Malaria has long been an indelible part of Egypt’s history, with evidence of the disease traced back to around 4000 BCE. The same malady that once plagued the pharaohs is now consigned to history, no longer a spectre haunting Egypt’s future. The certification by WHO is an accolade for Egypt’s dedication to public health. It is particularly noteworthy in a nation with over 100 million residents, where eradicating a deeply entrenched disease requires perseverance, innovation, and unity.

As Dr Tedros Adhanom Ghebreyesus, WHO Director-General, eloquently stated, “Malaria is as old as Egyptian civilisation itself, but the disease that plagued pharaohs now belongs to its history and not its future. This certification of Egypt as malaria-free is truly historic and a testament to the commitment of the people and government of Egypt to rid themselves of this ancient scourge.”

Egypt’s Journey to Eradication: A History of Determination

Egypt’s odyssey towards eliminating malaria is a saga of collective willpower. It began in the early 20th century when the government introduced measures to reduce human-mosquito contact. As early as the 1920s, Egypt implemented agricultural reforms, including restricting rice cultivation near residential areas — a strategy designed to minimise breeding grounds for malaria-spreading mosquitoes.

However, it wasn’t until 1930, when malaria was declared a notifiable disease, that systematic public health interventions began in earnest. Establishing the first malaria control station, focusing on diagnosis, treatment, and surveillance, paved the way for structured disease management. Yet, despite these early efforts, Egypt faced major setbacks during the Second World War, when a spike in cases reached over three million due to population displacement, service disruption, and the proliferation of *Anopheles arabiensis*, a highly efficient mosquito vector.

The post-war era, marked by the construction of the Aswan Dam in 1969, introduced a new challenge. The dam’s vast water reservoirs became fertile breeding grounds for mosquitoes, intensifying the risk of malaria outbreaks. Egypt responded with a robust public health and vector control initiative, collaborating with neighbouring Sudan to manage this new threat.

By 2001, Egypt had brought malaria under control, and in 2014, when a small outbreak emerged in Aswan, the country demonstrated its resilience. The outbreak was swiftly contained through early case identification, immediate treatment, and heightened public education, proving the effectiveness of Egypt’s surveillance and response systems.

A Symbol of Hope for the Region

Egypt’s certification as malaria-free by WHO is not just a personal victory for the country but also a beacon of hope for other nations still grappling with malaria. Egypt is only the third country in the WHO Eastern Mediterranean Region to achieve this status, following in the footsteps of the United Arab Emirates and Morocco, and the first to do so in over a decade.

This success reflects the country’s unwavering commitment to public health. Dr Hanan Balkhy, WHO Regional Director for the Eastern Mediterranean, celebrated Egypt’s achievement: “Today, Egypt has proven that with vision, dedication, and unity, we can overcome the greatest challenges. This success in eliminating malaria is not just a victory for public health but a sign of hope for the world, especially for other endemic countries in our region.”

Egypt’s sustained investment in robust health systems, particularly its focus on integrated disease surveillance, has been the cornerstone of its achievement. Moreover, community engagement and regional collaboration have played critical roles. Egypt’s partnerships with neighbouring countries, especially Sudan, have been crucial in preventing cross-border malaria transmission, helping to secure the nation’s malaria-free status.

Sustaining the Success: A Vigilant Future

Though Egypt has won the battle against malaria, the war on maintaining its malaria-free status is ongoing. The WHO certification is not an end but a new beginning, as highlighted by Dr Khaled Abdel Ghaffar, Egypt’s Deputy Prime Minister. He emphasised the importance of vigilance in sustaining this milestone, stating, “Receiving the malaria elimination certificate today is not the end of the journey but the beginning of a new phase. We must now work tirelessly and vigilantly to sustain our achievement through maintaining the highest standards for surveillance, diagnosis, and treatment.”

Egypt must continue its robust strategies to uphold its malaria-free status, including integrated vector management, rapid responses to imported cases, and a comprehensive early case detection and treatment system. The cross-border collaborations integral to achieving certification will remain essential in preventing a resurgence of the disease as Egypt continues to engage with endemic countries in the region.

A Legacy of Public Health Triumph

Egypt’s certification as malaria-free serves as a reminder of what can be achieved when a nation unites behind a common goal. It symbolises the end of an ancient battle and a future where public health can continue to flourish in the face of adversity. The lessons from Egypt’s journey provide invaluable insights for the global fight against malaria, offering a roadmap for other countries striving to eradicate the disease.

With this achievement, Egypt joins a distinguished group of nations that have successfully interrupted malaria transmission, providing inspiration and hope for a world where the elimination of this ancient disease is no longer a distant dream but a realistic possibility. The journey continues, but the future is bright for a malaria-free Egypt.

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As the world gradually recovers from the shockwaves of the COVID-19 pandemic, the spectre of another potential public health crisis looms ominously on the horizon. A recent report in The Lancet on the risks of avian influenza H5N1 at mass gatherings is a critical reminder that our vigilance against infectious diseases must remain steadfast, especially as we approach a summer filled with major religious, cultural, and sporting events.

Mass gatherings have always been fertile ground for spreading infectious diseases, serving as hubs for international transmission. From the annual Hajj pilgrimage to the bustling celebrations of Kumbh Mela, these events draw millions of people from around the globe, creating perfect storm conditions for pathogen spread. The resurgence of avian influenza, particularly the H5N1 strain, poses a renewed threat that demands immediate and focused attention.

The Silent Spread of H5N1

H5N1, also known as Highly Pathogenic Avian Influenza, has been on the radar of global health authorities since its emergence in 2004. Despite not currently transmitting easily from person to person, recent reports of mild or asymptomatic human cases in the USA, China, Vietnam, and Europe are alarming. The first human case in the USA was reported in 2022 in Colorado, linked to direct poultry exposure. Similarly, England has documented 298 cases since October 2021. This underscores the virus’s persistence and the potential for rapid, widespread outbreaks if left unchecked.

Lessons from History: Preparedness Pays Off

Historical precedents demonstrate the critical importance of proactive public health measures. The past decade has seen mass gatherings successfully navigate Zika, Ebola, and COVID-19 threats through meticulous planning and surveillance. For instance, the 2015 Africa Cup of Nations in Equatorial Guinea proceeded safely amidst the Ebola outbreak, thanks to stringent health protocols and international cooperation.

The ongoing efforts to prevent outbreaks at events like the Tokyo 2020 Olympics and various religious gatherings highlight the effectiveness of preparedness. Yet, these successes should not breed complacency. The ever-evolving nature of viral pathogens necessitates continuous vigilance and adaptation of our health strategies.

The One Health Approach: A Unified Front Against Zoonotic Diseases

The interconnectedness of human, animal, and environmental health underscores the need for a comprehensive One Health approach. Mass gatherings often involve the consumption of animal products and, in some cases, live animal sacrifice. This creates multiple avenues for zoonotic transmission, particularly with avian influenza viruses.

Countries hosting mass gatherings must implement rigorous screening and testing protocols for poultry and other animals to mitigate these risks. This includes mandatory surveillance of imported animals and those used in religious rituals. Wastewater surveillance can also provide early detection of viral presence, allowing for swift intervention.

Bridging Knowledge Gaps: Research and Surveillance

Mass gatherings present unique opportunities for real-time research and data collection. Understanding the transmission dynamics of H5N1 and other zoonotic pathogens is crucial for developing targeted interventions. Enhanced surveillance, using advanced diagnostic platforms, can identify and monitor emerging threats, filling critical knowledge gaps.

The Path Forward: International Cooperation and Vaccine Development

Ultimately, the global community must unite in the face of these emerging threats. Developing and distributing effective vaccines for H5N1 and its variants will be pivotal in safeguarding public health. Collaborative efforts involving organisations like the WHO, FAO, and OIE are essential for a coordinated response.

A Two-Year Effort to produce a global pandemic treaty misses its deadline. On Friday, May 24, Tedros Adhanom Ghebreyesus, the director general of the World Health Organization, announced that the negotiators from the group’s 194 member nations couldn’t reach a consensus in time for the World Health Assembly, which started this week.

The goal had been to draft a document that could be adopted at the meeting and then sent to countries for ratification. However, the sticking points—including the willingness of richer countries to share vaccines and treatments with less well-off countries in the Global South—could not be resolved in time.

What Next?

Scientists predict the next pandemic could occur soon, perhaps in two years or twenty. Still, the message is clear: proactive surveillance and preparedness are not optional. They are imperative. By learning from past experiences and embracing a unified approach, we can protect millions of lives and ensure that mass gatherings are celebrated safely worldwide.

Christopher Nial is a senior partner at FINN Partners. He specialises in global public health and the intersection between climate change and public health. With over 30 years of experience, he is passionate about leveraging public health strategies to save lives.

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At the forefront of these preventable tragedies is pneumonia, a leading cause of death that can often be averted through inexpensive vaccines and antibiotics. Immunisation campaigns and community health programs can ensure that treatments reach those in need, transforming a potential death sentence into a manageable condition. Simple practices, such as promoting exclusive breastfeeding, can also bolster a child’s immune system against pneumonia and other diseases.

Diarrheal diseases, closely linked to poor sanitation and unsafe water, are another major threat to young lives. However, the provision of oral rehydration solutions (ORS) and zinc supplements offers a beacon of hope. These treatments, costing mere cents per dose, can swiftly restore hydration and save lives. Moreover, investing in clean water initiatives and basic hygiene education provides a sustainable path to disease prevention.

Malaria, a relentless killer in many low-income regions, particularly Sub-Saharan Africa, can be effectively combated with insecticide-treated mosquito nets and prophylactic antimalarial medications. These interventions, surprisingly affordable, can drastically reduce malaria incidence and mortality among vulnerable infant populations.

Neonatal conditions, such as complications from preterm birth, infections, and birth asphyxia, highlight the critical need for improved maternal and newborn care. Skilled birth attendance, a cost-effective strategy, can prevent many such deaths. Additionally, kangaroo mother care (skin-to-skin contact) and basic neonatal resuscitation techniques offer low-cost, high-impact solutions to neonatal mortality.

Lastly, malnutrition — a pervasive threat to child survival — can be addressed through nutrition education, support for exclusive breastfeeding, and the provision of vitamin A and micronutrient powders. These interventions prevent death and promote healthy development, all at a minimal cost.

The narrative of child mortality in low-income countries is not solely one of despair but also one of hope and opportunity. By implementing these low-cost interventions, the global community can make significant strides in saving lives and nurturing the potential of millions of children. It is a testament to the power of simple, affordable solutions facing daunting challenges, offering a brighter future for the world’s most vulnerable populations.

Low-cost interventions that save lives

Pneumonia

• Vaccination: The pneumococcal and Hib vaccines can prevent many pneumonia cases. The cost can vary, but Gavi, the Vaccine Alliance, has negotiated prices as low as USD 1.5 per dose for some vaccines in low-income countries.
• Exclusive Breastfeeding: Encouraging exclusive breastfeeding for the first six months of life can significantly improve a child’s immunity. The costs here are more about education and support systems for mothers.
• Access to Antibiotics: For cases where pneumonia develops, timely administration of antibiotics can save lives. A full course of antibiotics for pneumonia treatment can cost less than USD 0.50 per child.

Diarrheal Diseases

• Rotavirus Vaccination: Rotavirus vaccines effectively prevent the most common cause of severe diarrhoea in children, with costs in Gavi-supported countries around USD 1–3 per dose.
• Clean Water and Sanitation (WASH): Providing access to clean water and promoting handwashing can drastically reduce diarrheal diseases. The cost per child can be very low when spread across communities but varies widely depending on the specific intervention and infrastructure development.
• Oral Rehydration Salts (ORS) and Zinc Supplementation: These are highly effective treatments for diarrheal diseases, costing as little as USD 0.50 for ORS packets and zinc supplements for one treatment course.

Malaria

• Insecticide-Treated Nets (ITNs): Mosquito nets treated with insecticide are a simple, effective way to prevent malaria. The cost per net is typically around USD 2–3, and each net can protect up to two children for up to three years.
• Indoor Residual Spraying (IRS): Spraying the inside of homes with insecticides can also reduce malaria transmission. The cost varies but is generally between USD 3–7 per person per year.
• Antimalarial Drugs: Prophylactic antimalarial drugs for pregnant women and young children in high-risk areas can prevent illness. The cost per treatment is around USD 0.50 to USD 1.
• Artemisinin-based combination therapies (ACTs) are the cornerstone of malaria treatment recommended by the World Health Organization (WHO) for uncomplicated Plasmodium falciparum malaria. The cost of ACTs in low-income countries varies, influenced by factors such as local policies, subsidies, the involvement of global health initiatives, and whether the drugs are purchased in the public or private sector. A typical course is just three days of treatment, and the cost to the healthcare system is less than USD 1.
• Anti-malarial vaccines: The R21 vaccine is the second malaria vaccine recommended by WHO, following the RTS,S/AS01 vaccine, which received a WHO recommendation in 2021. Both vaccines are shown to be safe and effective in preventing malaria in children and, when implemented broadly, are expected to have a high public health impact. Three to four doses are administered at USD 2 — USD 4 per dose.

Neonatal Conditions

• Skilled Birth Attendance: Ensuring that births are attended by skilled health personnel can significantly reduce neonatal deaths. Training community health workers can be relatively low-cost, with significant returns in reduced mortality.
• Thermal Care: Simple practices like kangaroo mother care (skin-to-skin contact) can prevent hypothermia in newborns with negligible cost.
• Basic Neonatal Care: Including clean delivery practices, proper cord care, and early breastfeeding initiation. The cost here is more about training and education than direct intervention costs.

Nutritional Deficiencies

• Exclusive Breastfeeding: Promoted for the first six months to provide all necessary nutrients and improve immunity.
• Vitamin A Supplementation: This can significantly reduce child mortality from all causes, with each dose costing as little as USD 0.02 to USD 0.30.
• Micronutrient Powders: Sprinkle on foods can combat malnutrition, costing about USD 0.03 to USD 0.10 per sachet.

How many children between the ages of zero to five live in low-income countries

Unfortunately, there isn’t a single, definitive source with data on the exact number of children aged 0 to 5 living in low-income countries. This is due to a few reasons:

• Defining “low-income countries”: Different classifications are used by organisations like the World Bank. These classifications can change over time.
• Data collection challenges: Gathering accurate data in low-income countries can be difficult due to resource limitations and infrastructure issues.

However, we can look at child poverty data as a proxy. UNICEF reports that 333 million children live in extreme poverty worldwide, meaning they lack necessities like food, shelter, sanitation, healthcare, and education. This data can give us a general idea of the magnitude of the problem.

What can be done?

Governments, NGOs, and civil society play pivotal roles in mitigating child mortality in low-income countries, leveraging their unique positions to initiate, support, and scale up various interventions. Here are ways these entities can collaborate and contribute effectively:

Strengthening Healthcare Systems

• Governments can allocate increased funding to health services, ensuring that healthcare facilities are adequately staffed, equipped, and accessible to the population, including remote areas.
• NGOs often work to fill gaps in healthcare provision, providing training for healthcare workers, supplying medical equipment and medications, and setting up mobile clinics to reach underserved communities.
• Civil Society can advocate for improved healthcare policies and transparency in healthcare funding, ensuring that resources are allocated effectively and equitably.

Promoting Preventative Measures

• All three can collaborate on vaccination campaigns to protect against pneumonia and measles. Education campaigns to promote breastfeeding, proper nutrition, and hygiene practices can also substantially impact the situation.
• NGOs and civil society can support the distribution of mosquito nets and conduct awareness campaigns on their use to prevent malaria, a leading cause of child mortality.

Improving Water, Sanitation, and Hygiene (WASH)

• Governments can invest in infrastructure to provide clean water and sanitation facilities, which are crucial for preventing diarrheal diseases and improving overall health.
• NGOs frequently engage in WASH projects, constructing toilets and facilitating access to clean water through wells and filtration systems.
• Civil Society can mobilise community involvement in maintaining and protecting water and sanitation infrastructure and promote hygiene practices.

Ensuring Food Security and Nutritional Support

• Initiatives to improve access to nutritious food can significantly impact child health. Governments can implement policies and programs to support agricultural productivity, subsidise essential foods, and ensure nutritional programs reach vulnerable populations.
• NGOs may provide direct food aid, support school feeding programs, and teach sustainable farming techniques to communities.
• Civil Society can raise awareness about malnutrition, advocate for policy changes, and support community-based nutrition and gardening projects.

Education and Empowerment

• Educating girls and women has a profound impact on child health outcomes. Governments can ensure equal access to education, while NGOs can provide scholarships or support for girls’ education.
• Civil society, including local communities and parent groups, can advocate for educational reforms and support initiatives that empower women and girls.

Advocacy and Policy Influence

• Civil society organisations can lobby for policies prioritising child health, including environmental protections to reduce pollution and combat climate change, which impacts children’s health.
• They can also be crucial in holding governments and international bodies accountable for their commitments to child health and rights

Collaboration across these sectors is crucial for creating sustainable change. By pooling resources, sharing knowledge, and coordinating efforts, governments, NGOs, and civil society can significantly reduce child mortality rates and improve health outcomes for children in low-income countries. Their combined efforts can address the root causes of child mortality, ensuring that children have the chance to lead healthy, productive lives.

Concluding

The stark reality of child mortality in low-income countries, particularly among infants aged 0 to 5, represents a profound global health challenge. Yet, as outlined, the breadth of low-cost, highly effective interventions available to combat this crisis offers a beacon of hope. These interventions, ranging from vaccinations and exclusive breastfeeding to access to clean water and nutritional supplements, underscore a critical truth: the power to reduce child mortality significantly is well within our grasp.

Moreover, the detailed strategies for pneumonia, diarrheal diseases, malaria, neonatal conditions, and nutritional deficiencies illustrate a clear path forward. The low-cost solutions presented are feasible and offer a high return on investment regarding lives saved and improved health outcomes. The role of artemisinin-based combination therapies (ACTs) in treating malaria, the impact of skilled birth attendance on neonatal survival, and the potential of vitamin A supplementation to bolster child health further highlight the array of tools at our disposal.

The task ahead requires a concerted effort from governments, NGOs, and civil society. Through increased funding, the implementation of health programs, advocacy, and education, these stakeholders can change the trajectory of child health in low-income countries. The call to action is clear: by embracing these low-cost interventions and fostering collaboration across sectors, we can address the root causes of child mortality and ensure that every child has the opportunity to thrive.

This collective endeavour presents a compelling opportunity to redefine the future for millions of children in low-income countries. As we move forward, let the narrative of child mortality be one not of despair but of hope, action, and profound transformation. Together, we can turn the tide against these preventable tragedies, paving the way for a healthier, brighter future for the world’s most vulnerable populations.

The post Main Cause of Death in Infants Ages Zero to Five in Low-Income Countries; Hope for a Better Future appeared first on Medika Life.

Attending the ENBEL (Enhancing Belmont Research Action to support EU policy-making on climate change and health) conference in Brussels, which focused on ‘Health Impacts of Climate Change — Advancing the European Adaptation Agenda to 2030,’ profoundly heightened my awareness of the pressing need for more robust financial resources in health adaptation to climate change. The conference unequivocally illuminated that current levels of health adaptation funding for addressing climate-related challenges are woefully inadequate.

New research, funded by ENBEL, provides concerning evidence that only a tiny fraction of international climate adaptation financing has been directed towards health needs over the past decade. Analysing data from 2009–2019, just 4.9% of multilateral and bilateral climate adaptation funds went to health projects globally. This equates to only US$ 1.4 billion out of over US$ 29 billion in total adaptation financing over a ten-year period. Worse still is the pitiful amount for projects with explicit health objectives, just US$ 0.1 billion.

Not only are overall volumes low, but very little targets core health system needs. Projects where health was the primary focus made up only 0.5% of multilateral climate funding, mostly for infectious disease control and surveillance. Vital areas like heat warning systems, climate-resilient health facilities, expanded mental health services, and local community health adaptation still lack investment.

The implications are troubling. As the Lancet Countdown on Health and Climate Change clarifies, climate change already contributes to disease, death, and health inequality worldwide. The Lancet Countdown tracks health financing via an indicator, showing a year-on-year increase in health adaptation spending from 4.6% in 2015–2016 to 5.6% in 2020–2021. However, more is needed to manage the health burden of recent climate events.

Sub-Saharan Africa faces an especially heavy burden yet still needs commensurate international support. The World Bank predicts the region will incur 80% of the global rise in climate-linked malaria and diarrheal disease by 2050. This will further strain overburdened health systems.

Adaptation financing can help change course. Funding water and sanitation systems adapted for climate extremes reduces water-borne illness. Warning systems allow preparation for heat waves and disasters. Resilient clinics maintain health services through storms and floods. We have the knowledge and tools for health adaptation but need the resources to implement them at scale.

Some progress was made at COP27, with a breakthrough agreement on a new “loss and damage” fund to support climate-vulnerable developing countries. But major gaps remain. Health ministries have yet to fully access climate funding opportunities, whilst health benefits often remain assumed, not measured, in many adaptation projects across sectors like agriculture and water. Accurate tracking of health financing is essential to verify where money flows.

Addressing the shortfall in climate funding for health adaptation is a shared responsibility that extends well beyond the donors. It’s imperative for governments in developing countries to prioritise health adaptation in their national climate plans and investments. Health leaders have a role in better articulating the risks and suggesting viable solutions.

Above all, the broader ecosystem of health financing — encompassing governments, global health organisations, and corporations — must internalise that climate resilience is not a separate issue but an integral component of strengthening health systems and achieving universal health coverage. As we ponder the pivotal question raised in the beginning — where will the needed funds come from — it’s clear that our collective health depends on an inclusive, multifaceted approach to financing climate resilience.

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Doctors still struggled to keep me alive as my fever spiked to 105 degrees Fahrenheit and my resting heart rate hovered around 175. I had multiple intravenous bags of quinine dripped into me, a routine treatment that brought with it the unfortunate risk of sudden cardiac arrest due to my infection while on Larium, a controversial and, in hindsight, ineffective antimalarial drug.

It’s a massive understatement to say malaria sucks, but I am among the lucky ones who get to say it at all. Malaria remains one of the greatest public health threats facing humanity, infecting 241 million people each year and inflicting incalculable damage on the economic prospects of endemic countries. If my description of malaria sounded bad, how could a 4-year-old kid battle the disease without most of the resources I had in Kinshasa? Most of the 500,000 people killed yearly by malaria are children under 5 – a vicious toll on future generations.

That’s why this week’s announcement by the WHO approving the use of a second malaria vaccine is astoundingly good news. Since the introduction last year of Mosquirix, the first-ever malaria vaccine brought to market by GSK last year, health officials have been trying to balance the limitations of the vaccine – both in efficacy and supply – with the high cost and urgency to get it distributed. With the approval of R21/Matrix-M, developed by the Serum Institute of India, Oxford University and Novavax, comes the potential for greater price competition and sufficient supply.

The news couldn’t come soon enough. As climate change expands the habitat of malaria-carrying mosquitos, two issues are rapidly emerging. First, regions that have been malaria-free for decades – or have never experienced malaria – will be in the projected range of vector-borne diseases within a matter of years. These include North America and parts of Europe. At the same time, the overuse of prophylactic medications, such as chloroquine-based drugs, is fueling increased resistance in regions such as Southeast Asia.

Second, malaria primarily afflicts rural communities in many areas where malaria is endemic. No longer. Researchers are now tracking new forms of malaria that are settling in densely populated urban areas. This is a potential tectonic shift in the threat that vector-borne disease poses to sustainable economic development and health system resilience. Seasonal outbreaks may crash worker productivity, shutter universities, and overwhelm hospitals.

The two approved malaria vaccines may help prevent the worst-case scenario looming in our future, but they are not solutions by themselves; they are part of a Swiss Army knife of tools that public health officials are deploying to contain malaria. Some, like insecticide-treated bed nets, provide trusted, low-cost and accessible interventions for low-income populations worldwide. Other theoretical options, such as genetically modifying male mosquitos or making humans “invisible” to the insects, may prove more effective in grabbing headlines than protecting communities. But with more volatile weather patterns and increased resistance fueling a surge in malaria mosquitos, nothing should be off the table or dismissed out of hand.

Why is malaria prevention more than a feel-good development story? The answer to that question lies in a simple calculus. Most of the potential for future economic growth will come from markets in the Global South. Several countries in Africa, Latin America and Southeast Asia represent a surge in young, increasingly educated and upwardly mobile consumers. The rise of megacities and other large urban centers can focus economic productivity, but such concentration also dramatically increases the impact of widespread, uncontrolled disease outbreaks.

The implications for the business community are clear. As we saw with COVID-19, the potential for disease outbreaks to cause prolonged economic disruption is high. And the ripple effects are extensive. Vector-borne diseases such as malaria are not the same as the next pandemic threat, of course. Thankfully we have a variety of tools to prevent and treat malaria.

The imperative now is to make sure we apply a greater sense of urgency and policy support to fund the research and mitigation programs that are necessary to protect vulnerable populations today, as well as the growth markets of tomorrow. This requires the global business community to become vocal champion for public health initiatives that help blunt a future where disease-carrying mosquitos can derail the economic vitality of the next generation of consumers.

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How was Salk’s vaccine received? Researchers said it was “junk science” and tended to dismiss it, favoring the live virus from Sabin’s lab. Not only was Salk’s vaccine safer, but it was also quickly manufactured and readily available to the public. But the dueling virus controversy lasted until the 1990s when Sabin’s vaccine was discontinued because it could infect others.

The Salk vaccine was involved in an unprecedented 1.8 million children in a human experiment to test its effectiveness. Salk had already tested the vaccine on himself and his family, and none developed polio.

The problem with the notable presence of the polio virus in NYC wastewater is that other countries worldwide still use the Sabin vaccine. Traveling and being vaccinated abroad means the virus has carriers that, unwittingly, bring the virus back to the US. Once here, it quickly enters the wastewater system and can spread the virus to the unvaccinated.

How many know about the 1949 polio epidemic that swept the nation and placed infants in iron lungs? The huge tubes, in short supply, were airlifted from location to location as the virus spread with unprecedented speed, striking the nation’s young. A complete explanation of the virus and how it attacks the body can be viewed here.

From 1916–1919, over two thousand people in New York City, primarily in Brooklyn, died from polio infection, which, thanks to the Industrial Revolution, drove people to cities where they were packed into poor living situations, a lack of nutrition led to disease and sewage quickly carried the virus into homes.

Does that sound familiar? Is wastewater carrying the virus throughout apartment buildings and into homes? Yes, it can last up to one week in those situations. Infection is as close as your sewer system. Other viruses can still live on surfaces, including clothing and towels.

What other virus is being discovered anew in the sewage systems of the US and abroad? Yes, it’s Covid-19, and just like polio, the human waste in the sewage systems carries the virus to distant areas from its origin in someone’s home. As I write, New York state has to combat both polio and Covid-19 in its wastewater.

Up to 30 percent of those infected have no symptoms, and therein lies the main problem. If someone isn’t sick, they don’t think they need to be vaccinated or take steps to protect others by keeping a safe distance or wearing a mask.

The Covid-19 virus has mutated as all viruses do, and the new iterations present new challenges. These mutations have managed to either disguise themselves or, in other ways, avoid the body’s immune system protection and the vaccines that depend on this for our safety.

To ward off the iterations, new innoculations will continue to be needed and, conceivably, into the future. Each fall will bring a new-and-improved vaccine for the still mutating viruses. Viruses don’t stop mutating.

Those who have received misinformation about vaccines and refuse to be vaccinated will continue to present agreeable hosts for the viruses while endangering others.

Politics and business have failed to adequately address this enduring danger in a wish to reassure the general public and get all of us back to business. In my opinion, the CDC’s efforts have been poor, and a shuffling of management has already begun.

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One of the phrases I tell myself came directly from a Maternal Fetal Medicine (MFM) attending, and anyone who trained at MSU has heard this.  “It’s better to have a living patient without a uterus than to bury them with it.”  I remember my intern year and the first time I heard this phrase.  It seemed so obvious to me.  Of course, I would do a hysterectomy to save someone’s life.  

I was chief rotating on the MFM service during my third year of residency.  We arrived early to conduct medical rounds, check patient vitals, ensure fetal status was stable, and plan for the day ahead.  We had been watching a patient for premature rupture of membranes (PPROM).  She had a very desired pregnancy and was seven weeks away from the fetus being able to survive outside of the uterus.  I was rounding with an amazing attending, and she was precise, detail-oriented, and focused on doing the right thing.  She spoke about all the pregnancy options with the family daily.  

She was keenly aware of the risks of continuing a pregnancy with PPROM.  One of the risks of this pregnancy is infection.  If the bag of water, the amniotic sac, is broken, then there is an open area where bacteria can take hold.  Unfortunately, this infection can become significant and risk the mother’s life.  

One day, this very thing happened to our patient.  Once an infection starts, patients often have more pain, uterine tenderness, and vaginal discharge.  Sometimes people will begin bleeding and can hemorrhage.  The uterus is a muscle; if infected, you can imagine, it will respond with contractions.  

At the same time, the infection could spread through the patient’s body.  This is something called sepsis.  A patient’s heart rate goes up, blood pressure can go down, and chills, dizziness, and a loss of consciousness can occur.  People can develop shortness of breath, nausea and vomiting, diarrhea, and other dangerous symptoms.  As sepsis progresses, organs can start shutting down.  When septic shock appears, mortality is between 30-50 percent.  

Physicians need to be trained to notice when someone is becoming sick and developing an infection.  The concern is the progression of the infection to shock and death.  In some states, the legislation is so vague that physicians wait for patient instability to act.  In Missouri, an ectopic pregnancy was being observed, and physicians felt like they couldn’t legally act until someone showed changes in their vital signs and hgb dropping, which means bleeding internally.

Now, imagine the physician unable to act to save a life – confused – confused by the ambiguity of state law – not medical best practice.  Imagine years of training and oversight; the patient must be shunted aside for procedures and policies. Will the residents of the future be trained to turn an eye to a primary medical credo written millennia ago and guiding skill and mission? “Do no harm.” 

These pregnancies aren’t viable, meaning the fetus will not survive outside the patient’s body.  If the patient dies, the fetus dies.  We are handicapping physicians from practicing evidence-based medicine.  We are putting people at risk, even in our hospital systems.  Who is going to be held accountable for this? Who will take responsibility for the impossible position healthcare workers are in?  

We should be acting in the best interest of our patients, always. 

Physicians specializing in women’s health should be part of critical policy conversations.  We are endangering the lives of the American people.  Laws created in 1849, like in Wisconsin, have no business regulating what a physician can and can’t do in modern-day healthcare.  Let healthcare be provided by the people who trained their whole lives to provide it.  Hospitals, administrators, nursing staff, and physicians need to meet and develop ongoing policies to handle things in a timely fashion instead of waiting for life-threatening events to happen.  

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Now, Amanda leads a global team working to make the world safer from the next epidemic while also urgently responding to COVID-19. Medika Life Editor-in-Chief Gil Bashe spoke with Amanda on the challenges facing public health efforts around the world.

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Gil Bashe:  Amanda, I would like to talk about the core problems that you and Resolve to Save Lives work to address. Let’s talk about why these problems are critical to public health globally, why we have to be much more aware of them, and what’s at stake for the world if we neglect to address the challenges that Resolve to Save Lives has decided to shoulder?

To start, what brought you to global public health? I know you’ve worked with very established organizations like the International Red Cross in the past. Can you talk a little bit about the mindset and transition for a moment?

Amanda McClelland: It’s a good question. Like many people who worked in West Africa during the Ebola epidemic, it raised several issues centered around how to make sure something like that didn’t happen again.

As part of the International Federation of the Red Cross, our work needed to scale across 90 – 100 countries with 17 million volunteers. The work is at the community level, which is so critical. Yet, it was missing a connection point into government systems and structures. We’ve led a lot of advocacy and tried to put communities at the center of our efforts, but it didn’t move beyond the kind of rhetoric of “communities are important.”  There was nowhere for communities to engage inside the existing architecture, whether that be at a domestic or global level.

After 15 years of responding to outbreaks, I’ve been going back to the same countries for different reasons. I worked in Sierra Leone from 2012–to 2013 during a very large cholera outbreak. I was back there in 2014–2015 for Ebola. And despite this, the recovery that we talked about didn’t fit sustainably.

Dr. Thomas Frieden approached me about joining Resolve to Save Lives with a focus on strengthening community systems and targeting preparedness as a full-time position, tapping into my real-world experiences. This was an opportunity to try to make sure that we weren’t going back to the same countries over and over again, and that we were building systems that could detect diseases and respond sustainably.

Bashe:  You and Resolve to Save Lives recently launched an important campaign.  You’ve just taken on non-communicable disease and specifically cardiovascular disease. That is rare when people are frightened about the next pandemic.  Too often we forget to recognize that 70 to 80% of people around the world perish from non-communicable diseases such as heart disease, diabetes, respiratory disease, and mental health illnesses.  Now you are elevating the conversation around cardiovascular disease, why?

McClelland: So often people think it’s a bit strange that we work in two areas, preventing epidemics and cardiovascular illnesses. You’re right, we picked two problems where we think we can save the most lives. COVID-19 has shown us the absolute relationship between infectious diseases and the health of a population.

The impact of COVID’s abilities or mortality from COVID is a stark reminder that a healthy community is critical. Social cohesion and community engagement are at the center of all public health problems. And that comes through in cardiovascular disease and epidemics.

Bashe: I find this to be fascinating because when talking about people most at risk for COVID severity or death, tragically often we talk about people with chronic illnesses, it could be obesity, it could be cardiovascular disease, it could be diabetes. Together these comorbidities are tipping points leading to COVID-related death.

McClelland:  I’m a primary health care nurse by training, so I go one step further and look at those individuals who have chronic conditions—those people who get asked to come back in six months.

What’s the root cause of that? Many of these people, don’t have access to care promptly. They don’t necessarily have good health literacy, good nutrition advice, or access to nutritious food. We know that COVID is disease oriented. But we need to understand that there is a relationship in many countries between low socio-economic indicators, access to care and the increasing amounts of chronic diseases that can easily become acute—like they did during COVID-19—and overwhelm the health system.

We must provide clinical care along with public health interventions for those diseases and start collaborating more effectively. And we think about this as a spectrum, from prevention to early detection and early treatment, all the way through to chronic care and palliative disease. If we don’t start working together, we’re going to lose people through the cracks and that’s where it becomes acute.

Bashe: Great answer. I know you recently had a campaign in Africa and as a global organization, could you talk a little bit about the work you’re doing in Africa?

You know I’m a very big believer that when we look at health, we tend to look at the health of the developed world. There are many problems in ensuring health in the developed world, and among developing nations. They are working to put together infrastructure. I would appreciate your perspective about developing and developed but also why Africa specifically?

McClelland: So, my opinion on this is changing quite a lot and I’ll give you one example. When COVID started, I was working in lower-middle-income developing countries.

For the last 15 years, even in Australia, I worked with indigenous communities that you could say were sometimes worse. I lived in an Aboriginal community, which had massive health challenges and an inexcusable disparity between aboriginal health and the white population in Australia. But when we started the COVID-19 response, Dr. Frieden came to me and said we were going to start responding in the U.S. because New York was getting hit extremely hard.

I said I can’t. I haven’t worked in a high-income country for many years, I don’t understand the American health system. We don’t have anything to add in this context. But we did it. We mobilized a team of 45 people and supported numerous activities at the local level across partner jurisdictions. We ran two different teams—a U.S. team and a global team. We wrote two different sets of guidance—guidance for high-income countries and guidance for low-income countries.

After the first eight weeks, we realized the challenges were similar. High-income countries don’t necessarily have highly resourced public health departments. The public health departments here in the United States are completely underfunded and understaffed. The challenges that we face in Uganda, Liberia and Nigeria were actually to manage because there was a lack of bureaucracy. Teams knew how to collaborate with partners and how to accept outside help. They were able to accelerate through the challenges, trying to supplement like high-income countries.

Across the board, the fundamental challenges remain the same—poorly paid and under-staffed public health systems. Core data infrastructure, the ability to manage data and the ability to make good decisions on that data are commonalities that we all face. We have more in common than we think. There are different challenges in terms of access and cost of care, but not from an epidemic prevention perspective, and also from a chronic disease perspective. Moreover, the under-resourcing of public health is common across many, many developed and developing countries.

Bashe: Could you talk a little bit about what you’ve been doing in Africa, specifically?

McClelland: When we were first starting Resolve to Save Lives, we looked across the globe at where we, as a small but nimble non-governmental organization (NGO), could add the most value. Through an initial assessment, we realized the burden of infectious diseases in Africa, so that was a logical place to start.

When the COVID-19 pandemic began, it became clear that the missions and social measures that developed countries were going to put in place to control COVID would have a significant secondary impact in low-income countries that would make it extremely difficult to maintain.

And so very early on in our work in the pandemic, as early as 2020, we joined up with Africa CDC, WHO Africa, World Economic Forum and several product companies, including IPSOS, as part of the Partnership for Evidence-Based Response to COVID-19 (PERC) to collect data on how public health and social measures would be implemented on the continent.

We wanted to measure both the epidemiology and the secondary impacts such as food insecurity and education disruptions. So, we started our work in Africa with regular large-scale surveys during the pandemic, which we did in four waves across 20 countries. We were able to provide decision-makers with enough data to make balanced decisions. Balancing risk and corporate control against the secondary impacts that those measures caused, strengthened our understanding that the pandemic was not just a health issue. It was also a political and social issue that required data and information from all sides to be able to make informed decisions.

Bashe: And what have been some of the results, I mean that’s the program but how do you see the impact of your efforts?

McClelland: We spoke to the World Bank on global funding and others in terms of where we were seeing change on the ground. We noticed that countries that did very well at the beginning of the pandemic were those that leveraged their public health to enforce social measures. They quickly had political support.

There was a large amount of public trust in most of the countries with the initial government response. But we also saw economic impacts in those countries along with security incidents. While strong trust in the public health system improves outcomes, people’s behavior was also impacted by their ability to meet their daily needs. You can only protect yourself from COVID if you still have enough food and enough fuel, etc.

We have to make decisions based on risk, and we saw the risk perception of the community go up and down with the various waves of the COVID Delta wave. We also see political disruption move up and down with the epidemic curve, along with secondary impacts, as governments turned on and off safety measures. It reinforced the idea that we cannot make these types of decisions just based on cases or deaths.

Every country must find a balance for what works for them in terms of balancing out access to economic opportunities and food and security against what they will accept as a level of COVID. And we’ve seen examples of that. New Zealand versus the United States varies in terms of how they managed COVID and the economic impacts, but also the absolute mortality that caused them.

There are varying thresholds of what is acceptable in different communities. Some communities accepted zero deaths and, in some places, 1,500 deaths a week is still the norm and things are getting back to normal. It is important to understand that pandemic control is a choice that’s driven by politics and communities. And that was a difficult realization for many, that the dependency wasn’t wholly and solely within the health domain, that we were one actor of many trying to influence how this was controlled.

Bashe: When you look at the next six months to a year, what do you hope to achieve?

McClelland: We hope to have this recognized as a once-in-a-generation opportunity to build forward better and to make sure that we recognize the threat that biology still has to us—that we haven’t outsmarted the germs, so to speak.

There are things that you can do to control the risk to make sure that we’re better prepared, to make sure that individuals and systems are more resilient. We have this opportunity in the next six months. We must harness the political will, the financial resources required and the lessons that we’ve learned during COVID to make sure that we build a more protected and healthier world. There is a significant risk that we don’t learn any of these lessons and then we go back into this cycle of panic and neglect. The next six months are so critical for us.

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The next six months may be critical for us.  Keep watching the work of Resolve to Save Lives and their in-the-trenches team to see the progress that they are making to sustain and save lives around the world.

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