Ebola outbreak highlights global rise in epidemics

Ebola outbreak highlights global rise in epidemics
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A year after the deadly Ebola virus broke out in the Democratic Republic of the Congo, public health officials are struggling to contain what has become the second-worst epidemic of the virus in modern history.

That outbreak — which as of Wednesday had infected more than 2,700 people and killed two-thirds of them — is just one of a troubling spread of viral epidemics happening around the world.

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Some say the spread of preventable diseases is a worrying trend in a turbulent world, in which public health is among the first victims of both crumbling institutions and popular mistrust of expert opinion.

“Public health is really closely tied to the social, political and economic issues of the world. Where they go awry, public health can quickly go awry,” said Michael Osterholm, who directs the Center for Infectious Disease Research and Policy at the University of Minnesota. “This is a worldwide phenomenon that is happening. Public health is struggling, with a number of diseases in a number of cases.”

At the same time as Ebola ravages two provinces in the east, Congo is suffering through a severe measles outbreak that has actually killed more children than Ebola.

In Yemen, the worst cholera outbreak ever recorded has sickened more than a million people who live amidst a merciless proxy war between Iranian- and Saudi-backed forces.

In Venezuela, malaria has made a jaw-dropping comeback half a century after it was eradicated. One public health group estimates that more than a million people are suffering from malaria as the public health system collapses along with the economy.

Along the Afghanistan-Pakistan border, more polio cases have been diagnosed this year than in all of last year, and the total number of cases may understate the spread of that disease by a factor of a thousand.

In those cases, viruses have spread because the public health institutions meant to prevent them are either unable to do their jobs or unwelcome by a distrustful public.

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The World Health Organization (WHO) and others responding to the Ebola outbreak have recommitted themselves to engaging with skeptical communities in Congo, some of whom believe the spread of a virus they have never heard of is a government hoax meant for ethnic cleansing.

In Yemen, Afghanistan and Pakistan, public health workers are unable to access populations behind enemy lines. In Venezuela, international aid workers are unwelcome as President Nicolás Maduro fights to save his government.

“Very little is being done to try to cool those politically unstable environments, and that seems to be different now from where we were 10 or 15 years ago, where there was a concerted efforts among world governments to try and stabilize those areas,” said Christopher Dye, a former top WHO epidemiologist. “The failure to do that is likely to be part of the explanation for what we’re seeing in terms of disease outbreaks.”

Even in countries where public health systems are functioning, a new wave of populist skepticism of expert opinions is fueling outbreaks. The measles virus is spreading through many European countries, and the number of measles cases in the United States this year has already surpassed several previous yearly totals combined.

Measles has spread through an increasing number of children who have not been vaccinated against the virus, either because their parents have cultural, religious or philosophical objections to vaccines, or because they have bought into repeatedly debunked junk science that purports to link vaccines to other ailments.

“Measles really shows the fault lines in society and public health,” said Tom Frieden, the former director of the Centers for Disease Control and Prevention (CDC). “You have the ability to eliminate it, as the U.S. did, as the whole Western Hemisphere did. … What’s new is the social media contagion, the ability to get wrong messages spreading very, very quickly.”

By and large, global public health is improving. Life expectancies are up, even in the poorest nations, and billions have been lifted out of crushing poverty. But the number of infectious disease outbreaks has increased four-fold in recent decades, said Rebecca Katz, a global health security expert at Georgetown University — and those epidemics are becoming more complex.

It is no longer sufficient to leave outbreak response to health-centric organizations such as WHO and CDC or nongovernmental groups like Doctors Without Borders, Katz said. Instead, they require comprehensive intervention across sectors, from peacekeeping to economic development.

“More and more, we’re going to be seeing these type of events that are beyond one sector,” Katz said. “Success in these events relies upon a multifaceted response.”

Across the world, the institutions capable of organizing public health campaigns have seen a widespread degradation in the level of trust they inspire among increasingly skeptical populations. That lack of trust exists both in isolated communities in Congo’s North Kivu province and in populist anti-vaccination groups on the right and left in the United States.

“A lot of the basic premises of an open, globalist, diplomatically oriented world are just no longer the operating principles, and we don’t know what the new operating principles are,” said Prabjhot Singh, who directs the Arnold Institute for Global Health at the Icahn School of Medicine. “We have yet to say, OK, what’s a response and a mode of being that’s compatible with hyper-local social moors, nationalistic response systems and yet can negotiate across geographies when classic modes are down?”

Public health, on a national or international level, tends to rely on three pillars, Singh said: The ability to craft a message for public consumption, the authority to deliver that message, and the efficiency to deliver treatment or prevention through a functioning bureaucracy. In many places, one or more of those pillars have collapsed.

“We may be getting to a little bit of a biblical reminder point that institutions matter,” Singh said. “You have to redesign institutions, but in some ways things will have to get a lot worse.”