Africa’s Destiny with Pandemics, By Dele Agekameh
Its recent outbreak in some West African countries may not have initially been accorded much attention, but today, as a result of the havoc it has so far created and the ease as well as the rapidity of infection, everybody is now on his toes across the globe. Now, Ebola has suddenly assumed the status of the fastest-growing killer virus in the world. And to affirm this horrible and disturbing status, last Friday, health experts declared the Ebola epidemic an international health emergency that requires a coordinated global approach.
At the moment, Guinea, Liberia, Sierra Leone and lately, Nigeria are battling the deadly virus, which has defied any known cure. So far, the virus is believed to have infected at least 1,779 people, killing 961 or more, thereby making it the worst outbreak in the four-decade history of tracking the disease. According to the World Health Organisation, WHO, “the possible consequences of further international spread are particularly serious in view of the virulence of the virus, the intensive community and health facility transmission patterns, and the weak health systems in the currently affected and most at-risk countries”.
The history of the disease is well known. Unfortunately, since it was first recognized in 1976, all the 18 outbreaks so far recorded occurred in Africa alone. Ebola may be a native of Africa but now the virus is threatening to go global and, by declaring it an international public health emergency, it shows how seriously WHO is taking the current outbreak. But tough statements, definitely, won’t save lives. Perhaps, what should really worry all of us now as the battle against the virus rages, are the words of Peter Piot, the scientific adventurer who discovered the virus: “We shouldn’t forget that this is a disease of poverty, of dysfunctional health systems and of distrust”.
In 1976, Piot, a 27-year-old medical school graduate training as a clinical microbiologist, undertook a voyage of discovery to the then Zaire, where, out of sheer determination, he ventured into the thick forest in one of the remotest areas of the country and unearthed the disease. Piot is now 65 years old. It’s been 38 years since the first outbreak and the world is now experiencing its worst Ebola epidemic ever. At the last count, the disease has reared its ugly head in four West African countries of Guinea, Liberia, Sierra Leone and Nigeria. Out of these, Nigeria has been least affected, recording fewer deaths. Unlike in the past when the outbreak is confined to only one country, the current situation is unprecedented as the spread of the disease across four countries is making it more complicated to deal with than ever before.
As Piot rightly observed and I agree with him, “this is a disease of poverty, of dysfunctional health systems and of distrust”. The current Ebola’s spread in West Africa is a reminder of the vast development needs that persist in some of the region’s poorest countries despite claim to rapid economic growth and investment. The vast majority of Africans live miserably in slums and squalor. Africa faces endemic poverty, food insecurity and pervasive underdevelopment, with almost all the countries lacking the human, economic and institutional capacities to effectively develop and manage their water resources sustainably. As a result of this, a large number of countries on the continent still face huge challenge in attempting to achieve the United Nations water-related Millennium Development Goals (MDGs). Although the crucial role of water in accomplishing the continent’s development goals is widely recognized, various governments on the African continent seem not to be moved by the appalling living standard of their people both in the urban and rural areas. Thus, clean water becomes a scarce commodity.
Besides, Sub-Saharan Africa is the world’s poorest and least developed region, with half its population living on less than a dollar a day. About two-thirds of its countries rank among the lowest in the Human Development Index. A recent report by the United Nations Department of Economic and Social Affairs, UNDESA, gave an analysis of data from 35 countries in sub-Saharan Africa, representing 84% of the region’s population, showing significant differences between the poorest and richest fifths of the population in both rural and urban areas. According to the report, “over 90% of the richest quintile in urban areas use improved water sources, and over 60% have piped water on premises. In rural areas, piped-in water is non-existent in the poorest 40% of households, and less than half of the population use any form of improved source of water”.
The report stated that despite efforts and approaches to extend and sustain water, sanitation and hygiene systems and services continue to suffer leading to different health complications in Africa as a whole, especially Sub-Saharan Africa, thereby causing avoidable deaths. “The water and sanitation position in West/Central Africa is of particular urgency, as the region has the highest under-five mortality rate of all developing regions: 191 child deaths per 1,000 live births.” This is underscored by recurrent outbreaks of cholera in both urban and rural areas, a situation that equally underlines the poor state of this region’s basic living conditions. This is a serious concern because of the associated massive health burden, as many people who lack basic sanitation engage in unsanitary activities like poor solid waste and waste water disposal, open defecation and other dirty habits. The practice of open defecation that is rampant in Africa is widely believed to be the primary cause of faecal oral transmission of disease with children being the most vulnerable.
As if all these are not enough, there is also rapid and almost uncontrollable population growth and rural-urban migration. Despite the efforts of some Sub-Saharan African countries and cities to expand basic services and improve urban housing conditions, rapid and unplanned urban growth has increased the number of settlements on unstable, disaster-prone and high-risk land where diseases and other phenomena disasters with devastating consequences are prevalent. Among developing regions, Sub-Saharan Africa is estimated to have the highest prevalence ofurban slums and it is expected to double to around 400 million by 2020. Again, this rising population is driving demand for water and accelerating the degradation of water resources in many countries on the continent.
Africa has joined India and China as the third region of the world to reach a population of 1 billion people, and it is expected to double this by 2050, the UN says. By then, there will be three times as many people living in Africa’s cities, and the continent that had fewer than 500,000 urban dwellers in 1950 may have 1.3 billion. The breakneck transformation of a rural population into a predominantly urban one is neither good nor bad on its own, but the issue is that African countries should plan their cities better, to avoid mega-slums and vast areas of deprivation developing across the continent. This is because, in most slums in Africa, basic amenities like potable water, quick disposal of garbage, sanitation facilities and toilets are not available. People in slums face many battles. Besides poverty, the health situation is very bad. Since slums are considered illegal, the government feels no obligation to provide water and proper sanitation to slum dwellers. This high density and over-population means viruses and diseases can spread easily and cause epidemics. And when people are ill, there are not enough health services, doctors, nurses and medicines available for them, or even if these are available, people often lack the money to pay.
The sickening living conditions in many African countries may not have attracted much attention from the global community all this while. However, the ravaging Ebola virus that is currently knocking at the doorstep of everybody has, once more, forced global attention on Africa. With the experience of Nigeria, where a Patrick Sawyer, an American-Liberian diplomat, imported Ebola into the country from Liberia, the whole world has suddenly woken up from slumber to the stark reality that the entire global community is at the risk of contacting the deadly virus. What this calls for is the need for global cooperation and strategy to combat the recalcitrant disease. Not rhetoric. Not empty promises!