The Economist - USA (2022-01-22)

32 Asia TheEconomistJanuary22nd 2022

Lousyinfrastructurealsohelpsdrug­re­

sistantinfectionsspread.Forexample,wa­

ter sources around Hyderabad, a drug­

makinghubinsouthernIndia,arefullof

antibioticandantifungalresidue,saysa

recentstudyinJournalofInfection. Asa re­

sult, microbes in the surrounding area

havedevelopedresistance.

Covid­19has madethings worse, be­

causemanypeoplewronglybelieveitcan

betreatedwithantibiotics.Arecentstudy

froma teamledbyGiorgiaSulisofMcGill

UniversityinCanada lookedathowsales

ofantibioticsforadultsincreasedinIndia

duringthefirstwaveofcovid­19.Theyesti­

matedthatnervousIndiansgobbleddown

216mexcess doses. Anopenletterfrom

doctors on January 14th lambasted the

country’shealthauthoritiesforthe“wan­

ton”and“unwarranted”useofantimicro­

bialsinresponsetotheOmicronvariant.

Antibioticstreatbacterialinfections,not

viruseslikesars­cov­2.

Theeconomicburdenofsuperbugsis

growing.In 2016 Britishgovernmentscien­

tistspredictedthat,ifnoseriouseffortis

madetocheckantimicrobialresistance,it

couldkill morethan10mpeopleayear

globallyby2050.Theyalsoestimatedthat

it mightreduceglobaloutputbya cumula­

tive$100trnoverthatperiod.Suchnum­

bersarehighlyspeculative.Whatisclear,

however,isthattreatinga patientwitha

drug­resistant infection is costly—be­

tweenthreeandfourtimesmoresothan

treating one with an infection that re­

spondstoantibiotics,estimatesDrWalia.

Sofar,effortstoavoidnurturingsuper­

bugshavebeenpatchy.In 2020 India’sen­

vironment ministry proposed limiting

antibioticresiduepermittedinwastewater

releasedbydrugfactories.Lastyearitqui­

etlyrenegedonthispromise.Severalanti­

bioticshavebeenbarredforuseinlive­

stockinPakistan,IndiaandBangladesh.In

2019 over­the­countersalesofantibiotics

(forhumans)werebannedinIslamabad,

Pakistan’scapital.

Rulesareoftennotenforced,however,

saysProfessorHasan.Restrictingsalesis

alsotricky.WhilemanySouthAsianstake

toomanyantibiotics,otherssufferoreven

diebecausetheyhavetoofew,saysDrWa­

lia.Morewidelyavailablecheapdiagnos­

ticswouldpreventdoctorsfromprescrib­

ingthewrongdrugs,saysDrChisti.But

thiswillonlyhelpsomuch.Hard­upla­

bourerswouldrathergostraighttoa shop

andbuycheapantibioticsthanforkout

firstfora doctor’sappointmentandtests.

Bettersanitationandhealthcarewould

reducedemandforantibiotics.Bettermed­

icaltrainingwouldcurboverprescription.

Allthiswouldslowthespreadofantimi­

crobial resistance, making millions of

SouthAsianshealthierandmoreableto

work.It wouldalsocutmedicalbills.Fight­

ingsuperbugsmaybecostly,butfailingto

dosoisevencostlier.n

The drugs don’t work

Deaths attributable to antimicrobial resistance

2019,per100,000people

Source:TheLancet *CentralandEastern

MiddleEast&

northAfrica

EastAsia,South-

EastAsia& Oceania

LatinAmerica&

theCaribbean

Europe*&

CentralAsia

SouthAsia

Sub-SaharanAfrica

2520151050

68

254

84

74

389

255

Deaths, ’

Tonga’svolcaniceruption

A kingdom cut off

W

ordcameatlast.Three  days  after

Hunga  Tonga­Hunga  Ha’apai  volca­

no  in  the  Kingdom  of  Tonga  erupted  on

January 15th, the prime minister’s office re­

leased  a  statement.  The  eruption  was  an

“unprecedented disaster” for the archipel­

ago and three deaths were confirmed. The

blast  created  a  vast  ash  cloud  and  led  to  a

tsunami  (two  people  drowned  across  the

Pacific  ocean  in  Peru).  Explosions  of  vol­

canic gas were audible more than 2,000km

away  in  New  Zealand  and  plumes  of  gas

rose more than 20km into the sky. In a bib­

lical flourish, pebbles rained down on the

Tongan  capital,  Nuku’alofa,  located  some

65km south of the volcano.

The eruption was driven by subduction,

a  process  whereby  one  of  Earth’s  tectonic

plates  (in  this  case  the  Pacific  one)  sinks

beneath  the  edge  of  another  (in  this  in­

stance  the  Indo­Australian  one).  Hunga

Tonga­Hunga Ha’apai sits within the “Ring

of  Fire”,  a  geological  fault  line  encircling

the Pacific. Tongans call the islands afflict­

ed  by  the  region’s  frequent  earthquakes

those which “jump back and forth”. 

The  volcano  is  1,800  metres  tall  (mea­

sured  from  the  sea  floor)  and  takes  its

name  from  the  two  parts  of  the  rim  of  its

crater,  or  caldera,  which,  before  the  latest

blast  at  least,  rose  above  the  sea:  Hunga

Tonga and Hunga Ha’apai. Shane Cronin, a

volcanologist at Auckland University, reck­

ons that the latest eruption probably came

from the caldera itself. 

An eruption in December 2014 filled the

gap between the volcano’s two islands with

ash, joining them. “The island’s formation

also probably seeded its destruction,” says

James  Garvin,  chief  scientist  at  nasa’s

Goddard  Space  Flight  Centre.  “As  it  rose

from the sea, layers of liquid magma filled

a  network  of  chambers  beneath  it.”  When

the magma in those chambers erupted on

January 15th, the vast explosion in the seas

and skies seems to have been coupled with

an implosion in the rocks below as some of

those  chambers  collapsed,  undermining

the  caldera  and  its  rim. Satellite  images

now show that only a chunk of one of the

former islands remains visible.

The  true  number  of  deaths  among  the

country’s 100,000 people is unknown. So is

the extent of damage to crops, villages and

livelihoods.  Communication  with  Tonga

was  possible  only  by  satellite  phone  ini­

tially; the submarine cable that connects it

to Fiji and thence to the outside world was

severed.  Repairs  could  take  weeks  as  the

closest  repair  vessel  is  2,500km  away.

Flights in and out of Tonga were suspend­

ed at first, owing to ash on the internation­

al airport’s runway. Flights carrying aid are

now arriving.

New  Zealand  and  Australia  have  sent

surveillance flights over the archipelago to

assess  the  damage.  Reports  suggest  that

roads  and  bridges  have  been  destroyed,

though the airport is intact. Grim satellite

images show heaps of ash smothering en­

tire islands. Emergency workers are hand­

ing out food, water and tents, according to

the prime minister’s office. Water is partic­

ularly  vital:  many  Tongans  capture  fresh

rainwater  from  their  roofs  to  drink.  Ash

has probably contaminated it. 

Navy  ships  carrying  aid  from  Australia

and New Zealand are on the way. The hope

is  they  do  not  also  carry  covid­19.Tonga’s

only  case  so  far  was  caught  at  itsborder;

one disaster must not lead to another.n

WELLINGTON

The scale of the damage

remains unclear

Paradise lost