FORGING THE CHAIN

S
94
THE SUSTAINABILITY
PUZZLE
Sustainable is a fashionable word. Lately it has been
applied to almost everything: sustainable development,
sustainable energy, and sustainable climate.
Ironically, it is most often used when a situation is
anything but sustainable.
Sustainability is only important when a problem is
under control and when a good state of affairs needs
to be maintained. At which point the initial problem
is often forgotten until it recurs. Sustainable control
of tropical diseases is most often mentioned during
outbreaks.
The most important consideration when a disease
has not been eliminated is dedicating all efforts
and resources to doing so. When public health programmes
are efficiently and effectively conducted –
and when sufficient will and resources are available
– it is possible to reduce human cases of a particular
disease in a particular region or country to zero. But
the problem is not solved. For many tropical diseases,
the causative organisms will persist in animal hosts
and will still pose a threat to humans.
The challenge with sustainability is that maintaining
control over an eliminated disease requires a different
approach and falls into a different category of
behaviour, which has not been particularly successful
with individuals or with humans. Attention, motivation
and funding are easier to maintain when there is a
crisis. Being perpetually on guard against something
that may occur loses impetus after a while.
Targeted disease-elimination programmes must eventually
give way to surveillance programmes that are
less costly but harder to justify as developing countries’
budgets are renewed year after year with no
new cases being reported, and as they mull over how
best to spend their limited resources. Experience has
shown the importance of preparing in advance for
when NTDs are brought under control. Health systems
have to be adapted and different strategies adopted
to cope with the new situation. Otherwise, sooner or
later, the diseases will be neglected once again and,
when that happens, they will resurge. Tropical disease
specialists refer to these instances of repeated history
as “the penalty of success”.
Sleeping sickness and yaws are prominent examples.
Both diseases were virtually eliminated in the
1960s and re-emerged two decades later. Failure to
maintain control over them was a tragic shortcoming
of human psychology and organizational behaviour
that cost hundreds of thousands of lives.