An Epidemiological Apartheid for the Arctic

Scientists, doctors, and climate activists have called the Zika virus outbreak a preview into the kind of public health threats that will increasingly plague humanity as the world warms. But the southern hemisphere isn’t the only geographies to see an outbreak of new diseases.

For the first time in this region of the Arctic, the tropical intestinal parasite Cryptosporidium has been discovered in Nunavik, Quebec. Cryptosporidium, a microscopic parasite that lives in the intestine of mammals, is quite common across the tropic region – but never before has it been found in Nunavik.

The parasite can transmitted both through the ingestion of contaminated food or water and through infected individuals. It causes Cryptosporidiosis, an illness of diarrhea, cramps, and vomiting that can last several weeks. While most infected individuals recover, the disease can be fatal for young children and people with weakened immune systems, such as transplant recipients, cancer patients, or those with AIDS.

The disease "disproportionately affects young children at critical stages of growth and brain development, and, in other countries, repeated infections have been associated with reduced linear growth, impaired cognitive development, poor performance at school, less economic productivity, and lower adult height," say Dr. Cedric Yansouni of Mcgill University to HNN from his lab at McGill University. "Worryingly, these effects are exacerbated by food scarcity, which is reported at least sometimes by a substantial minority of households surveyed in the Canadian Arctic."

The findings were published last month by Dr. Yansouni and his team in the esteemed journal PLoS Neglected Tropical Diseases. The team of researchers at the Research Institute of the McGill University Health Center (RI-MUHC) in partnership with the Nunavik Department of Public Health, Institut National de Santé Publique du Québec, and Health Canada. The team focused on an outbreak of Cryptosporidium across 10 villages in Nunavik between April 2013 and April 2014. The outbreak affected 69 people, mostly children under the age of five, though the actual number of cases is probably higher due to under-reporting.

Distance as Deadly as Diseases

One reason for the projected under-reporting is just how difficult access to healthcare is in the Canadian Arctic. There is no access to local testing for those who feel sick. Instead, samples are taken and sent 2,000 kilometers south to Montreal to be tested.

"The lack of access to conventional diagnostic testing in most communities means that specimens need to be sent to distant laboratories for testing, which typically yield a result at least 2 weeks later", says Dr. Yansouni.

"Without testing, it is difficult to diagnose specific infections, to determine what treatment they require if any, and to detect outbreaks. Barriers to timely diagnosis delayed the recognition of human cryptosporidiosis in this outbreak, and likely resulted in more widespread transmission. Since this event, we have moved to implement molecular diagnostic testing platforms in some Arctic communities, which can be used with minimal infrastructure and greatly accelerate time-to-diagnosis and treatment."

Telehealth holds the potential to close the distance gap it the Canadian Arctic by enabling healthcare providers to improve the health regardless of where patients live. Medical professional can perform digital x-rays, remote diagnosis, and consult remotely with the help of high speed Internet connection. However, despite many telemedicine reports beginning as early 2000, remote healthcare in the Arctic is a story of unfulfilled potential with slow uptake of innovation and slower Internet speeds, states Heather Exner-Pirot in a blog post. 

The Need to Change Healthcare Systems

Even if access to doctors was improved and a diagnosis was made, Canadians affected by Cryptosporidiosis could need to access treatment through the Special Access Program. A treatment for Cryptosporidiosis is readily available in the United States and other countries where the disease is normally found. But because it is so rare in Canada, the treatment is marked as a nonmarketed drug in Canada. It is only made available to doctors through the Special Access Programme for treating patients with serious conditions when conventional therapies have failed, are unsuitable, or unavailable.

The potential dangers of a new outbreak of Cryptosporidiosis may require not only adaptations to the Canadian healthcare system for Cryptosporidiosis, but for other warm weather diseases projected to spread north, according to a workshop report published in the International Journal of Circumpolar Health. 

While this particular outbreak of Crytosporidosis did not demonstrate an obvious link to climate change in the north, Dr. Yansouni does say that, "several animal hosts in the Arctic have been found to harbour Cryptosporidium spp., and it is possible that climate changes will alter the relationship between people and their environment in the future." 
Higher temperatures of climate change increase the rate of development, survival through the winter, and reproduction of pathogens, and in turn the prevalence of infectious diseases in the Arctic. While the impacts on human disease in the Arctic is not yet fully understood, scientists fear that pathogens like the West Nile virus, Hantaviruses, and tick-borne encephalitis viruses will be seen in across the Arctic region in the future.

An Epidemiological Apartheid

When the Zika virus began to rapidly spread in January, climate change activist and 350.org founder Bill McKibben called the outbreak the beginnings of an epidemiological apartheid – an era where the world is divided into relative safe and dangerous zones in an opinion published in The Guardian. 

From Zika in the south to Cryptosporidiosis in the north, the widening of disease inflected geographies is not only creating new medical challenges; it’s also exacerbating existing socio-economic vulnerabilities in already marginalized geographies. Northern Canadian communities must deal with already existing systemic problems like exceptionally high food prices and suicide rates in addition to emerging health threats that bring the possibilities of developmental delays in the next generation.

Cryptosporidiosis may be one of the first new southern diseases discovered in the Arctic, but it will not be the last. It is up to circumpolar countries across the region to view Cryptosporidiosis as a glance into a future north where diseases no longer stop at the Arctic Circle and take steps today to ensure that the Arctic doesn’t become a dangerous zone in the new epidemiological apartheid.