Seeing the terms “viral haemorrhagic fever” and “west Africa” together will conjure grave images for our readers. The 2013–16 Ebola virus disease epidemic was an unprecedented event, not only in terms of illness and death but also for showing the frailties of international preparedness for infectious disease outbreaks. Nigeria is in the midst of its largest ever outbreak of Lassa fever. At the same time, a mooted 80% cut to the US CDC's Global Health Security Agenda threatens to create a vacuum in essential epidemic mitigation activities.
The Global Health Security Agenda was launched by the USA in 2014, with additional funds from the G7 nations. Its aim is to strengthen national and international capacity to prevent, detect, and respond to infectious disease threats through, among other things, training health-care workers and establishing reporting systems. It has helped improve surveillance and response to outbreaks of infection across more than 50 countries.
But funding for the CDC's work on the Global Health Security Agenda is set to end in 2019, and under the Trump administration's America First approach there is little prospect of renewal. As a result, the CDC is facing a huge reduction in its contributions in 39 of the 49 countries where it operates (including China, Haiti, and DR Congo), according to a report in The Wall Street Journal. Without the CDC, key relationships and expertise will be lost.
The timing of this news is all the more notable as it comes during Nigeria's Lassa fever epidemic. From Jan 1, to March 4, there have been 1121 suspected cases of Lassa fever in Nigeria. 353 have been confirmed with another eight probable, including 86 deaths. The disease has been reported across 18 states but is focused in the south, in Edo (44% of cases), Ondo (25%), and Ebonyi (16%). Cases have also been reported recently in Benin, Ghana, and Liberia, but whether these cases are related to the Nigerian outbreak is unclear.
Lassa virus—the cause of Lassa fever—is considered a pathogen with epidemic potential. It is listed as a priority pathogen on WHO's R&D Blueprint, which aims to fast-track research during epidemics. It is also one of the Coalition for Epidemic Preparedness Innovations' (CEPI's) three targets for vaccine development (currently, there is no vaccine for Lassa fever). CEPI recently announced its investment of more than US$37 million in Themis Bioscience, which will support the development of vaccines for Lassa fever and Middle East respiratory syndrome up to phase 2 trials. In short, Lassa fever is precisely the kind of pathogen that the Global Health Security Agenda is designed to counter.
The Ebola epidemic took hold largely in post-conflict countries with extremely weak health systems and no experience of handling the disease. By contrast, Lassa fever is endemic to west Africa and Nigerian health officials have dealt with outbreaks before. Although the Nigerian health system has its shortcomings, it has more than ten times the number of doctors per person than Liberia and Sierra Leone and is better prepared for global health emergencies. Indeed, Nigeria was quick to contain the Ebola virus infections that spread to the country in 2014. The Nigerian CDC, established only in 2011, has responded quickly, establishing dedicated treatment units, tracing contacts of patients, and enhancing surveillance. WHO is deploying personal protective equipment to prevent nosocomial transmission, advising on enhanced infection and control measures, and lending technical expertise. The epidemic is not yet the threat to regional and international health that Ebola was. Next time, the global health community may not be so lucky.
The acceleration in R&D borne out of the Ebola virus disease epidemic, such as the WHO R&D Blueprint and CEPI, are an essential part of pandemic prevention. New research, such as a study of renal damage in patients with Lassa fever by Peter Okokhere and colleagues published on March 6, is advancing our understanding of the disease. But new high-tech treatments, diagnostics, and vaccines will not be enough. Strengthening health systems, ensuring basic laboratory capacity, and sharpening surveillance and emergency responses are also needed—just the sort of activities that the Global Health Security Agenda is working to ensure. The US administration seems intent on pulling away from its primacy in global health security. Who will fill the void?
For the Wall Street Journal report on the CDC cuts see https://www.wsj.com/articles/cdc-to-scale-back-work-in-dozens-of-foreign-countries-amid-funding-worries-1516398717
For the latest data on the Nigerian Lassa fever outbreak see http://www.ncdc.gov.ng/diseases/sitreps/?cat=5&name= An%20update%20of%20Lassa% 20fever%20outbreak%20in%20Nigeria
For more on CEPI's announcement see http://cepi.net/cepi-partners-themis-bioscience
For more on the relative strength of Nigeria's health system see http://apps.who.int/iris/bitstream/10665/255336/1/9789241565486-eng.pdf?ua=1
© 2018 A B Dowsett/Science Photo Library