So the World Health Organization has lifted its advisory on travelling to Toronto. Good. But don't think this ends the matter. The SARS epidemic has brought home the threat of global disease to Canada. And there's much we must do to confront it. Most importantly, Western countries, including Canada, must do more to fight global diseases, and use their research and scientific strengths to create the weapons to do so.
The death toll of SARS has been relatively small (and, one hopes, will stay that way). Throughout the 20th century, some 20 million to 40 million people have died from major epidemics, one of the most notable being the great influenza epidemic of 1918-1919. About two billion have died in childhood, chiefly from diarrhea, vaccine-preventable diseases such as measles, and childhood pneumonia, diseases that are rare here but still common in poor countries. SARS sharply reminds us that in today's global village, major threats can spread fast and easily create economic havoc. No country should consider itself immune.
The good news is that when public-health systems function well, they have a pretty good track record in responding to disease threats. Key elements are sustained funding, good monitoring, trained staff who can act on public-health priorities, and operations research to determine what works and what doesn't.
In 1994, a plague in India scared off international tourists, resulting in the cancellations of flights into the country and striking a devastating blow to India's tourism industry and economy. India had a smaller plague outbreak last year, but thanks to lessons learned from 1994, public-health officials responded with a better infrastructure system in place.
Such public-health systems aren't targeted at specific diseases; rather, they attempt to control almost all of them. Malawi, one of the poorest countries in the world, began public-health campaigns in 1996 to control measles, another epidemic-prone viral illness. In 1999, only two confirmed cases of the illness were reported.
However, it is precisely this public-health infrastructure that has been allowed to erode in too many poor countries. In China, poor monitoring as well as a culture of official secrecy is partly responsible for SARS escaping from Guangdong region.
The most important consequence of poor public health is millions of avoidable deaths among the global poor. The number of children who die before their fifth birthday in poor countries every year is greater than the populations of Toronto and Montreal combined. As we have seen with SARS, poor public health in one part of the world can be a breeding ground for global threats.
Changing this will require more aid money. Many voices, from Bono to Bill Gates, have endorsed calls for a war chest of from $27-billion (U.S.) to $38-billion annually to combat the major killers of the poor -- a five-fold to eight-fold increase over the current $5-billion per year set aside for health aid. In macroeconomic terms, these amounts are puny. They represent less than 10 cents per $100 of annual GDP of the world's richest countries. Governments from rich countries are avid participants of the antidisease rallies, but most conveniently forget their wallets at home. Canada contributes only 3 per cent of all aid from the richest governments. Even if all of Canada's aid were focused on health, it would be only a fraction of the requirement. Using this money wisely is crucial.
So what can Canada do? First, it should quickly and substantially increase our financial commitment to the WHO and the Global Fund on AIDS, Tuberculosis and Malaria. WHO's budget for monitoring global epidemics is a paltry $18-million per year.
But Canada could perhaps best serve the poor by super-sizing its science infrastructure to focus on global diseases. SARS has demonstrated the need for a Canadian equivalent to the U.S. Centers for Disease Control and Prevention. We can do one better, by focusing our science on improving the arsenal against big killers worldwide.
The remarkable achievement by British Columbia researchers who sequenced the gene of the SARS virus shows what is possible. These scientists set aside their normal cancer research to focus as a team on the challenge. Two challenges Canada could take up immediately are to find a better control for the West Nile virus, and to find ways to combat drug-resistant tuberculosis.
Such Canadian programs would build capacity to deal with future bioterrorism threats. Most importantly, Canada would help the poorest of the poor by focusing on the big diseases of our time. Rerouting even a fraction of Canada's annual aid funding of $2-billion (Cdn.) could kick-start such an effort.
The promise of science is enormous. Vaccine research paired with WHO and UNICEF leadership explains why 75 per cent of the world's children are vaccinated today (compared to 5 per cent in 1970). Millions of children are alive who would not otherwise be. Canada can't compete in the world with its military might. But surely it can use its brain power to wage war on the diseases of the poor. Millions of lives could be saved -- some of them our own.
Prabhat Jha is Canada Research Chair of Health and Development at the University of Toronto, and director for the Centre for Global Health Research at St. Michael's Hospital.
