[This article has been published in Spanish in Planeta Futuro-El País]
Eradicating yaws is within our reach and the cost is very low
It was in 2010 when I was in London finishing my specialist training in infectious diseases that an Australian friend—also a physician—told me about a job in a hospital located on a tiny island lost somewhere in the Pacific Ocean, where a doctor was urgently needed. I had two options: to return to the hospital in Barcelona where I had just completed my residency or to set off for an island in Papua New Guinea, but I had to decide quickly. A couple of days later I was on a plane heading to Lihir island. At the time, I had no idea how life-changing that journey would prove to be.
The island of Lihir is less than half the size of Ibiza and belongs to Papua New Guinea, one of the poorest countries in the world. The life expectancy of the islanders is just over 62 years, 20 years less than that of many European countries and neighbouring Australia. It seems incredible that the mere fact that a person is born a few kilometres further north or south can determine whether they will live a full life in the first world or will have to fight for survival and live in extreme poverty. The journey to this remote island in a small propeller plane from the country’s capital city Port Moresby takes over two hours. Lihir island is known because an Australian mining company extracts gold from its mountains. Although the company does contribute minimally to the island’s development, the presence of the mine also highlights the contrast between the population that lives with hunger and the other that does not.
Yaws is a perfect example of the vicious circle linking poverty and disease
Almost 20,000 people live on the island, and poverty is generalized and extreme. Most of the population live in small clusters of houses with no electricity or running water. The situation is exacerbated by the tropical climate (extreme heat, humidity, constant rainfall), and infectious diseases—such as malaria and tuberculosis—wreak havoc among the population. What struck me most, however, was the large number of children who came to my office to be treated for very painful ulcers that affected every part of their bodies. Although I had specialised in infectious diseases, I was unable to put a name to the condition that caused these ulcers, and I had never encountered it before. It was the staff at the Lihir health centre who enlightened me. “It’s yaws”, I was told. And the tone of voice was that of someone who has accepted as normal the existence of a condition that would certainly have set off every possible alarm if it appeared in Europe.
Yaws affects more than 100,000 children every year, with cases reported in 13 countries in West Africa, South America and the Pacific region
Yaws is a disease caused by infection with the bacterium Treponema pallidum, subspecies pertenue. It affects more than 100,000 people worldwide every year, with cases reported in 13 countries in West Africa, South America and the Pacific region. As I mentioned above, the infection presents in the form of skin ulcers and in the advanced stages it can destroy the cartilage of those affected (in the nose, for example) and cause bone deformities. Yaws is a mutilating disease that leads to disability. The infection is transmitted through direct contact with an affected person. In Lihir, the scarcity of running water, lack of sanitation and overcrowded living conditions facilitate transmission of the disease, particularly among children aged between 5 and 15 years. I will repeat the statement I wrote just a few lines above: yaws affects more than 100,000 children every year. In addition to the pain caused by the ulcers, yaws is also a terrible scourge because of the age at which it attacks: children with yaws cannot go to school or play with other children because of the risk of contagion. As a result, they are stigmatised. Furthermore, the prolonged absence from school makes it more difficult for them to get the education they need to pull themselves out of poverty. Yaws is a perfect example of the vicious circle linking poverty and disease.
After coming in contact with yaws on Lihir, I started to look for information on the causes, history, geographic spread and treatment of the disease. Yaws was almost eradicated using penicillin injections in the 1950s, but eliminating the infection from the most inaccessible areas of the planet proved impossible. Finding sufficient qualified personnel to administer injections in remote areas was difficult and the treatment of children was complicated by the fact that the injections are very painful. In the end, the infection resisted eradication, reestablishing itself in the areas from which it had been eliminated and neither the affected countries nor the international community reacted. Nor did the pharmaceutical industry because of the scant profit to be made from the production of the drugs used to treat the infection.
We discovered that a single dose of azithromycin was just as effective a cure for yaws as the penicillin injections
The fact that no advances had been made in the treatment of yaws in decades gave me hope and obliged me to do something. After months of research, we discovered that a single dose of azithromycin was just as effective a cure for yaws as the penicillin injections. Azithromycin is an antibiotic found in most pharmacies, easy to administer, pain free, and cheap: yaws can be cured at a cost of just €0.50 per patient. This was a revolutionary discovery because it made it possible to envisage the definitive eradication of the disease from the planet. Today, the World Health Organisation (WHO) has drawn up a strategy for the eradication of yaws by 2020, based on the distribution of azithromycin to all the affected communities in the world. As a result of this discovery, we are on the brink of a historic event—the total eradication of the disease—something only achieved once before, in the case of smallpox.
We are on the brink of a historic event—the total eradication of the disease—something only achieved once before, in the case of smallpox
Although we have the necessary knowhow to eradicate yaws, the struggle is now focussed on obtaining one key resource: the money to bring the treatment to all the places where it is needed. We calculate that it will cost around 300 million euro to eradicate yaws. This might appear to be a large amount of money but, in fact, it is less than half of what a football club like Barcelona or Real Madrid spends on new players every year. It is around 2.5% of the military budget for Spain (a country not at war with anyone). I could cite hundreds of examples. In every case, the message is the same: eradicating yaws is within our reach and the cost is very low.
We calculate that it will cost 300 million euro to eradicate yaws, it is around 2.5% of the military budget for Spain (a country not at war with anyone)
As in so many other cases, it is money that will determine whether this story ends with a victory for common sense and solidarity, or whether yaws goes down in history as another flagrant example of suffering that persists simply because of the indifference of those who have the means at their disposal to end it. Today, my team and I are working intensely to mobilise the resources necessary to eradicate yaws. This year, we will extend our project to other provinces of Papua New Guinea and reach a much larger population. The possibilities are immense, but we still lack the necessary resources.
This might be the first time a disease will be eradicated thanks to the altruism of ordinary people
In recent months it would seem that this message has reached companies like EMS, the largest and most important pharmaceutical corporation in Brazil, which pledged to donate the drugs needed to eradicate yaws on 19 April last in Geneva during the most important annual meeting on neglected tropical diseases.
Until the international community and the affected countries also take responsibility, you can help to eradicate yaws. This might be the first time a disease will be eradicated thanks to the altruism of ordinary people. If so, it would be a doubly historic event, and one of which future generations will be proud.