H5N1

Austerity to blame for 130,000 ‘preventable’ UK deaths – report

Via The Guardian: Austerity to blame for 130,000 ‘preventable’ UK deaths – report. Excerpt and then a comment:

More than 130,000 deaths in the UK since 2012 could have been prevented if improvements in public health policy had not stalled as a direct result of austerity cuts, according to a hard-hitting analysis to be published this week.  

The study by the Institute for Public Policy Research (IPPR) thinktank finds that, after two decades in which preventable diseases were reduced as a result of spending on better education and prevention, there has been a seven-year “perfect storm” in which state provision has been pared back because of budget cuts, while harmful behaviours among people of all ages have increased. 

Had progress been maintained at pre-2013 rates, around 131,000 lives could have been saved, the IPPR concludes. Despite promises made during the NHS’s 100th birthday celebrations last year to prioritise prevention, the UK is now only halfway up a table of OECD countries on its record for tackling preventable diseases.  

The report is concerned with preventable diseases or disorders such as heart disease, lung cancer or liver problems, which can be caused by unhealthy lifestyles and habits, formed often at a young age. It finds evidence of disturbing reductions in physical activity in schools and chronic underfunding of health visitors. 

The lead researcher and author, Dean Hochlaf, said: “We have seen progress in reducing preventable disease flatline since 2012. At the same time, local authorities have seen significant cuts to their public health budgets, which has severely impacted the capacity of preventative services. 

“Social conditions for many have failed to improve since the economic crisis, creating a perfect storm that encourages harmful health behaviours. This health challenge will only continue to worsen.” 

The IPPR calls for a “radical new prevention strategy” involving a renewed and increased commitment to the state’s role in preventing disease. 

“No longer can we place the burden of responsibility exclusively upon the individual, while turning a blind eye to a social environment which makes healthy lifestyles difficult to achieve. This means investing in public health and ensuring the government takes a greater responsibility to create a healthy environment.”

This is not exactly breaking news. I reviewed a book on the subject back in 2013, and Rupert Virchow, the author of this blog's catchphrase, said much the same thing almost 150 years ago.

North Kivu: The agents of the Ebola response of Mangina on strike

Via mediacongo.net: North Kivu: the agents of the Ebola response of Mangina on strike. The Google translation:

This is bad news for the fight against the Ebola epidemic, which is in its tenth month in the DRC and has already claimed more than 1,000 lives. Since Monday, May 27, 2019, provincial and local agents engaged in the Ebola response in Mangina and surrounding areas are on strike. Mangina is a locality in the territory of Beni, 30km southwest of the city of Beni in the province of North Kivu. 

These agents claim five months of salary arrears. The people fear that the efforts made so far to eradicate this disease are unsuccessful, urging the Ministry of Health to quickly find a solution to avoid further contaminations.

Radical ideas are needed to break the DRC's Ebola outbreak. Here are some

Via The Conversation, suggestions by Mosoka Fallah, Deputy Director General of the National Public Health Institute of Liberia: Radical ideas are needed to break the DRC's Ebola outbreak. Here are some. Excerpt:

As one of the lead coordinators of the national response to Ebola in Liberia, one of my main jobs was to ease the widespread fear. We did so by engaging with local communities. We recruited them to help in a number of ways, including being active case finders and leading negotiations with hostile community members.  

A lack of trust is evident from troubling reports that many are resisting vaccination. We don’t yet know why. The resistance sits side-by-side with peoples’ receptiveness to other Ebola treatment. 

From my previous experience it suggests that health workers must find a way to break through to clear the path for an effective vaccination drive – and to ensure that opposition doesn’t quickly grow into resistance to the overall response.

The grim facts are undisputed: the current Ebola outbreak is expanding, largely unabated. And there is a growing risk that it will spill over to neighbouring countries with the potential of spreading internationally. The possibilities are terrifying. 

What can be done 

What can leaders of the response do? 

We had to think outside the standard conventions of emergency response.  

First, they can incentivise community leaders (chiefs, healers, women, priests) on a fixed stipend to head the response in their respective towns or villages. Doing this will lead to a network of trusted messengers who can effectively communicate to a frightened, confused people. We did this in Liberia. And it can be done in the DRC, despite the challenges of war.

In Liberia we also incentivised a local gang that had been infected by offering them illicit drugs. It was unconventional – there were no rules for this kind of engagement – but it worked: we negotiated a self-quarantine of 32 homeless gang members. We also offered food to armed robbers in exchange for safe passage through a slum called West Point.  

Second, food can be used to incentivise community response and volunteer self-quarantine. Food has historically being used as a weapon of war, but we turned it around in Liberia and used it as a force for Ebola containment. We did this successfully in collaboration with the World Food Programme. We provided food to entire villages where Ebola had occurred. Village leaders then decided that for 21 days no one would leave their villages and no new visitors would be allowed. By providing food and their basic needs these local leaders became empowered to work with their people to contain the outbreak.  

Third, find all means necessary to incentivise the rebels and make them a part of the response. A trusted third party – like the Southern African Development Community, WHO or some other organisation – must convince the national government to allow them to meet the warring factions and give them the resources to take steps in their territory. 

The ideal option is to appeal to all factions for a freeze on war for 42 days so that massive response efforts can be done. This was done by James P. Grant, the distinguished late president of UNICEF, in El Salvador. He launched the “Days of Tranquility” to allow the warring factions to cease fire to allow immunisation. He succeeded by using the influence of the Catholic Church. 

In the DRC major stakeholders could be corralled into supporting a “42 Day Cease Fire for Ebola”. If we are to win the current war on Ebola, we must employ unconventional approaches, even ones that might be considered controversial. The fact is, people who are poor and neglected are more susceptible to infectious diseases and distrustful of authority. Distrust of authority, civil war and Ebola are a recipe for disaster even with the most costly response and medical counter measures. 

Time is ticking.

Red Cross short of funds to fight Ebola in eastern DR Congo

Via Digitalcongo.net: Red Cross short of funds to fight Ebola in eastern DR Congo. Excerpt from the Google translation:

The Red Cross broke funding for an effective fight against the Ebola epidemic in the eastern Democratic Republic of Congo. This situation could force this organization to reduce its control activities while the number of cases of affected people soars. 

Thanks to external support and generous donors, Red Cross relief workers and a team of humanitarian workers were tasked to join the International Federation's Field Assessment and Coordination Team to analyze needs on the ground and determine the measures to be taken to stem the outbreak. 

Red Cross teams, including 110 volunteers from the DRC Red Cross, were delivering essential items to local communities and health centers, including stretchers, chlorine for disinfection, safe burial equipment and informative posters.  

The contribution of DRC volunteers was essential to stopping the outbreak, especially in remote areas. Volunteers have even been hard at work raising awareness and disinfecting homes where people are suspected of being affected by the disease. In addition, volunteers were ready to assist residents in safe and respectful burial, which is essential for any Ebola control operation.

DR Congo: We cannot scale down while Ebola escalates, says IFRC

A news release from the IFRC: DR Congo: We cannot scale down while Ebola escalates, says IFRC. Excerpt:

Geneva, 16 May 2019 – The international community must urgently increase its investment in Ebola response efforts in the Democratic Republic of the Congo before the outbreak escalates further, warns the International Federation of Red Cross and Red Crescent Societies (IFRC).  

Despite some successes in containing the outbreak, there has been an alarming increase in new cases in recent weeks. Twenty per cent of the 1,671 cases recorded up to 11 May occurred during the last three weeks, according to figures from the DR Congo Ministry of Health. Since the outbreak started in August 2018, more than 1,100 people have died, making this the second deadliest Ebola outbreak in history. 

Emanuele Capobianco, IFRC’s Director of Health and Care, said: 

“The Ebola response faces a double jeopardy of insecurity and critical underfunding. The security situation is complex, and will require a range of responses, including continued increased community engagement. However, the funding situation could be fixed. We need more investment now. 

“We cannot afford for Ebola to become entrenched in North Kivu and Ituri, nor can we allow it to spread to urban areas where it will be much more difficult to control. And we cannot allow it to cross international borders.”

DRC: Ebola affects the economy of Beni, Butembo and Lubero, says FEC

Via Radio Okapi: DRC: Ebola affects the economy of Beni, Butembo and Lubero, says FEC. The Google translation:

The outbreak of Ebola haemorrhagic fever in Beni, Butembo and Lubero (North Kivu) has negatively affected the economy in this region. According to the president of the local group of the Federation of Enterprises of the Congo (FEC), Polycarpe Ndivito, production and trade with some neighboring countries and the export of some products to Uganda and Kenya are slowing down as a result of this epidemic.  

He is talking about a loss of several million dollars since the declaration of this disease in the region.  

Polycarpe Ndivito reports distrust of traders in rural areas:  

"The production itself has fallen sharply because people are suspicious, for example those who leave Butembo as a center to go to rural areas. They can not get in easily because the (villagers) with whom they have to collaborate in rural areas are saying, 'People who come from Butembo have Ebola virus disease' and that affects production."  

According to him, the marketing of local products, banana, tea, wood, cocoa, coffee, is also affected by the epidemic. Customers who had to leave Kampala (Uganda) or Kenya to buy these products no longer come for fear of the disease. This fear slows trade. 

"We can export coltan, cocoa, cinchona, wood. We are more than 5 million [US $] a day. Put that month, how much are you? All this is slow motion!" lamented Polycarpe Ndivito.

Lack of funding: The Ebola response in the DRC may be compromised!

Via mediacongo.net, a report from The Tropical Storm: Lack of funding: The Ebola response in the DRC may be compromised! Excerpt from the Google translation:

The alarm bell has just been sounded by the World Health Organization (WHO)    

While visiting Beni and Butembo, North Kivu last week, the Director General of the World Health Organization (WHO) and the WHO Regional Director for Africa called on the international community to "fill the large funding gap "of the Ebola response in a difficult security environment, as the number of new cases continues to rise.  

Ten days after the attack on a Butembo hospital participating in the response to the Ebola outbreak, Dr. Tedros Adhanom Ghebreyesus, WHO Director-General, and Dr. Matshidiso Moeti, WHO Regional Director for HIV / AIDS. Visited the country to inquire about the situation after the attack during which Dr. Richard Mouzoko, an epidemiologist from the UN agency, was killed by armed men while working with his colleagues in fight against the deadly virus that is raging in eastern DRC.  

"The death of Dr. Mouzoko deeply moved me. During this mission, he was on my mind all the time as we met other dedicated colleagues, "said Dr. Tedros, who was accompanied by Dr. Matshidiso Moeti, the WHO Regional Director for Africa. 

With the attack on Butembo Hospital, the WHO staff "has gone through something unimaginable and still wants to continue this vital work," said Dr. Matshidiso Moeti. "We need the security situation to be under control for them and for the local population," she added. 

Strong increase of new cases on land 

In Butembo, WHO's number 1 expressed deep concern about the insecurity and lack of funding facing the Ebola response. "Cases are increasing because of violent acts that delay us every time," said Tedros, adding that the UN agency has already begun to adjust its response.  

Dr. Tedros urged the international community to increase funding for the Ebola response. To date, only half of the funds requested have been received. This funding gap could lead WHO and its partners to cancel some activities just when they are most needed and threaten to reverse efforts to end the epidemic.  

Most of the Ebola response activities, including community outreach, vaccination and investigation of possible cases of illness, were re-launched after a slowdown caused by the attack that cost Dr. Mouzoko's life and two wounded, reports the UN agency. But the growing number of Ebola cases reported in recent weeks is a source of deep concern and weighs more heavily on limited resources. 

"This disturbing increase in the number of cases is another call to action," said Dr. Matshidiso Moeti. "We are entering a phase where we will need major changes in the response," said Dr. Tedros. "WHO and its partners can not meet these challenges without the intervention of the international community to fill the large funding gap," he warned.

Tilapia, a fish to feed the world, and the deadly virus that may destroy it

Via the South China Morning Post: Tilapia, a fish to feed the world, and the deadly virus that may destroy it. Excerpt and then a comment:

A small African fish called the tilapia may be vital for meeting the future food needs of humanity, according to scientists, but they are also concerned that a killer disease discovered in recent years could wipe out the species. That, they warn, would have devastating social and economic consequences for China and the rest of the Asia-Pacific region. 

Although its name may not be widely known, the freshwater tilapia is second only to carp as the world’s most widely farmed fish, and China is the largest producer. With global production of farmed tilapia reaching 6.3 million tonnes in 2018 and an estimated market value of US$9.8 billion, the little fish is big business. That’s because it is an essential source of protein, revenue and employment in the developing world. 

An advantage of farming tilapia was once its resistance to disease, which is a constant problem in intensive fish farming. But a new virus has caught the industry off guard. Tilapia lake virus, or Tilapia tilapinevirus, was identified in 2014. 

Scientists know little more about it, except that it has a morbidity rate of up to 90 per cent, depending on the strain, and is highly contagious. The first indication of the virus on a fish farm is lots of dead tilapia. 

“It’s definitely alarming,” says Mohan Chadag, principal scientist (aquaculture) for World Fish, an international non-profit organisation that supports fishing and aquaculture research, and is headquartered in Penang, Malaysia. 

The tilapia lake virus was discovered in Israel and Ecuador. It has since been reported in 12 other nations and regions, including many in Asia: Thailand (2015), Indonesia and India (2016), the Philippines, Malaysia and Taiwan (2017). Mexico reported its first cases in 2018.

Widely regarded as the “poor man’s fish”, tilapia grows quickly, and worldwide production is almost double that of Atlantic salmon. It has rapidly become a vital source of cheap protein for growing populations in the developing world as wild fish stocks dwindle. 

About 42 per cent of all fish the world consumes is farmed, and that proportion is set to rise to more than 50 per cent within a decade, according to the UN Food and Agriculture Organisation. 

Tilapia is key to this growth, and it’s not just poor nations that eat it – it’s the fourth most consumed fish in the United States.

Tilapia production is undertaken in 87 countries and it’s particularly big business in Asia, which produces more than 70 per cent of the total. 

China, which so far has not reported a single outbreak of the killer virus, is the world’s top producer, at 1.8 million tonnes in 2016, according to the China Fishery Statistical Yearbook 2017, and has probably risen since. Other major producers include Indonesia, Egypt, Bangladesh, Vietnam, the Philippines, Brazil and Thailand.

I wrote about tilapia in The Tyee back in 2011, when it seemed to be a far better alternative for fish farms in British Columbia than Atlantic salmon; our fish farms have materially damaged the wild stock, but our politicians continue to support them.

At least as alarming is China's reliance on tilapia. African swine fever is already panzootic across China, posing no direct threat to humans but killing almost every pig it infects. (See Mike Coston's Avian Flu Diary for the details: he's recorded its horrifying spread province by province.)

 

If China runs short of protein, we all run short. China can buy what it needs elsewhere in the world, but that could deprive scores of nations around the world by pricing them out of the market, just as England imported tons of food from Ireland in the midst of the potato famine of the 1840s.

 

Food insecurity leads to political insecurity, which inevitably leads to war, population displacement, and yet another demonstration of the "advanced" nations' selfish refusal to be inconvenienced by others' needs.

DR Congo: Imminent hunger crisis threatens Ebola-stricken North Kivu

Via ReliefWeb, a report from the Norwegian Refugee Council: DR Congo: Imminent hunger crisis threatens Ebola-stricken North Kivu. Excerpt:

An average of 87 per cent of displaced people are living on just over a meal a day in areas already plagued by conflict and Ebola in Congo’s North Kivu. Families affected by the deadly virus have lost access to food and are on the brink of malnutrition. Ebola cannot be eradicated if people are left starving, warns the Norwegian Refugee Council. 

“Fighting Ebola should not make the world forget that millions of Congolese cannot find enough to eat,” warns NRC DR Congo Country Director, Maureen Philippon. “This is due to conflict and insecurity, displacement, a series of poor harvests and upset economic activities. The current Ebola crisis further worsens these conditions.” 

An unintended consequence of the outbreak has been its adverse effect on the economy of upper North Kivu. People infected or suspected of Ebola infection have been forced to abandon their work when they are incubated.  

According to recent data collected by the United Nations, several areas in upper North Kivu—including areas affected by the Ebola outbreak— are experiencing major spikes in hunger rates. During the first three months of year, the province experienced between a 31 and 66 per cent increase in hunger among displaced families and the communities hosting them. 

“We are deeply concerned that the international community is sacrificing one crisis for another, rather than looking at the whole picture, and now the population is suffering further as a result,” warned Philippon. “We must rethink how we address these needs.” 

Upper North Kivu’s territories have been insecure for years with massive inter-communal and inter-ethnic conflicts causing the majority of farming families to flee and abandon their fields. This has led to instances of crop failure and a decline in markets. Low humanitarian funding has also had a crippling effect on the people in need within these areas. Several aid agencies have had to close operations in the beleaguered province between 2017 and 2018. 

“People are much less likely to seek treatment or be treated successfully for Ebola if their basic needs are not being met,” said Philippon. “If we continue on this course, we will face a double wave of sickness and loss of life much sooner than we think.”

Liberia post Ebola: Ready for another outbreak?

Via The Lancet, an excellent report: Liberia post Ebola: ready for another outbreak? Excerpt:

Comfort Gbainsay is huddled on a bed under a mosquito net at the CB Dunbar Maternity Hospital in Gbarnga, a small city about a 3 hours' drive from Liberia's capital Monrovia. A few days ago, she started feeling weak. She had stomach cramps and was breathing fast. At the hospital, she was diagnosed with stomach ulcers and typhoid fever. The 37-year old is 3 months' pregnant. 

The ward is veiled in darkness. With a torch in one hand and a spoon in the other, Gbainsay is eating her dinner from a plastic container. There are not enough funds to run the hospital generators 24 h a day, so electricity is scheduled. This will be her third child, says Gbainsay. Her large eyes look exhausted, her voice is muted. She gave birth to her other two children at CB Dunbar, but back then, she says, she did not have to pay for any of her medication. 

CB Dunbar is a government hospital and therefore drugs and services should be free. The National Health and Social Welfare Policy 2011–2021 focuses on an essential package of health services, and the country has set itself the goal of reaching universal health coverage. However, the coverage index for essential health services lies at 34, the target value being 100. Gbainsay has already spent more than LRD3000, or around US$18, on medication during her stay, a third of her monthly income as a teacher. 

“The drugs that were here, they gave me; the ones that were not here, they told me to go out and buy”, she says. One of the prescribed medicines is out of stock at all pharmacies in Gbarnga and she had to send her husband to Monrovia to buy it. 

“Everything is becoming very difficult because of, I don't know, the economic condition or because of the new president”, she says. “Over the past year, things that we easily used to do just can't be done easily nowadays. If you don't have money, things don't work for you.” 

The new president Gbainsay is referring to is ex-footballer George Weah, who was sworn in as head of state in January, 2018. Voters had high expectations and hoped he would rein in corruption, kick-start the economy, alleviate poverty, and rebuild the health system after the Ebola outbreak of 2014–15, which killed 4810 people in Liberia, including almost 180 health workers. When the haemorrhagic fever struck, the health sector was on a slow path to recovery after years of brutal civil war that had ended in 2003. 

However the new president has other priorities, as he highlighted in his second annual message in January, of this year. “…I have set my eyes on roads as my administration's path to delivering a better living condition for the Liberian people”, he said and added that good road connectivity will, among other things, “reduce travel times to schools and hospitals”. Health care was otherwise barely touched upon.