Paul Farmer was Right: Global Health Inequities

Salmonella typhi—the same disease millions of people in India contract every year—was exotic enough in New York to significantly lengthen my time in the hospital and slow my care down. In previous blog posts, I’ve detailed how my questions following this experience led me to pursue an independent research project and reach out to the Wadsworth Department of Health lab, where I recently finished interning at. It also made me curious about the history of global health and the biases behind what infectious disease research is prioritized and funded. I eventually found myself reading about Paul Farmer, the physician and anthropologist who spent his career working in Haiti and Rwanda and documenting outbreaks and standards of medical care. 

While in Haiti, Rwanda, and other impoverished countries, Farmer asked a question that made a lot of people uncomfortable. Why do the diseases that devastate the Global South receive so little urgency, so little funding, and so little attention, regardless of how prevalent they are? His answer was simple. It’s a matter of power and resources. In the United States, Tuberculosis and Salmonella are consistently characterized as “re-emerging” diseases, and are only given real consideration when outbreaks occur. In many countries in Africa and Asia, these diseases are long-standing and a continuous health issue. The National Institute of Health will categorize outbreaks based on causes (ex. industry, pollution) specific to a nation-state. It fails to address race and social inequality or acknowledge the fact that diseases know no political boundaries. 

Before beginning my internship at the Wadsworth Center, I traveled somewhere where Tuberculosis is extremely common: Chennai. In between dance classes with my Bharatanatyam teacher, I had the opportunity to speak to the Chief Medical Officer of Infectious Diseases at VHS, Dr. Kumaraswamy. I spoke with him on his experience developing and promoting HIV Antiretroviral therapy in India and dealing with the TB burden, as well as how he’s collaborated on research with universities and institutions within the United States, including the NIH. It was striking to see how familiar the disease was and how quickly patients were administered treatment.

In the United States, TB is not a disease of the distant past, or only of faraway places. It disproportionately affects Hispanic, Black, and immigrant communities, and multi-drug-resistant strains are growing. It's just not particularly visible to the people in charge of setting research agendas, which goes back to Farmer’s commentary on power structures. This is part of why my time at Wadsworth this summer has felt so personal. I've spent six weeks studying Mycobacterium smegmatis—a close relative of TB—and trying to understand the genes that help Tuberculosis evade immune cells. This work has real public health relevance and could culminate in the development of novel non-antibiotic therapies to make for a faster and more targeted treatment of TB. 

COVID-19 showed us that global scientific cooperation is possible when those with higher levels of power decide something is urgent enough. Farmer spent his career arguing that urgency to collaborate and develop new vaccines shouldn't depend on who's suffering. I'm starting to believe him.