The closure of the 20th Century has taught us many lessons about infectious diseases and their resilience in the face of defeat. The heady victories of 1950s, 1960s and 1970s over smallpox, malaria (northern hemisphere), yellow fever, dengue, cholera, TB, plague and other major infectious diseases being declared won.
The declaration contributed to the initiation of increasing apathy and complacency in the last three decades of the 20th Century – public health infrastructure and hygiene deteriorated to the point where they provided little protection against infectious diseases.
There was a public health paradigm shift from treatment of diseases to surveillance and emergency response introduced as a recommended method of controlling epidemics. There was the redirecting of resources from infectious diseases to non-communicable diseases and public health priorities. The fuel of epidemics was added – unprecedented population growth, unplanned urbanisation, modern air transport of people, animals and commodity (Globalisation).
The jet airplane travelled faster and provided the ideal mechanism to transport pathogens(germs) to new geographic regions and as globalisation increased and so too did the movement of pathogens among centres of the world and the jet became a ‘Petri dish’.
In late December last year, the world woke up to a new disease ravaging Wuhan City, Hubei Province in China and the culprit, as usual, a virus-unconventionally named by the media coronavirus later baptised on February 11, 2020, by World Health Organisation (WHO) as ‘COVID-19’ still improper name compared to the generic naming’s eg Ebola virus.
Learning from the mistakes of the West African Ebola outbreak, WHO through its International Health Regulations Emergency Committee, declared it a Public Health emergency of International Concern on the January 30, 2020. The outbreak caught the scientists with little surprise and public health specialists with what they have often anticipated - the danger of emerging and re-emerging diseases due to our culinary behaviours, ease and extreme mobility of the summative global population.
The global population is like a ‘wave in the sea’, the population and its health move in tandem. Long gone is disease now a confinement of human habitation, race and societal reach.
There are many factors that have contributed to the emergence of epidemics, but only three have been the principal drivers: urbanisation, globalisation and lack of effective controls of global human movements – ‘the unholy trinity’.
While crowded human settlements are today’s established norms of urbanisation, especially in Africa, these intimate living is associated with ideal settings, which provides for ‘pooling’ of diseases – in this case viruses and periodic generation of epidemics, which occasionally can trigger global pandemics. Cities have modern airports were tens of millions of passengers pass each year, providing ideal mechanism for transportation of viruses to other cities, continents and regions where there is little or ineffective controls.
The world now is a floating Petri-dish unless we change our culinary and settlement behaviours to conform to the legal laws and laws of nature. Let’s delve into two sticky issues; an issue for Public Health Laws,’ which directly derive from enforcement and natural laws, which governs the world of serenity of nature.
The current epidemic of COVID-19 and secondly, the previous outbreaks of Ebola and measles all relating to environment; either environment of food collection and gathering or environment of habitation hence my conviction of legal laws and laws of nature vis-a-vis reinforcing each other. How do we then reverse the trends – several things must be done, but we shall zero in on only two aspects:
Public health specialists, policy makers, policy analysts, political heads should pay attention to travel medicine with redesign of our public health facilities, for example, the movements of viruses and vectors via people travelling by air must be given priorities, especially in ‘Hot Zones’, – airport designs, and security – the VVIP/VIP are the most travelled and they must be the most screened.
Second, outbreak of epidemics and pandemics should help policy makers and analyst to focus on redesigns of our towns, municipalities and cities so that empathy for human habitation is corroborated with rights movements of human settlement. The ‘lock down of Wuhan City, Hubei Province in China with a total population of Uganda and South Sudan combined, is a new unprecedented public health enforcement, which many governments in Africa may not do due to politico-economic reasons.
Should public health laws be above other constitutional laws when it comes to epidemics and pandemics? These are questions to be answered in emerging and re-emerging infectious diseases. There is need to deliberately re-design urbanisation programmes, population growth programmes and reproductive health services to become Hollier in the Trinity.
Policy makers must develop the political will and provide the support needed to develop, implement and maintain these programmes.
Dr Elima is director Gulu Regional Referral Hospital. firstname.lastname@example.org