Sometimes in a crisis, broad thinking is obscured. The Ebola crisis in West Africa is one such crisis.
We think we are safe if the West Africans are confined to their own countries. Yet Ebola is not the end of infectious diseases.
The
rate at which we are setting the stage for opportunistic diseases,
including infectious ones, is worrying. Our priority now should be the
role of public health in Africa.
The majority of
African media are rushing to prescribe short-term interventions, such as
avoiding handshakes or hugging, but these are not sustainable
solutions.
Several
factors contribute to the emergence of new diseases like Ebola. These
include poor or non-existent public health facilities, crowded and
unplanned urban settlements, interactions with the animal kingdom, and
other sources that have not been established yet.
KILLED 100 MILLION
The
unfortunate thing about Africa is its failure to learn from the past,
especially from Europe, which was once ravaged by bubonic plague
outbreaks.
Ananya Mandal noted in his article “Human
Diseases Caused by Viruses” that the 1918 flu pandemic, commonly
referred to as the Spanish flu, spread across the world like HIV/Aids.
It
was caused by an unusually severe and deadly influenza A virus. The
victims were often healthy, young adults in contrast to the weakened and
elderly, who are the usual victims.
It killed around 100 million people or at least five per cent of the world's population in 1918.
Studies
show that the Influenza A virus causes influenza in birds and some
mammals, and is the only species of influenza virus A. Some isolates of
influenza A virus cause severe disease in domestic poultry and, rarely,
in humans.
Occasionally, viruses are transmitted from
wild aquatic birds to domestic poultry, and this may cause an outbreak
or give rise to human influenza pandemics.
EXPERIMENTAL MENINGITIS DRUG
Most
of these outbreaks have no medicine. In most cases researchers are
forced to use drugs that have not been approved. An analysis, "Ebola
outbreak: Africans understandably wary about promised cures", by Daniel Schwartz of CBC News, reveals a 1996 drug experiment that went awry in Nigeria.
Schwartz
says when a meningitis epidemic was under way, the American
pharmaceutical company Pfizer arrived in the hot zone in Kano. Its
representatives immediately set up their clinic next to the makeshift
tents of a hospital then staffed mostly by Doctors Without Borders.
Meningitis,
an inflammation in a membrane surrounding the brain or spinal cord,
affects mostly children, and, without treatment, about half of those
infected will die.
Pfizer had a new treatment that it
wanted to test, so its doctors gave Trovan (floxacin) to about half the
200 children they treated, while the other half received an approved
drug for meningitis. About five per cent of the patients taking the
experimental Trovan died, while some others were left blind, deaf and/or
paralyzed.
DRUGS WITH NO MARKET
In
the aftermath, the US Food and Drug Administration refused to approve
Trovan. Hundreds of Nigerian parents sued Pfizer, and the company
eventually settled in 2009. (Its position was that it was the disease
that had caused the deaths and other conditions.)
Pfizer
claimed to have had permission from the local hospital to conduct its
experiment, but the approval letter was said to be a forgery. Pfizer
claimed it had informed consent from the patients’ families but could
not provide written proof.
Clearly,
drug manufacturing companies have no incentive to spend resources on
drugs that have no market and are only relevant during a crisis like the
one we are in at the moment. Europe has largely dealt with breeding
grounds of such outbreaks.
That leaves Africa with two
options, that is, adopt and maintain modern living standards with
strict public health regulations for every citizen, or spend a great
deal of resources on research to develop the capacity to deal with such
epidemics.
Let me now look at some of the causes that
we have control over and perhaps challenge you as the reader on what we
need to do collectively to get our continent’s public health in line
with other parts of the world. In my foolish approach to research, I
asked myself this question: Where do viruses come from?
Several
research papers converge on what Dr Ananya Mandal summarizes in the
table below arguing that there are several viruses that have an animal
or plant reservoir from where they affect humans.
Table 1: Some of the common reservoirs of viruses.
| Virus | Animal reservoir |
| Influenza | Birds, pigs, horses |
| Rabies | Bats, dogs, foxes |
| Lassa and Hanta viruses | Rodents |
| Ebola and Marburg viruses | Monkeys |
| HIV-1 and -2 | Chimpanzees, monkeys |
| Newcastle disease | Poultry |
| West Nile virus | Birds |
Source: Ananya Mandal, MD
Public Health
In
my view, the answer lies in what we do with our public health. Prior to
the Ebola outbreak, the Pew Research Center, in a survey conducted
between March 6, 2013 and April 12, 2013, in six African nations
established that concerns about public health are widespread in
sub-Saharan Africa, and there is considerable support in the region for
making public health challenges a top national priority.
In
particular, people want their governments to improve the quality of
hospitals and other health-care facilities and deal with the problem of
HIV/Aids. The survey also finds broad support for government efforts to
address access to drinking water, access to prenatal care, hunger,
infectious diseases, and child immunization.
Table 2: Public Health Priorities
While walking within Mukuru kwa Reuben
(one of the shanty areas of Nairobi) on a research mission, I saw pigs,
chicken, goats and rats feasting on solid waste from the shanty. Nearby
were kiosks selling all manner of things.
There were
no public health officials in this breeding ground of future
outbreaks. And no one will be safe because most of the help the rich in
posh neighbourhoods have resides in such shanties.
It
is no longer a poor man’s burden. It is our burden. We are in it
together. It is perhaps cheaper to clean up, and provide running water
and modern plumbing to the poor rather than suffer the deaths that may
arise out of some unknown infectious epidemic.
ANIMALS IN URBAN AREAS
The
majority of urban areas have by-laws regulating the keeping of animals
in urban set-ups, but they are not enforced. For the good of all, we
need to keep animals that we cannot manage out of residential areas.
The
least we can do is to create the awareness of the dangers we generate
when we do not adhere to acceptable hygienic standards.
Our
culture is such that we love pets but lack the drive to provide for
them in terms of keeping up with vaccinations or grooming, which begs
the question: Why keep the pet if you cannot maintain it?
DEVOLUTION FAILURE
In
the past few weeks we have seen the level of incompetence within county
governments to manage health care. To save face, the governors must
convene and surrender health-care services to the national government as
a sign of good leadership. They can take up the challenge of managing
health care once they develop capacities.
As it is at
the moment, they continue to disenfranchise doctors whose morale is at
its lowest owing to poor pay and work conditions. Some drastic decisions
must be made to change the deplorable conditions of our health
facilities.
We often fail to fully appreciate the total
cost of sick people in looking at direct cost, yet the days they miss
from their workplaces are costs. Health economists are not part of our
health-care system, which may be the reason why even the national
Treasury or Parliament fail to understand the full impact of having a
large number of unhealthy people.
Until we appreciate the full cost of health care, the focus on preventive health care or any reforms will fail.
There
is need to declare health care a national crisis such that we suspend
the Constituency Development Fund (CDF) (which has become a cash cow for
some MPs) and utilize the resource to build the infrastructure for a
national health-care system as a priority.
AN AUDITOR DISBURSING MONEY
We
also need to leverage public-private partnerships (PPPs) for
infrastructure development. We must aim to build first-class facilities
and management systems that will lower the cost and stem health tourism
to India that runs into billions of shillings.
Sometimes
a tragedy like Ebola is what it takes to comprehensively deal with our
public health system. The CDF, which was meant to devolve resources, has
been overtaken by the creation of counties. The CDF kitty is sufficient
to build our health-care infrastructure if supplemented with
private-public partnerships.
In any prudent financial
system, an auditor should not be disbursing money. What our Parliament
is doing with CDF is like keeping a lion in a goat’s pen; in other words
“Paka haachiwi kitoweo kukilinda”.
It is the collective will of the people to ensure that public health is a priority.
Paul
Farmer said, “But if you're asking my opinion, I would argue that a
social justice approach should be central to medicine and utilized to be
central to public health. This could be very simple: the well should
take care of the sick.”
Dr Ndemo is a senior
lecturer at the University of Nairobi's Business School, Lower Kabete
campus. He is a former permanent secretary in the Ministry of
Information and Communication. Twitter:@bantigito
No comments :
Post a Comment