By the late 20th century, many infectious and deficiency diseases that were once commonplace seemed to have been confined to the history books. Now, thanks to government action and inaction, and backwardness, they're back...

Welcome to the 21st century: the return of the killer diseases

WORKERS, JULY 2008 ISSUE

BRITAIN WAS supposed to see the end of infectious diseases. This feat of public health was achieved by a combination not of drugs, doctors and hospitals but of clean water, proper sewage systems and better nutrition. Of course there were medical advances such as vaccination, antibiotics and widespread availability of barrier contraceptives, combined with greater knowledge and awareness of illnesses. In 1980 the World Health Assembly declared one disease – smallpox – eradicated throughout the world.

But in recent years, some diseases thought to have largely died out have seen a resurgence. Let's look at why.

Measles
2007 saw the biggest rise in occurrence in cases of measles since the Health Protection Agency started collecting data in 1995. There were 971 cases in England and Wales – an increase of 30 per cent on 2006. Of these, nearly four fifths were in children under 15 and linked to small outbreaks in nurseries and schools.

Measles, which is highly infectious and can be transmitted between people breathing the same air, used to be endemic in the UK. After the introduction of a vaccine in the 1960s, cases fell massively. In the early 1990s the World Health Organisation set a target to eradicate measles by 2000. The strategy relied on protecting 95 per cent of the susceptible population using the combined measles, mumps and rubella vaccine, MMR.

But in 1998 a team of researchers including Andrew Wakefield published a controversial paper in The Lancet describing a novel inflammatory bowel condition in 12 autistic children. It said behavioural problems had begun in 8 of the 12 children shortly after receiving the MMR vaccination.

Uptake of the MMR vaccine plunged. While in 1996/97 92 per cent of 2-year-old children in England received both doses, by 2003/04 it was only 80 per cent. Although levels of the vaccination uptake have begun to improve, there are still pockets of very low uptake, particularly in London.

"The plan was to clear polio and then measles. We were well on the way to doing that in this country. It is disgraceful that that chance should be gone," says Eithne McMahon, Consultant at Guys and St Thomas' Hospital.

"In order to ensure that you do not get the disease spreading, the target we are aiming for is 95 per cent uptake with 2 doses of vaccine and it is quite hard to realise. You don't need that kind of coverage with a lot of other infections," says Dr McMahon. "Autism was a fear parents felt threatened with. Because there was no measles around, no one was afraid of measles. Once people start to see that this is a very serious and potentially fatal illness that is best avoided, that helps the pendulum swing back in the other direction."

Dr McMahon is perhaps being a little polite. That so many British people can be so easily swayed not only to do the wrong thing by their children, but by other people's children – the possibility of a critical mass of epidemic proportions being achieved through the lack of use of MMR vaccine is very real – is a sign of the backwardness of our thinking, as well as our susceptibility to pseudo, or just plain wrong, science.

Tuberculosis
The tuberculosis vaccine BCG used to be given to all children through the schools programme, but this ended two years ago, and it is offered only to babies in high incident TB areas or with parents or grandparents from high-incidence countries. BCG is not as effective a vaccine as MMR, and probably would not get through medical trials if it was new today. There is a misconception that TB was eradicated in Britain, but it never was. Although the figure got down to around 5,500 cases in 1987, every year since then has seen an increase. Last year there were 8,496 cases recorded, and although this is a tiny decrease on the previous year about 40 per cent of all reported cases of TB occur in London.

Great Ormond Street Infectious Disease Consultant Delane Shingadia says that while the UK as a whole has only seen slight increases of TB, rates have almost quadrupled in the capital in the past 10 years: "The WHO cut-off for a high incidence country is a rate of 40 cases per 100,000 population and London has now exceeded that at about 43 per 100,000." Some 70 per cent of TB cases in Britain occur in people not born here.

Although a TB screening programme is in place for migrants entering the UK from countries with a high incidence of the disease, Health Protection Agency Consultant Ibrahim Abubakar says that this is not the solution.

"In 80 per cent of cases the disease developed at least two years after arrival and often in other parts of the body than their lungs, so a chest X-ray would not pick it up anyway," he says. Abubakar says TB resurgence is caused by the breakdown of infrastructure in former Soviet republics and sub-Saharan Africa, and by the latter continent's HIV epidemic. "Our data does not suggest that the epidemic has in any way affected the indigenous population. If you look at the absolute number of UK-born white individuals, the numbers getting TB are actually dropping."

If you add to this the WHO's estimate that around a third of the world's population has latent TB, then we can see what might lie ahead for Britain with unrestricted economic migration.

Rickets
The bowed legs characteristic of rickets was frequently seen after the industrial revolution on children living in urban slums on a poor diet. The disease is linked to a deficiency in vitamin D, which is needed for strong bones and is found in certain foods, but is also made by the body if the skin is exposed to sunlight of the right wavelength. In the winter in Britain there is not enough sunlight of the right wavelength in areas north of Birmingham to enable the body to do this, so residents who do not go out in the sun, who cover up or have darker skin are at particular risk of vitamin D deficiency.

When rickets reappeared in the 1970s among children across Britain, a public health campaign to reduce it by issuing vitamin D drops to everyone at risk was launched. As time went on, the NHS stopped providing the vitamins and children stopped taking them. The Department of Health now estimates rickets can affect 1 in every 100 children from communities which originated in Asia, Africa, the Caribbean and the Middle East.

In 2005 paediatricians in Bradford were seeing around 60 children with vitamin D deficiency every year, predominantly from the South Asian community, and about a third of these had rickets. "We felt that in 2005 we shouldn't be seeing any children with that kind of problem," one of Bradford's Public Health Consultants said at the time.

In Blackburn, around one case of rickets a week is being identified in the South Asian community. The NHS in both these areas is now spending hundreds of thousands of pounds a year on vitamin D supplements. Children from these communities often do not get much sunlight until they go to school because they stay at home with their mothers and adolescent girls are at particular risk when they start wearing the hijab. In Blackburn the local NHS organisation is even employing someone who can take Asian women out for walks around local parks and away from the suppressive households who deny them the sunlight that they and their children need.

Syphilis
Once associated with sailors with a girl in every port, syphilis began resurging in the 1990s in former socialist countries of Eastern Europe when health systems collapsed. Cases in Britain have increased tenfold, from 301 in 1997 to 3702 in 2006.

While the disease can be concentrated amongst gay men, the "globalised" party scene is also contributing to the problem with cheap flights taking over from sailing ships as conduit of the infection. The Director for the Centre of Public Health in Liverpool says, "It is just as easy and maybe quicker for people in Manchester using a cheap flight to go to a party in Berlin as anywhere else, so you are exposed not just to the profile of infection within your own country but the profile within another country as well."

So what are the morals of these stories? To begin with, improving working conditions and infrastructure such as sewage and housing can eradicate disease. This is very difficult to do within capitalism, because the imperative is not people's health but maximising profits.

The collapse of the economies of those socialist countries to the west of the Soviet Union, and of the Soviet Union itself has had a massive effect within those countries. Added to that, workers have been encouraged to migrate elsewhere, both to make a living themselves but also to undercut the wages of western European workers. In so doing they have spread many diseases which were previously eradicated from Britain. Countries such as Czechoslovakia, the German Democratic Republic and parts of the Soviet Union once had among the best health systems in the world.

Further unrestricted economic migration from parts of the world whose populations are even poorer and who have little or no defence against some of Britain's climatic and other difficulties is further spreading once-eradicated diseases.

Employers care little or nothing about this. Apart from anything else, they know that the tab for all these imported diseases will be borne by those working here not by those employing them.

No civilised country can abrogate responsibility for its own borders. Without border control there can be no planning, and with no planning there can be no certainty that life-threatening conditions can be eradicated, or even effectively dealt with. There will be no improvement in health without control of Britain's borders.

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