As the global debt crisis mounts, preventable diseases are surging in poor countries, yet a rational allocation of resources could easily stop this, argues John Clarke

The World Health Organisation (WHO) has reported that cholera cases in some of the poorest countries are increasing alarmingly. Almost a year has passed since the WHO ‘classified the global resurgence of cholera as a grade 3 emergency, the highest internal level for a health emergency requiring a comprehensive response at the three levels of the organization’ and the situation continues to worsen.

Preliminary data shows that cases of the disease soared throughout 2023, with ‘4,000 cholera deaths and 667,000 cases globally.’ The worst outbreaks were in Malawi and Haiti ‘where the number of deaths reached 1,771 and 1,156 respectively, making it the worst outbreak in Malawi’s history.’

Machinda Marongwe, the programme director of Oxfam in Southern Africa, described the situation as ‘terrifying’ and suggested that the rapid spread of cholera was creating ‘an uncontrollable health crisis’ that was ‘overwhelming the health systems of these countries.’

To make matters even worse, at ‘least 30 other countries have reported new cases since the beginning of 2024.’ Zambia, which had noted 7,500 cases since October, saw 500 new cases and 17 deaths in one 24-hour period in early January. Schools have been closed in that country and the president has urged people to leave the towns and move back to rural areas to try and contain the outbreak.

‘Predictable and preventable’

In October of 2022, the WHO was forced to halve the doses of cholera vaccine given to people in ‘outbreak hotspots’. Mike Ryan, the executive director for the WHO’s health emergencies programme, said at the time that we ‘shouldn’t have to do it … it is purely based on the availability globally of vaccines.’

Tedros Adhanom Ghebreyesus, the WHO director general, also stated that rationing ‘must only be a temporary solution … we need a plan to scale up vaccine production as part of a holistic strategy to prevent and stop cholera outbreaks.’

As WHO representatives offered these comments, they were confronting a situation where Shantha Biotechnics had announced its decision to stop production of ‘one of only two cholera vaccines for use in humanitarian emergencies.’ The data that the WHO has released this month suggest that the need to ‘scale up vaccine production’ has still not been responded to in the face of a worsening health crisis.

Apart from the indefensible lack of available vaccines, it must be noted that the spread of cholera is very largely attributable to poverty and global inequality. It is ‘an acute diarrhoeal infection caused by eating or drinking food or water that is contaminated with the bacterium Vibrio cholerae.’

While cholera ‘can kill within hours if untreated,’ timely and adequate medical care can save most people who become infected and the disease must be considered both ‘predictable and preventable. It can ultimately be eliminated where access to clean water and sanitation facilities, as well as good hygiene practices, are ensured and sustained for the whole population.’

In several key ways, the present state of global capitalism ensures the spread of cholera and other diseases that could readily be contained with a rational allocation of the necessary resources. In September of last year, the WHO and the World Bank issued a joint report on universal health coverage or the lack thereof. It found an ‘alarming stagnation in the progress towards providing people everywhere with quality, affordable, and accessible health care.’

The report also showed that ‘more than half of the world’s population is still not covered by essential health services.’ Despite its promotion of ‘the fundamental human right to health’ and the suggestion that its findings constituted ‘a wake-up call to the global community,’ there is little reason to expect that the billions of people who are denied the most basic forms of healthcare will see any improvement in their situation in the immediate future.

It is certainly true that the impacts of colonialism, exploitation and distorted development that impact the Global South could only be reversed over an extended period. However, when it comes to health-care provision and vulnerability to preventable illnesses, dramatic improvements could be obtained rapidly if existing resources were made available.

In 2017, the WHO estimated that ‘it would cost about $58 per person, per year to achieve universal health care in all low and middle income countries. That comes to about $371 billion per year by 2030.’ If this were provided, ‘97 million pre-mature deaths would be averted, including more than 50 million infants and children who die in childbirth or before their 5th birthday … Life expectancy would jump, anywhere between 3.1 and 8.4 years.’

Similarly, in 2021, the UN’s World Food Programme pointed out that ‘41 million people are knocking on famine’s door’ and that children across the world are ‘dying of hunger at a rate of one every five, six seconds.’ Yet, it estimated ‘that ending hunger by 2030 would cost US$40 billion per year.’

Given the vital role that adequate sanitation plays in preventing the spread of cholera, it’s worth noting that the UN World Water Development Report 2021 found that three billion people across the planet ‘lack adequate access to hand hygiene facilities.’ It estimated that ‘achieving universal access to safe drinking water and sanitation in 140 low and middle-income countries would cost about USD 114 billion per year.’

The $525 billion that would be required for universal healthcare, the elimination of hunger and adequate sanitation can be usefully measured against some obvious indicators of how resources are actually allocated. In 2022, for example, the US spent $877 billion to preserve its overwhelming military superiority, an amount that constituted 40% of the global military budget.

The Tax Justice Network suggests that at least $21 trillion in financial assets are sitting in offshore tax havens and that an additional $427 billion is diverted into them every year. The spread of cholera is an entirely preventable tragedy that flows from the social and economic system we live under and the priorities of the present world order.

Global crisis

The proliferation of cholera at the present time is also driven by a several-sided global crisis, and a major element of this is the huge growth of international debt. ‘The stock of external public debt in low and middle-income countries stands at over $3 trillion — a doubling since 2010 — and private creditors hold nearly 60 percent of it.’

At the same time, three-fourths ‘of the countries facing debt difficulties are also designated by environmental experts as highly climate vulnerable.’ Poor countries must deal with the devastation caused by climate impacts, even as they are compelled to hand over vital resources needed to preserve the health of their population to banks and other lending institutions.

The health of people in the Global South has also been undermined by the impacts of the cost-of-living crisis. Supply shocks, attributable to the pandemic and invasion of Ukraine by Russia, led to an inflationary surge that has caused enormous hardship in poor countries.

At present, Israel’s brutal assault on Gaza and the support it has received from US-led Western powers threaten to create a disastrous regional conflict. Already, the Red Sea trade route has been substantially disrupted. This may have ‘devastating effects on the global economy, reigniting inflation and disrupting energy supplies.’ Such consequences will only deepen poverty in the Global South and increase vulnerability to disease.

Preventable threats to public health are very much a feature of the present period. Even in the UK, a return of Victorian-era diseases has been noted. The dramatic and deadly spread of cholera in the poorest countries is a more terrible expression of the same development. Such needless deaths and the appalling conditions that produce them are not only humanitarian catastrophes. They also constitute an indictment of global capitalism at the end of the first quarter of the twenty-first century.