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Ed Webb

Virus exposes gaping holes in Africa's health systems - 0 views

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Africa pandemics health publichealth WHO

shared by Ed Webb on 08 May 20 - No Cached
  • The United Nations Economic Commission for Africa (UNECA) has warned that even with intense social distancing, the continent of 1.3 billion could have nearly 123 million cases this year, and 300,000 people could die of the disease.
  • Africa has carried out a fraction of the COVID-19 testing that other regions have - around 685 tests per million people, although the rate of testing varies widely between countries. By comparison, European countries have carried out nearly 17 million tests, the equivalent of just under 23,000 per million people.
  • Africa’s public health systems are notoriously ill-equipped, but there is also little public data on the resources they have to fight the virus. Reuters sent questions to health ministries and public health authorities across Africa. Health officials or independent experts provided answers in 48 out of Africa’s 54 countries, to create the most detailed picture publicly available on resources including intensive care beds, ventilators, testing and essential personnel.
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  • The continent averages less than one intensive care bed and one ventilator per 100,000 people, Reuters found.
  • Donations have poured in from a foundation set up by Chinese billionaire Jack Ma, and the World Bank is helping procure more than $1 billion worth of equipment for Africa.
  • even in a best-case scenario, Africa could need at least 111,000 more intensive care beds and ventilators - more than 10 times the number it has at present.
  • Tanzania, publicly criticised by the WHO for not restricting large gatherings, has sometimes gone for days without updating its coronavirus figures and has refused to tell donors anything about its public health resources
  • In Madagascar, where the president is pushing a botanically-based remedy untested in an international clinical trial, the health ministry took five weeks to respond to Reuters questions about the number of ventilators in the country.
  • The WHO does not have the funds to carry out detailed surveys on a regular basis, Yao said. "Information is critical for us to better help," he told Reuters. "It's difficult to anticipate their overall needs if you don't have accurate information."
  • around 685 tests have been carried out per million people - far below the 37,000 per million in Italy or 22,000 in the United States.
  • South Africa accounts for 30% of Africa’s tests, although it has less than 5% of the population. Nigeria, which has 15% of the population, has carried out just 2% of testing; it began by testing strategically then broadened it out, Health Minister Osagie Ehanire said. Chad and Burundi have carried out fewer than 500 tests each. Chad said it didn’t have enough testing kits and staff after many of them had fallen ill; Burundi did not respond. Tanzania carried out 652 tests and identified 480 cases.
  • The Africa CDC, set up by the African Union in 2017, worked with the WHO to rapidly roll out testing. In January, only South Africa and Senegal could test for the new coronavirus, but now all African countries can perform tests apart from tiny Lesotho and the island nation of Sao Tome and Principe.
  • Intensive care beds are expensive, difficult to run, and very unevenly distributed. Chad, an oil-rich but impoverished nation of 15 million people, has only 10, whereas the island nation of Mauritius, a financial hub home to 1.2 million, has 121.
  • The continent’s three giants - Nigeria, Ethiopia and Egypt - have 1,920 intensive care beds between them for more than 400 million people
  • Kenya has 518 beds in its public and private facilities, but 94% are already occupied by non-COVID-19 patients
  • Under a best-case scenario - what Imperial College researcher Charlie Whittaker described as a complete lockdown for an indefinite time - at least 121,000 critical care beds will be needed at the peak of the pandemic on the continent, Reuters found. That compares with 9,800 at present
  • Africa has no history of building ventilators. South Africa’s state-owned defence company Denel plans to begin making them, and institutions in Kenya and Senegal have developed prototypes. But authorities in Senegal say they’ve only certified imports before; it could take months to get a prototype certified and mass-produced.
  • In many nations like Nigeria, South Sudan and Zimbabwe, electricity is extremely unreliable and hospitals depend on diesel-powered generators. Some health facilities in poorer, often rural, areas are unable to pay for the constant refueling and maintenance they need.
  • Continent-wide, one doctor serves an average of 80,000 people, World Bank data shows. There are more in wealthy Mauritius - 2 doctors per 1,000 - but countries like Liberia, Malawi or Burundi have far fewer.
  • only nine countries have one or more physicians qualified to administer anaesthetics per 100,000 people, according to the World Federation of Societies of Anaesthesiologists. Most have staffing levels comparable to Afghanistan or Haiti.
  • the World Bank is helping more than 30 African nations source medical supplies. South Sudan recently received a donation of five ventilators, bringing its total to nine. But the new ventilators have yet to be plugged in because the isolation centre is being expanded
  • Private hospitals are generally better staffed, but their revenues have dropped by an average of 40% since March, mostly due to a decline in elective surgeries and regular outpatient chronic treatment, said the Africa Healthcare Federation, an umbrella organisation for the private healthcare sector. Private hospitals are also having to spend more on protective equipment, and private insurance companies are delaying settling claims in many countries, said Dr. Amit Thakker, the head of the federation.
Ed Webb

Inside the Trump Administration's Decision to Leave the World Health Organization - Pro... - 0 views

www.propublica.org/...-the-world-health-organization

US USA pandemics Trump publichealth diplomacy institutions WHO UN

shared by Ed Webb on 20 Jun 20 - Cached
  • The United States is the largest donor among the WHO’s 194 member states, giving about $450 million last year. The WHO said the U.S. cut in funding would affect childhood immunizations, polio eradication and other initiatives in some of the most vulnerable parts of the world
  • The administration plans to fill the void left by its withdrawal with direct aid to foreign countries, creating a new entity based in the State Department to lead the response to outbreaks, according to interviews and a proposal prepared by the department. The U.S. will spend about $20 billion this year on global public health. (About $9 billion of that is emergency aid for COVID response.) But the senior administration official conceded that important activities led by the WHO, including vaccination initiatives, need to continue. It is not yet clear what will happen to those programs when American funding and participation end, the official acknowledged.
  • The new directive will require officials to divert their attention from pandemic response in order to review a list of their WHO-related activities and try to justify them on national security and public health safety grounds
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  • The flu vaccine that Americans receive at drugstores and doctors’ offices is based on work that the CDC and Food and Drug Administration conduct through the WHO
  • Since 2004, the U.S. has helped build a global network of WHO flu centers, buying lab equipment and training scientists. The centers in more than 100 countries collect samples from sick people, isolate the viruses and search for any new viruses that could cause an epidemic or pandemic. The CDC houses one of five WHO Collaborating Centers that collect these virus samples, sequence the viral RNA and analyze reams of data on flu cases around the world, while the FDA runs one of the four WHO regulatory labs that help vaccine makers determine the correct amount of antigen, which triggers the immune response, to include in vaccines.
  • The Trump administration’s plan to bypass the WHO and address global health problems directly with foreign governments will run into trouble in the Middle East, South Asia, Africa and other regions where Americans encounter hostility or have difficulty operating
  • The onslaught of the coronavirus has hurt immunization activities worldwide, causing a rise in measles and other diseases.
  • fear that the U.S. decision will endanger a WHO-led program that has come tantalizingly close to the eradication of polio
  • The uncertainty has caused concern in the pharmaceutical industry as well as the government, officials said. The CDC could lose access to the data and virus samples that protects Americans from potentially deadly strains of flu from around the world.
  • “People coming into countries in WHO shirts to work on polio or AIDS are less threatening,”
  • “No one is looking for U.S.-based alternatives to WHO,” he said. “Dead on arrival. There is no way they are going to be supported or even accepted.”
  • The WHO has a history of bringing together ideological rivals. William Foege, a CDC director under Presidents Ronald Reagan and Jimmy Carter, credits the global agency for uniting American scientists and their counterparts from the Soviet Union during the Cold War to eradicate smallpox in a little more than a decade.
  • “It’s not a failed bureaucracy,” said Foege, who worked on the international fight against smallpox. “If you go there and see all they do every year, and they have a budget for the entire world that’s smaller than many medical centers in this country.”
  • global health experts across the political spectrum admit that the WHO needs reform
  • “In general, the WHO is deferential to member states,” Kolker said. “Yes, it should have been more aggressive in response to Chinese obstruction. Tedros surely realizes the public statements were too deferential to China. But the organization is not dominated by China. Its weaknesses reflect the challenges we have long faced in international collaboration on public health.”
  • “There’s one country that’s desperate for the United States to leave the WHO, and that’s China,” Sen. Chris Murphy, a Connecticut Democrat, said at a hearing Thursday of the U.S. Senate Committee on Foreign Relations. “They are going to fill this vacuum. They are going to put in the money that we have withdrawn, and even if we try to rejoin in 2021, it’s going to be under fundamentally different terms because China will be much more influential because of our even temporary absence from it.”
Ed Webb

Somalia is Set to Be Ravaged by the Coronavirus, and Terrorists Will Profit - 0 views

foreignpolicy.com/...rus-pandemic-somalia-al-shabab

pandemics Africa Somalia Ethiopia Kenya Djibouti hornofafrica health publichealth terrorism failedstates

shared by Ed Webb on 13 May 20 - No Cached
  • Somalia has been spinning on a crisis carousel: war, famine, terrorism, climate stress. Now, the coronavirus pandemic is set to steer the country towards another hemorrhaging of human life. Even with a youth population above 70 percent, the virus will likely compound Somalia’s chronic medley of miseries. With each passing day, an uneasy question looms large: If the pandemic has left such death and upheaval in its wake in the world’s most powerful countries, what impact will it have on one of the world’s most fragile?
  • a psychological readiness for catastrophe. Extreme violence has long been a fact of daily life in Mogadishu, under siege by one of the deadliest terrorist groups in Africa, al-Shabab, which, by conservative estimates, has killed more than 3,000 people in the past five years and wounded tens of thousands in the past decade. Somalis, often touted for their resilience amid unrelenting adversity, are no strangers to mass loss of life.
  • As of Monday, 1,054 infections—out of a miniscule testing pool—and 51 deaths have been confirmed. The true spread is doubtless far worse.
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  • Despite testing far less than its neighbors, Somalia has the highest death toll in East Africa. On April 17 and 18, 72 people were tested, out of which 55 were confirmed positive, a staggering 76 percent infection rate. Since this revelation, the Somali government has stopped sharing the numbers of people tested with the public.
  • Anecdotal accounts of COVID-19 symptoms and a spike in burials abound. “There is extraordinary community transmission. Infections and deaths are out of control,” explained a Mogadishu doctor on the condition of anonymity. “And why visit a hospital if they can’t treat you?” Somalia’s health infrastructure is mere scaffolding: scarce public hospitals struggling with a lack of equipment, unaccredited doctors in private facilities offering unaffordable services, and medication that is as low-grade as it is scarce.
  • Somalia’s best-equipped medical institution, Erdogan Hospital in Mogadishu, was shut down in April after 3 of its doctors were infected. Martini Hospital—kitted with 76 beds—is the only medical facility in the whole country designated to treat the infected
  • Answers to this acute health crisis lie in part with the government’s 2020 budget, which allocated $9.4 million for health spending, a mere 2 percent of the national budget. A whopping $146.8 million was reserved for security institutions—a telling indication of a cash-strapped state facing widespread security threats.
  • The group heralded the disease as divine punishment for the treatment of Muslims globally. Weaponizing the disease, al-Shabab ushered in Ramadan with an attempted vehicle-borne explosive attack at a military base on the first full day of the holy month.
  • Like the virus, al-Shabab transcends national borders and presents risks not only to Somalia but to its pandemic-weakened neighbors, particularly Kenya, which has weathered violent attacks from the group for years. Born out of a power vacuum itself, al-Shabab will capitalize on lapses in states’ security apparatus as governments redirect resources from preempting terror attacks to enforcing curfews
  • risks reversing critical security gains
  • Kenya’s northeastern towns lying on its border with Somalia have been particularly vulnerable to devastating al-Shabab attacks. In response to the illegal smuggling of people and goods from both Somalia and Ethiopia, Kenyan security authorities have recently ramped up aerial surveillance along its borders, in part, to curtail cross-border infection. Ethiopia’s health minister announced last week that 13 of its new cases were imported via illegal migration from Djibouti and Somalia
  • More than 80 percent of global trade passes through the Gulf of Aden
  • the resurgence of piracy can be expected
  • For more than a year now, the central government has been embroiled in a rancorous fight with two of its federal states. This being an election year, the fledgling Somali state finds itself at a critical juncture. It remains to be seen whether federal elections will be postponed, following in the footsteps of neighboring Ethiopia.
  • The disappearance of remittances—a lifeline for millions on the continent and estimated at $1.4 to $2 billion annually in Somalia alone—makes the situation all the more desperate. These critical cash flows have dried up as a global recession sets in and incomes of workers in the diaspora shrink.
  • harrowing statistics from across Europe show that Somali communities have been disproportionately affected by COVID-19. In Sweden, Somalis are dying from the virus at “an astonishing high rate” according to the BMJ despite accounting for only 0.69 percent of the population. The World Bank is calling on governments to designate remittance companies as an essential service, a crucial step to easing restrictions on these financial flows.
  • The populations most at risk in Somalia are those living in the densely populated camps scattered across the country. More than 2.5 million internally displaced people live in these cramped conditions, already weakened by malnutrition and compromised immune systems, and with limited access to clean water, soap, or bathrooms.
  • According to the World Food Programme, the number of food-insecure people in East Africa is projected to reach up to 43 million in the next few months—more than double what it is now—sparking fears of conflict over scarce resources.
  • The specter of drought and famine, alongside the unforgiving plague of locusts that has ravaged crops in recent months
  • deadly flash floods
  • will force more people to move, compounding the internal displacement crisis and heightening intercommunal tensions  even as it spreads the disease further
  • Border closures across the region have throttled migration flows, making it ever harder for people to escape conflict or starvation. This will simply force migration into the shadows, opening up avenues for human trafficking and exploitation. Irregular movement of refugees has already been observed across the Horn of Africa’s highly porous borders.
  • During  Friday prayers at Mogadishu’s Marwazi mosque on April 10, armed forces tried to forcibly disperse a congregation of worshippers without notice. A massive demonstration broke out, and shoulder-to-shoulder prayers continue across the country today
  • Riots swept the streets of Mogadishu again on April 24 in response to the fatal shooting of two innocent civilians by police as they tried to enforce a curfew. Ramadan, replete with nightly rounds of public taraweeh prayers, is likely to catalyze disease spread in the absence of clear communication with communities and Islamic leaders.
  • The virus demands self-sufficiency. Countries are forced to make do with their own systems, however broken.
  • government’s restrictions on press freedom and access to information about the novel coronavirus to the detriment of its own people
  • As has often been the case in the disaster-prone country, it will be up to grassroots community groups, the private sector, and members of the diaspora to mobilize en masse to contain the crisis.
  • Two officials at the Ministry of Health have already been arrested on corruption allegations related to COVID-19 response donations, denting public confidence.
  • With domestic flights suspended, it is all the more critical to invest in hospital and testing capacity across the country. This cannot be achieved without genuine collaboration between the federal government and its constituent member states.
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