Ebola: The Ripple Effects (infographic)

For better or worse, Ebola is becoming old news. Aside from the initial case in Dallas that was transmitted to two nurses, there have been no more cases here in the U.S., and panicked predictions of a massive outbreak causing mayhem and catastrophe never materialized (much like public health experts said they would not – funny how that works).

The outbreak in West Africa is ongoing and continues to be a tragedy on a massive scale that is losing public interest. We previously posted an article by Mary Anne Mercer on lost opportunities and the weaknesses in the healthcare systems that the outbreak has laid bare. Now, the MPH@GW blog has kindly provided an infographic on the outbreak and its collateral damage.

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Making Social Justice the Ultimate Goal

In the global health field, we generally understand that investing in health is critical for a nation to prosper. But would you consider a lack of investment in health to be a social injustice?

The United Nations’ Under Secretary-General Michel Sidibe thinks so. In this short interview with CCTV News, he talks about how the Ebola outbreaks in Guinea, Liberia, and Sierra Leone have exposed global health failures and explains why health is an investment, not an expenditure.

Prior to watching his interview I’d never really labeled a weak health system as a social injustice in my mind. But health is a right and a shortage of health workers, the inability to provide basic health services, and lack of infrastructure – all of which have become very apparent in the Ebola outbreak – are in fact social injustices. So I think this is a very apt way to label the current situation as it puts a broader lens on the issues and ties everything into the bigger picture of the role of health in society.

His interview made me think of universal health coverage (UHC) because the definition of UHC requires social justice. It addresses the issues of access, equity, and capacity. I wonder if there will be an increased focus on moving towards UHC for the three Ebola-affected countries as part of their rebuilding efforts.

What do you think will be the biggest social justice issues coming out of the Ebola outbreaks? And how do you think we can best address them?

Remembering My Aunt, Dr. Ameyo Adadevoh, Who Stopped Ebola in Nigeria

This blog post originally appeared on the Management Sciences for Health (MSH) blog and was authored by Video Editor Niniola Soleye. This reposting does not convey an endorsement of MSH from the IH Section.

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L to R: MSH staffer Niniola Soleye and her aunt, Dr. Ameyo Adadevoh 

My aunt, Dr. Ameyo Adadevoh, identified and contained the first case of Ebola in Nigeria.  She paid with her life because the health system was not ready to deal with Ebola.  The system has since caught up, and is today a model for other countries.  But the loss of such a gifted doctor and family anchor is incalculable.

Ebola arrived in Nigeria at a time when doctors at all federal government hospitals were on a labor strike (my aunt worked in a private hospital).  After ongoing negotiations with the government failed to meet their demands, the doctors – desperate to see significant changes in the health system and seeking improved salaries, positions, and titles – reached their breaking point.  So they went on an indefinite strike.

Patrick Sawyer – the index case – left quarantine in Liberia and collapsed at the airport in Lagos, Nigeria.  He was trying to travel to a meeting of the Economic Community of West African States (ECOWAS) in Calabar, Nigeria.

When he arrived at my aunt’s hospital, another doctor diagnosed him with malaria.  My aunt first encountered him during her ward round the following day and once she saw him she suspected Ebola even though she had never seen an Ebola patient before.  She questioned him and he denied being near anyone suffering from the virus but she immediately contacted the Lagos State and Federal Ministries of Health and got him tested.  While waiting for the test results to come back, the pressure on my aunt began.  Liberian government officials (and the patient himself) insisted that she discharge him so he could attend the ECOWAS conference.  She held her ground and resisted his release.  They even threatened to sue her for a violation of human rights (holding him against his will) but she remained steadfast for the greater public good.  Though she didn’t have the proper protective gear or protocols, she created an isolation area in her hospital to continue his treatment and protect her staff.  The patient couldn’t be moved because there was no isolation facility available in Nigeria at the time —the infectious diseases hospital in Lagos wasn’t functional.

The test results came back.  Patrick Sawyer’s Ebola diagnosis was confirmed, and he died in her hospital.

My aunt became ill ten days later and was taken to a makeshift isolation ward that had been set up for all the Ebola cases in the infectious diseases hospital.  The conditions of the facility were so poor that she and other patients were eventually moved to a former tuberculosis ward that had been donated by the USG.

Between the doctors’ strike and the lack of preparedness, the Ebola outbreak in Nigeria could have been a thousand times worse.  My aunt’s actions helped prevent a major spread of the virus across the country.  Because she raised the necessary red flags quickly and refused to discharge the patient, all Ebola cases in Nigeria can be traced to a single path of transmission originating with the index case. That’s no small feat in a country of more than 170 million people.

The events leading to my aunt’s death were a clear result of the larger health system troubles in Nigeria.  That said, today, Nigeria is Ebola-free.  In fact, other countries – including the US – are now looking to Nigeria to share best practices for the response and containment of Ebola.  This demonstrates that the health system eventually did catch up to Ebola, but the response was too late for my aunt and several others who were on the front lines.  If the index patient had ended up in another hospital under the care of another doctor, the delayed response from the health system may have been much more costly.

There are so many lessons to learn from the current Ebola outbreak in West Africa.  For me, the most obvious one is the importance of health system strengthening as a means to not only improve overall quality and access for all, but also to give countries the ability to properly respond to unexpected health challenges like Ebola.  If any of the affected countries had stronger health systems before this outbreak, the number of fatalities would have been significantly reduced.  We must learn from this outbreak and focus on health system strengthening as a crucial part of the rebuilding process.

One of the biggest challenges in the Ebola current outbreak is a shortage of health workers.  The high fatality rates in this Ebola outbreak reflect that.  Health workers at all levels of a health system need to be properly supported, incentivized, and protected.  They shouldn’t have to go on strike in order to improve their health systems so they can provide higher quality care.  My aunt and the more than 200 other health workers in West Africa who also lost their lives in the battle against Ebola shouldn’t die in vain.

I’m so proud that MSH is developing a solid short-term and long-term response to the Ebola outbreak in West Africa.  As part of my role at MSH, I’m supporting the Ebola response team and I see that as my way of continuing my aunt’s legacy through my job and helping to prevent other families from experiencing what my family has gone through in the last two months.

For me, the inability of the Nigerian health system to adequately prepare and quickly respond to the Ebola outbreak was an agonizing, first-hand example of the need for MSH and it reinforced the importance of the work we do.  My aunt’s death is still very painful but it comforts me to know that I am part of an organization that’s truly committed to saving lives (in everyday practice, not just in theory) and is dedicated enough to step into a crisis situation and mobilize the expertise and resources that are so desperately needed.

Let’s Get Ethical: Giving Untested Experimental Drugs to Ebola Patients

West Africa is in the throes of the worst Ebola outbreak to date. Ebola virus disease, the hemorrhagic fever caused by the Ebola virus, has been seen in small but often deadly outbreaks in tropical sub-saharan Africa since its discovery in 1976. Though researchers are fairly certainly that it is transmitted through bush meat, and fruit bats are suspected, no animal species has been confirmed as a reservoir. Combined with the fact that the virus is highly contagious and so often deadly (usually because there is little to no medical infrastructure in areas where outbreaks occur), it is the source of international fascination and fear. It is the perfect plot device for outbreak movies and sensational media reports – a mysterious ailment from the heart of darkness that could rear its ugly head in our packed population centers at any moment.

Although it’s not quite as scary as movies like “Outbreak” would have you believe, the havoc that it is currently wreaking in West Africa is most definitely real. The most recent update from WHO puts the death count at 932 and the number of cases (both suspected and confirmed) at over 1,700. Guinea, Liberia, and Sierra Leone have been battling the virus since the spring, and last week it made its way to Nigeria and there was even a suspected death in Saudi Arabia. We all know that international air travel means that these types of illnesses are only a plane ride, which raises the question of why we haven’t made more progress in developing a vaccine or treatment for such a devastating disease.

Frankly, most global health and development professionals know the answer – if the only market for potential drugs is among the poor in central Africa, commercial drug companies won’t exactly be lining up to put money into the research:

The factor preventing such trials in humans, though, has been cost, said Dr. Daniel Bausch, an associate professor of tropical medicine at the Tulane University School of Public Health who is currently stationed at the U.S. Naval Medical Research Unit 6 in Lima, Peru.

That’s because, while the National Institutes of Health and the U.S. government often fund the early animal safety and efficacy testing of a vaccine, pharmaceutical companies typically fund the human clinical trials to take a drug or vaccine to market.

“When you have a population or situation with Ebola where it only sporadically occurs, and it occurs really in the world’s poorest populations, it’s not exactly an attractive candidate for the pharmaceutical industry on the economic side,” Bausch said.

That all changed, however, when two American aid workers who were treating Ebola patients in Liberia fell ill with the virus themselves. Dr. Kent Brantly, a doctor working with Samaritan’s Purse, and Nancy Writebol, a nurse employed by Service in Mission, are now all over U.S. and global headlines as the first Westerners to contract the virus – and, because of their privileged status, as the first people to receive an experimental treatment in the early stages of development before being flown back to Emory for medical care (despite objections from Donald Trump and Ann Coulter).

Though several people have raised objections to bringing Americans back stateside for treatment (particularly at what it probably cost), Emory is probably the safest and best-equipped facility to treat and contain the patients. Samaritan’s Purse is footing the bill for transporting them, so no government funds are being used. Bringing them back to the states for treatment is not so much of an issue, in my opinion – but using an experimental drug which is untested in humans is another matter.

At first glance, an outbreak of a disease with a high fatality rate (usually 40-70%) and no cure seems like the perfect situation to bypass the standard drug testing and approval process, which can take several years. However, it is the recklessness generated by precisely this type of desperate situation that raises ethical dilemmas. Does informed consent really count when patients are panicked at the prospect of imminent death? What if the drug is administered to the afflicted on a large scale and turns out to be toxic, or causes long-term disability? Who determines which patients to prioritize and how to protect those most vulnerable – such as children or pregnant women – who may react very differently to the drug?

Additionally, the fact that the drug has only been given to the two Westerners raises a very different, but equally important, problem. The international community has struggled for years to bring critical medicines to populations with the greatest need, who are simultaneously the least able to afford them. The fact that this experimental treatment was given to two aid workers – who, unlike their patients, have the support of large and wealthy organizations and will be more able to access the needed high-quality supportive care than their own patients – raises some disturbing questions.

The WHO has announced that it will convene a panel of medical ethicists to discuss and provide guidance on the issue. The pharmaceutical companies that develop and manufacture the drug are, naturally, chomping at the bit to get a large production run funded in order to provide ZMapp, the experimental serum, to a large number of Ebola patients. It is unclear how the global health community will move forward. But perhaps it can serve as a lesson to the pharmaceutical industry to take a more active interest in developing therapies for diseases that may not seem lucrative at first glance. Perhaps then we’ll be prepared for an unexpected multi-country outbreak – instead of having to scale up an untested drug developed by a tiny biopharmaceutical.

IH News Global Health Weekly News Round-Up

  • May 31 was observed as World anti-tobacco day by the World Health Organization.
  • The Fitness Industry Council Canada has announced June 1 as National Health and Fitness Day.

Politics and Policies:

  • The Republic of Congo has passed a law that prohibits the purchase, consumption and possession of tobacco for minors, pregnant women and mentally ill. The advising and any kind of promotion of tobacco are also prohibited in the country. Smoking is prohibited in public places.
  • According to the World Health Organization On June 10th Ethiopia is launching an emergency mass-vaccination campaign against yellow fever.
  • According to the Ghana’s Minister of Health, the country is committed to ban all forms of tobacco advertisements and promotions.
  • Smoking in presence of children equaled to physical violence in Latvia.
  • Russia’s smoking ban came into effect on Saturday. It involves no smoking in public places and curbing cigarette advertising and sales.

Programs:

  • The World Health Organization (WHO) in Gambia is launching polio campaign to vaccinate 400,000 children under five years.
  • The Ministry of Finance of Lesotho has signed two agreements totaling $17 million with the Global Fund to fight against HIV/AIDS, tuberculosis and malaria.
  • Professionals for Humanity International (PROFOH) have announced its third free medical screening in this year in Nigeria.
  • After the discovery of polio this week, United Nations emergency team rushes to vaccinate 424,000 people living in a refugee camp in Kenya.
  • Zimbabwe is going to conduct its first national tuberculosis prevalence survey with an objective to determine the national prevalence of bacteriologically-confirmed pulmonary TB among people aged 15 and over.
  • Rotary India extends its help to Pakistan in its polio vaccination drive.
  • The World Health Organization is calling on the countries to ban advertising about the tobacco products.

 Research:

  • Improvement of maternal health and reduction in child mortality in some countries was highlighted in a recently released report ‘Accountability for Maternal, newborn and Child Survival ‘.
  • According to the director of the National Institute of Combat of HIV (INLS), the prevalence of HIV in Angola has not changed since 1997.
  • According to the researchers patients who have developed oral cancer due to HPV can have sex with their spouses or long term partners.
  • According to a study done by the researchers at the Institute for Clinical Evaluative Sciences, rates of diabetes have jumped 15 fold within a decade for the Chinese Canadians.
  • A systemic review confirms that the licensed medicines for smoking cessation are successful in assisting people to quit smoking.
  • Scientists are using new optics-based single virus detecting methods for determining the exact viral load of a sample by counting individual virus sample.
  • New malaria vaccine developed by the team Japanese researchers has cut the infection rates by 72%.
  • A study conducted in over 13 hospitals in Indonesia, Singapore, Thailand and Vietnam shows that doubling Tamiflu vaccine dose does not help in severe flu.
  • Results of a study warn development of resistance to drug used in treatment of H7N9 virus.
  • A group of scientists discover how a single gene mutation helps brain cancer cells to survive and drive tumor growth.
  • According to the United Nations scientists, Fukushima No.1 nuclear plant has very low radiation doses and there is no increased risk of cancer on local residents.
  • According to the experts nearly one-sixth of young adults in Sri Lanka are overweight. Lack of nutrition education and food culture of the country are reasons for this problem.
  • A study states that particular combination of bacteria in the human digestive system can identify patients who have or are likely to develop Type 2 diabetes.
  • A study shows that the Coenzyme Q10 cuts the mortality rate by half in heart failure patients.
  • Report released by EU says that several new health risks are emerging from new chemicals, products and changing lifestyle patterns. It is important to address these issues all together.
  • According to a study fizzy drinks do harm to the teeth as drugs.
  • New vaccine for lung cancer has been developed by the scientists of Argentina and Cuba. It activates the body’s immune system to promote its destruction.

Diseases & Disasters:

  • Tornadoes hit Oklahoma again on 1st June. Death toll rises to 9.
  • A report issued by the Chinese Ministry of Land and Resources state that the ground water of China is poisoned. It did not address the severity and scope of this problem.
  • Death toll from bird flu has risen to 38 in China.
  • According to the reports of the United Nations, there is a suspected outbreak of Ebola fever in the north of the Democratic Republic of Congo.
  • According to the reports by Ghana Health Service, cholera outbreak hits greater Accra region.
  • The World Health Organization is concerned about the new strain of Coronavirus which has killed 55 of the confirmed cases.
  • A Starbucks in Hong Kong used water from the public restroom to brew coffee.
  • Pakistan is facing a severe measles epidemic. Since the start of 2013 about 239 deaths have been reported.
  • According to the Ministry of Health, Philippines, new cases of HIV infections recorded in the month of April were 388. It was 67 percent higher than those recorded in April 2012.
  • According to the reports Singapore is facing Dengue epidemic. More than 7,700 people are reported to be infected as of May 25.
  • Frozen berry and pomegranate mix has been reported to be linked to hepatitis A outbreak in five states in U.S.