Prof Rotimi Jaiyesimi
The complexities of global health and why it is every one’s business
Disease and Health
The absence of any disease condition in our bodies, though often taken for granted is welcome news. Millions of people suffer from diseases that include infections (bacterial, viral, fungal), chronic illnesses such as diabetes, hypertension and neglected tropical diseases among others. The socio-economic effects of these diseases on individuals and society are in large quantum.
Public and Global Health
Health has come to the forefront of discussions and news item. Once upon a time, diseases did not make global headlines. With the ease or transportation, increasing multilateral relations and international migration. The world has become a small village and it has become easy for Internatinal spread of disease. This is why global health now takes prominence in policies and strategic planning.
Variations across nations
The disease patterns vary between nations. However, infectious diseases can be spread across borders irrespective of their strains and types. No nation is immune to outbreaks of infectious diseases.
Not my business
While high income nations and philanthropists have made financial and technical contributions towards improving the health indices of LMICs, these in the face of the high disease burden has not made the desired impact. The Ebola epidemic ravaged the Democratic Republic of Congo and to a much lesser extent Nigeria is faced with the Lassa fever outbreak. These and neglected tropical diseases have not received the international attention and financial support required to contain or eradicate them.
In situations of epidemics and/or pandemics, most countries are not spared and it is paramount that cost should never a barrier to screening, testing and treatment.
Covid-19 - The latest global health concern
This is a novel virus named for the crownlike spikes that protrude from its surface. The coronavirus can infect both animals and people and can cause an array of respiratory problems and illnesses such as the common cold, pneumonia-like illness, influenza infections, Severe Acute Respiratory Syndrome(SARS) and the Middle East respiratory syndrome-related coronavirus (MERS). The latter two are severe forms associated with higher mortality. The mortality rate of Covid-19 is about 3-4 per cent.
Diseases know no boundaries
Covid-19, a pneumonia-like illness of varying severity that is transmitted from person to person. It can also be transmitted from asymptomatic individuals. There are 287,927 people infected, 11949 deaths globally affecting 187 of the 195 countries in the world.
The first entries of coronavirus Into Africa were through individuals who took flights from Italy, a high income country. This reminds us of the ease in which diseases can spread across nations. The number of 54 African countries with reported cases of covid-19 infection has risen to 50 nations. There are 473 confirmed cases and 8 deaths in Africa ( these numbers become over 600 when some North African countries whose numbers are placed in the Arab region are included!).
Response to epidemic infections
Adequate and appropriate responses are required to contain the spread of infections and these depend on the resources available to the health systems.
Unlike high income countries, the inadequate health facilities in Low to Medium countries (LMICs) is unquestionable as is their preparedness for an infectious viral epidemic. In addition, the cost of screening, testing and treatment in LMICs creates a barrier to health care. Conflict stricken countries such as Syria, Afghanistan and Iran are also vulnerable countries. Contact tracing in such circumstances will be near impossible.
Simple inexpensive precautionary measures such as hard washing, use of hand sanitizers, sneezing or coughing into disposable tissue or into one’s elbow, social distancing, self-isolation among others should continue to be promoted globally. These interventions will be great armamentaria in the quest to combat Covid-19 in LMICs.
The response of the world community to Covid-19 and previous viral epidemics has far exceed the response to diseases such as Ebola and neglected tropical diseases in LMICs. The diseases continues to cross borders with cases reported in 187 nations. The World Health Organization raised its global risk assessment for the new coronavirus to “very high” from “high” as some countries struggle to contain the pathogen.It is now a pandemic, a big threat to global health.
It is now apparent that no country is immune from this disease. The Chinese and Italy have embarked on a complete lockdown in affected cities, with China reporting success while it continues spread in Italy because of an initial slow response to the alert and its aging population who are more vulnerable. Achieving lock downs is not strictly possible in LMICs where the political governance structure is weak or in war-stricken areas.
Measures of containing the spread will require investment in the health systems which at present is weak and not resilient. There is no doubt outbreak related health spending will increase and this cost will be expected to be borne by individuals and governments. We have witnessed the strain on the health service system in the west. One can only imagine what will happen in LMICs should this virus continue to spread exponentially. Things will fall apart with dire consequences.
Trade with China, the index country, has been affected and seen a crash in economic activity and the financial markets globally. Sporting events, religious pilgrimages, flights and schooling have been cancelled at short notice with loss of the expected return on investment. Stock markets plunged at the end of February, with an index of global stocks setting its largest weekly fall since the 2008 financial crisis, with more than $5 trillion wiped off the value of stocks globally.
Overseas aid and Global Health
Recent years have seen the reduction of overseas aid to LMIC. The UK governments plans to dissolve the Department for International Development and bring its operations under the Foreign and Commonwealth Office would have a negative impact on the world’s poorest people.
Training, Research and Development
Funding is required for mitigating the impact of the epidemic. This is required for the strengthening of health systems through the training of healthcare professionals, for meeting the outbreak related vaccine development and distribution.
It is heartening to witness a rapid response in the form of a public-private partnership between the European Commission and pharmaceutical companies to provide funding for projects to develop treatments and diagnostics against the COVID-19 outbreak. It is hoped that should this research be successful, the outcome vaccines or treatment will be made available and affordable to all nations especially LMICs.
Politics and Leadership
While the USA faces a possible health crisis and emergency, its President stated that
‘Everything is absolutely under control, and anyone who tells you otherwise is just out to get him’. Governments should not play politics with the health of the people.
A number of governmental and non-governmental agencies have risen to the occasion. The United Nations have released funds and the Bill and Melinda Gates Foundation has made a donation of $100 million to help efforts in LMICs (lower- and middle-income countries).
Global health instability can create economic and political instability as we have witnessed with Covid-19 infection. LMICs should consider biting the bullet and introduce a lock down in their major cities and a ban on international and local flights. Failure to undertake these albeit difficult decisions will leave the nations’ populace exposed to the virus. Prevention in better than cure.
This is globalisation in action and nations need to rally together to prevent the socio-economic impact of diseases and protect our health. Global health is a complex system, a global security issue and it is everyone business.
Professor Rotimi A K Jaiyesimi
Associate Medical Director for Patient Safety and Consultant Obstetrician & Gynaecologist
Basildon University Teaching Hospital, Basildon, UK
CEO, Trojan Medical Group
21 March 2020
Photo credit - WHO