Coronavirus and apparent omissions in global public health (2)

ADVOCACY and sensitisation are good, but they are not sufficient in cases of unpredictable outbreaks of infections with no known or documented precedents. The approach to handling disease outbreaks should be multidimensional. Health authorities on the global front need to work out protocols for safe, easy and quick diagnostic tests in cases of novel infections, such that the scientists and investigators are not put in the harm’s way. The authorities should expand the scope of traceability in the nexus between diseases and food chain. They should lead the campaign to ban illegal wildlife trading, hunting and breeding, with deterrent legal measures as the world becomes increasingly more interconnected.  The move might run into a hitch as various cultures begin to kick in a bid to protect their cultural practices, superstitions and beliefs.

The subject of “one health” needs to be given greater attention now more than any time before and professional interface in the multidisciplinary field of “one health” should be well highlighted and encouraged. This is to avert a perpetuation of silo mentality in practice among medical and allied professionals on one hand and the policy experts on the other. The case of BSE in the UK serves as a sad reminder of what silo or compartment approach could do and provides some key lessons. There might be future occurrences of novel infections without antecedents and the way to resolve such crises quickly should be to avoid clashes between public health, commerce, policy experts and politicians. The conflict between public health, commerce and politics during the BSE outbreak was shameful. No less shameful was that of the coronavirus in Wuhan, in which a government, seeking to save its face, reprimanded a medical doctor that first sounded an alarm and a warning of possible outbreak, with the quarantine of seven patients. The initial handling of the index case by the government provided opportunity for the virus to spread. The world cannot afford a repeat of that, and the traditional official reporting line may sometimes have to be circumvented if bureaucracy would create needless complications and put lives at risk.

With the current trade war between the US and China, a delicate situation arises. Blatant commercial protectionism, in the form of one country resisting the products of another, could be allowed to masquerade as public health protection in the forms of non-tariff barriers, which can undermine the perception of public health. Outlandish and extremist views may likely rise to the surface from any country. By initially trying to silence health professionals, the Chinese authorities lost the golden opportunity of preventing the coronavirus infection from becoming a global pandemic. Every other effort thereafter is belated. And China will have a huge price to pay for this. A big lesson here is that helping the less developed countries step up their health and medical emergency preparedness and responses is an imperative – not an option – for the global community. Politics and officialdom should not be allowed to stand in the way of emergency responses.

Health departments, immigration agencies, aviation industry, hotels and resorts need to be empowered and involved in sharing health-related information on disease spread.  There is no doubt that such a system of information sharing might run into some procedural hitches or will intrude into individual travellers’ personal details and private lives. It is necessary to work out ways to prevent critical geopolitics that impinge on or hinder remedial interventions as in DR Congo militias’ onslaught against Ebola control. In DR Congo, the armed militias act on beliefs, suspicions, conspiracy theories and superstitions, some of which are probably shared by high ranking politicians in position of power. The killing of immunisation officers in Pakistan couldn’t have been successful without the tacit knowledge of some people in public offices. In South Africa, Jacob Zuma, as vice president openly confessed that he slept with a confirmed HIV patient and thereafter apologised to the South Africans, saying he took a bath shortly after the sexual escapade. This was explained away by his massive political supporters as irrelevant to his prospect towards becoming the country’s president. He became president afterwards. The danger was that his disposition, though personal, might have had a policy and political impact on a country that, sadly, has become an exemplar in HIV/AIDS prevalence in Africa. How well or how poorly such a political figure’s disposition has affected the control of HIV/AIDS in the country could best be figured out.

Global organisations need to step up their work on novel epidemics. In matters of global diplomacy, trade and transport treaties as well as economic cooperation, the relevance of public health diplomacy and the role of public health diplomats should no longer be treated as tangential. Just as countries have security accords, business deals and economic collaboration, public health should be accorded prominence in such agreements.  The World Health Organisation (WHO) will have to increase funds and personnel specifically dedicated to public health, especially those concerning communicable diseases, in collaboration with relevant organisations such as the Food and Agriculture Organisation (FAO) and the World Animal Health Organisation (OIE) in order to ramp up action against zoonoses. It will be most appropriate for the UN General Assembly to build on WHO’s collaborative platform by providing a special session in September 2020 for novel infectious epidemics similar to what it did in 2018 on non-communicable diseases. Renewed attention needs to be given to cases of tuberculosis, H1N1 swine flu, avian influenza, Lassa Fever, Zika virus infection, Brucellosis, anthrax or any other disease that has the potential of becoming a pandemic. International trade and commercial collaboration will need to be done with recourse to competent national and global authorities on possibilities of afflictions associated with infections and contaminations in spite of, and in addition to, official measures to prevent disease spread.

Situations of epidemics present peculiar opportunities for some actors: politicians seeking heroism, humanitarian actors, special interest NGOs, activists, media seeking to make screaming headlines and business concerns, many of which manipulate such emergencies for their personal or corporate advantages, sometimes at the expense of the victims. Corruption prevails in countries that don’t have proper governance and institutional frameworks to handle emergencies, unforeseen events and humanitarian crises. Inadequate understanding of the dynamics of global supply chains is a major incentive for some of the associated complications. Economic cooperation, regional integration and bilateral trade relationships hardly lay emphasis on critical facts of disease dissemination other than those superficially known in food exports. Infections, causative organisms, mode of transmissions, incubation periods, clinical signs or mutations are hardly mentioned.  In addition to more and more trading agreements being signed by countries, there should be robust feedback and policies at the national and international levels. Countries need to take inventory of constant travellers and monitor their history to assist in efforts to rule in or rule out possible acquisition or transmission of infections.

The interface between wildlife or feral animals and domestic animals needs constant research and should be well communicated on a continuous basis because of the dynamic situations globally. Advisory messages on public health should be shared with organisers of major events that involve large crowds or gatherings. Implications of these may have far-reaching implications, part of which might be seen as curbing people’s freedom of public gathering. Emphasis should include indicators to look out for and quick remedial steps to take. Whether localised or pandemic, viral infections are hardly amenable to drugs but many could be vaccinated against to raise antibody levels high enough to prevent active infection or their establishment as clinical conditions if done early enough before exposure to live infective organisms. It is now time to characterise the various infections of global relevance according to their infectivity, severity, incubation periods, disease duration and the risks they pose to individuals, communities and countries, as acute, chronic, debilitating or contagious. Their impacts on trade, travels, economy or productivity, generally, will be of great significance. The world needs to embark on strategies to prevent rogue regimes, rebel forces, insurgents or militias from using known infectious agents as biological weapons. The case of botulinum is well known. There must be a clamp down any semblance of collaboration, trade relations or assistance between laboratories and any belligerent groups. National and global intelligence and security community should be vigilant and constantly observe regional security architecture and interpret it from the standpoint of public health policies.

The dichotomy between rural and urban settings is such that rural populations exist with little or no official notice or intervention during epidemics, resulting in situations that perpetuate such epidemics as the neglected rural areas feed the diseases back into the urban centres. In many poor countries, the rural and urban poor cannot pay for their health coverage under normal circumstances, much less during epidemics. In the urban centres, however, public and rapid mass transit vehicles such as buses, trains, ferries and aircraft are potential means of spread of contagions. Religious, social and other forms of mass gatherings need certain precautionary measures to prevent them from acting as possible means of spread of diseases. Africa has had its fair share of epidemics and needs to be better protected in the future. Cases of Zika, Ebola, Lassa Fever, Measles and Swine Flu are known to have disrupted nations’ economies in addition to human mortalities.

Recent case of Coronavirus infection should serve as useful lessons. Countries’ quarantine services should be more proactive and embark on active surveillance, while also applying rules of equivalence in the matters of international trade at the bilateral and multilateral levels. While looking at the upsides of globalisation, its downsides should be acknowledged and guarded against. Regional cooperation and nation-to-nation cooperation on political and economic fronts should not be isolated from critical issues of public health threats arising from trades and human movement across the borders. The control of trans-boundary human and animal diseases should be at the heart of all regional cooperation platforms. Seasonality is critical in public health policy, on morbidities, mortalities and other complications. The world has four broad seasons, some more favourable for the spread of certain diseases than others. In the tropics where the seasons are not as clearly divided, and where many diseases can occur all-year-round, the knowledge of this should be put in appropriate context. Developing countries hold great significance because of the danger of insidious spread of diseases from there to other areas, given a boost by international aviation business.

As the world’s distance shrinks, we need to keep in mind that any disease anywhere in the world is just a matter of days away from other parts of the world and we need to constantly watch out against them, making round-the-clock efforts to prevent their spread and protect ourselves against them. We all need to get involved in protecting ourselves as well as others for our common good.