An ‘Illegal’ Outbreak of Plague
The new nation of Turkmenistan, one of several Central Asian republics that rose from the Soviet Union’s ashes, is ruled by a 64-year-old dictator named Saparmurad A. Niyazov, a strutting, miniature Saddam Hussein who calls himself Turkmenbashi (father of the Turkmens). A man of monstrous ego and modest intellect, he has outlawed beards on men and forbidden women to wear gold teeth, a sign of status.
The capital of Turkmenistan, Ashgabat, boasts an enormous golden revolving statue of the Turkmenbashi, oriented toward the sun so that its rays always shine on the statue’s face. Niyazov is also building in the desert -- at a cost of $6.5 billion and using water diverted from a parched countryside -- what he calls “The Great Turkmen Lake.” The world keeps quiet about Niyazov’s eccentricities, aware that his vast wealth comes from control of one of the world’s largest supplies of natural gas. All of this would be amusing, more or less, if we didn’t think too hard about the effects of such policies. But over the last few months, the Turkmenbashi has taken the health of his nation’s 5 million people into his own hands, with potentially devastating consequences.
In March, he dismissed 15,000 licensed healthcare workers “to save money” and replaced them with conscripts. In June, the Turkmenbashi fired Turkmen doctors and other health workers with foreign degrees, saying their training was “incompatible with the Turkmen education system.” Most disturbing, he has declared all infectious diseases -- cholera, AIDS and other scourges -- illegal and has forbidden any mention of them.
Turkmenistan’s Anti-Epidemic Emergency Commission has stated that “the epidemiological situation on the territory of Turkmenistan is safe. There are no cases of dangerous diseases.” If only that were true.
According to both Gundogar, a Turkmen opposition group, and the Turkmenistan Helsinki Initiative, a deadly plague epidemic has broken out in the Turkmenbashi’s territory. Yersinia pestis, the germ that causes plague, is widespread among rodents throughout Central Asia, and the strains they carry are among the oldest, most virulent and most dangerous in the world. In the barren deserts of Turkmenistan, the leading plague reservoir is a burrowing rat-sized animal with legs like a miniature kangaroo, Rhombomys opimus, the great gerbil. Recent years in Central Asia have been good for gerbils, producing bumper crops of the grains they eat. More grain means more gerbils, and more gerbils means more plague.
These outbreaks happen periodically, and with good public health systems in place they can be managed. The Soviets in their day responded quickly, though they kept news of the outbreaks from the outside world. In 1950, according to a recent account by Russian plague expert Lev Melnikov, a large plague outbreak in Turkmenistan killed several hundred people. That outbreak originated with a nomad hunter who bedded down overnight in gerbil territory and was bitten by infected fleas. He returned to his family’s encampment; the disease spread rapidly to his lungs, and soon everyone in the settlement was infected. Some relatives fled to other nomad tents before they died, spreading the disease further. Only a heavy-footed response from the Soviet government, with medical teams, military quarantines and enormous pyres to burn the infected corpses of the nomads together with their tents brought the epidemic under control.
But the Soviets and their hundreds of trained plague experts no longer run the show, and the Turkmens are at the mercy of the Turkmenbashi’s policies. At least 10 people are known to have died of plague this summer, and some reports place the figure considerably higher. The Turkmen government has responded, predictably, by declaring the word “plague” illegal. It has also instituted border controls “to prevent disease from entering Turkmenistan from neighboring states.”
Still, reports continue to trickle out: of deaths in Merv in the southeast, in the capital city of Ashgabat, in the city of Turkmenbashi (formerly known as Krasnovodsk) on the shores of the Caspian Sea. Though some reports state that this outbreak of plague is bubonic, and thus spread only by infected fleas or by direct contact with a sick animal, others claim that the disease has become pneumonic, or lung-borne, the most feared and lethal form of the disease.
The Black Death of 1347-1351, which originated among the rodents of Central Asia, seems to have been a largely pneumonic plague, augmented by human-to-human transmission via fleas carried by people. It spread across the known world, killing at least 40 million people in the deadliest pandemic in human history. Today, when people are infected by any form of plague, about 85% survive if they are treated promptly with appropriate antibiotics. Even in the absence of antibiotics, skillfully handled quarantine and isolation can break the chain of transmission. But these approaches to plague management require something that’s missing in Turkmenistan: acknowledgment that the disease is a problem.
How bad is plague in Turkmenistan going to get? It is possible that -- unknown to the outside world -- the severely crippled Turkmenistan healthcare system has somehow managed to curtail the outbreak. But we cannot ignore the possibility that the plague may continue to spread. The secrecy that characterizes the Turkmenbashi’s regime prevents the outside world from knowing what is going on inside the country’s borders. “Turkmenistan is a black box,” said Raymond Zilinskas, an expert on biological weapons and disease in the territory of the former Soviet Union. Turkmenistan’s neighbors, Uzbekistan and Russia, are understandably worried. Tests run in Uzbekistan have confirmed the presence of plague in fleas and rodents in areas near the Turkmen border; cattle breeders, oil workers and geologists, along with thousands of camels, have been vaccinated in recent weeks. Most important, Uzbekistan has tightened border controls to prevent panicked or sick people from slipping over the border. Seven mobile anti-epidemic teams have also been sent to patrol the region. Russians, for their part, have banned the import of monkeys, cats and camels from Turkmenistan out of fear these animals could carry the infection.
So far as we can tell, the Turkmen government’s strongest response to the outbreak has been to make its remaining health workers sign a pledge that they will not use the word “plague.” But secrecy and denial can have devastating consequences. The startling eruption of a new, dangerous respiratory illness, SARS, in Guangdong, China, in the autumn of 2002 was kept a close secret by the Chinese government for months. The mainland Chinese outbreak eventually seeded nine other major outbreaks around the world; more than 8,000 people were infected and almost 800 died. Had the Chinese government asked for help from the World Health Organization and the U.S. Centers for Disease Control and Prevention, those outbreaks need never have happened, and hundreds of lives -- not to mention billions of dollars -- could have been saved.
It is terrible to think that because of one man’s hubris, and his ironfisted control of an isolated country, the lives of unknown numbers of people may be at risk. As Central Asia expert Martha Brill Olcott puts it: “The president is wholly unpredictable and does not behave rationally.... No one takes seriously that his policies can have tragic consequences for the people of Turkmenistan and those of neighboring countries.”
The dead of Turkmenistan are tragic enough. But we also need to remember that epidemic disease does not often respect borders.