Coronavirus and the collapse of global public health

In the neverending war between humans and microbes, the smaller of those two combatants is perpetually probing for the weakest link. 

That could be a wet market in Wuhan where a virus jumps from a bat or a pangolin into people. It could be the gig economy in the US, where infected people might be too financially stretched to self-isolate and forgo two weeks’ pay. Or it could be a health system in an impoverished country, say in Africa, where testing is inadequate, doctors and nurses in short supply and hospitals at breaking point. 

In the unfolding coronavirus drama, Africa has been the dog that doesn’t bark, or in this case perhaps the bat that doesn’t squeak. There have been relatively few reported cases. Egypt, where dozens of Nile cruise passengers are in quarantine, is the worst affected. About 10 other countries have confirmed cases. But that only makes just over 100 cases, mostly in north Africa, in a continent of 1.2bn people. Italy, with 60m people, has more than 12,000 cases.  If the numbers are to be believed, Africa has been remarkably lucky. So far. 

There are several plausible explanations. One is that the numbers are not credible. When the outbreak began in China, there were only two labs in sub-Saharan Africa able to test for the virus. That situation has improved. More than 40 countries have some testing capacity. Still, it is not enough. If the number is low, one explanation may be that many cases have gone undetected in a population with a median age of 19. 

Another is that African health systems, however under-resourced, are used to dealing with infectious diseases. When, in 2014 a Liberian man with Ebola collapsed in the arrivals hall of Lagos airport, Nigerian authorities did a remarkable job of tracing his contacts and quarantining them, snuffing out the outbreak.  Last month, when an
Italian businessman became Nigeria’s first case of coronavirus, the authorities — already dealing with a far-worse Lassa fever outbreak — sprang into action. So far, the number of reported infections is just two. 

The third explanation is one that few scientists would dare suggest for lack of robust evidence: that the virus doesn’t do well in hot weather. If that is true, there could be respite on the way in the northern hemisphere as winter turns to spring and summer. Although that would not end the epidemic, it would buy time for health systems to prepare and researchers to test a vaccine. 

Africa may have been spared the worst of the coronavirus outbreak, for the time being at least. More often, it is at the forefront of the fight against
infectious diseases. Only this month, the last Ebola patient in the Democratic Republic of Congo was discharged. That starts a 42-day countdown to declaring an end to an outbreak that has killed 2,264 of the 3,444 people infected — a “kill rate” that makes coronavirus look benign. 

The war against Ebola, fought in the hardest conditions imaginable — including a real, low-level war — is a victory not only for Congo but for the world. If coronavirus has taught us anything it is the fact of our interconnectedness. 

These issues have been brilliantly highlighted by the author Laurie Garrett, who has written for decades about our eternal vulnerability to microbes. In Betrayal of Trust: Collapse of Global Public Health, she warned against a global shift from public to private health. 

In an age when the perceived threat is greater from non-communicable diseases — such as cancer, hypertension and diabetes — the temptation is to view health through a personal lens. The individual with the best medical insurance or best fitness regimen will be the healthiest. That ignores two facts. One is that the most effective health interventions, from clean water to antibiotics and vaccines, have all been collective. The second is that infectious diseases have not been defeated. They have, at best, been kept at bay. 

This has implications for rich and poor regions alike. For countries such as the US or the UK, it means you ignore public health — and the health of the most vulnerable in society — at your peril. In poorer parts of the world, it means that anyone’s battle against disease is everyone’s battle.

Last week, the US Congress approved roughly $8bn to fight coronavirus at home. A few days earlier, the UN had released a meagre $15m to help the world’s most vulnerable countries fight the same outbreak. 

Such a skewed response suggests that, collectively, we have not listened to what global health experts have been telling us for years. In the fight against infectious disease, your problem is also very much my problem.

david.pilling@ft.com