Jimmy Whitworth
by Jimmy Whitworth
Kinshasa must have been an exciting place in the 1920s. This bustling port on the Congo river was growing rapidly, and with the arrival of the railway the population exploded. Kinshasa was the gateway for all the riches of what was then called the Belgian Congo, as rubber, gems, minerals, ivory and exotic woods made their way out of the country. Think of the Klondike mashed up with 19th-century New York.
This, according to research published in Science, was the perfect incubation ground for HIV to develop into the pandemic that was unleashed in the 1980s. Lots of migrant men looking for work, busy commercial sensual workers and unsterilised needles shared between patients at clinics combined to allow a virus that had previously infected just a few hunters deep in the forests of Cameroon and Gabon to spread rapidly. It went on to infect people throughout Africa, apparently unrecognised for decades. What’s striking is not only how far and for how long an infection as devastating as HIV could have spread without being noticed, but also how modern life, with urbanised living and fast easy transport, makes us increasingly vulnerable to epidemics. This outbreak is the biggest that we have ever seen and the reasons are at least partly social, rather than biological. Not only has the epidemic struck a highly mobile population, which has allowed it to spread to urban areas such as Monrovia, the capital of Liberia with a population of about 1 million, but after years of debilitating civil war and insurgency the local population has shown scepticism towards the support offered by health workers and national authorities.
This, coupled with very weak in-country health systems and almost nonexistent surveillance, meant that we all woke up very late to the scale of the epidemic. By the time we realised the size of the problem, the remaining health services had been overwhelmed and the epidemic had spiralled out of control. As we battle now to raise the necessary global resources needed to combat the epidemic, experts are starting to think about what we need to put in place now to prevent such a catastrophe arising again. If we don’t do this, we are all vulnerable to another deadly epidemic taking hold in the region and perhaps spreading more widely around the world. What are desperately needed are better tools for preventing future outbreaks. We need better diagnostics, effective medicines and vaccines. While it is difficult to do research in these kinds of crisis settings, it is essential that we do make the effort in order to be better prepared for the next epidemic. Each time an Ebola outbreak occurs, we need to learn from each epidemic and take that forward to confront the next.
At last week’s Global Symposium on Health Systems Research in Cape Town, representatives of development agencies and NGOs discussed plans for “building back better” for the countries of this region of west Africa to ensure that in five years we have functional health systems that have some resilience to absorb unexpected shocks, with reporting systems that allow us to track emerging infections much more rapidly.
Better surveillance systems inevitably mean that there will be more false alarms, with potential epidemics that never take off, but that is a small price to pay if we are better prepared to tackle emerging epidemics before they become uncontrollable. THE GUARDIAN
by Jimmy Whitworth
Kinshasa must have been an exciting place in the 1920s. This bustling port on the Congo river was growing rapidly, and with the arrival of the railway the population exploded. Kinshasa was the gateway for all the riches of what was then called the Belgian Congo, as rubber, gems, minerals, ivory and exotic woods made their way out of the country. Think of the Klondike mashed up with 19th-century New York.
This, according to research published in Science, was the perfect incubation ground for HIV to develop into the pandemic that was unleashed in the 1980s. Lots of migrant men looking for work, busy commercial sensual workers and unsterilised needles shared between patients at clinics combined to allow a virus that had previously infected just a few hunters deep in the forests of Cameroon and Gabon to spread rapidly. It went on to infect people throughout Africa, apparently unrecognised for decades. What’s striking is not only how far and for how long an infection as devastating as HIV could have spread without being noticed, but also how modern life, with urbanised living and fast easy transport, makes us increasingly vulnerable to epidemics. This outbreak is the biggest that we have ever seen and the reasons are at least partly social, rather than biological. Not only has the epidemic struck a highly mobile population, which has allowed it to spread to urban areas such as Monrovia, the capital of Liberia with a population of about 1 million, but after years of debilitating civil war and insurgency the local population has shown scepticism towards the support offered by health workers and national authorities.
This, coupled with very weak in-country health systems and almost nonexistent surveillance, meant that we all woke up very late to the scale of the epidemic. By the time we realised the size of the problem, the remaining health services had been overwhelmed and the epidemic had spiralled out of control. As we battle now to raise the necessary global resources needed to combat the epidemic, experts are starting to think about what we need to put in place now to prevent such a catastrophe arising again. If we don’t do this, we are all vulnerable to another deadly epidemic taking hold in the region and perhaps spreading more widely around the world. What are desperately needed are better tools for preventing future outbreaks. We need better diagnostics, effective medicines and vaccines. While it is difficult to do research in these kinds of crisis settings, it is essential that we do make the effort in order to be better prepared for the next epidemic. Each time an Ebola outbreak occurs, we need to learn from each epidemic and take that forward to confront the next.
At last week’s Global Symposium on Health Systems Research in Cape Town, representatives of development agencies and NGOs discussed plans for “building back better” for the countries of this region of west Africa to ensure that in five years we have functional health systems that have some resilience to absorb unexpected shocks, with reporting systems that allow us to track emerging infections much more rapidly.
Better surveillance systems inevitably mean that there will be more false alarms, with potential epidemics that never take off, but that is a small price to pay if we are better prepared to tackle emerging epidemics before they become uncontrollable. THE GUARDIAN
