Добавить новость
smi24.net
News in English
Июль
2024

The United States is tackling international public health all wrong

0
Vox 
MUBENDE, UGANDA - OCTOBER 13: Red Cross workers don PPE prior to burying a 3-year-old boy suspected of dying from Ebola on October 13, 2022 in Mubende, Uganda. Emergency response teams, isolation centres and treatment tents have been set up by the Ugandan health authorities around the central Mubende district after 19 recorded deaths and 54 confirmed cases from an outbreak of the Ebola virus. The first death from this outbreak of the Ebola-Sudan strain of the virus was announced on 19 September and as yet, there is no vaccine for this strain. (Photo by Luke Dray/Getty Images)

In early December 2013, in the low-lying mountains of Guinea in West Africa, a 2-year-old named Emile Ouamouno had a sudden onset of strange symptoms: high fever, bloody stool, and vomiting. On December 6, the boy died in his home village of Meliandou. Emile’s 4-year-old sister, mother, and grandmother died shortly after, each suffering similar symptoms.

In March, scientists identified the cause of the deaths: the Ebola virus. By then, 82 more people had died. By May, the outbreak had spread to neighboring Liberia and Sierra Leone as the death toll neared 200. 

These were the early months of what would become the deadliest Ebola outbreak in history. From 2014 to 2016, the outbreak overwhelmed health systems in Guinea, Liberia, and Sierra Leone. Seven other countries including Italy, Spain, the United Kingdom, and the United States, also reported Ebola cases, primarily among health care workers and travelers who had recently been to West Africa. 

In all, more than 11,000 people died. 

The epidemic caught the world by surprise, exposing vast weaknesses in the world’s ability to contain and quell infectious diseases. The Centers for Disease Control and Prevention (CDC), Department of Defense, and other diplomatic and development agencies responded immediately, mobilizing one of the largest outbreak response efforts in history. 

The Ebola crisis played a role in kickstarting longer-term US government investment in global health security, a broad term that refers to activities needed to prevent, detect, and respond to infectious disease threats, such as training health care personnel and building laboratories equipped to test for a wide range of pathogens.

Though the CDC and other US government agencies were already involved in outbreak response activities globally before 2014, the Ebola crisis cemented a more permanent and sustained approach to building long-term global capacity to address infectious disease threats. In 2014, the CDC solidified its commitment to this by creating a new department: the Division of Global Health Protection, which is solely dedicated to global health security. The US government, alongside more than 70 other countries, also launched the Global Health Security Agenda, which provided a blueprint for bolstering global health security around the world.

Why I reported this

Before becoming a fellow at Vox, I worked as an infectious diseases epidemiologist and global health security adviser in Africa. I observed many inefficiencies in the US government’s program. I thought we were squandering millions of taxpayer dollars and an opportunity to make the world safer from infectious diseases. I set out to interview others with long careers working in various facets of global health security to understand the root cause of these issues and to learn how we can do better in the future.

Have questions or thoughts? Email me at jessica.craig@vox.com.

Over the past 10 years, the US government has doled out at least $8 billion to the CDC, the United States Agency for International Development (USAID), and the Department of Defense for their global health security programs. (This figure excludes additional emergency funds provided for Zika and Ebola outbreak responses, the Covid-19 pandemic, and support for other infectious diseases such as HIV, tuberculosis, and malaria.) The theory was that an infectious disease anywhere was a threat everywhere, so every country’s global health security capacity needed to improve.

The Ebola crisis, and earlier pandemics such as swine flu in 2009, was a harbinger of crises to come: Zika, Covid-19, monkeypox, a resurgence in dengue, tuberculosis, and other diseases. Despite the influx of funding, we have seen that the world remains unprepared for infectious disease threats.

From 2017 to 2018, I was a contractor at the CDC’s Division of Global Health Protection, and last year, I briefly served as a global health security technical advisor at USAID. Although there have been some strides in the right direction, by and large, the US hasn’t meaningfully reached many of its goals.

Arguably, global health security has faltered because of a lack of solidarity. The US government has approached health security with too much of a traditional national security approach, focusing more on keeping foreign threats out of the US than quelling all threats globally. As such, US government agencies continually fail to understand or address local needs or to develop true partnerships with foreign governments, instead dictating how “partners” in foreign countries should build health security capacity with little to no local buy-in.  

Earlier this year, the Biden administration launched a new US Global Health Security Strategy, which outlines the goals for global health security for the next five years. Though the strategy highlights the importance of cooperation, country ownership, and science-based approaches, it doesn’t clearly outline how agencies will achieve those guiding principles. While the continued commitment to global health security is necessary, if the US government does not address fundamental issues underlying its programming, infectious diseases and future epidemics will continue to claim millions of lives each year and cause billions in economic losses.

What does it take to prevent, detect, and respond to infectious diseases?

What if when Emile Ouamouno first showed up at a health clinic in his rural village in Guinea, the doctors there had already been trained to identify symptoms of an Ebola infection? What if they could have immediately put him into an isolation room away from his family and other patients? What if the nurses could have donned hazmat suits and gloves, collected a blood sample from Emile, then sent it down the hall for a laboratory technician to test for a range of potential viruses or bacteria causing his sickness? What if just hours after discovering Ebola virus in his blood, the laboratory technician could have reported this finding to government staff across the country, immediately triggering a response to contain the spread of Ebola to just one village?

To prevent infectious diseases and to rapidly identify early signs of an outbreak and contain its spread, countries need four things, according to David Heymann, a professor of infectious diseases epidemiology at the London School of Hygiene and Tropical Medicine (he also previously supported Ebola outbreak responses in Africa when he worked at the CDC):  

  • Local-level health care systems that are adequately funded, staffed, and equipped to take care of their people. This means having doctor’s offices and clinics that are accessible to the population they serve and having enough doctors and nurses even in the most remote clinic. And it means having pharmacies consistently stocked with vaccines and medicines.
  • A broader, well-functioning public health system that can facilitate important information and investigations with key players. This includes functioning laboratories, a system for collecting data on disease incidence, and a system for health care providers to quickly alert officials when they come across a patient with an infectious disease that could spark an outbreak. You need teams of epidemiologists and researchers to investigate outbreaks, monitor trends in cases and deaths, and conduct contact tracing. You need public health officials communicating with the general public and working with policymakers and politicians. You need existing policies and procedures that outline how to mobilize resources to areas with outbreaks. 
  • Health and public health systems that care for animals, an important source of zoonotic infectious diseases that may spillover from animals to humans. And you need people in the human and animal health sector to collaborate, share information, and come up with a strategy that protects both humans and animals.
  • Finally, it helps to have healthy populations, where risk factors for severe disease and death — such as obesity, diabetes, malnutrition, or HIV infection — are not very prevalent. 

Unfortunately, most countries are lacking on all fronts. 

Researchers from several NGOs and universities developed The Global Health Security Index, which comprehensively assesses country capacity to prevent, detect, and respond to infectious diseases. In their 2021 report, they found that even after significant investment and effort during the Covid-19 pandemic, “all countries remain dangerously unprepared to meet future epidemic and pandemic threats.” 

Of 195 countries included in their index, 126 did not have an overarching national public health emergency response plan, 128 have no plan for testing for novel pathogens during a public health emergency, and 169 countries did not have national health security plans that addressed the risk of zoonotic diseases. Beyond the index, health care systems in developing countries are woefully understaffed. Some 47 countries in Africa face severe shortages of health workers, and 4.5 billion people around the world do not have full access to health services. 

There are a lot of complex moving parts within global health security. Sometimes the challenge seems insurmountable. While the CDC, in a statement to Vox, said that it recognizes global public health is a “team effort,” unfortunately the current paternalistic approach alienates its most important partners, according to the experts Vox spoke with. 

Global health security requires solidarity that we don’t have

While the US government’s global health security funding does, in part, fulfill a humanitarian mission to improve the lives and livelihoods of people around the world, experts have accused the US government of pushing too much of a US-centric agenda that is primarily focused on keeping diseases out of the US rather than developing true partnerships and building capacity around the world. 

There are several examples of this. The US government invested heavily in developing at least two effective and FDA-approved treatments for Ebola; however, to date, these drugs remain largely siloed away in US stockpiles for national security and biodefense and have not been made readily available in foreign countries during Ebola outbreaks, according to Doctors Without Borders

Heymann points to the Covid-19 pandemic as another example. While the US and European governments were criticized for not sharing the Covid-19 vaccine, the discourse among public health officials in Africa was vastly different. In 2021, Heymann asked public health leaders from Africa what the most important vaccine was to them. They said it was the malaria vaccine. They reported that they did not need the Covid-19 vaccine because the toll was lower compared to other diseases, perhaps because populations in Africa are generally younger and have fewer comorbidities. (A lack of testing likely also reduced the number of cases and deaths recorded.) In fact, the officials Heymann spoke with saw the vaccination push as “a measure of the North to protect itself by making us get vaccinated,” he said.

There is widespread perception that global health security is an American program pushing an American agenda, or perhaps more broadly an effort devised for the benefit of the Global North. Local officials and organizations do not trust American and European global health security staff, according to Syra Madad, the chief biopreparedness officer at NYC Health + Hospitals

This perception is one reason why foreign governments do not prioritize global health security  and do not dedicate domestic funds to maintaining systems that the US and other donor countries invest in. More than 150 countries included in the 2021 Global Health Security Index did not have domestic funding for epidemic threats. Competing health priorities and a general lack of domestic funds certainly play a role, too.

“The reality is, you can invest money, you can invest resources, but there’s only so much you can do, unless the other country comes to the table and says, ‘You know what, we are going to not only use this funding and resources, but we’re going to now take this on, and it’s going to be our country issue. We’re going to invest in it, we’re going to maintain it.’ And that’s really what’s been the struggle,” Madad added. 

What can we do differently in the next 10 years? 

Although the US government may have little to show for its massive investment in global health security in the past 10 years, it could be laying an important foundation for future work. Developing the health and public health systems required to prevent, detect, and respond to infectious diseases is certainly a long game.  

“The requirements around the world for making substantial progress are huge. The world is very big. It’s very susceptible to infectious disease,” Tom Inglesby, the director of the Johns Hopkins Center for Health Security, said. “So moving the needle on real preparedness is difficult.”

First and foremost, the US government needs to forge true partnerships with foreign governments where ideas are exchanged back and forth and both parties jointly work toward building health security capacity. The US government should also require local buy-in and domestic investment from foreign governments; this would help ensure that the areas where the US is putting taxpayer dollars is a true priority in the country. 

“We have to decolonize ourselves,” Heymann explained. “It’s no longer, ‘we’ll give you the money, and you do it.’ It’s ‘you request the money from us, and then you put in your share, and we’ll put in our share,’” he said. “If countries aren’t engaged in wanting to do the job, then why should we be giving the money? That’s just forcing them to do something they don’t want to.” 

Madad also recommends that the US government open up more direct funding lines to the frontline clinics and community-based organizations that are knee-deep in responding to epidemics rather than funneling those funds through larger institutions such as the Ministry of Health or World Health Organization. She also recommends focusing on building capacity at the primary health care level, such as those rural clinics like the one Emile Ouamouno visited after he became infected with the Ebola virus. 

“A lot of it all starts with primary care,” Madad said. “If you have a good primary care infrastructure and you’re building that workforce around it, then you’re able to really detect cases of a novel or an emerging or reemerging infectious disease much sooner,” she said. “If we’re able to really invest in primary care around the world and provide the resources and the workforce to be able to provide this primary care, then we would be in much, much better shape.”








В депо «Чита» будет установлен первый цифровой весоизмерительный комплекс системы подачи песка под колесные пары локомотива

Баскова, Киркорова и Лазарева погнали с экранов: попались на непотребщине

Рэпер Баста открыл свой ресторан в Marins Park Hotel Екатеринбург

В Третьяковке на Кадашевской набережной открылся концертный зал


Las 'Guerreras del Agua' se dan un baño de bronce en el Mundial de Singapur

La UFC anuncia un mes de octubre mayúsculo

Why Juventus spent 111m this summer for only one new player

Adil Rami carga contra Lamine: "No puedo ni verlo, que le den..."


Отдых в отеле, джип и частный дом: какие взятки мог получить экс-губернатор Тамбовской области

НПС построит новые съезды с Северо-Восточной хорды

Axenix и RightStep стали партнерами в области комплексной цифровизации промышленных предприятий

Дивеево ..


Microsoft warns of 'active attacks' on its government and business server tech, with one cybersecurity expert claiming that they should 'assume that you have been compromised'

Краткая биографическая справка о центральных персонажах Mafia: The Old Country

Brütal Legend is free in honor of Ozzy Osbourne, but only for 666 minutes

'I destroyed months of your work in seconds' says AI coding tool after deleting a devs entire database during a code freeze: 'I panicked instead of thinking'



В Москве завершился сбор с руководителями финансово-экономических подразделений Центрального округа Росгвардии

Оркестр полиции Республики Сербской впервые выступит на фестивале «Спасская башня» в Москве

В Третьяковке на Кадашевской набережной открылся концертный зал

Оркестр полиции Республики Сербской впервые выступит на фестивале «Спасская башня» в Москве


Математика Савватеева возмутило заявление о "лишних" учителях

Оркестр полиции Республики Сербской впервые выступит на фестивале «Спасская башня» в Москве

Вредоносный код в Firefox: атака на цепочку поставок через NPM-пакеты

Кара небесная: людей какого типа молния поражает смертельным ударом


Игровые терминалы в ТЦ: союз ради будущего

Работа над качеством: цифровой аудитор внедрен на горячей линии московских судов

Ученый Толстых объяснил, что московские ливни вызваны мощным атлантическим циклоном

После ареста иномарки в Подмосковье должник погасил задолженность по алиментным платежам


Винус Уильямс: Если Серена вернется, она даст вам знать

Винус Уильямс получила wild card на турнир категории WTA 1000 в Цинциннати

Новак Джокович проводит 900-ю неделю в топ-10 рейтинга ATP

Теннисист Медведев: когда я играю хорошо, могу победить любого


Солнечная погода и до 29 градусов тепла ожидаются в Москве 25 июля

Игровые терминалы в ТЦ: союз ради будущего

Адвокат Грачева заявила, что Седокову хотят привлечь к уголовной ответственности

В Самарской области за полгода открыто 410 вакансий для сисадминов, что на 22% меньше, чем годом ранее


Музыкальные новости

Sky News: умерший Осборн с 2019 года страдал от травмы позвоночника

Баста, Слава и Шура снимутся в новом документальном сериале «Вирус попсы»

Врач Поляков: Киркоров рискует сойти с ума из-за препарата для похудения

Аранжировка Песен. Аранжировка Музыки. Создание Аранжировок.


«Каникулы с Росгвардией» проходят в регионах Центральной России

В Третьяковке на Кадашевской набережной открылся концертный зал

В Москве завершился сбор с руководителями финансово-экономических подразделений Центрального округа Росгвардии

Оркестр полиции Республики Сербской впервые выступит на фестивале «Спасская башня» в Москве


Кайрат Бермуканов поддержал Петра Яна перед боем в Абу‑Даби

Путин дал указание рассмотреть проблемы онкологии в Архангельской области.

Собянин: создание 5 центров женского здоровья завершат в этом году

Адвокат Грачева заявила, что Седокову хотят привлечь к уголовной ответственности


Несколько автомобилей столкнулись на внешней стороне 92-го км МКАД

На МКАД в Москве произошло массовое ДТП, движение затруднено

В Москве росгвардейцы оказали помощь пострадавшей в ДТП мотоциклистке (видео)

Водитель Audi сбил трех пешеходов, переходивших дорогу на западе Москвы


"Ультиматум Трампа: потенциальные последствия для Путина"

Сигналы становятся всё громче. Переговоры - только ширма. Главное решится не в Стамбуле

Путин дал указание рассмотреть проблемы онкологии в Архангельской области.

Соболезнования в связи с авиакатастрофой в Амурской области выразили зарубежные лидеры


Обнаружен новый штамм коронавируса: он очень заразный и забирает голос

Депздрав Москвы оценил ситуацию с распространением нового штамма коронавируса

Новый штамм коронавируса "стратус" фиксируют в Москве с мая

Депздрав Москвы: новый штамм коронавируса "стратус" фиксируют в Москве с мая



Компания КИТ МЕД представляет революционный аппарат SONOQUEEN — первую в мире анатомическую HIFU-технологию для anti-age терапии в России

Путин дал указание рассмотреть проблемы онкологии в Архангельской области.

Новый штамм коронавируса "стратус" фиксируют в Москве с мая

Фитнес-марафоны на паузе: суд продлил домашний арест блогеру Лерчек


Британский журналист: Зеленский - мелкий жулик и крыса, которому «недолго осталось» в этом мире


Игровые терминалы в ТЦ: союз ради будущего

«Каникулы с Росгвардией» проходят в регионах Центральной России

"Монсон о спортсменах, которые меняют гражданство в сложный период для России"

Пять земельных участков для размещения НКО доступны на городских торгах


Лукашенко с иронией отнесся к санкциям, запрещающим ему въезд в Эстонию

Лукашенко посоветовал не злить его и не допускать падежа в животноводстве

Лукашенко заявил, что в Белоруссии «на всякий случай» готовятся к войне

Лукашенко поделился мнением о самой идеальной профессии.


Мэр Москвы: Улучшим транспортную доступность Южного и Северного Бутова

Сергей Собянин поздравил москвича — победителя международной олимпиады по физике

Собянин: Около 10 тыс. москвичей начали переселение по реновации этим летом

Сергей Собянин. Главное за день


Исследование выявило снижение инвестиций в экологически чистую энергетику США.

Детеныш краснокнижной боливийской обезьяны появился на свет в Московском зоопарке

6 лет вместе. В Москве пройдет выставка, посвященная пандам Жуи и Диндин

Московские студенты начали исследовать влияние климатических изменений на сток рек Ямала


После ареста иномарки в Подмосковье должник погасил задолженность по алиментным платежам

В Правительстве прошщло совещание по реализации проекта строительства ВСМ Москва – Санкт-Петербург

Адвокат Грачева заявила, что Седокову хотят привлечь к уголовной ответственности

Ученый Толстых объяснил, что московские ливни вызваны мощным атлантическим циклоном


Республика Алтай вошла в десятку регионов России по развитию ипотеки

Настольный термотрансферный принтер штрих-кодов iDPRT iE4P

Путин дал указание рассмотреть проблемы онкологии в Архангельской области.

70 участников СВО в Архангельске показали мотивацию выше госслужащих — Цыбульский


Россияне выбирают Крым для отдыха с детьми – названы города-лидеры

В Симферополе на базе «Клинического госпиталя для ветеранов войн» функционирует гериатрический центр для пожилых людей с возрастными нарушениями

Лавандовое поле горит в Симферопольском районе Крыма

"Россия дала мне возможность быть счастливым": Джефф Монсон в Крыму


Винус Уильямс проиграла во втором раунде турнира в Вашингтоне.

После ареста иномарки в Подмосковье должник погасил задолженность по алиментным платежам

Патрушев: НАТО усиливает давление у морских границ России

ТАСС: суд арестовал счета основателя «Русагро» Мошковича почти на 3 млрд рублей














СМИ24.net — правдивые новости, непрерывно 24/7 на русском языке с ежеминутным обновлением *