Search

Rift Valley fever (RVF) is a devastating zoonotic mosquito-borne viral hemorrhagic fever disease that threats human and animal health and biodiversity in Africa, including in Rwanda. RVF is increasingly outbreaking in Africa, leading to devastating impacts on health, socioeconomic stability and growth, and food insecurity in the region, particularly among livestock-dependent communi-ties. This systematic review synthesizes existing evidence on RVF's epidemiology, transmission dynamics, and the prevention and control measures implemented in Rwanda. Our findings high-light the rapidly increasing prevalence of RVF and the expansion of its geographical distribution and host range in Rwanda. Furthermore, the review reveals gaps in local evidence, including the existence of competent vectors of RVFV and the risk factors associated with the emergence and spread of RVF in the country. This underscores the urgent need for prospective research to inform evidence-based health policymaking, strategic planning, and the development and implementation of cost-effective preventive and control measures, including diagnosis and surveillance for early detection and response. It also calls for the institutionalization of a cost-effective, multisectoral, and transdisciplinary One Health strategy for reducing the burden and risk of climate climate-sensitive and zoonotic diseases, including RVF, in the country. We recommend exploring cost-effective human and/or animal vaccination mechanisms for RVF, integrating AI-powered drones into dis-ease vectors surveillance and control, and the routine implementation of genomics-enhanced xenosurveillance to monitor changes in pathogens and vectors dynamics in order to inform poli-cymaking and guide the control interventions. [ABSTRACT FROM AUTHOR]

Objectives: Arboviruses pose a significant global health challenge. This study investigated the seroprevalence of major human arboviral infections, including yellow fever (YFV), dengue (DENV), Crimean-Congo hemorrhagic fever (CCHF), Rift Valley fever (RVF), West Nile virus (WNV), and chikungunya (CHIK), in Darfur region from September to December 2018. ELISA-IgM was used to detect antibodies. RT‒PCR was used to differentiate YFV infection from vaccine-immuno-response in IgM samples. Results: A total of 152 blood samples were collected, with 123 (80.9%) from males and 29 (19.1%) from females. The participants were grouped by age: 50 (32.9%) were under 20 years, 96 (63.2%) were aged 20–45 years, and 6 (3.9%) were over 45 years. The seroprevalence rates for YFV, DENV, and CHIKV were 68 (44.7%), 23 (15.1%), and 5 (3.3%), respectively. There were 11 molecularly-confirmed YFV cases (7.2%). Among these, 3/11 were positive for DENV-IgM, and 1/11 was positive for CHIKV-IgM. Among the 68 YFV-positive individuals, 15 (22.1%) had been exposed to DENV, and 2 (2.9%) had been exposed to CHIKV. Co-exposure to DENV and CHIKV was detected in 3 (1.9%) patients, while 2 (1.3%) patients had triple exposure to YFV, CHIKV, or DENV. No exposure to CCHF, RVFV, or WNV was detected. [ABSTRACT FROM AUTHOR]

Objectives: Marburg virus disease (MVD) is on the WHO list for pandemic-prone pathogens. The current outbreak in Rwanda provides an opportunity to map outbreaks and generate information to inform policymaking, resource mobilization, and guide the implementation of cost-effective response strategies. Methods: We synthesized available information about MVD to build holistic, up-to-date evidence to inform policymakers, public health leaders, and healthcare and public health services providers in their development and implementation of cost-effective preparedness, prevention, and control measures. Results: We have identified 20 outbreaks of MVD that occurred in 14 countries between 1967 and 2024; these outbreaks led to 580 confirmed cases and 423 deaths in total. We summarize the available information about the main clinical signs, diagnostic tools, primary reservoir, transmission dynamics, and case management protocol. We also document the best practices in the prevention and control of MVD outbreaks, including the implementation of a multisectoral One Health strategy for preparedness, prevention, and response to MVD outbreaks that incorporates the strict implementation of WASH and infection prevention measures, contact tracing, and the isolation of infected and suspected humans and animals, and enhances the implementation of the International Health Regulations, particularly efficient cross-country coordination. Conclusions: In the absence of a licensed treatment or vaccine for MVD, the response strategy to MVD should focus on preventive measures, including community engagement to promote the reduction in contact between humans and reservoirs, the supportive care and isolation of patients, and proper waste management. High risk populations such as frontline responders, including healthcare providers and community health workers, should be prioritized so that they can access all currently available protection measures. [ABSTRACT FROM AUTHOR]

Background: The escalating threat of infectious disease outbreaks in Africa, particularly emerging and re-emerging diseases, necessitates urgent and comprehensive action. The frequency of these outbreaks demands a robust enhancement of notification and reporting systems to enable swift public health interventions. Tropical diseases such as malaria, COVID-19, typhoid fever, yellow fever, arboviruses, cholera, rabies, schistosomiasis, tuberculosis, black fungus, meningitis, evolving pathogens, and antimicrobial resistance pose significant health risks globally, especially in Sub-Saharan Africa. The region faces complexities in healthcare, including weak systems, inadequate surveillance, socioeconomic disparities, and other issues. Poor health literacy, traditional practices, and distrust hinder effective disease control and contribute to disease emergence in Sub-Saharan Africa. Continuous research and global collaboration are essential to address these public health concerns, especially given Africa's unique challenges. Disease surveillance emerges as a highly effective strategy, crucial in regions vulnerable to infectious diseases. Establishing and strengthening comprehensive surveillance and reporting systems at individual, regional, national, and international levels is crucial due to the unpredictable nature of borderless outbreaks and their significant impact on morbidity, mortality, and economic stability. National surveillance relies heavily on effective control mechanisms within local community areas, necessitating the active involvement of medical personnel. Successful systems depend on functional countries using collected data for timely warnings and localized interventions. Stakeholders, including governments, health authorities, and international organizations, must collaborate urgently to implement and sustain these vital systems, mitigating the devastating consequences of infectious disease outbreaks. Additionally, a holistic approach is crucial, involving prioritized local production of vaccines, medicines, and diagnostics through initiatives like the African Vaccine Producers Initiative. This approach emphasizes the need for domestic pharmaceutical production, intensified public awareness campaigns, and the training of the next generation of global health leaders, ensuring multidimensional strategies, political and diplomatic skills, and evidence-based assessments. Conclusion: Collaboration among governments, international organizations, and educational institutions is essential for successful policy advocacy and implementation to strengthen health security and mitigate the continuous rise of infectious diseases on the continent. [ABSTRACT FROM AUTHOR]

One Health is increasingly recognized as an important approach for health systems, particularly with respect to strengthening prevention, detection and response to zoonotic and other emerging disease threats. While many global health security frameworks reference the importance of One Health, there are fewer existing methodologies, tools, and resources for supporting countries and other regional or sub-national authorities in systematically assessing their One Health capabilities. We describe here two methodologies, One Health Systems Assessment for Priority Zoonoses (OHSAPZ) and One Health Transboundary Assessment for Priority Zoonoses (OHTAPZ), which have been developed to assist with creating consensus lists of priority zoonotic diseases for cross-sectoral consideration; identification of current strengths and gaps in One Health communication and coordination between sectors (and, in the case of OHTAPZ, between countries); and the development and dissemination of prioritized recommendations for future capacity strengthening. Implemented to date in seven diverse countries in Africa and the Eastern Mediterranean regions, these tools provide a modular, flexible and easily adaptable approach to One Health systems assessment that can support national capacity strengthening, regional epidemic preparedness, and compliance with international frameworks. [ABSTRACT FROM AUTHOR]

The global health security (GHS) Index assesses countries' level of preparedness to health risks. However, there is no evidence on how and whether the effects of health systems building blocks and socioeconomic indicators on the level of preparedness differ for low and high prepared countries. The aim of this study was to examine the contributions of health systems building blocks and socioeconomic indicators to show differences in the level of preparedness to health risks. The study also aimed to examine trends in the level of preparedness and the World Health Organization (WHO) regional differences before and during the Covid-19 pandemic. We used the 2021 GHS index report data and employed quantile regression, log-linear, double-logarithmic, and time-fixed effects models. As robustness checks, these functional form specifications corroborated with one another, and interval validity tests confirmed. The results show that increases in effective governance, supply chain capacity in terms of medicines and technologies, and health financing had positive effects on countries' level of preparedness to health risks. These effects were considerably larger for countries with higher levels of preparedness to health risks. The positive gradient trends signaled a sense of capacity on the part of countries with higher global health security. However, the health workforce including doctors, and health services including hospital beds, were not statistically significant in explaining variations in countries' level of preparedness. While economic factors had positive effects on the level of preparedness to health risks, their impacts across the distribution of countries' level of preparedness to health risks were mixed. The effects of Social Development Goals (SDGs) were greater for countries with higher levels of preparedness to health risks. The effect of the Human Development Index (HDI) was greatest for countries whose overall GHS index lies at the midpoint of the distribution of countries' level of preparedness. High-income levels were associated with a negative effect on the level of preparedness, especially if countries were in the lower quantiles across the distributions of preparedness. Relative to poor countries, middle- and high-income groups had lower levels of preparedness to health risks, an indication of a sense of complacency. We find the pandemic period (year 2021) was associated with a decrease in the level of preparedness to health risks in comparison to the pre-pandemic period. There were significant WHO regional differences. Apart from the Eastern Mediterranean, the rest of the regions were more prepared to health risks compared to Africa. There was a negative trend in the level of preparedness to health risks from 2019 to 2021 although regional differences in changes over time were not statistically significant. In conclusion, attempts to strengthen countries' level of preparedness to health shocks should be more focused on enhancing essentials such as supply chain capacity in terms of medicines and technologies; health financing, and communication infrastructure. Countries should also strengthen their already existing health workforce and health services. Together, strengthening these health systems essentials will be beneficial to less prepared countries where their impact we find to be weaker. Similarly, boosting SDGs, particularly health-related sub-scales, will be helpful to less prepared countries. Moreover, there is a need to curb complacency in preparedness to health risks during pandemics by high-income countries. The negative trend in the level of preparedness to health risks would suggest that there is a need for better preparedness during pandemics by conflating national health with global health risks. This will ensure the imperative of having a synergistic response to global health risks, which is understood by and communicated to all countries and regions. [ABSTRACT FROM AUTHOR]

• Partnerships and collaborations key to mitigate the effects of the COVID-19 pandemic and to prepare for future pandemics. • The inequitable access to COVID-19 vaccines is a failure of humanity and will continue to have significant economic and health consequences if not addressed. • Deliberate actions are required to establish sustainable vaccine manufacturing on the African continent. • Innovative vaccine technologies, regulatory and financing mechanisms are critical to strengthening global health security. The Developing Countries Vaccine Manufacturers Network held its 22nd Annual General Meeting in October 2021. Vaccine manufacturing experts, leaders from global public health organizations and dignitaries from governments and multilateral organizations discussed the challenges and opportunities emerging from the COVID-19 pandemic. Over 350 delegates from 33 countries, representing over 70 organizations partook in the meetings deliberations. The development and scaled-up production of several safe and effective vaccines against COVID-19 resulted in over 12 billion doses being produced by the end of 2021. Unfortunately, this scientific achievement and outstanding industry effort has been overshadowed by the striking inequity in access to COVID-19 vaccines. High and upper middle-income countries have received 75% of the vaccines, while in Africa, less than 5% of the people are fully vaccinated. The inequitable access to vaccines is an issue of national health security, which has stressed the need to establish local vaccine manufacturing capacity in Africa. Key partnerships, initiatives and the deliberate strategies required to achieve sustainable manufacturing on the continent were discussed. The ability to acquire technology, access markets and financing mechanisms, and workforce development were reported as key enablers to achieving a healthy ecosystem. Innovative vaccine technologies, new regulatory approaches, and the importance of voluntary technology transfers in increasing the global supply capacity of both COVID-19 vaccines and traditional vaccines were highlighted. In reviewing the lessons learned from the pandemic, speakers shared a consensus that innovation and partnerships will be central to any solution proposed to mitigate the current pandemic and prepare for future ones. [ABSTRACT FROM AUTHOR]

Background: The attainment of global health security goals and universal health coverage will remain a mirage unless African health systems are adequately funded to improve resilience to public health emergencies. The COVID-19 pandemic exposed the global inequity in accessing medical countermeasures, leaving African countries far behind. As we anticipate the next pandemic, improving investments in health systems to adequately finance pandemic prevention, preparedness, and response (PPPR) promptly, ensuring equity and access to medical countermeasures, is crucial. In this article, we analyze the African and global pandemic financing initiatives and put ways forward for policymakers and the global health community to consider., Methods: This article is based on a rapid literature review and desk review of various PPPR financing mechanisms in Africa and globally. Consultation of leaders and experts in the area and scrutinization of various related meeting reports and decisions have been carried out., Main Text: The African Union (AU) has demonstrated various innovative financing mechanisms to mitigate the impacts of public health emergencies in the continent. To improve equal access to the COVID-19 medical countermeasures, the AU launched Africa Medical Supplies Platform (AMSP) and Africa Vaccine Acquisition Trust (AVAT). These financing initiatives were instrumental in mitigating the impacts of COVID-19 and their lessons can be capitalized as we make efforts for PPPR. The COVID-19 Response Fund, subsequently converted into the African Epidemics Fund (AEF), is another innovative financing mechanism to ensure sustainable and self-reliant PPPR efforts. The global initiatives for financing PPPR include the Pandemic Emergency Financing Facility (PEF) and the Pandemic Fund. The PEF was criticized for its inadequacy in building resilient health systems, primarily because the fund ignored the prevention and preparedness items. The Pandemic Fund is also being criticized for its suboptimal emphasis on the response aspect of the pandemic and non-inclusive governance structure., Conclusions: To ensure optimal financing for PPPR, we call upon the global health community and decision-makers to focus on the harmonization of financing efforts for PPPR, make regional financing mechanisms central to global PPPR financing efforts, and ensure the inclusivity of international finance governance systems., (© 2024. The Author(s).)

Introduction: Health systems including mental health (MH) systems are resilient if they protect human life and produce better health outcomes for all during disease outbreaks or epidemics like Ebola disease and their aftermaths. We explored the resilience of MH services amidst Ebola disease outbreaks in Africa; specifically, to (i) describe the pre-, during-, and post-Ebola disease outbreak MH systems in African countries that have experienced Ebola disease outbreaks, (ii) determine the prevalence of three high burden MH disorders and how those prevalences interact with Ebola disease outbreaks, and, (iii) describe the resilience of MH systems in the context of these outbreaks., Methods: This was a scoping review employing an adapted PRISMA statement. We conducted a five-step Boolean strategy with both free text and Medical Subject Headings (MeSH) to search 9 electronic databases and also searched WHO MINDbank and MH Atlas., Results: The literature search yielded 1,230 publications. Twenty-five studies were included involving 13,449 participants. By 2023, 13 African nations had encountered a total of 35 Ebola outbreak events. None of these countries had a metric recorded in MH Atlas to assess the inclusion of MH in emergency plans. The three highest-burden outbreak-associated MH disorders under the MH and Psychosocial Support (MHPSS) framework were depression, post-traumatic stress disorder (PTSD), and anxiety with prevalence ranges of 1.4-7%, 2-90%, and 1.3-88%, respectively. Furthermore, our analysis revealed a concerning lack of resilience within the MH systems, as evidenced by the absence of pre-existing metrics to gauge MH preparedness in emergency plans. Additionally, none of the studies evaluated the resilience of MH services for individuals with pre-existing needs or examined potential post-outbreak degradation in core MH services., Discussion: Our findings revealed an insufficiency of resilience, with no evaluation of services for individuals with pre-existing needs or post-outbreak degradation in core MH services. Strengthening MH resilience guided by evidence-based frameworks must be a priority to mitigate the long-term impacts of epidemics on mental well-being., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Wirsiy, Tahmo, Tatah and Brett-Major.)

Following the 2013–2016 outbreak of Ebola virus disease (EVD) in West Africa, governments across the region imposed a ban on the hunting and consumption of meat from wild animals. This injunction was accompanied by public health messages emphasising the infectious potential of wild meat, or ‘bushmeat.’ Using qualitative methods, we examine the local reception and impact of these interventions. Fieldwork was focused in 9 villages in the Eastern and Southern provinces of Sierra Leone between August and December 2015. We conducted 47 semi-structured interviews, coordinated 12 informal group discussions, and conducted direct observations throughout. We also draw from research undertaken in Sierra Leone immediately before the outbreak, and from our participation in the EVD response in Guinea and Sierra Leone. Our findings underscore the social and political reverberations of hunting proscriptions. Messaging that unilaterally stressed the health risk posed by wild meat contradicted the experiences of target publics, who consume wild meat without incident. This epistemic dissonance radically undercut the effectiveness of the ban, which merely served to proliferate informal networks of wild animal trade and sale—rendering the development of acceptable, evidence-based surveillance and mitigation strategies for zoonotic spillovers almost impossible. Further, the criminalisation of wild meat consumption fuelled fears and rumours within communities under considerable strain from the health, social, and economic effects of the epidemic, entrenching distrust towards outbreak responders and exacerbating pre-existing tensions within villages. These unintended consequences are instructive for public health emergency response and preparedness. While wild meat is a risk for zoonotic infection, mitigating those risks entails interventions that fully take into account the local significances of hunting—including a communicative engagement that is designed, validated, and continually refined before emergency situations. Ultimately, our research questions the value of legal sanctions as a means of behavioural change in an emergency context. [ABSTRACT FROM AUTHOR]

A challenging concept to teach, few combined courses on epidemic-related global health diplomacy and security exist, and no known courses are currently available that have been exclusively designed for African nationals. In response, the University of California, San Francisco's Center for Global Health Delivery, Diplomacy and Economics (CGHDDE) developed and delivered a workshop for LMIC learners to better understand how politics, policy, finance, governance and security coalesce to influence global health goals and outcomes., (© 2022. The Author(s).)

Humanitarian emergencies, including complex emergencies associated with fragile states or areas of conflict, affect millions of persons worldwide. Such emergencies threaten global health security and have complicated but predictable effects on public health. The Centers for Disease Control and Prevention (CDC) Emergency Response and Recovery Branch (ERRB) (Division of Global Health Protection, Center for Global Health) contributes to public health emergency responses by providing epidemiologic support for humanitarian health interventions. To capture the extent of this emergency response work for the past decade, we conducted a retrospective review of ERRB's responses during 2007-2016. Responses were conducted across the world and in collaboration with national and international partners. Lessons from this work include the need to develop epidemiologic tools for use in resource-limited contexts, build local capacity for response and health systems recovery, and adapt responses to changing public health threats in fragile states. Through ERRB's multisector expertise and ability to respond quickly, CDC guides humanitarian response to protect emergency-affected populations.