Bill & Melinda Gates Foundation

How to Prevent the Next Health Crisis

August 07, 2014

The Ebola epidemic sweeping through West Africa is causing understandable panic in local communities and international concern about the future spread of this killer virus. Yet there’s another disease which has been more deadly this year. One that nearly cost me my medical career, and which – unlike Ebola – can be easily prevented.

 This represents a completely man-made real health threat, and could end up being far more destructive than the current Ebola epidemic.

As a young medical student in Nigeria, I contracted cerebro-spinal meningitis (CSM), eventually falling into a coma for two weeks. When I regained consciousness, I had temporarily lost my hearing. This was lucky; some other patients lose their lives.

Epidemic CSM is common in Northern Nigeria which lies in a climate zone known as the meningitis belt cutting across the northern parts of West Africa. In this region CSM is spread through the air among people with close contact. I probably caught it, through either a viral or bacterial infection, on my long bus ride to medical school.  

Even when the disease is diagnosed early and treated, up to 10 percent of patients die. At this moment, Nigeria, my home country, is battling the largest outbreak in recent times; this year alone there have been more than 1,000 cases and nearly 100 deaths. 

In the meningitis belt there have been nearly 12,000 cases with more than 1,000 deaths—surpassing the toll of the current Ebola outbreak. Though the numbers paint a scary picture of mounting health crisis, there is a solution. Cerebro-spinal meningitis is a vaccine preventable disease (VPD).

That’s why the recent World Health Organization (WHO) report sent shivers down my spine. According to that report, across the globe, nearly 22 million children around the world were not vaccinated last year, leaving them vulnerable to killers including measles, diphtheria, typhoid and meningitis.

Without vaccines, we are vulnerable

This represents a completely man-made real health threat, and could end up being far more destructive than the current Ebola epidemic.

In Nigeria, as in many developing nations, poverty, limited education, the lack of political will and pseudo-religious extremism by groups such as Boko Haram, have impeded the delivery and adoption of effective health interventions such as vaccination for CSM and other diseases. Nigeria has joined Pakistan and Afghanistan to become a center for the resurgence of vaccine-preventable diseases such as polio, and an example of how political insecurity can work against health equity.

In the United States, impediments to universal vaccination take the form of another kind of religious extremism, along with concerns about vaccine safety and a general mistrust of government. These have lead to the recent Texan measles epidemic. Conclusive evidence from large-scale research has shown that vaccines do not cause autism or sudden infant death syndrome. Yet The Centers for Disease Control and Prevention (CDC) continues to work hard to allay public anxiety about vaccine safety.

 Let’s not forget the 22 million kids who didn’t get vaccinated last year. Like me, many of them aspire to great things in the future -- a future that may never come if we don’t give it some shots.

According to the CDC, certain diseases like polio and diphtheria are becoming rare in the developed world thanks to aggressive vaccination programs. But vaccinating against these diseases remains a crucial endeavor. 

Vaccines stop the leak

I like to compare vaccination to bailing out a boat with a slow leak. When we started bailing, the boat was filled with water. But we have been bailing fast and hard, and now it is almost dry. We could say, "Good. The boat is dry now, so we can throw away the bucket and relax." But the leak hasn't stopped. Before long we'd notice a little water seeping in, and soon we’d be awash again.

It’s happened before. In 1974, Japan had a successful pertussis (whooping cough) vaccination program, with nearly 80 percent of Japanese children vaccinated. Then rumors began to spread that the vaccination was no longer needed and that the vaccine was not safe, and by 1976 only 10 percent of infants were getting vaccinated. In 1979 Japan suffered a major pertussis epidemic, with more than 13,000 cases of whooping cough and 41 deaths. In 1981 the government began vaccinating again, and the number of pertussis cases dropped.

With smallpox, we "stopped the leak" in the boat by eradicating the disease with vaccination. Our children don't need smallpox shots anymore because the disease no longer exists outside of a few labs. If we keep vaccinating now, we can eradicate other diseases, and in the future parents may be able to trust that diseases like polio and meningitis won't infect, cripple, or kill children.

The opportunity of vaccines

For now Ebola cannot be prevented by a vaccine, which is one of the reasons it is so terrifying. But diseases such as CSM can. As a physician, I fear that we’re losing ground in the fight against preventable disease. But I also see an opportunity to safely and inexpensively make people’s lives better with vaccines. We can start by engaging with more religious leaders to encourage vaccination. More importantly, we must invest in job creation to bring families out of poverty. When a family is hungry, vaccination is their last priority. In the meantime, we must ensure that everyone has access to vaccines, no matter their income or location.

Let’s not forget the 22 million kids who didn’t get vaccinated last year. Like me, many of them aspire to great things in the future -- a future that may never come if we don’t give it some shots.

 
  • Tags nigeria, Vaccines
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