Sunday is usually quiet, with most governments and health agencies silent on news. But I'm getting rumours of new outbreaks, and suspicious quiet about others, both of which make me think about the problems of epidemic intelligence—both the professional kind, like CDC and ECDC, and the entirely amateur kind, like this blog.
A problem I share with the professionals is that poor countries have more health problems, and also tend to have repressive or plain incompetent governments. (Some are competent only in repression.) So when rumours began popping up about a viral hemorrhagic fever in Sudan, the only source of information was Radio Dabanga—which operates outside Sudan. The rumours seemed to involve a chikungunya outbreak in Kassala state, but chikungunya is not hemorrhagic. Severe dengue can be, but it's relatively rare; the two diseases are both mosquito-borne and have similar symptoms. So maybe Sudan's really dealing with a dengue outbreak involving a strain that's new to the local population: if you've recovered from one strain of dengue, you may be at risk of severe dengue if you contract another.
In fairness, Sudan's Federal Ministry of Health does have a news item on it its website about "joint medical experts" conducting a study of chikungunya in Kassala. But when I try to access it I get warnings about how hazardous visiting that page may be. So I don't know what it says or even the date of the news item.
This in turn raises another issue: poor countries with serious outbreaks have terrible official websites for their health ministries, or no websites at all. During the West African Ebola outbreak, Guinea had no site, and Liberia and Sierra Leone started with terrible sites that only slowly improved. Presumably those governments figured their own citizens weren't online that much so a website would be pointless. The idea that the rest of the world might be interested didn't concern them.
I've also heard of something going on in Eritrea, but good luck getting beyond rumour: Eritrea is a thoroughgoing dictatorship, and we tend to learn about health issues there only when refugees turn up in Europe or the Middle East suffering from relapsing fever or MDR-TB. I can't find an Eritrean ministry of health website; even Wikipedia falls back on the CIA Factbook and other outside sources. WHO AFRO's Eritrea page has very little information, and much of it is dated.
More prosperous countries can pose problems too. Saudi Arabia is a case in point, still offering minimal information about MERS. And now, with Brazil haing elected Jair Bolsonaro as president, we can expect the Brazilian ministry of health to become much less transparent than it was, for example, during the yellow fever outbreak.
If Bolsonaro is elected, and carries out his stated policies such as opening the Amazon and selling off Indigenous peoples' land to the highest bidder, major outbreaks are inevitable: dengue, yellow fever and measles are likely to become more entrenched, and Zika could return, while the ministry will surely lack the funds to address them.
Or if it has the funds, it won't have the personnel—the Cubans in the "Mais Medicos" program will go home, and many Brazilian healthcare workers will leave the country in search of a safer place to work. So a public health disaster could affect a country of 209 million—but we will learn of it only through social media and political refugees.
Yes, it's depressing. But that's all the more reason to push ahead with more epidemic intelligence efforts—especially professional, but with the amateurs lending what help we can.
Recent Comments