Outbreaks in a rapidly changing Central Africa lessons from Ebola Vincent J monster PhD Daniel G Bausch MD ma DeWitt PhD Robert Fisher PhD Gary Cobb enger’ PhD Cesar munos font ela PhD Sarah a Olsen PhD stephanie ann Seyfert PhD armand sprecher MD Francine to me PhD Moses Missa koi MD and Jean Vivian mumble a PhD article figures Media.
Metrix 5 references West and Central Africa are.
Experiencing explosive growth in.
Urban populations economic activities and connectivity the recent Ebola virus epidemic in West Africa demonstrated the.
Vulnerability of the local healthcare infrastructure to newly emerging infectious diseases two key factors contributing to the epidemics unprecedented size were growth related large urban populations that overwhelmed the public health infrastructure of these resource poor countries and the extensive spatial and technological connectivity of the population dot 1 these factors for tendon increased risk in central Africa of emerging infectious diseases caused by both known and unknown pathogens such unwelcome side effects of rapid growth can be mitigated only by strengthening.
The healthcare infrastructure including diagnostic and.
Clinical capacity to meet the health care needs of the population investment.
In the training of healthcare workers and African scientists expansion.
Of research capacity development of disease surveillance programs focused on humans livestock and Wildlife and rapid deployment of control measures when outbreaks occur outbreaks.
Of Ebola virus disease in central Africa 1976 to 2018 a review of past outbreaks of Ebola virus zaire ebolavirus above in central Africa Gabon of the.
Congo Rock and Democratic Republic of Congo DRC is instructive before 2013 above outbreaks consisted of relatively small numbers of cases see table.
And were effectively contained by basic Public Health quarantine and containment measures the largest abof outbreak before 2013 occurred in the DRC in 1976 and comprised 318 cases these outbreaks occurred predominantly in remote regions where they had limited opportunity to spread over wide geographic areas in the 2014 and 2017 above outbreaks in the DRC for instance the initial zone otic introduction from a wildlife reservoir in a remote area resulted in limited human to human transmission and rapid containment only sixty-six cases were detected in humans.
In the 2014 outbreak and eight in the.
2017 outbreak in stark contrast 28,000 646 cases of abhava were reported during the 2013 to 2016 epidemic in West Africa that outbreak dispersed rapidly over large geographic areas in Africa including major urban centers and there were several cases of nosocomial infections in Europe and the United.
States among the West African casualties were more than 500 health care workers whose lost further decimated and already extremely thin workforce rapid spread contributed to the inability to control the outbreak for more than two years and the extended epidemic resulted in an estimated 2.
Loss in the gross domestic products of Liberia Sierra Leone and Guinea the overall costs of the international response exceeded three dollars and ninety cents billion dot to the unprecedented scale of the West African epidemic has been attributed to a combination of factors large urban.
Populations minimal public health infrastructure a slow response from international partners and pensive connectivity of the populations the recently contained outbreak of Ebola virus disease in the equator or province of the DRC appeared to be unusual for the region in part because of such connectivity with major waterways connecting the at the center of the by quero region with major population centers including Kinshasa population eleven point eight million and Kissin Guinea 1.6 million in the DRC and Brazzaville 1.
Although the outbreak did not.
Reach those cities cases were reported in the regional capital of mangaka 1.2 million these circumstances were alarmingly similar to those surrounding the West.
African epidemic but the rapid response of the DRC ministry of health and.
International partners including the likely benefit from the deployment of the vsv Ebola vaccine.
Managed to block further spread however only 7 days after that Ebola outbreak was declared over a new outbreak was declared in the Malacca health zone territory of Beni.
And the DRC province of North kevo mAb Alico is a challenging area given its political instability several large population centers Goma population.
1 million buta bo 670,000 and many 230,000 and substantial cross-border movement into Uganda and Rwanda in light of the increase in frequency of Ebola outbreaks in DRC and their relatively rapid detection.
It seems that it would be well worth the relatively small cost of investing in diagnostic capacity and training to avert the cost of containing any large outbreak we believe that a.
On investment could be expected from financial and educational support.
For improving and expanding the clinical care infrastructure even if the ongoing outbreak in the DRC can be rapidly curtailed.
The demographic data clearly indicate how the advance of the human footprint across Central Africa has exacerbated the risk of large outbreaks over recent decades Central Africa has.
Undergone profound changes in.
Population structure a rapid decline in death rates in particular among children less than five years of age has contributed to rapid population increases combined with a demographic shift toward large numbers of working age people dot 3 in addition Central Africa is experiencing the world’s fastest rate of urbanization with 50% of the Central African population expected to live in urban areas by 2030 and rural cities with populations exceeding 1 million such as mangaka and Goma.
In DRC are becoming more common throughout central Africa Ebola infections and outbreaks in West and Central Africa one important factor in the potential rapid Geographic spread of emerging infectious diseases is road construction for logging mining and hydroelectric activities that continues to open access to remote locations in Central Africa facilitating movement between previously isolated communities see map for road construction and other anthropogenic disturbances directly alter ecosystems in which pathogens reside dot 5 these activities not only open previously pristine areas but also reduce traveling times to end.
From highly urbanized areas such as Kinshasa and Brazzaville both of which are increasingly hubs for global connectivity from which Asia South and North America and Europe can be reached in less than 12 hours large infrastructure programs such as the program for infrastructure development in Africa will soon facilitate.
Even greater connectivity among African countries and regions clearly Central Africa is rapidly approaching a tipping point Africa’s economic development is a positive change that cannot and should.
Not be stopped at the same time rapid economic and demographic transitions bring the challenges of emerging infectious disease outbreaks of increased frequency size and global impact yet there is an alternative to this foreboding narrative of development associated Infectious Diseases rather than pose a risk continuing population growth and increasing income and.
Help spur greater demand for infrastructure to support sustainable economic development including implementation of.
Basic health services a substantial proportion of.
Economic gains associated with extractive.
Or road building activities could be used to strengthen public health preparedness for emerging diseases in addition rather than spending exorbitant amounts reactively for control operations international donors could invest in long-term public health and prevention infrastructure directed and sustained.
Investment is urgently needed before ongoing demographic and economic changes conspired to cause major outbreaks of both national.
And international consequence this investment could include training and education of healthcare workers especially in rural areas to identify report and properly handle cases of unknown emerging diseases as well.
As increases in diagnostic capacity and.
Access to clinical care in both urban and rural areas.
In addition the region will.
Need well-trained African scientists.
Who can strengthen the much-needed clinical research infrastructure for testing new vaccines and therapeutics recent economic gains in several Central African countries have not yet resulted in.
Increased investments in healthcare infrastructure thus strong international commitments of donor funds.
Will be necessary to prevent devastating infectious disease outbreaks World Bank trust funds such as the pandemic emergency financing facility can provide rapid surge financing during the initial stages of a severe outbreak but we believe that long-term funding programs should also be made available for direct investment.
In the strengthening and sustaining of general health systems this strategy will not only enable a better and faster response to emerging infectious diseases but will also result in permanent improvements in quality of life through better access to care disclosure forms provided by.
The authors are available at net.
Org the view is expressed in this article are those of the authors and do not necessarily reflect those of their respective organizations this article was published on August 22nd.