What the Pandemics of History Can Teach
As the Global Report for Research on Infectious Diseases of Poverty by the World Health Organization (WHO) explained, “Poverty creates conditions that [favor] the spread of infectious diseases and prevents affected populations from obtaining adequate access to prevention and care. Ultimately, these diseases…disproportionately affect people living in poor or [marginalized] communities.” This is what the pandemics of history can teach all countries.

While the number of people living in extreme poverty worldwide has dropped over the last 20 years, research has suggested that poverty will grow for the first time since 1999 due to the COVID-19 pandemic. Despite the many lives this disease has affected, hope exists that the world will be able to overcome this global setback.

A Quick Lesson in Terminology

In simple terms, infectious disease epidemiology is the study of the spread and burden of communicable diseases over time and, to understand pandemics of history, it is important to first know a few epidemiologic terms. The COVID-19 pandemic is an epidemic that has spread across national and continental borders. An epidemic marks a particularly sudden increase in the spread of a specific disease. Diseases are endemic when present within a population at steady levels.

The notable scientific and technological advancements that occur through the lessons of diseases past and present are of course vital to global health. However, a look through these histories can also provide context and even comfort in the face of COVID-19. Here are three examples of defeated plagues from history.

3 Defeated Pandemics of History

  1. The Black Plague: The Black Plague caused great destruction in Asia and Europe during the mid-1300s. It is a prime example of what the pandemics of history can teach. The movement of sailors from port to port was a significant influence on the spread of the bubonic plague—rats that were aboard ships, as well as sailors themselves, transmitted the disease, leading port officials to eventually restrict passengers from leaving ships for 30-40 days. This practice, known as quarantine, has of course played an important role in mitigating the spread of COVID-19.
  2. The Spanish Flu: Despite the comparisons between the 1918 influenza pandemic and COVID-19, there remain key differences. The Spanish flu primarily struck younger people who were otherwise healthy. Meanwhile, COVID-19 deaths have disproportionately included older populations. Many countries put public health measures in place in 1918. They bear an obvious resemblance to those deployed against COVID-19. Many can also be thankful for the many scientific and technological innovations of the last 100 years. The COVID-19 pandemic will hopefully end before killing 50 million people.
  3. Smallpox: Smallpox waxed and waned in many areas of the world as early as the 4th century and WHO eradicated it in 1980. Nonetheless, from the years of tragedy and struggle came lessons and innovations serving the world today. For perspective, over a millennium passed between the first cases of smallpox and Edward Jenner’s scientific discovery of a smallpox vaccine, and it was nearly another two centuries before the disease underwent eradication.

Light at the End of the COVID-19 Tunnel

Public health officials have continued to utilize the lessons of the past. What the pandemics of history can teach has informed the public health measures and campaigns of today.

– Amy Perkins
Photo: Pixabay

Influenza in sub-Saharan AfricaAfrica is known for being one of the world’s poorest continents. Poverty directly affects a person’s susceptibility to diseases like influenza. To combat this disease, the future of healthcare in Africa requires funding to improve accessibility in rural regions. Here’s what you need to know about influenza in sub-Saharan Africa.

Influenza in Sub-Saharan Africa

While sub-Saharan Africa only accounted for an estimated 7,000 influenza deaths in 2015, this remains the most common and deadly global disease. The mortality rate of influenza in sub-Saharan Africa affects children under the age of five and those over 75. Though the mortality rate seems low compared to the U.S., it does not take into account the presence of healthcare services in Africa versus the U.S. In contrast to Africa, the U.S. had 22,705 influenza deaths in 2015. While these statistics are higher, the U.S. also has more accessible healthcare.

Furthermore, studies have shown that influenza affects many more people than accounted for. Research from the World Health Organization (WHO) shows 40% of antibodies for flu (B) were found in community members 40 years of age and older. This reveals that the virus continued to circulate with no monitoring processes. Importantly, this lack of surveillance contributes to countries’ and NGO partners’ ability to prepare for the next outbreak.

Higher rates of influenza in sub-Saharan Africa are typically found in low to middle-income regions with little resources and access to sanitation and healthcare. In particular, influenza puts nearly “two-thirds of the 34 million” persons infected with HIV at a higher risk for infection and mortality. Existing diseases such as HIV thus put a significant amount of the African population at risk for influenza.

Healthcare in Africa

Africa continues to possess one of the world’s worst healthcare infrastructures, despite funding from the U.S. In 2006, the U.S. gave R100 billion to the South African National Health Insurance (NHI). However, the U.S. provided $28.8 billion to those uninsured in the U.S. during that year, nearly twice the amount granted for all international health.

Rural regions in sub-Saharan Africa account for 60% the population, while urban areas contain 40%. Rural regions lack accessible healthcare compared to urban regions. Due to industrialization, urban areas have greater access to healthcare facilities and university hospitals.

Across many parts of Africa, the ratio of doctors to patients “is below 1/1000 population, with the ‘ratio of physicians per 1000 population essentially unchanged between 2004 (0.77) and 2011 (0.76).” Demand for physicians within these regions is increasing. However, although Africa is producing more physicians, many migrate to the U.S. This leaves rural regions of sub-Saharan Africa with few qualified healthcare providers.

Solutions and Aid

Awareness and aid are crucial to improving infrastructure and healthcare in Africa, so that it can respond to influenza outbreaks. The W.H.O. has created the Africa Flu Alliance, finding factors leading to the underfunding of healthcare to assess its overall impact. Similarly, the Africa Flu Alliance created a “strategic road map” of targets to control influenza in sub-Saharan Africa. It hopes to influence organizations, private funding and projects to support the organization’s initiatives.

Private sectors and nonprofits contribute to approximately half of Africa’s total healthcare funding and expenditures. Twenty-two organizations and nonprofits are working to combat the gap between health services in rural and urban areas. In addition, The African Network for Influenza Surveillance and Epidemiology (ANISE) was created in 2009, with a growing network alongside the CDC. Continual meetings from 2009 to 2012 allowed officials and representatives to discuss achievements and areas of improvement.

Reducing Aid Dependency: Can It Work?

Despite the reliance on Western assistance for years, President Trump’s foreign aid budget cuts could be incredibly harmful or begin for Africa. Given the situation, governments within Africa will need to strive for improvements in monetary policies, transparency and reduced corruption. To improve self-sufficiency, experts recommend regional integration, or “the process by which two or more nation-states agree to co-operate and work closely together to achieve peace, stability and wealth.” Initiatives like Africa’s Continental Free Trade Area (CFTA) will enable 54 countries to trade freely. This will improve Africa’s economic stability by an estimated 50% increase in trade.

The battle of influenza in sub-Saharan Africa correlates directly with the absence of monitoring for significant health concerns. Expanding upon the existing healthcare infrastructure can not only contain and treat disease but also help grow Africa’s economy. Surveillance will be key in this process, as statistics tell actors what they need to improve. But with the support NGOs, funding can help control influenza in sub-Saharan Africa.

Allison Lloyd
Photo: Flickr