This blog piece has been first published in Africa Health Journal, July 2018
Latest Ebola response holds key to global health security
Thomas Cueni discusses the important role of immunisation and the critical role of the pharmaceutical industry in combatting new threats such as with Ebola
The recent deadly outbreak of Ebola virus disease (EVD) in the Democratic Republic of Congo (DRC) prompts fear, not just in the affected region, but around the world. Following the notification of an EVD outbreak by the Ministry of Health of DRC on 8 May, the International Health Regulations (IHR) Emergency Committee concluded that the conditions for a Public Health Emergency of International Concern had not been met. However, the World Health Organization (WHO) considered the public health risk very high at the national level. Ebola is a horrifying disease, and the thought of what an uncontained outbreak might bring understandably has put the region and world on alert.
This time around, the response has been strategic and swift, with an intensive program of ring vaccination. Targeting front-line health professionals, people who have been exposed to confirmed EVD cases and contacts of contacts, the programme has reached over 4,500 people between 21 May through 17 June. The rVSV-ZEBOV vaccine has been made available and rapidly delivered to the DRC through the collaboration of MSD, BARDA, WHO, Gavi, and MSF – among others. During the 2014 EVD outbreak in West Africa, we did not have a vaccine, but thanks to these collective efforts, a vaccine has been available during this outbreak. As noted by the WHO, vaccination provides hope for highrisk communities but also, crucially, protection, with the latest update showing vaccination seems to be helping to contain further spread of the EVD.
The swift response in the DRC occurred at the moment world health leaders gathered for the seventy-first World Health Assembly. In his opening address, Dr Tedros Adhanom Ghebreyesus spoke of three ‘keys’ to the future success of the WHO – reform of the institution, political support and partnership. It is our view that the combined and intensive vaccination effort in the DRC exemplifies all three. Above all, it shows the critical importance of partnership as local health workers, clinicians, politicians, manufacturers and the wider global health community came together, learning the lessons from previous outbreaks of infectious disease and creating a powerful, coordinated and united front.
Ultimately, the way the national, regional, and global health community has risen to the challenge of confronting Ebola demonstrates our collective ability to safeguard the health of populations working at its best. At the heart of that operation was a vaccine. So often, as humanity has struggled to combat disease, the greatest triumphs have revolved around vaccines. Dr Tedros hailed the eradication of smallpox through immunisation as ‘one of the greatest achievements not only in the history of WHO, but in the history of medicine.’ Today, 26 diseases are preventable through immunisation – an extraordinary feat of innovation and commitment.
It is welcome then, that through the Business Case for Immunisation on the African continent 2018-2030, a landmark document driven by WHO regional offices, the leadership of WHO are seeking to protect and grow such health gains made over the last few decades by placing countries at the centre and making immunization a core strategy in efforts to achieve universal healthcare coverage (UHC) and health related sustainable development goals (SDG).
As highlighted during the 71st World Health Assembly when we launched our IFPMA at 50 Global Health Progress report, vaccines have played a key part in the transformation of global public health. Now with the Business Case for Immunisation and the accompanying transformation of WHO’s immunisation and surveillance support as set out in the priorities of the 13th General Programme of Work, there is the prospect of sustained routine immunisation programmes.
The WHO estimate this paradigm shift in immunisation will by 2030 save at least 1.9 million lives, avert 167 million illnesses and save up to $58 billion over ten years in the African continent. The return on investment is projected to be to be 37 fold.
With immunisation gaining increasing political traction and cross-sectoral support, this is a crucial moment to redouble efforts to strengthen routine immunisation systems, particularly in countries such as Nigeria, who need tailored support to expand the reach of immunisation services. The Gavi Board decision to exceptionally extend its support for Nigeria up to 2028 is therefore a great step forward in delivering the bold support envisioned by the WHO.
Only through partnership – collective vigilance, collective organisation, and collective effort – can the diseases that threaten us be effectively confronted now and in the future. As the WHO recognises, universal health coverage and global health security are ‘two sides of the same coin.’ The WHO Business Case has the potential to become the foundation of the post2020 global immunisation strategy supporting domestic investment decisions, and replenishment efforts. With this, and the growing effective collaborations across the health community, momentum is on our side once more for achieving breakthroughs in global public health.