Policy Issues

David Gijon

PMAP 3311

Georgia State University

TO: THE GLOBAL HEALTH DEPARTMENT

THROUGH: THE UNITED STATES GOVERNMENT

FROM: DAVID GIJON

RE: GLOBAL HEALTH POLICY – EMERGING INFECTIOUS DISEASES

SYNOPSIS

Health is a very important factor in any economy and therefore a central issue in all social policies. Emerging infectious disease is one that is newly discovered to occur in human beings, newly occurring in a different population than the first time, newly affecting more people(mostly fatal) or a disease that has developed new strains that are resistant to drugs. Examples include, Ebola Virus, Malaria, HIV/AIDS and Influenza etc. All these have been a pandemic at one point in history; it is even shocking to learn some of them are emerging’ and still killing many more people. It was therefore important for the US government to come up with a policy to deal with these pandemics. Although the ‘hot spots’ for these diseases are Sub Sahara Africa and Asia, Americans continue to be affected directly and indirectly. It is the reason why the government, multilateral institutions and organizations decided to address this issue in the Global Health Policy. The most recent touch up on this policy was on May5, 2009 when President Obama announced the Global Health Initiative. This is a six year $63 billion initiative that will provide a comprehensive health strategy to dealing with Emerging infectious diseases and other health care targets. The key focus on this policy is the shift from focus on processes to more focus on outcomes in which case the United States will only invest where outcome will be achieved.

However, most recently the Ebola virus emerged in West Africa and statistics say the number of fatalities continues to double every 24 hours. Thousands of children are still dying in Africa from Malaria infections, the HIV/AIDS prevalence rate is still very high and statistics show that every second that passes someone is infected with tuberculosis. Why are Americans and the whole world still living in fear of these very infectious diseases? Technology levels have advanced, the world has basically changed yet these diseases that killed people in the 70s are still taking livelihoods to date. The world needs to know why there has not been any development in dealing with these diseases in this time and age.

The developing countries are most affected. Their health infrastructure is poor, the population growth is high, poverty levels are still getting high and their standards of living are not improving. What can be done to stop these pandemics in these already frail nations? Is this a problem for the American government seeing as most of the outbreaks are taking place in Africa and Asia? Yes, with globalization effecting easy travel across borders these infections can easily spread and enter the United States of America.

There is urgent need to encourage micro management of emerging infectious disease pandemics. Each and every country should take up the responsibility of protecting the whole world from the infection and spread of these diseases. Adequate training of personnel on response, planning and execution; setting up lab facilities for screening, researching for vaccines and drugs development; setting up Disease Intelligence systems for surveillance and to train the public on behavior change, how to prevent and effectively manage the spreading of these diseases.

Policy makers and scholars have gone back to research and are trying to come up with effective ways to deal with these pandemics. The Global Health policy is not sufficient and there is urgent need to either improve it or completely change it. In my opinion, there is need to incorporate a reality touch to the existing policy. The policy talks about improving existing systems, however, this horizontal expansion at the expense of vertical management of this issue will not help the problem. For instance, instead of carrying out a random campaign to vaccinate against diseases e.g. polio, first focus on treating the existing disease that the people are ailing from that includes malnutrition.

The United State government takes the health of its citizens very seriously hence the need to protect their citizens living abroad with a global health policy.

Despite the world’s wealth of information, technology and resources; Emerging Infectious diseases continue to conquer and kill millions of people globally. Since 1980, new Emerging Infectious diseases are discovered whilst the old ones are reemerging. This is a problem because in this age and time, with all the available technology and resources, Americans should not lose their livelihoods to diseases that can be prevented or avoided. Emerging Infectious Diseases are slowly turning out to be global killers. The biggest problem is they are unforeseen attacking previously very healthy people in a very short period of time. They attack and kill so fast that by the time they are reported as an epidemic so many lives are already lost. Examples include the avian strain of influenza that attacked Hong Kong in 1997; the most recent case is the Ebola virus that is currently spreading in West African countries killing hundreds; it is reported that every second someone in the world is infected with Tuberculosis Bacilli; Malaria is still a killer disease with 85% of its victims being children; HIV/AIDS is still a killer disease with millions of people dying annually. More shocking is how these diseases are evolving into strains that are resistant to drugs, for example there is a strain of Tuberculosis that is multi-resistant to drugs. There is also a case where two of these infectious diseases attack a community simultaneously. For example in the 70s Tuberculosis attacked a US city and there were people whose immune system had been lowered by the HIV/AIDS infection and a case where influenza patients are easily susceptible to the pneumonia bacteria and although this bacteria is easily treated by antibiotics when another flu epidemic hits, it might just evolve into a multi-resistant bacteria and we will have pneumonia as another killer disease.

The outbreak of one infectious disease in any part of the world should send the whole world into a cautious state because for example the multi-resistant tuberculosis microbes can very easily move from one country to another within hours. Others like HIV/AIDS, once it starts in a small town the chances of it spreading to the whole world are very quick. Currently the Ebola virus outbreak in West Africa has the whole world alarmed.

These Emergence Infectious Diseases can be said to have emerged from various factors; increased contact between people and animals, trade and travel due to interglobal connections, high world population growth and poor health facilities, services and infrastructure. There are some countries/ regions that have all these factors combined and are therefore the most adversely affected by these diseases. Although EIDs are found mostly in Asia and Africa, the fact that they are infectious means that everyone is at risk, including America. Most of this EIDS are as a result of poverty, and inequality. The IMF and World Bank’s structural Adjustment Programs in the 80s and the pharmaceutical companies keen on making profits, are some of the reasons developing countries can not access quality healthcare; hence the quick spread of these diseases as well as their reemergence. The pharmaceutical companies that tried to provide generic medicines that were cheaper were faced with law suits and even threatened sanctions. Most people access health services through paying cash, insurance companies are too expensive for them, when they walk in and find expensive health care they go back home. They are nursed by relatives and caregivers who due to lack of knowledge do not know how to avoid infection and by the time this first patient passes on, the care giver is in a critical condition to and the cycle continues. Infections from contact with animals have been attributed to lack of knowledge and ignorance. Globalization has enabled exchange of information, resources and people across borders. This has helped improve trade, networking and exchange of cultures; it has however exposed regions to infections. The emergency infectious diseases are spread mostly through contact of body fluids with an infected person who puts everyone at high risk.

Table showing Emerging Infectious diseases since 1975 to July 2014

EMERGING DISEASE	YEAR IDENTIFIED	GLOBAL IMPACT
		CASES REPORTED	NO. OF DEATHS
Human Immunodeficiency Virus/ Acquired Immune Deficiency Syndrome	1981	77 million	40 million
H5N1 Influenza (bird flu)	1997	667	393
H7N9 Influenza (bird flu)	2013	460	168
H1N1 (2009) Influenza ( swine flu)	2009		284,500
Ebola Virus Disease	1976	3800	2350
Malaria		243 million annually	863,000 annually

The global health policy shifted its focus from disease specific approach to a population based approach. This is highlighted in the Global Health Initiative launched by the President that proposed six year $63 billion fund that will help to develop a comprehensive U.S global health strategy with most of the EIDS in focus as well as other health issues. The main strategy of this policy is to strengthen existing health systems. The six parameters that will be used to evaluate this strategy dubbed from WHO include service delivery, health workforce, information, medical products, vaccines & technologies, financing and leadership & governances. However, this policy deals with the horizontal approach to the problem at the expense of the vertical approach.

There is immense pressure on the US to come up with measures to control these infectious diseases immediately they occur. When the Ebola virus first struck in Zaire it took months before it was discovered after so many health workers and patients had lost their lives and the hospitals had become contagious regions killing scores of clueless citizens. When HIV/AIDS emerged, it took a while before surveillance was done and reported hence so many people were already infected and continued to infect many others. That is why health problems are still global killers, the policy is does not fully address the issue of its implementation. The response to an epidemic is still very poor, for instance, Ebola being disease that was discovered in the 70s still has not been able to be controlled through vaccines and treatments and will not be anytime soon until next year (2015) January. This is horrific considering the available technology and resources livelihoods are going to continue being lost until 2015.Malaria continues to kill many children who still cannot access proper health services due to financial constraints and lack of information. In summary, the reason why EIDs continue to be global killers is because the policy has been presented but the implementing process has failed.

Global healthcare is very important to the US government, whether it is to promote health equity and achieve humanitarian benefits or for their own ulterior interests; these interests include protecting trade, preventing epidemics, preventing bioterrorism or both. The US government has been seen to take a few steps to help deal with these global killers. For example, the Presidential Directive on emerging diseases that created huge awareness on EIDs and their impacts on livelihood; PEPFAR which was a also another presidential plan that set to provide millions of needy HIV/AIDS patients with antiretroviral treatment; following the SARS outbreak the US government came out very strongly to support the revision of the existing IHRs among so many others.

The biggest challenge in dealing with EIDs in most developing countries (which are adversely affected) is the lack of basic public health surveillance for timely detection and response plans. Technological challenges, inadequate resources and lack of capacity to develop and distribute diagnostics, drugs, vaccines and other treatment and prevention tools and information. Political inhibitions by corrupt government officials, poor leadership has also led to problems in accessing funds to deal with these emerging diseases. The HSS focuses more on general needs than specific needs, in most developing countries prone to these EIDs; they rely on donor funded help. By providing for the general needs i.e. funding for specific diseases or building hospitals the focus ends up on the general needs yet there are people dying with very specific needs that should be addressed first. It is therefore important to focus on horizontal aspect but it is more helpful to these people if the focus was vertical, specific and personalized.

The US should continue to engage in efforts to manage and control EIDs so that it can protect its citizens both at home and abroad. More effort, resources and technology should be involved in a bid to reduce the threat of these global killers. The global connection is growing and very soon, if not dealt with thoroughly, the EIDs will sneak into the America. Mechanisms to detect report and respond to EID threats need to be enhanced and improved. This can be done through; constant follow up on commitments laid in the Global Health Security Agenda, improving the existing global health investments to improve health systems, encouraging countries to fulfill their IHR obligations and encouraging scientific and technical cooperation between countries to ensure fast and effective detection and response.

Alternatively, the whole world should come together to form a global fund. It is imperative that the US incorporates the whole world on this issue. The global fund created will be for ‘social protection’ i.e. this fund will provide a safety net to finance all health related cost. Each country contributes according to their financial capacity and withdraws based on the needs. The most affected by these diseases are developing and undeveloped nations who basically do not have enough resources to handle these pandemics. It was observed that in most cases the foreign aid provided in during emergency outbreaks is barely enough to handle the magnitude of the problem. It will therefore be easier for a country to withdraw any amount of money they need based on the magnitude of the problem. This will help reduce global health inequalities because most of the contributed funds go towards the poorest nations. Similarly as middle income countries improve and grow their economies, the high income countries could decrease their contributions.

Another alternative would be the US government involves more organizations in fighting these pandemics. A holistic approach to handling this problem by incorporating more organizations, institutions and citizens should be applied. The success of a program depends on the human resource available to the program. In this case adequate resources should be put in place to facilitate the training of personnel to work globally. Epidemiologists and laboratorians needs to be trained to prepare and respond to threats at any time regardless of where they are. US should set up a central lab testing unit that will carry out regular testing and experiments all year round and not just as need arises. This lab should include a program to train foreign students from all over the world on health approaches to diagnosis and molecular epidemiology. A disease intelligent service should also be set Up in ‘hot spots’ of these diseases to ensure constant monitoring of the citizens and rapid response. The US government and other countries as well should avail their citizens with information on healthy interaction with various animals seeing as many of these infectious diseases are contracted from animals i.e. Mad Cow Disease, bird flu, Ebola etc.

Considering the magnitude of the problem established from the analysis, the suggestion to establish a global fund is very viable. Adversely affected countries have very poor health infrastructure and can benefit greatly from this approach. However, the poor leadership and governance in these countries raises the question of doubt on whether giving these same governments the mandate to withdraw money from this account will be effective in dealing with these issues. It is easier when donors and foreigners take the initiative to implement these programs themselves other than leaving the money to the corrupt leaders.

By involving the whole world in effort to fight these diseases, the US relieves itself of the pressure to carry out research, analyze, and implement on their own which is not cost effective. It is also important that the most affected countries are involved in the exercise to increase awareness. It becomes easier to micro manage the problem and hence it is easier to detect and manage the diseases when they happen. The only challenge with this would be lack of resources in some countries to run the programs suggested. Some countries already have a problem implementing basic education and providing health facilities to all their citizens. Therefore suggesting that they sponsor citizens to take up courses on Epidemiology and set up laboratories might be a big problem for them.

The second policy is more effective and realistic than policy two. Most countries in Africa are in debts, can barely sustain their economy and others are very unstable hence do not have any money left to contribute. However if these countries can get donors to help them set up laboratories, provide trained personnel and set up Disease Intelligence Surveillance then they will be on track on handling and managing these diseases. What the first policy does not say is in what ways will these countries use this money? Do they have adequate technology and personnel to help invest this money?

Policy two is costly but can once effected is the best. It states that each country micro manages its own health policy on Emergence Infectious Diseases. Every country sets up their strategies and plans on how to research, detect, respond and manage an infectious disease. It may borrow from the US government HSS plan on the six parameters and use them to build their own policy. However, some countries might need donor support in setting up and maintaining these programs. The first step in helping the people is by educating them on the problems they are facing. Once they have the knowledge and information then they will help in reducing the risks of these infectious diseases. Given that we have already established that these diseases mainly affect the poor, then it is important also to equip them with resources to improve their livelihoods. Provision of laboratories and hospitals will also help in detection and rapid response.

I therefore call to action all the Health Agencies, donor programs, Non Governmental Organizations to help the less developed countries that also happen to be the hot spots of the Emergence Infectious Diseases to set up training facilities, laboratories, Intelligence services and public training on the management of these diseases. Equip the society with information, human resource and facilities to facilitate detection, rapid response and management when these pandemic strikes.

In partnership with the HSS, USAID and WHO we can carry out research and draw a budget on what is required to set up this resources and carry out the training. The communication plan would basically be using the media to reach out to the people in areas adversely affected to come out and help in the research on what is required to manage this pandemics.; reach out to the governments of countries and states to help implement this policy by providing logistical support and reach out to the professional in this field to attend these trainings and become part of these global movement to fight Emerging Infectious Diseases.