Rabies

I had no idea, but apparently rabies remains a serious health problem in parts of the world:

Each year, the disease kills about 55,000 people — that’s 150 a day — almost all of them in the poorest parts of Africa and Asia, and more than 7 million people receive post-exposure treatment after being bitten by a rabid animal. Treatment is not just expensive, but time-consuming: a full course of vaccination requires five visits to a hospital or health clinic during one month. Which, if you live in rural Africa, can mean many hours of travel and time not working. Indeed, the global economic cost of rabies is estimated to be more than $583 million. And that doesn’t count the trauma that deaths from rabies inflict on families and communities. For though rabies kills many fewer people than malaria, it causes far, far more fear.

Olivia Judson says the good news is that "Rabies could be eliminated in as little as five years" if we were willing to commit the resources. And, indeed, we should. One unfortunate consequence of the "aid doesn't work" literature is that it's tended to obscure the fact that even if aid doesn't produce economic growth (and I think this claim is overstated), public health aid most certainly does save lives. People used to die of smallpox and now they don't. 150 people die of rabies every day, and if we took action to stop that, that would be "working" in my book.

Comments

If people really wanted to eliminate rabbies I'm sure the free market would have already solved this problem.

Posted by Ron Paul | January 18, 2008 1:55 PM

We need to close the borders and deport rabies-carrying illegals before rabies becomes as deadly a scourge as leprosy here in the U.S.

Posted by Lou Dobbs | January 18, 2008 2:06 PM

anyone here willing to sponsor me for the Dunder Mifflin-Scranton Meredith Palmer Memorial Celebrity Rabies Awareness Pro-Am Fun Run Race for the Cure??

Posted by sean | January 18, 2008 2:13 PM

The problem with committing resources to African public health is that, unfortunately, it only worsens the already severe overpopulation crisis in many nations there. One of the root causes of the 1994 Rwandan genocide was an unprecedented population boom in the country owing to earlier improvements in public health, that caused an already dense population to reach a crisis point at which it could no longer feed itself.

It seems cold-hearted, but improving public health in Africa without first improving agricultural techniques and getting the population crisis under control will likely cause more problems in the long run than it solves.

Posted by Michael T Sweeney | January 18, 2008 2:13 PM

Re Michael T Sweeney

Don't worry, AIDS is taking care of the overpopulation problem.

Posted by SLC | January 18, 2008 2:17 PM

I'm skeptical that rabies could be eliminated at all. There are too many reservoirs of the disease.

Posted by Jeffrey Davis | January 18, 2008 2:25 PM

According to UNICEF, the average national IQ in many Third World countries can be raised for small amounts of money by fortifying staple foods with tiny doses of iodine and iron to prevent cognitive disabilities such as cretinism. Both steps were taken in the US between WWI and WWII, with dramatic success.

http://www.vdare.com/sailer/national_iq.htm

Clearly, at least some of the lower average IQs found in the Third World are caused by environmental deficiencies, and iodine and iron are two that we understand perfectly well how to solve. Raising average national IQ will probably raise per capita incomes as well, since Lynn and Vanhanen found a correlation of about 0.7 between per capita GDP and average national IQ in their 2002 compendium "IQ and the Wealth of Nations."

Posted by Steve Sailer | January 18, 2008 2:27 PM

Sean, my first thought was, holy cow, Michael Scott was right after all.

Posted by Jen | January 18, 2008 2:30 PM

What's more, if people aren't aware, rabies is a truly horrific disease to die from. Those who don't receive the inoculation within a small window of time following infection are almost without exception doomed to die an enormously painful death, while they go increasingly insane. If you Google pictures "rabies" you'll see some truly chilling images of people with rabies. For much of the history of the disease, the only treatment has been to strap victims to gurneys, keep them unconscious as much as possible and wait.

Posted by Freddie | January 18, 2008 2:36 PM

Treatment is not just expensive, but time-consuming: a full course of vaccination requires five visits to a hospital or health clinic during one month. Which, if you live in rural Africa, can mean many hours of travel and time not working.

Having been bitten by a rat in China and having undergone the full course of 5 rabies shots, you do not need a health clinic. You need a clean syringe and possibly a refrigerator (the French-made medication I used needed to be kept cold). I can see addressing this as being a serious problem in places where there is no electricity. However, providing a refrigerated stock of rabies medicine and clean syringes within easy travelling distance of these communities is not nearly the logistical problem this article makes it out to be.

Posted by Shochu John | January 18, 2008 2:53 PM

Even Easterly singles out public health as the one are where foreign aid has succeeded broadly. It's true that conservatives sometimes ignore this when exploiting the "aid doesn't work" genre, but the actual economists involved don't.

Posted by Sam Boyd | January 18, 2008 3:11 PM

The Rwandan genocide was born more of the RPF's invasion of Rwanda, the resulting civil war, decades of tit-for-tat pogroms, Hutu-Tutsi fighting earlier in neighboring Burundi and the president's assassination. The genocide's leaders in the Presidential Guard explicitly planned it as a counterinsurgency campaign against the RPF's Tutsi base.

In fact, economically most African nations are underpopulated to be able to reach maximum output. It's more a question of being stuck in a population trap of a 1:1 ratio of workers to dependents, meaning every worker has at least 1 or more dependents to care for (children, parents, etc.) while not having the necessary funds beforehand to do so. Ireland was in this trap for years before the pill, an improved educational system and low corporate taxes helped the Irish switch the balance more towards workers, encourage investment and educate the population.

Posted by Reality Man | January 18, 2008 3:14 PM

Great lets use b.s. neo-Malthusian arguments to say that people should die when they are bitten by a rabid Jackal. There is no population crisis in Africa. The idea of Africa as in a perpetual Malthusian crisis originates in bad colonial science and continues with bad post-colonial politics. The lie of the land : challenging received wisdom on the African environment / edited by Melissa Leach & Robin Mearns one of the better works on the subject.
Africa is under populated compared to almost any where else in the world. Famines in Africa are not environmental or agricultural crisis but political ones. Problems with hunger in Africa are largely the result of break down in systems of distribution or since the 1980s structural readjustment. If outside actors stopped trying to get African peasant to growth cash crops like cotton, many African nations would be producing a surplus of food. Look the example of Malawi where last year the government decided to ignore neo-liberal policy and slightly subside fertilizer for peasants. and as a result had a huge food surplus.
The high population density of Rwanda had little or nothing to with the 1994 genocide. It should be understood as originating in an attempt by the ruling elite to retain control over the state( and as there result everything else in the country) when Habyarimana seemly likely to share power with the RPF.

Posted by E.A. | January 18, 2008 3:25 PM

I should've expanded my thoughts further. Certainly, the Rwandan genocide was not entirely (or even primarily) about a reaction to a population crisis. However, the population crisis there was an important precipitant to the genocide, and without it, I'd argue the genocide would've been much less likely to occur. Certainly, there are ethnic tensions in many nations in sub-Saharan Africa, and desperate and corrupt governments in many places also. Why then, did the continent's worst genocide of the last half-century happen to occur in it's most-densely-populated naton?

While Africa in general is "under populated," Rwanda in particular is not. It has one of the highest population densities in the world, and the highest in Africa. A high population density is no problem in a nation like the Netherlands, where mechanized agriculture can provide a healthy surplus, but in Rwanda, where the vast majority of the population is engaged in small-scale subsistence agriculture it is a very real problem.

What many fear is that Rwanda is a preview of what may happen in many other highly populated African nations in the future. Few others have reached the population density of Rwanda circa 1994, but the astounding rate of population growth throughout much of Africa portends huge problems in the future. My argument is not that Africa is locked in some inexorable "neo-Malthusian" crisis, it's that too much aid money goes to treating disease and not enough goes to economic and agricultural development.

Posted by Michael T Sweeney | January 18, 2008 3:52 PM

An important distinction is that while Africa's problems have generally not been of the "Malthusian Trap" variety, Rwanda in particular could reasonably be viewed through that lens.

Africa in general was relatively underpopulated, at least until quite recently, but Rwanda was much more densely populated. It's at a pleasantly high altitude so disease is a little less of a problem, so higher population densities could be maintained before modern medicine. The land is of better quality for growing crops than most of Africa, and the people have a long tradition of political order. Rwanda and Burundi were one of the few kingships in Africa. (The traditional orderliness of the Rwandans helps explain why, like the Germans, they turned out to be so efficient at genocide.)

Much of the rest of Africa, a huge place, was traditionally underpopulated -- thus the common African cultural emphasis on fertility. It's not widely known, but African farmers competed with elephants. If there weren't a dense enough number of farmers to scare off the elephants, they'd eat all the crops. So, farmers tended to concentrate in some areas and abandon other large areas to elephants.

Posted by Steve Sailer | January 18, 2008 4:40 PM

1. So there is some magical tipping point that over what, 300 people per km, Africans go genocidal? So that 20% population density difference between Burundi and Rwanda is why there was genocide in one and “just” ethnic violence in the other. How do we explain the RPF’s counter genocide of Hutu’s and other peoples in the Eastern DRC in the Great African War. Was that a result of population density or historic contingency? Is it that sometimes there is genocide as a result of population density, and other times it just regular old genocide? Where else has overpopulation resulted in genocide?

2. Was there any evidence of overpopulation in Rwanda in 1994? If not what does it matter what the population density was?

3. Is violence in Africa more generally over land or is it over the control of the state? I would suggest that most violence is over control over the state. Clearly 1994 in Rwanda took that violence to another level, but the fundamental issue, the ability of a ruling elite, in this case the Akazu, to retain political and economic domination in the country is similar to other conflicts on the continent. Hutu moderates were among the first killed.

4. Is economic development helped by having a population burdened by a massive disease load? Does watching your child died from rabies after being bitten by rat increase GDP? Economies grow when people are safe, happy and healthy, and not when your population is riddled with malaria.

5. Africans do not need to be told how to farm. For some reason everyone thinks African do not know how to farm. Change U.S. and European Ag policy, and let Africans sells us their surplus so they can by the inputs they need.

Posted by E.A. | January 18, 2008 5:11 PM

As I said, the Rwanda genocide is famous because it is an outlier. As you imply, most African squabbles are over, in effect, mineral rights and other perquisites of being in charge of the government. Lots of people die, as in the Congo, but that's mostly because they are living on the edge of survival in the first place and war disrupts them (it's the same as the big die-offs in Chinese history during rebellions). Rwanda has a special horror to it because it was fairly well-organized.

Burundi is similar to Rwanda, only the minority Tutsi have managed to stay in power for 45 years by whomping the majority Hutu whenever they get uppity.

Posted by Steve Sailer | January 18, 2008 9:49 PM

Well, this thread has veered off, but just thought I'd add this: eliminating rabies is probably impossible, and it certainly can't be done in 5 years or with a few billion dollars.

You mentioned smallpox. Thing is, smallpox was easy. In fact, it was the most vulnerable of any major disease to eradication:

-- spread wholly by humans; no animal reservoir or vector
-- disease rarely asymptomatic; few or no symptom-free carriers
-- completely shut down by inoculation
-- inoculation cheap and simple (one shot)
-- inoculation long-term effective; one shot protects for many years
-- vaccine stable at room temperatures, doesn't need expensive "cold chain"

None of those apply to rabies. In fact, they apply to almost no other major disease. That's why, for instance, we haven't wiped out polio yet (though years of hard work have reduced it to a handful of cases per year) and why we haven't begun to eradicate, say, malaria.

Key point: smallpox was a fluke. Wiping out diseases is really hard.

Doug M.

Posted by Doug M. | January 19, 2008 2:12 AM

In your post you take sides, perhaps unwittingly, on one of the fault lines of public health. There is a large amount of money spent on what are called 'vertical programs' which target a specific disease: AIDS, leprosy, schistosomiasis, etc . . . Other people argue that this is mistargeted -- that the money would be better spent 'horizontally', to build up basic health care services, and improving management and access.

It is hard to say which one is right, and different diseases obviously have different solutions -- but there is a certain amount of evidence that the 'eliminate' approach, in which a disease is attacked intensively, with a target-oriented approach and a military-style administration, is not working that well. Smallpox is its only full success; polio is a partial success, with gains that may or may not be maintained -- and most deaths in developing countries are from diarhoea, pneumonia, measles, malaria, and other basic diseases that basic health care cures.

Or put another way -- why are these 'elimination' programs always aimed at developing countries? Why don't we attack and eliminate whooping cough in America? Because with basic, normal health services it is not a problem. Much of the mindset behind these vertical programs is a feeling that developing countries are a mess, spending money on infrastructure, administration, and management training is a waste of time, and we need to attack single problems, get rid of them, and then dial down our efforts. It is not how countries like Malaysia or Thailand improved the health of their populations, and it is not how European countries approached the same issue in the late 19th century.

Genocide is, of course, beside the point. Why bring it up in this thread, in such a pointless way?

Posted by Sam Nicholas | January 19, 2008 11:05 AM

"Africans do not need to be told how to farm. For some reason everyone thinks African do not know how to farm."

That certainly seems to have worked out in at least one case, according to this NYT article from last month . . .

"LILONGWE, Malawi — Malawi hovered for years at the brink of famine. After a disastrous corn harvest in 2005, almost five million of its 13 million people needed emergency food aid.

But this year, a nation that has perennially extended a begging bowl to the world is instead feeding its hungry neighbors. . . .In Malawi itself, the prevalence of acute child hunger has fallen sharply. In October, the United Nations Children’s Fund sent three tons of powdered milk, stockpiled here to treat severely malnourished children, to Uganda instead. “We will not be able to use it!” Juan Ortiz-Iruri, Unicef’s deputy representative in Malawi, said jubilantly.

Farmers explain Malawi’s extraordinary turnaround — one with broad implications for hunger-fighting methods across Africa — with one word: fertilizer.

Over the past 20 years, the World Bank and some rich nations Malawi depends on for aid have periodically pressed this small, landlocked country to adhere to free market policies and cut back or eliminate fertilizer subsidies, even as the United States and Europe extensively subsidized their own farmers. But after the 2005 harvest, the worst in a decade, Bingu wa Mutharika, Malawi’s newly elected president, decided to follow what the West practiced, not what it preached . . .

But I don't know anything else about that situation.

". It's not widely known, but African farmers competed with elephants. If there weren't a dense enough number of farmers to scare off the elephants, they'd eat all the crops. So, farmers tended to concentrate in some areas and abandon other large areas to elephants."

You know, I'm not sure this isn't actually true, at least in some places, but doesn't it sound completely crackpotted? It's the Sailer effect - everything he touches ends up seeming, in the end, like bizarre, often bigoted nonsense.

And marginally more on topic, if you happen to wake up to find a bat in the room (I've been told), contact your local health professional - they do serve as rabies vectors,* and apparently can have very hard-to-notice bites.

* I first typed this as 'rabies rectors', which is an . . . interesting image.

Posted by Dan S. | January 19, 2008 12:46 PM

"Each year, the disease kills about 55,000 people — that’s 150 a day..."

Chump change, as diseases go. How many unwanted, uncared for dogs does it kill each year?

Posted by Where's Sally? | January 19, 2008 1:49 PM

I think that elephant theory could be relevant, say, in 19th century, but since then the human population increased, and elephant population decreased, and factor 5 in each case is in the ballpark (factor 10?).

Fast population growth is detrimental to welfare in a very simple way. There is some necessary infrastructure per person even in the most poor states. If the population grows 1.5% in a year, you need to invest something to keep the necessary amount of infrastructure without even improving it. If the population grows 3%, these expenses double.

If you do not keep up with the necessary expenses, you may be in a vicious circle. The education becomes inadequate, and there is not enough people to properly maintain the infrastructure, so it depreciates faster. The same happens if people are to sickly to work efficiently and mantain the economic growth consumerate with population growth.

With slower population growth the same amount of savings and aid can accumulate to eventually assure enough education for faster growth in productivity and slower rate of crumbling of buildings, roads, power stations and power grid etc. with better mantainance, and accumulation eventually proceeds faster, the savings increase, foreign aid becomes irrelevant etc.

Posted by piotr | January 20, 2008 11:42 AM