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still unknown, or like the hemorrhagic fever, Ebola, kills 70% or more of infected
people and does not have a cure. Until recently it had not spread beyond a few iso-
lated areas of Africa and seemed to be containable. But in 2014 a major outbreak
occurred in three countries of West Africa, which has raised the spectre of a major
spread. Assistance in dealing with the outbreak is being helped by the addition of
skilled international medical teams, but the burial practices of many cultures in the
area, plus suspicion of western medical practices and the desire to avoid the stigma
of having a family member diagnosed with the disease, handicapped containment,
showing how cultural factors and very limited medical facilities impede medical
progress. With the exception of HIV-Aids the world has managed to avoid pandem-
ics for almost a hundred years since the so-called Spanish flu, a virus causing a
virulent form of influenza that killed at least 50 million and infected 500 million
world-wide in 1918-1920. But the new travel contacts and the increasing concen-
trations of people in urban places, puts this generally positive history of controlling
communicable diseases in the twentieth century at greater risk, which is also linked
to another emerging problem.
13﻽4﻽2﻽5
The Drugs Don't Work
This is the title of a provocative and chilling small topic by the British Medical Of-
ficer of Health and her colleagues (Davies et al. 2013 ). In it she describes an emerg-
ing crisis of Antimicrobial Resistance (AMR) caused by the fact that many micro-
organisms (bacteria, fungus, virus or parasites) no longer respond to the drugs that
have been invented to counteract their effect in creating various diseases. Although
reporting is flawed, it is estimated that 25,000 people die from such problems in
Europe annually from the inability of formerly effective drugs to work, more than
are killed on roads. Almost similar levels of deaths occur from AMR in the U.S.A.
(CDC 2014; WHO 2014b ). The reason is that the bacteria have developed resis-
tance to the drugs that killed them. It was something that Sir Alexander Fleming
warned about after accepting the Nobel prize for his discovery of penicillin in 1923,
namely that it is a fact of nature that bacteria and viruses mutate and develop new
forms, and those new disease-causing types will be resistant to drugs that previously
killed them. Hence no drug is going to be effective forever. The scale of this prob-
lem should not be underestimated, for similar conclusions have been reached by
other reports on the problem in the U.S.A. (CDC 2O14) and by the WHO ( 2014b )
in its first comprehensive survey of a number of AMR bacteria. If this mortality
was linked to some visible, known specific disease, there would be public pressure
for a cure. But since the deaths from these resistant microbes are scattered through-
out the country, they appear to be almost hidden, so the scale of the problem has
been underestimated until the last few years. The detailed tables in the WHO report
( 2014a ) also show that there are great variations between countries in the scale of
the problem, which varies with different disease-causing microorganisms. Some of
the biggest worries are seen in the case of tuberculosis where 20 % of previously
treated cases proved to be resistant to multidrug treatment cases in some countries,
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