The Next Victims of Ebola
The epidemic may be nearing “zero cases” — but it's still disrupting the delivery of vaccines for measles, polio, and other deadly childhood diseases.
When the Ebola epidemic in West Africa comes to an end, it will be marked by two simple words: “zero cases.” But this momentous milestone will also signal the beginning of a new struggle as the long and difficult process of recovering from a crisis that has claimed more than 10,000 lives commences. Ebola has not only drawn attention to the vast gap that exists between rich and poor nations; it has widened that divide too, setting the people of Liberia, Sierra Leone, and Guinea even further back. The opportunity to narrow and ultimately close this gap cannot be neglected.
Ebola has demonstrated, with brutal efficiency, that health and access to systems that protect it are the glues that hold societies together. Infectious disease can paralyze a nation as effectively as armed conflict. Therefore, as rebuilding begins, it will not be enough to get things back to the way they were before Ebola struck. They will need to be made better. This is all the more imperative because Ebola-affected states should be better prepared for the next health assault, which most likely will come from a more familiar disease — and sooner rather than later.
Indeed, even with zero cases, there will be more indirect casualties of Ebola. Tragically, most of these will be children. In 2014 alone, around 250,000 children in the three countries hardest hit by Ebola missed out on basic yet vital vaccinations. This means that outbreaks of other diseases are now likely to follow: for instance, measles — which is far more infectious than Ebola and kills 400 people globally every day — tetanus, pertussis (whooping cough), and polio.
The further tragedy is that prior to this outbreak, these countries were making progress on health. With help from global health organizations, Liberia had successfully raised its immunization coverage and had reduced childhood mortality by two-thirds since 1990. But the health system was not strong enough to withstand Ebola, and in 2014 it quickly collapsed. As a result, coverage of routine immunization dropped from 88 percent to around 60 percent.
This is very worrying because in many ways childhood immunization is the yardstick for the overall health of a nation. Not just because it reaches out to the most vulnerable people in a society, but also because immunization infrastructure and services play a pivotal role in enabling access to other essential interventions, such as maternal health care, nutritional supplements, deworming, and malaria prevention.
The World Bank estimates that Liberia, Sierra Leone, and Guinea are likely to lose 12 percent of their combined GDP as a result of the Ebola epidemic. To regain this economic ground and prevent a future disease outbreak, it is essential that the $5.1 billion committed toward Ebola emergency response and recovery in West Africa be used to its maximum potential. One way to do this would be through the modernization of the infrastructure and management of the human resources that support the Expanded Immunization Programme (EPI). Created in the 1970s by the World Health Organization (WHO) with the aim of reducing childhood mortality by making vaccines available to children everywhere, the architecture used by the EPI today is still much the same as what was used four decades ago. There are antiquated supply systems with aging cold-chain equipment — that is, the refrigeration required to keep vaccines viable — and limited means of tracking data. Together, these realities make it difficult to manage and optimize vaccine stock levels, as well as reach every child.
These problems are not unique to West Africa; they are common sights in many developing nations for the simple reason that modernization costs money. But through pooled procurement, market shaping, and the creative use of business incentives, it is possible to make necessary supplies more affordable. For example, using a pot of funds to purchase solar-powered fridges could help establish a more stable and attractive long-term market for the equipment, which in turn could attract more suppliers, stimulate competition, and drive prices down.
This sort of radical overhaul is not unprecedented. There was a similar approach undertaken to make vaccines affordable through the creation of Gavi in 2000. Gavi raises large-scale funding for vaccines and uses it to provide long-term predictability for manufacturers, helping to encourage new suppliers to enter vaccine markets and thus make those markets stronger. Gavi has achieved significant price reductions for new and underused vaccines — in some cases in excess of 90 percent. This has enabled Gavi and its partners, such as UNICEF and the WHO, to introduce vaccines that target, among other diseases, the most common forms of pneumonia and diarrhea, the two biggest killers of children under the age of 5. It has also led to the vaccination of an additional 500 million children since 2000, preventing an estimated 7 million premature deaths. Now, by applying the same principles to the underlying architecture that actually delivers vaccines and other vital services, more gains can be made: The global health community and governments can help create more robust and resilient health systems.
After more than a year of lost lives, lost economic growth, lost schooling, and, for many, lost hope, the temptation to rejoice about zero cases is great. And with two Ebola vaccines now in advanced testing, there is a chance that the next time the disease strikes, the world may already be better prepared to prevent its spread. But until childhood immunization rates rise significantly and health systems are strengthened, this ordeal will not really be over. The process of rebuilding is not just about one infectious disease; it is about fighting poverty by giving every child access to all lifesaving vaccines.
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