A reflection of health inequity in recent epidemics

Exclusively written for the Sting by Miss Charlene Chau, student and global health enthusiast, eager to exchange solutions on global health issues and health policies. Miss Chau is affiliated to the International Federation of Medical Students Association (IFMSA). Ebola, the cause of human and primate hemorrhages; polio, the root of flaccid paralysis; Zika, the hypothesised culprit of microcephaly in babies, all seem to catch newspaper headlines in recent years. Besides this, these three diseases all bear similarities in terms of the type of disease, location and the international response: Firstly, they are all zoonotic; secondly, they first broke out in developing countries, with high fatality rates, but when developed countries were affected, there were rarely any confirmed deaths; lastly, they were all declared as a PHEIC (Public Health Emergency of International Concern) by the World Health Organisation (WHO). Yet, these seeming congruences beg a question: Is it truly a coincidence, or does it point to an underlying problem? Looking at the statistics of countries being affected the most would one be able to elucidate the answer. The countries which the Centres for Disease Control and Prevention classified with “widespread transmission” of Ebola include Liberia, Sierra Leone and Guinea have HDI rank of 175, 179 and 183 respectively among 187 countries in 2014 (the year of the pandemic). For polio, the strain was found recently in a sewage in southern India, a country ranked 130th in the 2015 HDI. As for Zika, 1.3 million infections were confirmed in Brazil in 2015. Despite Brazil being positioned 75th out of 188 countries,infant mortality rates remain high compared to international standards. With low ratio of doctors to people, poor road and transportation systems that delayed the transportation of personal protection equipment, observed in the Ebola crisis; with the scarcity of supplies, such as clean running water (which facilitates transmission of polioviruses) and stable electricity (essential to maintain the potency of the polio vaccines during delivery); with the limited knowledge on diagnosis and surveillance due to the paucity of resources in Brazil, it is understandable why the WHO referred to these viruses as “deadly pathogens exploit(ing) weak health systems.” The pandemics, particularly the Ebola and Zika crises, were also consequences of the feeble responses of profitdriven research and pharmaceutical companies, as well as the sluggish responses of the WHO in detection and response to these outbreaks. After the Ebola crisis, a report in the Lancet recorded the criticisms of experts towards the WHO, that there was a lack of “highlevel political leadership or reliable and rapid institutional responses”. Whilst major reforms of the WHO’s response to epidemics must be strengthened, the spotlight should not merely be on them, evident from the fact that Zika still broke out despite the quick WHO response. If the global healthcare is likened to an edifice, the WHO is only the cement, but the individual healthcare systems are the building blocks. The WHO holds the huge responsibility of coordinating and responding, but more focus should be on those building blocks instead, building a competent, responsive health workforce, forming an adequate health financing system, and strengthening the leadership and governance. These should no longer be the privileges of the developed countries, but an entitlement to everyone. References:

1. 2014 Ebola Outbreak In West Africa Outbreak Distribution Map | Ebola Hemorrhagic Fever | CDC “. CdcÆgov†. N. p., 2016. Web. 22 June 2016.
2.  Human†Development†Report†2014†. Print.
3. India To Vaccinate 300,000 Children After Polio Strain Found In Sewage”. Scientific†American†. N. p., 2016. Web. 22 June 2016.
4. UNDP. Human†Development†Report†2015†. Print.
5. An Indictment Of Ebola Response”. Harvard†Gazette†. N. p., 2015. Web. 22 June 2016.

About the author A student and a global health enthusiast, eager to exchange solutions on global health issues and health policies. Was previously awarded Highly Commended in the Cambridge Newnham Essay Competition on the “Factors leading to the Ebola virus epidemic in West Africa”.