Politics and public health - infectious diseases

[Nereid]

Subtitle: Role of Science?

In https://www.physicsforums.com/showthread.php?t=111663", I introduced the general topic of the role of Science in Society, and the extent to which it makes sense to consider politics as some kind of mediator/facilitator/implementor of what scientists have found, for the benefit or detriment of a group of Homo sap. individuals, large or small, cohesive or otherwise.

Here I would like to explore how science has been implemented in one particular realm, a subset of 'public health', the control of infectious diseases.

At one level this is an open and shut case - almost universally individual humans regard disease as something to be feared, and promises that diseases contolled welcome. Further, much of the scientific results are, and have been for a long time, clear-cut and non-controversial. Too, 'in principle' methods for controlling 'infectious' diseases were sketched out a long time ago, and for many such diseases the 'costs' of effective control 'trivial'.

Today smallpox is gone, the plague is gone, polio is almost gone, ... Hooray!

But the story isn't so rosy - polio hasn't gone, malaria isn't at all under control, AIDS is spreading, and TB seems to be making a comeback. And so on.

Is the scientific understanding of the nature of these diseases flawed? Too limited to allow containment and control strategies that have, a priori, a high probability of success to be devised? Or perhaps it's in the implementation of those strategies? From a scientific (economics, in this case? or perhaps psychology?) perspective, are there shortcomings in devising 'natural mechanisms' for spreading the (infectious disease control) memes ('market forces' perhaps, or powerful combinations of marketing/advertising messages)?

Or is it that social institutions are resistant to implementing programmes that can deliver nothing but good to all but tiny, tiny minorities? That there are systematic failures in political systems, which inevitably sabotage public health programmes that deal with 'things' which are blind to state, nation, religion, gender, tribe, class, ...?

 

[alexandra]

Subtitle: Role of Science?

Is the scientific understanding of the nature of these diseases flawed? Too limited to allow containment and control strategies that have, a priori, a high probability of success to be devised? Or perhaps it's in the implementation of those strategies? From a scientific (economics, in this case? or perhaps psychology?) perspective, are there shortcomings in devising 'natural mechanisms' for spreading the (infectious disease control) memes ('market forces' perhaps, or powerful combinations of marketing/advertising messages)?

Or is it that social institutions are resistant to implementing programmes that can deliver nothing but good to all but tiny, tiny minorities? That there are systematic failures in political systems, which inevitably sabotage public health programmes that deal with 'things' which are blind to state, nation, religion, gender, tribe, class, ...?

Looking at the case of TB, the scientific understanding seems to be good/sound (but I'm no scientist, so perhaps a qualified scientist would confirm/deny this?) - economic considerations or, as you say Nereid, 'market forces' seem to be the obstacle. Here is an extract from a brief PDF report I found about this:

The specter of multidrug-resistant tuberculosis (MDRTB)
threatens the gains achieved by tuberculosis control
through international recommendations currently
accepted by 127 countries. The high cost of second-line
drugs is a clear example of a market failure serving as a
barrier to treatment of MDR-TB cases...

Some have suggested that MDR-TB may be untreatable in
low-income settings in part because of the high costs of
treatment regimens (10, 11). In addition, the diagnostic
procedures are complex and the laboratory services required
may be unavailable. In many cases, there is minimal evidence
of successful clinical management or of national-scale
management of MDR-TB. There is the further danger of
destabilizing DOTS-based TB control programs by focusing
on costly MDR-TB management. Ultimately, a vicious cycle
between health policy and market economics can result, i.e., a
lack of international policy contributes to high drug prices,
which, in turn, serve as a primary justification for not
implementing projects (to develop policy)...

More: http://www.accessmed-msf.org/upload/ReportsandPublications/21920011225196/GUPTA.PDF

I also watched a documentary on the Peruvian TB situation recently - that confirmed that the problem is socio-political/economic rather than a problem that scientific research has been unable to address.