Not
Just
Biology
A Holistic Approach to Understanding the
Emergence of Infectious Diseases
in Developing Countries
by Stephanie Oberfoell
H ow do dramatic ecological shifts precipitate the outbreak of latent
infectious diseases? Professor William Durham, the chair of the
Anthropological Sciences Department at Stanford University, and his
colleague, Assistant Professor of Anthropological Sciences James Jones,
have begun to address this question. Using a holistic approach, they study
how human-induced environmental change affects the transmission ecol-
ogy of diseases. Durham’s current investigation on the malaria outbreak
in Rôndonia, Brazil, in the 1980’s and the cholera epidemic in Peru in the
1990’s has revealed that cultural and social factors are also responsible for
the upsurge of the diseases.
Before 1980, Rôndonia, a state on Brazil’s western border with Boliv-
ia, was covered in closed-canopy rainforest and only sparsely inhabited.
The hostile headhunting tribes who occupied this region, numbering a few
thousand people at most, decapitated opponents’ heads in a pattern of tra-
ditional warfare that dated back millennia. In times past, this practice was
adaptive in that it resulted in the dispersal of local tribes, and increased the
local game supply. The large distance between tribes reduced the preva-
lence of malaria in the region. Furthermore, the closed-canopy forest did
not provide the standing puddles of warm water in direct sunlight that the
malaria vector—the Anopheles mosquito—needs in order to breed. As a
result, endemic malaria remained at low transmission, low virulence, and
low frequency before the construction of Brazilian Route 364.
In 1980, the United States-supported World Bank granted a multi-mil-
lion dollar loan to the Brazilian government to construct Brazilian Route
(BR) 364, a highway connecting the state of Rôndonia to the rest of Bra-
zil. BR 364 was intended to provide thousands of jobs in construction
and to allow access to potential farmland to help the growing population
of millions of unemployed and landless in the country.
Because the government widely advertised the route’s development,
millions of Brazil’s poor, landless farmers began to move into the sur-
rounding area. The migrants received government-granted land titles if
they built settlements and cleared forest for farming. They tried to grow
annual crops like rice, manioc, maiz, and beans, but the soil was poor. As
a result, the farmers slashed and burned more forest in hopes of finding
better soil.
Interactions between the westernized settlers and the indigenous head-
hunting tribes caused many problems. As the settlers continued to move
into the depths of the Amazon, they continually encroached upon the
land of the native headhunters. In retaliation, the headhunters burned the
settlers’ homes and killed their children and livestock. But both settlers
Layout designed by Candice Hsu Volume IV 31
Not Just Biology
and natives lost lives: the settlers, for their part, brought new diseases to
the region, killing as many as 60% of the indigenous people in some areas.
Durham hypothesizes that these cultural clashes, along with ecological
ones, contributed to the massive outbreak of malaria in Rôndonia.
The dramatic ecological shift triggered by BR-364 created the perfect
breeding ground for the Anopheles mosquito. In addition to the two to four
meters of rainfall each year in Rôndonia, the network of roads led to thousands
of kilometers of trenches and massive deforestation, creating warm, standing
puddles for mosquito larvae. The immigration of millions of Brazilians into
the region also created a high-density population for the rapid transmission
of malaria. “You couldn’t have planned a better environment for Anoph-
eles mosquito reproduction,” Durham claims.
Durham devised a method to quantify the disease effects of the
BR 364 construction by calculating the value of the “Basic Re-
production Number” using the “vectorial capacity” of the Anoph-
eles mosquito in Rôndonia. The reproduction number, R0, consid-
ers the transmissibility of the disease, the average contact rate of
people, and the duration of infectiousness. If R0<1, the disease will
die out by itself. If R0>1, there is an epidemic. The vectorial capacity,
VC, depends upon the number of blood meals per day per vector, the
proportion of blood meals taken on humans, the time interval between
blood meals, the vector’s average lifespan, and the vector’s development
time.
In Durham’s preliminary research, he found the Basic Reproduction
Number for malaria dramatically increased with BR 364 because each
Durham’s multidisciplinary approach allows him
to draw links where few have drawn links before.
variable in the numerator of the equation had increased significantly. He
hypothesizes that before the construction of the route, R0<1.0, whereas
now it is much greater than 1.0. In other words, this indicates that Rôndo-
nia went in a decade or so “from a disease ecology with low transmission
http://www.cdc.gov/malaria/biology/mosquito/frame.htm
to almost perfect conditions for maximum transmission.”
Paralleling the malaria scourge in Brazil a decade earlier, Peru in 1991
had a sudden upsurge of a previously quiescent disease—cholera. For over
50 years, R0 for cholera in the Americas was less than 1.0. But then along
came El Niño weather conditions in 1991. Durham hypothesizes that global
warming lies behind the “higher frequency and longer duration of El Niño
events” in recent years. The warming of the sea allows for the proliferation
of copepods, where Vibrio cholerae bacteria live. Vibrio cholerae produces a
toxin called choleragin which is responsible for the disease symptoms.
32 Stanford Scientific
Dr. Rita Colwell, former Director of the National Science Foundation,
has done extensive research on the topic. Specifically, she relates sea tem-
perature change to the bloom of the copepods and hence to the spread of
cholera.
Durham, however, causally implicates social conditions in the trans-
mission of cholera as well. He argues that prior to 1991, there were in-
ternational warnings that the overuse of the disinfectant, chlorine, could
thin the earth’s pro-
http://ehp.niehs.nih.gov/docs/2003/111-7/waterglass.jpg
tective ozone layer.
Although Peru used
chlorine to make
potable drinking water, the international community pressed Peru to de-
crease chlorine usage to save the ozone. With
the reduction in chlorine, the public water
supply became a convenient means for cholera to spread among Peru-
vians. Hence, Durham hypothesizes that human-induced environmental
change increased the prevalence of Vibrio cholerae in the seas, followed
by an easy transfer to the water supply.
Following the results of his work in Brazil and Peru, Durham hopes
more broadly “to draw links between human-induced envi-
ronmental change and the resurgence of some age-old
pestilences—influenza, cholera, and malaria—and
the emergence of some new ones, like HIV/AIDS
and Ebola.”
While the multiple variables of emerging
infectious diseases are difficult to track down,
Durham’s multidisciplinary approach is unique
in that it allows him to “draw links where few
have drawn links before.” He can begin to see
the whole picture by linking not just biological phe-
nomena, but cultural and social ones as well.
Before relocating millions of people into the forest, cut-
ting back on chlorine usage or making other large ecological changes,
Durham hopes that people in power will take a more interdisciplinary ap-
proach to development and planning. In the future, he hopes that forestry
officials and city planners will have policy agendas that factor in the effects
of human-induced environmental changes on disease ecology. S
Stephanie Oberfoell is a sophomore majoring in Human Biology
and considering a minor in Art History. After her undergraduate career,
she plans to pursue a Masters in Public Health and Doctor of Medicine.
She loves to travel, snowboard, admire art and advocate conservation.