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Inadequate response to Ebola should not be repeated with Chickungunya

 Dr Isabelle Nuttal of the World Health Organisation

The good news is that a prophylactic vaccine against chikungunya, developed by the Austrian biotech company Themis Bioscience GmbH, is reported to induce a significant neutralizing immune response to the disease and is confirmed as safe.

The not so good news is two-fold: first, none of the major health authorities of the world have yet endorsed the safety and effectiveness of the vaccine; and second, even if the vaccine is validated, it might be some time before it is produced in sufficient quantities and at a price that could make it available to regions of the world where chikungunya is a growing problem.
The World Health Organisation (WHO) describes chikungunya as: “a viral disease (genus Alphavirus) which is transmitted to humans by infected mosquitoes – including Aedes aegypti and Aedes albopictus. The name chikungunya originates from a verb in the Kimakonde language, meaning 'to become contorted'. This refers to the 'stooped' appearance of those suffering with joint pain”.
Since late 2013, chikungunya has become a serious problem in the Americas with more than 780,000 reported cases to date. It has spread rapidly through the Caribbean islands creating problems for the economies of these small states as the operations of small and medium-sized business are adversely affected by illnesses amongst key workers. 
The economic problem is worsened by reports in the international media that tourists in the Caribbean “are being struck down by a debilitating and potentially deadly virus carried by mosquitoes”. That scary language and the naming of several Caribbean countries, based entirely on unofficial sources, are likely to have a deleterious effect on tourism which is the mainstay of the majority of the economies.
In any event, Caribbean governments should be doing all in their power to arrest the spread of the disease in the interest of the health of their local populations and to protect their fragile tourism industries. All of them are trying to do so with the limited financial resources they have, particularly at a time of a protracted economic downturn following the 2008-2009 global financial crisis.  
The private sector in the region also has to become involved in tackling the problem. Businesses have much to lose if Chickungunya debilitates their work force and frightens away tourists. In this connection, a point made by Dr Isabelle Nuttall, the Director of Global Capacities, Alert and Response at the WHO, is instructive. She observes that: “The key to stopping the international spread of this disease is global vigilance”. That same observation is valid in the domestic context where the key to stopping the spread of the disease should be local vigilance. Part of that vigilance should be a meaningful contribution by the private sector to a joint fund with governments to combat Chickungunya. It is a special problem requiring special action.
Vigilance also requires education about the problem at a mass level. Denying the existence of the disease or playing-down the number of people it has affected is unhelpful to educating the public about the measures that each person should put in place to protect themselves, help contain the spread of the disease and eradicate the mosquito carriers.
If the problem intensifies hemispheric and international organizations should step-up to help deal with it before it becomes graver than it is, placing heavier burdens on already over-stretched budgets. 
It is noteworthy that the problem of Ebola in Sierra Leone especially is getting worse not better. The WHO has reported that Sierra Leone confirmed 533 new cases in the week up to November 16, with 63 deaths in five days between November 14 and 19. In part, this is due to the poor response of the international community, mainly the rich countries, when the disease erupted in West Africa. A delayed response, allowed Ebola to take root and to spread in poor and built-up areas. And, the international response occurred only after it became clear that the disease could penetrate the best erected customs and immigration barriers of every country. 
The WHO says 5,420 people have died of Ebola in eight countries out of 15,145 cases of infection since December 2013. But while this figure is alarming, it is small in relation to the almost 5,000 persons a week, mostly children in poor countries, who die from diseases like malaria.
The capacity for diseases, such as malaria, chickungunya and dengue fever, to spread is far greater than Ebola. These diseases are undetected global travellers, and once landed they become national residents. The current figure of 780,000 reported cases of chickungunya in the Americas is more than likely to rise, unless every country implements the measures necessary to eradicate the mosquito carriers. For the smaller and less resourced countries to act effectively they will need both a comprehensive national effort and international support in the form of money and technical support.
In the words of the WHO’s Dr Nuttal: “If the world wants global security, we have to work together to ensure poor countries have stronger health systems, including early warning systems to report outbreaks earlier”.
But, the experience with Ebola is not encouraging. The leaders of the G20 met in Australia in mid-November just days before a date set by the UN for commitments to combat the dreaded disease. At first, Ebola was not even on the agenda for discussion. Only intense pressure from representatives of civil society in major countries caused it to be included at the last minute. But the separate statement on Ebola issued by the leaders was long on encouraging words with no specifics of sums of money or dates for delivery. 
Developing countries in the Americas, particularly the small states of the Caribbean, cannot afford to wait for an unmanageable emergency to seek international help. While intensifying their own national efforts to cope with the predicament of chickungunya and dengue fever, which has affected people whose numbers are the equivalent of the entire population of Guyana or the combined inhabitants of Barbados, Antigua and Barbuda, St Kitts-Nevis, Dominica, St Lucia, Grenada and St Vincent and the Grenadines, they should also make the case to the international institutions for the resources needed now to prevent a crisis.

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