Coronavirus and apparent omissions in global public health

DISEASES AND INFECTIONS of epidemic proportions are becoming more frequent as recurring decimals at a global level. The consequences of globalisation are increasingly being felt as the speed, frequency and sheer number of trips across the globe increased exponentially over the past three decades. Within this period, beginning from the early 1990s, political reforms leading to relatively more relaxed and liberal requirements for entry into many hitherto heavily policed, restricted and closed countries such as the old communist countries of Eastern Europe and China created major incentives for more international trips and an unprecedented transformation of the global value chains, with more direct connections between countries as products and services move from one end of the world to another, as distance has become less limiting. The increase in journeys across the various countries of the world has brought with it enormous increase in trade, wealth, knowledge and more international engagements on one hand and untold crises and various existential problems on the other.

The unprecedented rise in GDP of many countries – big and small – has been attributable to globalisation in many cases. Some countries became global travel and transit hubs, tourism destinations or industrial nuclei within these three decades as in the case of Dubai’s UAE, some Caribbean island countries or Singapore and South Korea respectively. The facilitators of the global transformation seemingly concentrate on the success stories but ignored the attendant complications. While the more obvious issues of the major drivers of economic booms have taken the centre stage, the more nuanced, less obvious but no less important – and inextricably linked – issues have received an inexplicably low attention. The greater and more obvious attention on human traffic should have drawn attention to high impact but low frequency occurrences, among which are disease epidemics and their propensity to rise with size, variety and ubiquity. It is thus appropriate to envisage and prepare for upsurge of epidemics at national, regional and global levels as part of the current global dynamics.

The coronavirus epidemic of immediate concerns on the global scene provides a good basis to re-examine our preparedness for global challenges occurring alongside the unfolding globalisation trends and the prosperity it engenders. The attendant events and the shockwaves arising from them require more introspection by global and local actors on the policy landscape. So far, observations show that China has been more open in handling the coronavirus case than that of the (Severe Acute Respiratory Syndrome) SARS of 2002 to 2003. The former was marred with complaints and allegations of cover-up and official fraud. But try as it may, China cannot claim credit for being proactive in this coronavirus case as many people who became infected have most probably left the region of Hubei where Wuhan is the administrative capital, or have flown out of China to some places in Asia, Africa, Europe, America or Australia before the public acknowledgement and official containment efforts got underway. Subsequent reports, such as discovery of infected persons who were in Wuhan lately, lend credence to this assumption. In the US, at least, definitive confirmation of some people has proved this to be true. It probably took a lot of time and debate in China before it was finally agreed that the infection was not the usual flu and the source was from seafood and that the infection was transmissible from animal to man and from man to man. Emphasis is yet to be laid on possibility that the culture of eating live animals, such as rats or fish, as delicacies could be part of this puzzle.

Although the World Health Organisation (WHO), in the past couple of days, announced that it was too early to pronounce the coronavirus infection a global pandemic, evidences that have emerged so far point to the direction of a pandemic already in the making. The delay in making such a pronouncement could be to avert panic and possible reputational crisis for China while efforts are being made on containment. It is understandable that China would mount pressure on WHO to avoid making hasty pronouncement which may hurt its national economy on so many fronts. For the fact that China currently has a population that is a quarter of the whole of humanity and the fact that a lot of international travels are embarked upon by the country annually, it is safer to assume that hundreds of thousands of people have taken the coronavirus out from the Wuhan epicentre to the entire world through asymptomatic cases of infections in humans or animals, reservoir hosts, early stages missed by clinicians, misdiagnosed infections or outright cases of patients’ defiance even when suspicions had been raised but without a definitive diagnosis yet at the time of their outward international trips. After all, the Ebola case involving Mr. Patrick Oliver Sawyer, a Liberian-American lawyer that escaped from Liberia to Nigeria in 2014, was notable for being the index case for the introduction of Ebola virus disease into Nigeria during the West African Ebola epidemic. Sawyer, who was already having clinical signs of Ebola, boarded the plane and travelled to Lagos contrary to medical advice. His defiance led to the death of an unsuspecting female doctor who placed him under observation in a Lagos hospital. Similar occurrences could have happened in Wuhan despite the subsequent official lockdown of the city.   

Periods of economic boom, prosperity, peace, wellbeing and tranquillity create fertile grounds for complacency and lull in disease surveillance which in turn create opportunities for emergence or re-emergence of epidemics. Cases of re-emergence of measles and polio are good examples. Between January and April 2019, the number of confirmed cases of measles in the United States rose from 107 across 21 states to 695 in 22 states, the highest level since the country declared since it had eliminated the virus in 2000. On September 19, 2019, an outbreak of polio was declared in the Philippines as the disease staged a comeback due to poor sanitation and low coverage of immunisation, 19 years after the country was declared polio-free. The case of the Philippines could be contrasted with that of Pakistan where the lives of vaccination officials were at risk resulting from attacks by local communities on suspicion that vaccination exercise was for an ulterior motive other than to safeguard health.

Tech stocks, banks, automobiles, food products, sports accessories, pharmaceuticals, service industry, environmental activism and rights advocacies make news headlines almost daily. Despite the frequent and elaborate discussions and analyses on them in various high profile gatherings such as the World Economic Forum (WEF), regional and bilateral trading platforms or government-to-government summits, or regional bodies – such as APEC, ASEAN, ECOWAS, SADC, MERCOSUR, or rich countries’ clubs such as BRICS – issues of epidemic and disease transmission across countries hardly make a flicker on their radars. Notwithstanding their infrequent mention, there have been reported cases of enormous losses to some nations’ economies arising from major epidemics. Zika virus (ZIKV) infection, an emergent worldwide public health problem in which an estimated 1.3 million people were infected during a 9-month period in Brazil alone in 2015, came with enormous financial cost. By one estimate, social and economic costs were assumed to be up to US$ 18 billion in Latin America and the Caribbean between 2015 and 2017.

The impact assessment launched by the United Nations Development Programme (UNDP), in partnership with the International Federation of Red Cross and Red Crescent Societies (IFRC), put it in a range between $7 and $18 billion. “Aside from tangible losses to GDP and to economies heavily dependent on tourism, and the stresses on health care systems, the long-term consequences of the Zika virus can undermine decades of social development, hard-earned health gains and slow down progress towards the Sustainable Development Goals”, observed Jessica Faieta, at that time a UN Assistant Secretary-General and UNDP Director for Latin America and the Caribbean. A 2004 analysis estimated the cost of SARS crisis to the world economy at a total of about $40 billion. According to the authors, the economic consequences “go beyond the direct damages incurred in the affected sectors of disease-inflicted countries.” A global economy that receives a boost through the growth and dissemination of the economic impact of travel, trade and financial networks, is expected to be impacted directly and indirectly by epidemics.

Human traffic at the international levels has become so enormous that the public health implications cannot be treated in isolation. From China alone, in 2018, there were almost three million visitors to the U.S. In the 12 months to September 2018, no fewer than 1.42 million Chinese visitors arrived in Australia. The number of visitors from China to Dubai in 2018 ranked the fourth year-on-year growth with 875,000 visitors.  For Africa, two of the major tourism-based economies recorded relatively modest Chinese patronage in 2017, with about 69,000 Chinese tourists visiting Kenya, allowing China to rank as the fifth tourist source country. South Africa received 97,000 Chinese tourists during the same year. In addition to tourism for personal pleasure, sports tourism, medical tourism, food tourism, research tourism and various trips involving business all require transportation. This warrants a closer look at modes and means of transportation and their roles in facilitating the spread of disease epidemics. The use of aircraft, buses, yacht, trains or tram would require better, closer and more frequent monitoring and surveillance, with knowledge sharing for up-to-date and real time intervention planning, strategy and policy changes. A lot of these will need to be done for industries involving people’s mass movement, such as in tourism. A better scrutiny of gatherings at the parks, assembly halls and other places of congregation may be necessary to safeguard the people’s health.

The movement of people across the globe also warrants massive movement of foods of plant and animal origin to various places, as found in groceries, supermarkets, food marts, food tanks, restaurants and hotels. The culinary business involves the export of cultures and eating habits as well. The food service businesses that make exotic foods available in far-flung parts of the world embark on transportation from one region of the world to the other, sometimes with dire consequences. Food items eaten live or with minimal cooking come with their own peculiar risks. The government of UK had a big trouble having to clamp down on beef trade during the outbreak of Creutzfeldt-Jakob disease (CJD), also known as bovine spongiform encephalopathy (BSE) or Mad Cow Disease. CJD, a rare and fatal condition that causes brain damage, has been linked to the infectious protein (prion) as a causative agent. Its outbreak in the UK was marred by official mishandling, leading to the unceremonious exit of a government minister from office. The world can no longer afford those costly mistakes at the government, industry and scientists community levels that bogged down the identification, isolation and characterisation of the disease. It took the UK scientists between 1984 and 1997, from early observation of symptoms, identification to characterisation while crisis loomed and the risks posed to human and animal populations persisted. In cases involving microbial organisms, the advanced molecular markers and other tools have made early diagnosis easier.

As in the case of the Wuhan seafood market, the extent to which the coronavirus from that market would have gone could only be best imagined. It is possible that the virus may be found in a Chinese restaurant anywhere in Europe, Asia, North America, South America, in the Middle East or Africa, particularly in food handlers or food consumers in cases of inappropriately handled foods. Food tourism and hospitality business might well fit into the disease epidemic loop, in which case many travellers who did not pick up the coronavirus in Wuhan could pick it up in Dubai, Abu Dhabi, Johannesburg, Sydney, Mumbai or in Nairobi. Countries need to help each other to protect the people who are constantly on the move and those who are resident in specific places. The need for effective quarantine mechanisms, equivalence in food safety standard operating procedures and the strict application of Hazard Analysis and Critical Control Point (HACCP) becomes relevant; irrespective of country as national boundaries seem irrelevant in these situations. At the global level, a checklist of diseases with zoonotic and pandemic tendencies need to be compiled and shared with countries’ ministries of health, agriculture, animal resources, water and marine resources and environment in a collaborative way. The relevance of seasonality in the spread, morbidity and mortality in certain epidemic cases need to be established and properly communicated to the people to facilitate preventive measures.