WHO is concerned about an outbreak of pneumonic plague in urban areas of Madagascar. Presently, the risk of the disease spreading internationally is low.

Once again, a deadly pneumonic plague epidemic is spreading rapidly through the impoverished East African island state of Madagascar. According to science magazine SCINEX, more than 400 people had been infected with the disease by the middle of October and 48 of these have died. There are, however, striking differences to previous outbreaks of plague in Madagascar. Traditionally, it has mainly been bubonic plague affecting rural areas, but this time it is the highly contagious pneumonic plague which is spreading through urban areas. Although this form of plague is comparatively rare, it is highly virulent with a high mortality rate.  

The limited options for local authorities to respond, due to a lack of money, have been boosted by support from the World Health Organization (WHO). It has announced the release of around $1.5 million as initial emergency aid. In addition, more than 1.2 million doses of antibiotics have been sent to the island. Plague is caused by the bacteria Yersinia pestis, which is transmitted to humans by fleas found on small mammals. Unlike the bubonic plague, pneumonic plague can be spread from person to person. Nowadays, the Black Death, as it was known in the middle ages, is treated with antibiotics and the chances for a full recovery are good if treated early on. An important factor influencing the spread of the disease is general local conditions, particularly hygiene conditions, which intensify close contact between infected animals and humans. 

Accordingly, WHO is concerned about the first cases of pneumonic plague in the heavily populated urban areas of Madagascar where there is regularly poor hygiene. At present, the danger of the disease spreading internationally is relatively low. Compared to the recent outbreaks of haemorrhagic fever (especially in West Africa), where thousands of people died, the danger of the epidemic in Madagascar is likely quite low. The unease caused by people hearing the word Ebola in the affluent areas of Europe was the reason why poor countries were equipped with rudimentary medical infrastructure, albeit temporarily. 

However, once the immediate threat of the disease coming to Europe and North America subsided, the lack of medical care in these border areas faded out of view. Critics have pointed out that the diametrically opposed chances of good medical care between Madagascar and West Africa on the one hand and Europe or North America on the other, represent an opportunity to strengthen the fundamentals of effective infrastructure development rather than only thinking about it when something threatens our social space, as was the case with Ebola.