Why is there a resurgence of the disease?

Diagnosing Diphtheria: A Pandemic Story of Guinea and Its Implications for Immunization and Vaccination

Simar Bajaj is an American journalist who has previously written for The Atlantic, TIME, The Guardian, Washington Post and more. He was awarded the Science Story of the Year and the National Academies award for excellence in science communications.

Guinea was particularly vulnerable because of its low diphtheria vaccination rate – only 47% in 2022, with the hardest-hit Siguiri prefecture having even lower coverage at 36%. COVID-19 disrupted routine vaccination campaigns in West Africa and was associated with an uptick in vaccine mistrust, Mutreja says. But for diphtheria and other preventable childhood illnesses, the immunization problem predated the pandemic due to supply chain difficulties, insufficient funding, and complacency, among other reasons, leaving the region vulnerable to a cluster of cases swelling into an outbreak.

Louise Ivers, the director of the Harvard Global Health Institute, said that there was a shortage of vaccines and antitoxins which made responding to the outbreak difficult. Presently, only two or three companies make the antitoxin, and each batch of 1,500 doses takes about four weeks to prepare, harvested from horse blood. “Nobody wants to make it,” says Ivers, because of how rarely this antitoxin is usually needed – there were fewer than 9,000 cases globally in 2021 – and how impoverished communities facing diphtheria tend to be. It is in the category of low likelihood of commercial profit.

The disease, which was a global scourge for much of the 20th century, is also almost entirely preventable through vaccination. The World Health Organization put the diphtheria vaccine on their essential vaccine list in the 1970s. “Now, it’s a disease which is almost forgotten,” says Shyaka.

“This can kill by suffocating the patient,” says Adélard Shyaka, medical coordinator for Doctors Without Borders in Guinea. The toxin can damage the heart, kidneys, and nervous system when it moves through the body. Death can be as high as 50% of cases if diphtheria is not treated.

Diphtheria is a highly contagious bacterial infection spread through direct contact with infected sores or ulcers but primarily through breathing in respiratory droplets. The inflammation that blocks the airways is caused by the toxins released by the bacterium, and the thick mucus-like substance can form at the back of the throat.

Vaccines can break the cycle of adversity: A discussion with Mohammed Abdulaziz, head of disease control and prevention at Africa CDC

There are other benefits of the vaccine, including decreasing non-malaria deaths. At the press conference, Mohammed Abdulaziz, head of disease control and prevention at Africa CDC said that Malaria is a major reason for school absence, anemia and impaired cognitive development. “This vaccine is a crucial element in improving African children’s educational outcomes and cognitive ability, which can help break the cycle of adversity plaguing our youth.”

There were an estimated 257 million cases of this disease worldwide in 2022, with 600,000 deaths. Africa was home to 95% of these deaths, including almost half a million children under 5.

He suggests that contracting Malaria makes you more susceptible to Acquired Immune Deficiency Syndrome, the leading cause of death in Africa which can result in a death rate higher than 20%. A study in eastern Kenya shows that over half of bacteremia cases were caused by Malaria, and it appears that Malaria makes people vulnerable to other infections.

In an email to NPR, Hamel says that children with HIV or face chronic malnutrition can be at high risk for severe Malaria, which in turn can lead to death. “We have seen this before with malaria,” she says, in trials where children got insecticide-treated nets or preventive antimalarial tablets, “that the reduction in mortality is more than what one would expect from a decrease in malaria deaths alone.”

“The parasite is so plastic, so malleable, so quickly able to evolve all these interventions,” Plowe continues. “If you let up pressure, it will evolve, it will change, it will come back.”