Zika’s Dirty Secret? Income Inequality

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A health agent carries a bucket of guppy fish to place them in standing water to consume larva of Zika-transmitting mosquitoes in an empty lot of Rio de Janeiro's Tijuca neighborhood, Brazil, February 17, 2016.
Sergio Moraes / Reuters
A health agent carries a bucket of guppy fish to place them in standing water to consume larva of Zika-transmitting mosquitoes in an empty lot of Rio de Janeiro's Tijuca neighborhood, Brazil, February 17, 2016.

We hardly need more bad news this summer, so forgive me for being the bearer of some more, but here goes: Yellow Fever is back. We are fortunate enough to have been born long after the disease was subdued by science, at least in America, but if you want an idea of how horrible it is, consider the name the ancient Mayans gave this plague: Xekik, or “blood vomit,” a rather accurate description of a virus that eventually leads to bleeding in the mouth, eyes, and gastrointestinal system. The disease has already infected nearly a thousand people in Angola, and three other African countries have since reported cases, leading the World Health Organization to spring into action earlier this month and issue dire warnings. And Yellow Fever is not, sadly, alone: Zika may have disappeared from the chyrons of our cable news networks, but the virus is making inroads in Asia, raising fears of an outbreak there.

The numbers are grim: every year, more than a billion people around the world are infected, and more than a million die, from vector-borne diseases like malaria, dengue or yellow fever. And unlike, say, cancer, which strikes indiscriminately, vector-borne diseases frequently target the poor.

You hardly have to be an infectious diseases expert to understand why. When a disease is borne by mosquitoes, you can expect to see it occur more frequently in areas where mosquitoes are common, which, frequently, means neighborhood where used tires are piled up in the street, or where stagnant water stands by untreated, or where sanitary conditions are subpar. Most Americans are fortunate enough to enjoy healthier, safer environments, but many in other parts of the world routinely fall victim to treatable diseases are still struggling: According to recent data from the World Health Organization, 2.4 billion people, or nearly a third of the earth’s population, still lack access to improved sanitation facilities; an estimated 946 million still defecate outdoors, and 663 million lack access to reliable water sources.

As much as anything, viruses like Zika are largely the result of income inequality. The issue is a central one to the contemporary American political debate, but when it comes to global public health, partisans of all ideological stripes should easily agree to come together and solve problems quickly, effectively and affordably.

That’s because the most-effective means of preventing these diseases involve not the sort of advanced scientific discovery that Hollywood would like us to imagine when we think about epidemics—think of Dustin Hoffman in Outbreak—but much more common and cheap strategies like cleaning up filthy streets or supplying folks with protective nets.

Just look at Senegal: the African country, like many of its neighbors, was ravaged by malaria, but efforts by the Bill and Melinda Gates Foundation and other organization managed to supply bed nets to more than two-thirds of all homes. In a single year, the number of malaria cases dropped by 41 percent. The same encouraging trend was visible in dozens of other African countries, and several, like Morocco, were declared malaria-free.

News of disease spreading is never pleasant, then, but thankfully we have the means to fight back effectively. Because we live in a truly globalized world, and because outbreaks that begin in Rio or Bujumbura eventually find their way to Raleigh, North Carolina, we should support efforts—both by governmental bodies and non-profit organizations—to address income inequality’s deadliest aspect by doing whatever we can to keep as many people as possible free from the filth and misery that breed disease. It’s a major effort, but one wholly within our reach.

Dr. Farber is Chief, Divisions of Infectious Diseases at North Shore University Hospital and LIJ Medical Center.