The current Ebola outbreak in Democratic Republic of the Congo illustrates in microcosm the infectious disease risks posed by globalization and rapid travel. In previous outbreaks in the DRC, the virus was confined to villages and small towns so remote that infected humans didn't travel far enough to spread the disease before succumbing. But the Congo, the second longest river in Africa and the second largest by discharge volume of water, is often referred to as the region's super highway. A conduit for trade, the river links multiple cities and a combined population over 14 million. The virus spread upstream from Bikoro to Mbandaka. Might it travel down river to Kinshasa, a city of over 11 million with direct flights to other major cities including Paris (2.2 million), Nairobi (3.3 million), Johannesburg (10 million), Lagos (22 million), and more?
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The international infectious disease community learned a lot from the Ebola outbreak four years ago in West Africa. These lessons are already being applied. Criticized for its response to the initial round of cases then, the global health community has prioritized emergency preparedness and response. It has moved quickly in this instance. Tedros Adhanom Ghebreyesus, the WHO's director general, made an early visit to Bikoro to demonstrate the urgency of the situation. WHO is working in partnership with organizations like Doctors Without Borders. Designed to flexibly and rapidly respond to outbreaks and emergencies, the WHO's new Contingency Fund for Emergencies, has made cash available to responders far more quickly than in the case of West Africa.
In addition, propelled by the West Africa outbreak and the overwhelming public anxiety it engendered, researchers have developed new tools. For the first time, vaccination will play an integral part in the response to an Ebola outbreak. The WHO is sending vaccine developed by Merck to Congo. But the effort faces numerous logistical, cultural, and language challenges. The vaccine must be kept in a "cold chain" at -60 to -80 C in a hot and humid region where power supplies are erratic. Because the vaccine is not licensed, it has been offered to Congo under a "compassionate use" protocol demanding fully informed, signed consent from every person who receives it; this will require trained personnel and translators. Suspicion of western medicines lingers. And, of course, the quotidian health systems challenges that resource-poor nations face - limited communications, too few trained health workers, strained facilities, and inconsistent electricity - will hamper these emergency efforts, too.
Whether these responses prove effective enough to contain an epidemic will become apparent as the outbreak runs its course. As scientists, clinicians, and health care professionals, it is incumbent upon us to make certain that the public is informed and that public health decisions are evidence-based decisions, not poll-driven political calculations. Connecting us in an international infectious disease community, ProMED has for over twenty years made freely available the news that raises questions and the data on which the answers are built. But for ProMED to remain an active force and continue to provide validated, credible information every day, we need your help. Please give generously to keep ProMED unfettered and free. Your support now will help ensure that ProMED continues to meet the information needs of those who study infectious diseases, treat infected patients, protect the public health, and plan responses to future disease outbreaks. Thank you, and
Larry Madoff, MD
Homelessness in America | Chamber of Commerce
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