Despite tremendous technological advances in detecting and treating infectious diseases, curbing the global health threat posed by these diseases is increasingly complex. This is particularly worrisome given globalization trends characterized by extensive international trade and travel. In a vastly globalized world, diseases can easily spread through travel and trade routes, affecting populations and economies in other parts of the world. The recent Ebola epidemic in West Africa attests to this fact and raises fundamental questions about the capacity of global health systems to respond effectively. Similarly, the on-going Zika epidemic in the Americas demonstrates how easily diseases that were once geographically confined can spread and conquer large populations.
Central to this vulnerability is the limited capacity of health systems, especially in low- and middle-income countries, to effectively deliver basic health technologies. For example, long after malaria prevention and treatment technologies were introduced to the armamentarium of many health systems, the disease continues to adversely impact many communities in the African continent due to limited access to quality diagnosis and treatment options. This underscores the importance of effective delivery as a basis for any meaningful response to global health threats. Furthermore, experience from the HIV/AIDS epidemic continues to demonstrate the benefits of an effective roll-out of diagnostics and treatment options to those in need. Progress is especially significant in places where measures were implemented to expand access to antiretroviral treatment, beckoning the possibility of an HIV-free generation.
Some of the most successful responses to global health threats are characterized by multi-stakeholder partnerships. Bringing all stakeholders together to ensure effective coordination, pooling of resources, and delivery of essential health technologies is imperative for an effective health system response. Such technologies need not be expensive, state-of-the-art interventions; instead, they could consist of basic products, such as disinfectants for infection control, insecticide treated nets for malaria prevention, rapid diagnostic kits, and antibiotics to treat infections. Adopting point of care diagnostics and mobile technologies can also greatly enhance the supportive function of disease surveillance, which can ensure that epidemics are detected and addressed early.
A stark of example of the difficulties surrounding adequate healthcare resources is the recent Ebola epidemic in West Africa, which spiraled out of control and resulted in unprecedented mortality and socioeconomic effects that impacted the entire region. This was largely attributable to the weak health infrastructure that could not detect and respond to the epidemic effectively. The wider global health community must adequately prepare for such epidemics in the future by investing in strong disease surveillance systems that enable early detection and improve health delivery systems. This is particularly true when considering the likely future effects of climate change, population growth, and environmental degradation as drivers of resurgent infectious disease epidemics.
The lack of effective early warning systems in many African health systems often translates to delayed action in response to epidemics. The root causes of this deficiency are multifactorial and range from governance and implementation constraints to limited adoption and deployment of essential health technologies. For example, laboratory capacity is an essential component of any surveillance system, but is severely limited in the most peripheral parts of sub-Sahara Africa. Such an adaptive outlook could result in a faster and more targeted response to epidemics – ultimately saving lives and best utilizing resources.
Health data collection systems in the most peripheral parts of Africa are paper based, making the communication and analysis of medical data all the more difficult. Invariably, if data is not collected, analyzed, and reported promptly, action can be significantly delayed. However, widespread access to mobile phones in most African countries presents an opportunity through which health systems could speed up the collection, analysis, and dissemination of health information. By continuously updating data on digital platforms, decision-makers could detect the emergence of epidemics and access real-time monitoring of the progress achieved through control efforts. In fact, preliminary efforts toward this end in Kenya and Rwanda are already showing promising results.
Furthermore, effectively detecting epidemics requires integrating different data sources. Collecting health data through digital platforms makes it easier to combine different data streams, thereby helping decision-makers gain a fuller understanding of the epidemic. For example, data from wildlife and veterinary services could be a boon to early detection of zoonotic infections, such as rabies and Ebola, before they reach human populations.
Understanding the profile of the populations most susceptible to epidemics is also essential. Mobile technologies could enable confidential self-reporting of symptoms to healthcare providers, catalyzing further investigation and epidemic control before the disease spreads to additional population groups. As an information and health communication tool, mobile platforms could also deliver appropriate health messages to the population in question, relieving direct consultation pressure from health system providers and preventing possible panic in epidemic situations.
Once an epidemic is determined, effective control measures are required to prevent further spread. The efficacy of such measures is squarely anchored on health system considerations, such as strong human resource capacity, the integrity of logistic and supply chain systems to ensure delivery of medicines, essential health technologies, and the availability of functional health infrastructure. For instance, health facilities without basic protective equipment and medical supplies are likely to fail in fully implementing infection control measures – putting both caregivers and patients at risk of nosocomial infections. Similarly, inadequately trained health personnel are unlikely to meet the standard operating procedures required during epidemics.
At the macro level, health systems must have clear policy guidance for epidemic control measures to be effective. Because epidemics can spread across borders, strong regional collaboration mechanisms are essential. National coordination, too, is vital to ensure that all stakeholders act in tandem. Similarly, earmarking resources for emergency responses could shorten the time it takes to act once an epidemic is detected. However, mobilizing resources and creating strong coordination mechanisms require strong political will. Control measures, such as isolation and quarantine, entail political consequences that must be borne in mind.
The World Health Organization gives guidance to national health systems to strengthen their response capacity to meet International Health Regulations. Unfortunately, there is often a chasm between a country’s self-reported capacity and its capacity according to independent external reviews, raising questions about the ability of many countries to respond to global health emergencies. Deliberate efforts should be made to bridge these gaps. As highlighted above, global partnerships geared toward effective adoption and deployment of appropriate health technologies could do just this.
The recent Ebola epidemic raised the scepter of vulnerability in the backdrop of weak health systems. Invariably, in an increasingly interconnected world, global health systems are only as strong as their weakest link. Countries that are unaffected by epidemics would be remiss to ignore health trends in other parts of the world. There remains a need for solidarity across the global community to holistically address the health system vulnerabilities that hinder effective response in many countries.