Author: The stawa team

Have you ever wondered why stray animals that eat from the garbage bin rarely fall sick? Or how our pets who consume the family’s leftover food manage to remain hale and hearty? In contrast, we have been washing our hands, using different kinds of sanitisers, wearing a mask and eating fresh and clean food. Despite this, we seem to remain at constant risk of all kinds of pathogens. Why are humans so weak? Or, what has made humans so weak? The reality is the exact opposite. Humans are fairly strong but we suffer due to our behaviour and actions.

In the wake of the COVID-19 pandemic, it’s definitely a good idea to maintain a very high degree of hygiene. I have now learnt to trust the wisdom of the famous Ladakhi word: Lobs, which means “getting used to”. For instance, elders often say, “Don’t give boiled water to your children all the time or they will get used to it.” Most of us have survived on tap water and stream water while our children have grown up on filtered and boiled water. Similarly, the elders also say, “Oh, don’t wear that feather jacket. What will you wear in the winter?” In the same vein, they would also say, “Oh, don’t keep that baby so clean all the time, let it play in the dirt. It will make the baby strong.” Yes, diarrhoea and similar infections are most common among children who maintain a high level of hygiene. I have noticed that children from Europe and other developed countries are very susceptible to diarrhoea and contact infections such as Hepatitis A when they visit India.

Our immune system is very strong and dynamic. Though it faces challenges tackling some pathogens, our body is able to deal with most pathogens and provide immunity cover for the rest of our lives. Over several generations, we have developed an innate and natural immunity for many pathogens. In this regard, the novel coronavirus is different as it is a new virus that may have come from wild animals or may even be “artificial”…who knows!

This year has been exceptional in many ways. Besides the COVID-19 pandemic, other diseases seem to be lying low. For instance, we didn’t have diarrhoea during the diarrhoea season. Similarly, we always get several patients with pneumonia or the common cold in the hospital but the numbers have been much lower this year. In fact the incidence of most infections seems to be at the lowest I have ever seen. I cannot help but wonder what happened to the never-ending line of children in our OPD and the clinics. And what happened to waterborne diseases such as diarrhoea and jaundice?

We contract most infections due to our behaviour and actions. Our body has evolved to fight off most infections. However, most epidemics are caused by pathogens that originated in nonhuman animals. These pathogens do not cause their host animals any harm and become virulent when they manage to jump to humans who do not have any natural immunity to such new viruses. Similarly, we too have pathogens in our body that do not harm us but can cause infections in other species that lack immunity to them. Such ‘good bugs’ help us remain healthy. Through the course of history as we started domesticating and consuming various animals, many of their ‘good bugs’ started mutating and crossing over to humans.

A good example of this process is measles, which is caused by the measles virus. Measles is a common infection amongst children. It has caused epidemics and claimed the lives of millions worldwide. This virus is said to be closely related to the Rinderpest virus, which is a pathogen found in cattle. It is believed that the smallpox virus shares many similar characteristics. Smallpox has wiped out whole civilisations. Most researchers assume that animal domestication and their consumption that started around 6,000 to 10,000 years ago, created conditions that facilitated the emergence of smallpox. Similarly, a virus that causes common cold-like symptoms in humans originated in poultry and may have crossed the species barrier around 200 years back according to an article in the Journal of General Virology. An international team of scientists traced the origins of human tuberculosis to early humans when they lived in hunter-gatherer groups in Africa some 70,000 years ago. Similarly, chimpanzees in West Africa have been identified as the source of the HIV infection in humans. It is believed that the chimpanzee version of the immunodeficiency virus (called Simian Immunodeficiency Virus or SIV) was transmitted to humans and mutated into HIV after humans hunted these chimpanzees for meat and came into contact with their infected blood. Over decades, the virus spread across Africa and the world beyond. Other diseases such as Plague, Brucellosis, Lyme diseases, and Rabies have a similar history.

This seems to be true for the novel coronavirus too. We know that it originated in a wet market in Wuhan where a wide variety of wild animals like snakes, mongoose, bats, and wild cats were slaughtered for consumption. It is believed that the novel coronavirus has a zoonotic origin as it has a close resemblance to the bat coronavirus. However, there are some claims that pangolin may have served as an intermediate reservoir for the virus as it passed from bats to humans.

Overall, it seems we are suffering largely because of the suffering we have inflicted on animals and other life-forms. Although humans are physically small, our brain is disproportionately large and has enabled us to control the whole planet. In fact, many species have become extinct due to human activities.

Humans have long consumed other animals as food. This may have been relatively safe when these animals were raised in the backyard. However, this is now being done on an industrial scale and has become inhuman and unethical. In the last 50 years, while the human population has doubled the amount of meat being consumed has tripled in addition to the tonnes of fish being harvested. Intensive farming operations housing tens of thousands of animals in close quarters serve as ideal incubators for disease transfer of infectious agents from animals to humans, antibiotic resistance, food-borne illness, and the emergence of new viruses like the novel coronavirus. Antibiotic resistance, stems from the use of antibiotics to promote growth and suppress disease in confinement operations and poses a serious health concern. In fact a majority of the antibiotics produced are consumed by animals that are then consumed by humans.

Furthermore, the ever increasing demand for food has shifted the focus from ethics to efficiency. Animals are now being slaughtered by machines and through electrocution, which are painful. At the same time, many industrial farms employ procedures such as de-beaking, de-horning, de-tailing, castration, overcrowding etc. to increase their meat output. However, these practices cause physical stress to the animals and there is growing concern that meat produced in such facilities is laden with various stress hormones in addition to various pathogens and antibiotics.

By Dr Spalchen Gonbo

Dr Spalchen Gonbo is a Paediatrician based in Leh.

It is said that only fear brings people together. And, when the fear is that of death, the world will surely come together. In the wake of the COVID-19 pandemic, we have seen the world unite to develop a vaccine against the disease. Everyone seems to be waiting eagerly for a vaccine that will prevent COVID-19. Even people who otherwise oppose vaccines and those who regard vaccinations as a marketing conspiracy are now pinning their hopes on various trials underway.

However, this unity has turned into a contest, which is reminiscent of the race to reach space. And this time too, Russia seems to have won with its Sputnik-V vaccine for COVID-19. The word ‘sputnik’ means ‘fellow traveller’ in Russian. The word holds a special place in Russia’s history after Sputnik became the first artificial satellite that was successfully launched into space. At the time, Sputnik was way ahead of its time just as Sputnik-V is now. It has left the world, especially Russia’s Cold War rival, the U.S. of A, in a state of shock.

While the competition to master space flight was indeed a race, the development of a vaccine should not be treated as a race or contest. Many compromises are being made in this race to develop the first vaccine for COVID-19. According to various reports, Sputnik-V has not even completed its Phase 3 trials when it was declared a success. Many countries are bound to reject it till it undergoes more rigorous tests. The UK has already said it will not use Russia’s vaccine at the moment. Safety and effectiveness are key components of a vaccine. Most vaccines that are currently being used have taken anywhere from five to 10 years of development and have undergone five phases of testing.

We seem to have forgotten an important principle of medicine. Vaccines are but one strategy to prevent to prevent a disease. We must treat the COVID-19 vaccine as one of many approaches to control the disease and make it our only strategy. There are many different measures and non-pharmacological interventions to control the spread of the virus that can be implemented immediately but remain neglected. Furthermore, in the race to find a vaccine for COVID-19, we have started ignoring all other diseases and routine vaccinations that are putting people at unnecessary risk.

Let me put this in perspective. The seriousness of a disease is calculated in terms of mortality or death that it causes. I pulled up statistical data from the websites of World Health Organization and Medscape for diseases that have a relatively high mortality rate for which vaccines are available but are not mandatory. This includes Varicella (4.2 million complications and 4,200 deaths worldwide each year), Influenza (three to four million and up to 500,000 deaths worldwide each year), Hepatitis A (7,134 deaths in 2016), Pneumonia (2.56 million deaths in 2017), Hepatitis B, which is regarded as 100 times more infective than HIV and causes around 884,000 deaths each year. A total of 570,000 women were diagnosed with cervical cancer worldwide in 2018 and it claimed the lives of 311,000 women that year. Then there are serious bacterial diseases such as meningococcal meningitis whose mortality rate can exceed 50% if left untreated. Vaccines are available for all these diseases but most people do not receive them as they are ‘optional’ in many countries including India. Most people don’t regard these vaccines as necessary as the deaths caused by them are not as ‘visible’ as COVID-19. Many vaccines currently being administered such as BCG and MMR are said to provide a degree of protection against COVID-19. Similarly, the flu vaccine Pneumococcal also seems to help prevent some complications of COVID-19.

The deaths attributed to COVID-19 are visible as we are in the midst of a pandemic. It may soon become endemic or may vanish altogether. Even now, the deaths caused by COVID-19 are less than the number of people who die in accidents, which in 2018 was estimated to be around 151,417 in India alone. There is a common misconception that COVID-19 is lethal in the absence of a vaccine. This is simply not true. So far, the highest mortality rate for the disease has remained below 3%.

Take for instance the case of the Hepatitis B vaccine, which is known to prevent certain cancers of the liver. It has now been included in the Universal Immunisation Programme and every new-born in the country is receiving this vaccine. However, most adults and elders in Leh district have not been immunised with this vaccine. I specifically mention Leh district rather than Ladakh as a whole. The reason is that Kargil recently managed to vaccinate every person in the district. The end result is that most adults in Leh district have not received the Hepatitis B vaccine despite its high prevalence in some parts of Changthang.

I am not suggesting that we should stop looking for a vaccine, stop taking COVID-19 seriously or become complacent. However, safety and effectiveness are two most important qualities of a vaccine. A vaccine cannot be produced overnight. Interestingly, I recently discovered that vaccines have also been a part of disease prevention in Sowa Rigpa. In allopathic systems, vaccines undergo five steps of development. I would argue that we should not rush the process of developing a vaccine and invest in multi-pronged approaches for disease prevention. And most importantly, we must not neglect other diseases that are still infecting people and claiming lives for which we do have vaccines and treatment protocols. Vaccines are said to be humankind’s most important invention after the wheel. However, we seem to have forgotten a very simple principle: Vaccines do not save lives, vaccinations do.

By Dr Spalchen Gonbo

Dr Spalchen Gonbo is a Paediatrician based in Leh.