Sunday, March 15, 2015

Collateral damage from the Ebola outbreak

Today's global health field seems to be subject to many unforeseen consequences. A few months before the Ebola epidemic became international news, the public health infrastructure of West Africa left a lot to be desired. Only when the deadly virus threatened to extend beyond the confines of seemingly distant West African countries did people care to address the underdeveloped and clearly overmatched health systems of the region. Thankfully, the combined strength of incessant media coverage and the growing fears of an Ebolavirus pandemic resulted in a substantial influx of resources to strengthen the medical infrastructure of the countries hit by the outbreak.

The fixation on the Ebola crisis, however, appears to have come at the expense of public health interventions against a host of other infectious diseases in West Africa. Researchers at Princeton and Johns Hopkins have reported a significant decrease in routine medical procedures (such as measles and polio vaccinations) in Guinea, Liberia, and Sierra Leone due to the disruptions caused by the Ebola outbreak. Among these interruptions: the exclusive devotion of some health clinics to Ebola treatment, the outright closure of numerous medical facilities, and an avoidance of open clinics for fear of contracting the virus.

These factors have had several downstream effects on other public health measures. For instance, the researchers estimate that measles vaccinations decreased by 75 percent during the Ebola outbreaks, which means for every month Ebola stressed a healthcare system, an average of nearly 20,000 measles-susceptible children went unvaccinated. This would translate to 153,000-321,000 additional cases of measles resulting in 2,000-16,000 additional deaths during an 18-month outbreak of Ebola.

Similar trends have been witnessed following other disruptions (e.g., other disease outbreaks, natural disasters, and war) in already-weak health systems. In 2010, when severe flooding displaced millions of people in Pakistan, polio cases spiked as vaccine campaigns were interrupted.

Strengthening weak health systems should not have to rely on the fear that a pathogen may "escape" these communities and cause a pandemic. For now, unfortunately, it seems that building these health infrastructures remains subject to the will and convenience of the developed world.

- Nick

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