EYE OFF THE BALL
What’s Worse Than Ebola in West Africa? Almost Everything
Ebola’s getting the world’s attention right now, but long-standing programs against diseases like malaria and HIV/AIDS are being neglected and thousands more may die in the meantime.
ROME, Italy — Long before Ebola was a household word and a global crisis, West Africa was a daunting place. It was a corner of the world where you could get caught in the crossfire of any number of local criminal gang activities or civil wars if you were in the wrong place at the wrong time. But it was also a potential death trap for other reasons. It was a place where Westerners didn’t dare visit without a pharmaceutical arsenal of anti-malarials, antibiotics and anti-diarrheal tablets. Now, thanks to Ebola, they don’t dare visit at all. Guinea, Sierra Leone and Liberia—the West African nations now hardest hit with the Ebola epidemic—also had the highest per capita rates of maternal mortality, HIV infections and malaria deaths in sub-Saharan Africa. A shocking statistic among many is that, on average, one person dies of malaria there every 30 seconds.
Despite extreme poverty and internal strife, West Africa was also a place where education, attention and global investment meant pockets of progress, especially in Sierra Leone where the end of decades of civil wars had recently given way to new hope. Maternal mortality rates were improving because women living in extreme poverty sought medical attention and were taught the benefits of prenatal nutrition. Across the region, women also had many more opportunities for safe places to deliver babies, or, short of that, trained midwives to help them deliver at home. Childhood diseases like measles, polio and cholera were being beaten back thanks to improved education and successful immunization programs. In 2010, the World Health Organization announced that 908,000 malaria deaths had been averted in just a decade thanks to relatively simple measures like mosquito nets and anti-malarial drugs.
Now, the risk of losing that progress is all but certain. Patients are terrified to seek treatment in hospitals and parents are refusing to immunize their children out of fear they will be injected with the Ebola virus instead. In countries like Liberia, where 7 percent of children under five already die, fear could be fatal. Before Ebola, 97 percent of children were immunized, according to an eye-opening report by NPR. Now only 27 percent get their shots. “Ebola is shutting down the healthcare system,” Bill Gates, former CEO of Microsoft and current head of the Bill and Melinda Gates Foundation told The Guardian on the sidelines of the Sibos Banking conference in Boston last month. “More kids are dying of malaria in these three countries now than they were before Ebola came along. So it would be worth stopping the Ebola epidemic if the only benefit was that it put the health system back in place.”
Liberia is especially vulnerable to the Ebola crisis. In 2012, before Ebola reached epidemic proportions, there were 1.4 million cases of malaria, and 640 out of every 100,000 pregnant women died in childbirth or from pregnancy complications, according to the WHO. Liberia is also at the center of the HIV-AIDS crisis, where, as of 2012, 33,600 people were living with the disease, according to National AIDS Commission of Liberia. Counseling services and treatment centers in the cities had risen from just three in the whole country in 2006 to nearly 400 by the end of September 2012 with a special emphasis on preventing mother to child transmissions. (Sixty percent of the HIV/AIDS sufferers in Liberia are women.)
Now, many of the hospitals have closed down, either because medical staff are too afraid to work or patients are too afraid to set foot inside a hospital where they might catch the deadly Ebola virus, which means many HIV/AIDS programs have ceased offering services. The Liberian AIDS commission is now going door-to-door to administer antiretroviral medications to known patients. "If we do not go out to them then we will be having a disaster,” Sonpon Blamo Sieh, head of Liberia's National AIDS Control Program, told The Daily Beast by email. “We made some gains and 70 percent of our patients who need treatment were getting it. But if we lose that edge, we risk losing the battle completely.
The same goes for progress made in childhood diseases, both in prevention through immunization programs and in treatment through proper health care. Children who would have almost surely died a decade ago of cholera and diarrhea were surviving thanks to efforts by organizations like the Gates Foundation and the Gavi Vaccine Alliance, a public-private alliance that works to purchase vaccines for the world’s poorest regions. “Ebola is rightfully in the headlines this fall, and it is an urgent crisis requiring urgent global action. But at the same time, we can’t forget that quietly, beyond the headlines, millions of children continue to die from diseases like pneumonia and diarrhea. The good news is we have the power to stop both of these tragedies from replicating—and not with complicated technologies but with basic public health practices and better access to vaccines,” said Erin Hohlfelder, Global Health Policy Director for The ONE Campaign, an international organization launched by U2 lead singer Bono working to defeat world poverty by 2030 that advocates for organizations like Gavi.
“We as a global health community have to be able to walk and chew gum at the same time, ensuring that preventing a death from Ebola doesn’t mean a child dies instead from a vaccine-preventable disease like pneumonia or diarrhea,” she told the Daily Beast. “The world has the power to ensure we both contain the Ebola outbreak and make sure all children can grow up healthy, regardless of where they were born. But doing so will require leaders around the world to step up their political will and their resources to tackle these challenges together, with urgency.”
There is now concern among those who were making progress that all will be lost for at-risk children, in part because parents are too afraid to protect them—or they are dead. According to the United Nations Children’s Fund, around 3,700 children in Liberia, Guinea and Sierra Leone have lost at least one of their parents to the virus, which means Ebola orphan rates are climbing with the death rate. "Children are dying from measles and other vaccine-preventable diseases and pregnant women have fewer places to deliver their babies safely," the United Nations children’s agency UNICEF announced last month, noting that as many as 8.5 million people under the age of 20 live in Sierra Leone, Liberia and Guinea. Of these, 2.5 million are under the age of five and most susceptible to childhood diseases.
Many health care organizations that are at the front line of the Ebola battle now were already in place in the affected region before the outbreak. But the fact that they have had to divert funds and resources for Ebola means their original objectives have been sidetracked. Doctors Without Borders has had to close a 200-bed hospital in Sierra Leone that treated children under 15 and at-risk pregnant women in order to move non-essential staff out of the area. “It has been a very tough decision to make as we know that thousands of women and children rely on our services in the district and beyond,” Brice de le Vingne, Doctors Without Borders Director of operations said in a statement. “But the safety of our staff must remain our top priority and if we cannot guarantee flawless infection control in the hospital, we are putting our staff and patients at risk.”
De le Vingne says they plan to resume activities as soon as possible. “We really hope that in a few months, we’ll be able to focus once again on treating mothers and children as they are now being affected as Ebola collateral damage.”
What is perhaps most worrying is that many of the diseases not being treated while the world is focused on Ebola are far more contagious. On average, one Ebola sufferer will infect only two people, according to the World Health Organization, and illustrated in a graphic created by NPR. On the contrary, four people are infected on average by one HIV/AIDS sufferer; 18 people are infected, on average, by just one person with measles. And despite the fast-moving epidemic, Ebola is still not one of the top 20 killers in Africa where HIV/AIDS, respiratory infections, diarrhea, malaria and childbirth kill many more people every year. A stunning example is the fact that, according to the World Bank, in 2012, 1.2 million Africans died of HIV/AIDS and 550,000 died of malaria. While dramatic, the number of Ebola deaths is around 4,500, yet millions of dollars and resources have been sent to the region to stop the epidemic.
That may explain why those who wish to get back to their pre-Ebola work are among the most generous donors to the Ebola cause. The Bill and Melinda Gates Foundation, for example, have committed $50 million for research and prevention for Ebola, which has sidetracked much of their work to prevent malaria and polio in West Africa. Their initial investment aided in the creation of an Ebola Operation Center (EOC) in Nigeria, which helped stem the outbreak there, the company said in a statement. “Leveraging expertise and lessons from the national polio program, the EOC has been at the center of an aggressive push by the federal and state governments to contain the spread of the virus,” a Gates Foundation spokesperson said in a statement. “There is cautious optimism that this prompt action may have helped avert a broader outbreak.” Last week, Nigeria was declared Ebola-free.
As the Ebola Virus rages on, the same old problems that have plagued West Africa are still waiting. Now it is a race against time to see which moves faster—those suffering from the relentless problems or those who can stop them.