CORONA VIRUS : Global fight depends on the health system of vulnerable countries
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Review

CORONA VIRUS : Global fight depends on the health system of vulnerable countries

Dr Nahid Bhadelia, MD, MA

`The 2019 novel coronavirus has caused a public-health emergency in China, a global economic superpower. Like many in my field, I worry that if and when the emergent virus takes root in poorer countries that are already tackling outbreaks of other pathogens, it could wreak havoc of an even larger magnitude.

I am a physician who concentrates on outbreak preparedness against new infectious diseases, both in the United States and in countries with far fewer resources. I worked as a clinician in West Africa during the Ebola outbreak, and in New York City hospitals during the H1N1. My work—currently in western and equatorial Africa and previously in Asia and Latin America—has convinced me that global defenses against new infectious diseases are only as strong as the health systems in the poorest communities all around the world. The specifics of new diseases matter less than whether those communities can, with international support, build the resilience to face common (and uncommon) threats.

When I landed in Uganda a couple of weeks ago, the airport in Entebbe was screening for Ebola virus disease, because of the continuing outbreak in the neighboring Democratic Republic of Congo, and also for the novel coronavirus.That same week, a number of other diseases also threatened people living in the region. The Ugandan public-health authorities were simultaneously dealing with outbreaks of Crimean-Congo hemorrhagic fever and yellow fever.

Last week, WHO identified 13 African countries at high risk for transmission of 2019-nCoV due to direct links or high-volume travel from China. The damage the new epidemic might cause in Africa is not only a function of the disease itself, but also of how it could combine with other health threats and disrupt trade, travel, and educational endeavors on the continent.

The last two Ebola outbreaks—in West Africa from 2013 to 2016 and now in the Democratic Republic of Congo—have devastated the affected countries. If any good has come of those events, it’s that they have also led to improvements in many African countries’ capacity to tackle emerging infectious diseases, bringing in investment in diagnostic capacity and national coordination.

Nigeria, for example, has improved its national laboratory that tests infectious-disease specimens. That nation’s improved detection capabilities have improved surveillance not just of Ebola, but also of Lassa fever and of the growing incidence of monkeypox and other infectious diseases. There is greater regional leadership; the Africa Centers for Disease Control and Prevention—a.k.a. Africa CDC—has emerged as both a coordinator of and advocate for more resources and has led the efforts to conduct diagnostic testing for 2019-nCoV in multiple countries across the continent.

If the 2019-nCoV epidemic spreads around the world, rich countries may decide to test incoming travelers. In poor communities, identifying those carrying the virus will be even harder.

Nearly 90 previously unknown human pathogens have been discovered since 1980. Emergent diseases sometimes bring new attention and new resources; the Bill and Melinda Gates Foundation, for instance, recently made a major contribution to help tackle the novel coronavirus. Still, the central lessons of 2019-nCoV and Ebola are the same: Temporary support in the aftermath of an epidemic is not a substitute for much greater investment by the international community in health care in the most vulnerable countries all around the globe. The advent of 2019-nCoV should push us to look beyond specific diseases and toward how we can improve health care more generally—and contain the next pandemic before it starts.

Aster Medical Journal
www.theamj.org