When Debate Topics Collide: Infectious Diseases in West Africa

Recent posts looked at economics and demographics of West Africa for the proposed NCFCA resolution. Recently in the news, Ebola is back with an outbreak in Congo. The major 2014 Ebola outbreak brought this infectious deadly disease to the United States which spurred billions in funding to federal bureaucracies. Cost of the Ebola Epidemic (CDC)

The U.S. government allocated approximately $2.369 billion for Ebola response activities, including $798 million to CDC, $632 million to the Department of Defense, and $939 to the U.S. Agency for International Development.  In addition to providing personnel, technical expertise, and resources to the response, these funds established three new emergency operations centers in Guinea, Liberia, and Sierra Leone.

In response to the new outbreak: A pioneering vaccine is being sent to Congo in hopes of containing a new Ebola outbreak (Washington Post, May 11, 2018)

When the Ebola virus swept through West Africa in 2014, it hit capital cities so quickly that medical professionals were left with few options to prevent its spread. Soon, health-care workers and those who touched the bodies of the dead were coming down with the virus themselves and then passing it to others. By the time the outbreak was finally contained, more than 11,000 people had died.

Now, experts hope a vaccine can help contain a new outbreak of the virus in Congo — a simple intervention that could potentially have saved thousands of lives had it been ready in 2014.

Also Ebola Is Back And World Health Officials Are Racing To Stop Another Catastrophe (HuffPost, May 11, 2018), with obligatory criticism of the Trump administration:

Meanwhile, U.S. President Donald Trump has worried global health experts by proposing to rescind agencies’ Ebola funding left over from the last major outbreak and ousting his top global health security adviser the same week as the new outbreak was declared.

News last fall on research: Progress on two Ebola vaccines (NIH Research Matters, October 17, 2017) reports:

The 2014-16 Ebola outbreak in West Africa was an opportunity for researchers to test two experimental vaccines for safety and effectiveness. A previous report about one of the vaccines showed that it could induce immune responses in 40 healthy adults.

In early 2015, the researchers rapidly enrolled 1,500 men and women volunteers in Liberia who were 18 and older and had no reported history of Ebola virus disease. 

Some challenges in this report on how bystanders are protected in malaria research studies. Clinical trials’ ethical liability: risk to non-participants (UW Medicine Newsroom, April 12, 2018) suggests reforms:

Shah and co-authors propose that funding agencies take the lead in managing bystander risk. Agencies would be tasked to create a national database of reviewers: ethicists, policy experts, clinicians, patient representatives and scientists.

More broadly critical of U.S. policy and responses to international infectious disease is Report Slams U.S. Ebola Response and Readiness (NBC News, February 26, 2015):

Ebola started spreading in Guinea just about a year ago, but the response was slow. By summer, it was spreading quickly in Liberia and Sierra Leone, but the World Health Organization has admitted it was slow to raise the alarm and says it lacked the resources to move in and help as it should have.

…More than 23,000 people have been infected and more than 9,600 have died in West Africa. Eight patients landed in the U.S. and two of them died; two nurses who treated one patient were infected and recovered.

More infectious disease outbreaks are expected. Physicians gauge readiness for next pandemic (Healio Infectious Disease News, January, 2018):

“We will definitely get surprised in the next few years,” he said. “The history of the last 32 years that I have been the director of the NIAID will tell the [Trump] administration that there is no doubt they will be faced with the challenges their predecessors were faced with.”

Don’t Confuse Health Care Reform with Public Health (Cato Institute Commentary, March 18, 2010) emphasizes separating pubic health issues from health care issues:

The idea that health care contributes significantly to population health is both intuitively appealing and untrue. Nowhere is this better seen than in the improvement in infectious disease mortality during the 20th century, which was due primarily to non-medical advances, including progress in water and sewage treatment, food safety, insect control, housing, and income. Roughly 75 percent of the improvement occurred before medicine made a serious contribution with the introduction of effective antibiotics in the early 1940s.

Essentially all of the improvement happened before widespread use of childhood vaccines in the 1950s and 1960s. The current health care legislation includes no mechanisms to improve or expand on such broad-based prevention programs.

The primary responsibility for public health, moreover, resides with state governments. Federal agencies such as CDC lack the ability and authority to provide top-down control of the public health system, for both constitutional and practical reasons.

Infectious diseases are a severe problem in low-income countries with poor water and sewer infrastructure. World Health Organization (WHO) reports on Group 1 deaths (communicable, maternal, newborn and nutritional conditions) in Africa:

Group I [communicable, maternal, newborn and nutritional conditions]
In 2015, group I conditions accounted for 5.2 million of deaths (56.4%), down from 5.7 million deaths in 2010 (61.4%). Notable causes of death in this category were:

• lower respiratory tract infections (1 million),
• HIV/AIDS (760,000),
• diarrhoeal diseases (643,000),
• tuberculosis (434,000) and
• malaria (403,000).

Source: FACTSHEET: Africa’s leading causes of death (Africa Check, August 14, 2017) reports

Lower respiratory infection deaths are usually children under five and caused by a lack of electricity. Smoke from wood and dung fires for cooking and heat are the largest cause of death.

This 2015 TED talk looks at the Ebola story in Sierra Leone and how researchers prepare for future disease outbreaks. How we’ll fight the next deadly virus.

When Ebola broke out in March 2014, Pardis Sabeti and her team got to work sequencing the virus’s genome, learning how it mutated and spread. Sabeti immediately released her research online, so virus trackers and scientists from around the world could join in the urgent fight. In this talk, she shows how open cooperation was key to halting the virus … and to attacking the next one to come along.

A key point was bypassing the standard research process and instead quickly making disease data publicly available. Research silos are still a problem in the status quo.

Clean Energy for the Developing World
On the negative there are trade-offs when more money is allocated to address or prepare for infectious diseases, especially in poor countries. Aid money can be misused or siphoned off by corrupt government, or spent on flying about by the World Health Organization (see World Health Organization spent more on plane tickets and hotels than AIDS and malaria (Quartz, May 23,2017).

See also AEI’s Roger Bate’s article DDT is still useful (October 10, 2017):

DDT is still useful for poor nations suffering from insect-borne diseases. Green militants inside and outside the UN pushed for a DDT ban by 2007 during negotiations for the convention. Fortunately, the government of South Africa and several hundred scientists prevented this from occurring, and a decade after the proposed ban, it is still saving lives.

DDT is persistent in the environment and so it was wise to limit and eventually prevent its use in the countries that no longer required it….

Another claim is that public health funds could save more lives if directed to clean water and to clean energy. Many aid agencies, NGOs, and foundations are pushing wind and solar power to developing countries but these technologies are usually more expensive and less beneficial than heat and electricity from fossil fuels. (More on this claim in separate post. It is relevant both to the foreign aid and the international environmental agreements resolutions).

Consider the number of people who die each year, especially children, from traditional cooking and heating among the rural poor: Yes, indoor air pollution kills more than HIV/AIDS, malaria, TB (PolitiFact, May 18, 2017):

Emphasizing the need to bring clean fuel to the world’s poor, James Rockall, CEO of the World LPG Association, recently said that “more (people) die of indoor air pollution than malaria, HIV/AIDS and tuberculosis combined.”

Rockall’s statement showed up in a tweet from Stanford Energy, a research group at Stanford University, after he spoke there May 9.

Rockall confirmed that he did make this claim, and we decided to check it out.

Public health researchers have known for some time that in many poorer nations, fumes from dirty cooking stoves pose a health threat.

According to article the claim is based on Household air pollution and health (WHO, May 8, 2018, though this must be updated page as it is a year later than post it is mentioned in):

• Around 3 billion people cook using polluting open fires or simple stoves fuelled by kerosene, biomass (wood, animal dung and crop waste) and coal.
• Each year, close to 4 million people die prematurely from illness attributable to household air pollution from inefficient cooking practices using polluting stoves paired with solid fuels and kerosene.
• Household air pollution causes noncommunicable diseases including stroke, ischaemic heart disease, chronic obstructive pulmonary disease (COPD) and lung cancer.
• Close to half of deaths due to pneumonia among children under 5 years of age are caused by particulate matter (soot) inhaled from household air pollution.

Key for the infectious disease topic is that deaths from cooking and heating smoke (usually from wood and dung fires): “Household air pollution causes noncommunicable diseases…”

Putting Clean Cooking on the Front Burner (The World Bank, December 21, 2017) claims its World Bank loan portfolio of $130 million in “13 countries…has benefited 11 million people to date.”

there are nearly 3 billion people around the world who still rely on traditional, inefficient stoves for cooking and heating their homes, which burn wood, charcoal, coal, animal dung or crop waste. The estimated health, environmental and economic cost of this continued use of solid fuels staggering: $123 billion annually.

So it looks like money spent effectively in clean cooking could save more lives than money spent on addressing infectious diseases. Still, there is the challenge of spending or investing effectively toward whatever challenge is chosen. Economists argue that people on the ground are better off making their own decisions rather than just accepting whatever priorities are chosen for them by their governments or foreign NGOs and aid agencies.

Poor people would benefit from electricity and clean cooking fuel, but there is a lot more that poor people, women especially, would use electricity for. Washing machines would be a top priority, according to statistician Hans Rosling in this TED video The Magic Washing Machine.

 

 

 

 

 

Also, recommended for West Africa topic and the infectious disease resolutions is this recent TED Institute presentation Imagining a new future for health systems in Africa:

How can Africa, a continent that has 54% of the world’s communicable diseases but only 2% of the world’s doctors, develop a healthcare system that is both efficient and effective? Healthcare consultant Mathieu Lamiuex believes emerging economies could outperform developed nations’ healthcare systems by “leapfrogging” over their inefficiencies and deeply embedded mistakes. By creating an innovative and adaptive system based on modern innovations, Lamiuex believes we could do much more with much less.

See also Economic Freedom Is Key to African Development (CEI, April 20, 2017):

Many African nations have made great economic strides in recent years. As well as improving Africa’s per capita GDP by over 50 percent since 2000, some have made leaps forward in technological development. Examples include the cell phone revolution and the widespread adoption of digital cash in Kenya. In countries with poor landline telecommunication systems and limited access to finance, poor people are leapfrogging past old problems through the adoption of new technologies. Yet that is only a start. While these advances have made life better for millions of Africans, most Western approaches to development, whether at government agencies or the leading non-government organizations, neglect the importance of three key building blocks of prosperity: secure property rights, limited government, and affordable energy.