belittling of indigenous knowledge as inferior, then the the "stealing" of this "indigenous knowledge" and privatising it through licencing, patenting, etc (collectively called intellectual property rights). In effect, the local people are not profiting from their indigenous knowledge, sometimes even barred from using it themselves. Applying this to the case of western medicine: pharmaceutical companies scout the world's traditional medicines for those remedies that are actually very effective, then "researching" it in their labs to identify the specific ingredient(s) in the remedy that is producing the desired effect, then producing the pills and patenting it. Very little benefit, if any, flows back to the locals.

This is exactly what happened in a case in SA where the "indigenous knowledge" of local bushmen were used to develop a weight loss / eating depressant pill. It has been proven to be very, very effective, and is in approval stages at the FDA in the States. The primary culprits in this case was the local Council for Scientific and Industrial Research (CSIR), not the pharmaceutical company. Only after the community, with outside support, brought a legal case against the CSIR, were they given royalties. It should not have been an issue in the first place, as they were "owners" of that knowledge, though they may not have formalised it. How many other cases are out there where indigenous knowledge been "stolen" from local communities, with the latter remaining in poverty, and the fat cats of the pharmaceutical industry (or any other industry for that matter) only getting fatter?