According to a report by the World Health Organization (WHO) on 20 October, 2017, plague in Madagascar has claimed 102 lives. It has 1,297 documented cases, and a CFR (case fatality rate) of 7.9%.  To be clear: that means that of everyone who has contracted plague there, 7.9% of them have died.

Madagascar is split up into 22 “regions” and within them lie 114 “districts.” While the district of Antananarivo Renivohitra has been getting hit the hardest, 30% of the districts nation-wide have seen cases of plague.

Yersinia pestis – Wikimedia Commons

There are three types of plague: bubonic, pneumonic and septicemic. Well over half of these are classified as pneumonic plague, often known to be a progression from the infamous bubonic plague–which has claimed 20.8% of the recent cases in Madagascar.  Only one case was septicemic.  Again, these forms of plague aren’t necessarily completely independent of each other–they all stem from the same zoonotic bacteria, Yersinia pestis.  If they go untreated, pneumonic and septicemic plagues have a mortality rate of 99-100%.  Bubonic, the medieval “Black Death,” can go untreated and still have a staggering fatality rate of 40-60%.

Why do these outbreaks seem to happen so frequently in less developed countries? Why aren’t these biological threats constantly knocking at America’s door?

According to the CDC, there are some very basic things that the average person can do to prevent plague: things like controlling rodent populations in and around your home–in the United States, rodents are taken care of no problem. If you have an issue, you have access to tools and services that will help you get rid of them. On top of that, you have access to tools and services to make your home or place of business relatively uninhabitable for rodents in the first place.  The same goes for fleas from these rodents, as they can move to your pets too, Trojan-horsing their way into your home.

You might be on top of all these things, and you might not need anyone else to help you with rodent control or flea control.  Just remember that you don’t have to be the source of plague–once it has infected a person, it can move from one to the other. So it only takes one.

This is not to instill any kind of paranoia here–it just goes to show how much easier it is for people in developed countries to keep epidemics out, using their basic knowledge of hygiene, and built in systems of prevention.  We have access to simple things like soap, flea medication for pets, trash services, standardized construction; we also have access to larger entities like hospitals, clinics and the CDC.

A member of staff at a school in Antananarivo sprays against plague in a classroom at a school in the capital Antananarivo, Madagascar –
AP Photo/Alexander Joe

According to the UN, Madagascar is high on the list of LDCs (Least Developed Countries), and keeping up with these preventative measures is significantly more difficult than in the United States.  If we were to have an outbreak of some kind, you could expect authorities responding and quarantining at neckbreak speeds.  Patient zero would remain patient zero, whereas remote places don’t have that luxury. The Madagascar government is in no shape to completely contain and handle this crisis, and so they are at the mercy of the international community. All of that takes time–time that gives the disease the chance to gain a foothold that allows it to spread.