Future public health crises need a global immune system

The World Health Organization Had a Global Crisis: Polio, Mpox, Ebola, Marburg, Malaria, and Other Health Emergencies

It was that month that a wild-type Polio case turned up in Africa, and it was a huge blow for theEradication of the disease. Over the following months, we faced deadly cholera outbreaks in more than two dozen countries, the global spread of mpox (formerly known as monkeypox) and an outbreak in Ghana of Marburg virus disease, a deadly cousin of Ebola. More than 100 million people are forcibly displaced by waves of political violence and climate catastrophes, which can lead to increased disease and death from crowding, unsanitary conditions, malnutrition and the loss of basic health services. During May of this year, the World Health Organization reported a total of 56 health emergencies, an occurrence that has been described by the head of the W.H.O.’s health emergencies program as “unprecedented”.

The pattern now is that there are one emergency after another that diverts focus away from longer-term public health goals. There’s no sign that this is letting up. Displacement and activities like deforestation have increased contact between humans and wildlife — and thus the incidence of animal diseases leaping to humans. (The Ebola virus, for example, has been linked to bats as a possible source of spread.) As laboratories grow and safety measures lag, the risk of accidents is a significant concern. On average, between 1979 and 2015, more than 80 laboratory-acquired infections were reported per year, several involving transmission beyond those initially infected, and underreporting is rife. Synthetic viruses have made it simpler for bad actors to turn infectious diseases into weapons of mass destruction.

The Gazan hospitals: A cauldron of potential infectious disease outbreaks? WHO’s envoy to the Gazans visited by Msn Rafah

The rest of Gaza’s health infrastructure has crumbled in the aftermath of Israel’s attacks and ground offensive. Israel has accused Hamas of harboring weapons and fighters in and around hospitals, including in tunnels underneath them, which has put the facilities in the line of fire. WHO says only a quarter of Gaza’s hospitals remain partially functional.

“It’s our way of detecting the emergence of diseases that can result in an epidemic very, very, very quickly,” says Rick Brennan, the WHO’s Regional Emergency Director for the Eastern Mediterranean Region.

“There was a reasonably good system to detect disease outbreaks,” says Brennan, “to pick up cases of infectious diseases, to transfer the specimens to test them in the laboratories, and then implement control measures.”

“We used to culture bacteria in Gaza,” she says, and “prescribe medication based on the results. Now, we can’t do cultures or anything, and the infections are spreading.”

She’s also witnessed a torrent of respiratory illnesses. She says that she has had cases that didn’t respond to treatment. I can’t tell the shelter if they have COVID or not, I don’t have the equipment to do that.

“Wherever there’s overcrowding,” explains Marwan Al-Homs, director of the Mohammed Yousef El-Najar Hospital in Rafah, “these epidemics exist — inside shelters, even in tiny apartments where the number of inhabitants is 35 people.”

A shelter intended for 1,000 people is now hosting more than 30,000 people, but it was visited by the director of communications for UNRWA. She says that there are over 400 people sharing one toilet. The same thing happens for showers. There is not much water to start with, whether to clean or wash. There’s not much hygiene supplies.”

“It’s a cauldron of possibility of infectious disease,” says Amber Alayyan, deputy program manager for Doctors Without Borders in the Palestinian territories.

Last weekend, Ayadil Saparbekov, WHO team lead for health emergencies in the Palestinian territories, traveled from Jerusalem to Gaza to ferry rapid diagnostics for hepatitis and cholera into the enclave.

“I am bringing the testing kits to timely detect and to respond to different infectious disease outbreaks,” he said in a video posted on X, the site previously known as Twitter.

UNRWA’s Toumas underscores the importance of regular and sustained humanitarian aid, including hygiene supplies, vaccines and chlorine tablets. “All those things are absolutely critical in disease prevention,” she says.

The WHO wants to resuscitate a few of the local laboratories in Gaza that screening for diseases prior to the war.

They hope to bring a mobile laboratory from outside. We are looking at different options for testing specimen outside the country, particularly to Egypt. That’s proven a little bit more challenging than we’d expected.”

Brennan says that if we get an outbreak of flu into the overcrowded shelter, that could cause a huge problem. I’m very grateful that we have to this point. We haven’t had a deadly outbreak yet despite the increased rates.

Whether that good fortune lasts may depend on disease surveillance to identify the first handful of cases of something sinister — ideally, while it can still be contained.