Global health: How prepared are we for the next crisis?
By David Heymann
It has now been over a year since the Ebola outbreak in West Africa was first reported and it has since gone on to become the deadliest occurrence of the disease since its discovery in 1976, claiming the lives of more than 10,000 people. So what has the outbreak taught us and how prepared are we for the next global health crisis?
What lessons have been learned from Ebola?
We have learned that the initial response to an outbreak must be robust and complete so that the outbreak does not spread from rural areas, where it emerges from an animal source in nature, into neighbouring countries and urban areas.
We have also learned that community engagement is of the utmost importance - helping village elders, paramount chiefs and others understand how the disease is transmitted and how it can be stopped, including emphasis on safe burial practices.
Equally important is contact tracing - and daily monitoring of the temperature of those who are known to have been in contact with a patient - for three weeks, in order to identify those who are potentially infected with Ebola; and surveillance to identify patients and ensure their transport and management in a health facility where infection control is up to standard.
Ebola transmission is amplified if patients are admitted to health facilities where infection control is sub-standard; and where health workers inadvertently become infected and then unintentionally infect their family members, spreading the infection to the community.
Health workers are often infected because it is impossible to diagnose Ebola early - it has signs and symptoms similar to other infections such as malaria - and they are therefore at great risk of infection. It has been shown that the Ebola virus does not cause major outbreaks where health facility infection control is up to standard.
What governance issues are there when it comes to tackling an international health crisis?
The best means of dealing with an international health crisis is prevention - it has been known, for example, since 1976 that it is sub-standard health facility infection control that permits Ebola to spread, yet sub-standard infection control continues in many facilities. Emphasis must be placed on helping health facilities understand and use infection control measures as part of their routine activities.
The International Health Regulations are international laws that are meant to help prevent the international spread of disease, and they required countries to develop standard core capacity in public health between the years 2007 and 2014, yet many countries did not accomplish this and continue to be at great risk of not detecting and responding to outbreaks early, when their spread can be prevented.
What dangers lie ahead?
There continue to be many infectious disease risks that can spread internationally - some of them are known, others unknown. Those that are known include infections resistant to the medicines used to cure them (antimicrobial resistant infections). Infections such as Dengue, Chikungunya, and cholera all continue to spread throughout the world.
Those that are unknown - they emerge from a source in nature to infect humans - sometimes also have the potential to spread internationally. Sars in 2003 is an example - and others, such as Ebola, re-emerge from time to time. It is impossible to predict when these latter, emerging infections, will emerge or re-emerge, so it is important that all countries develop the public health capacity to detect and respond to infectious diseases when and where they emerge or re-emerge.
The way forward must therefore include stronger government engagement in developing core capacities in public health so that outbreaks can be rapidly identified and contained when and where they occur; and strengthening of global alert and response mechanisms to ensure a rapid and robust response - a safety net when countries are unable to detect and contain outbreaks on their own.