By Wilmot James
There are times when the narcissism of a political leader distracts us from attending to what matters in the world. US President Donald Trump is a case in point. Jeffrey Sachs recently observed that Trump’s conduct, characterized by "grandiose self-regard, pathological lying, lack of remorse, expressive shallowness, impulsiveness, failure to take responsibility for his own actions" and, as the events of Charlottesville illustrate, a frightening lack of a moral sense, has brought about a meltdown in the White House that may undermine many of the good projects started by his predecessors.
One of these projects is the 2014 Global Health Security Agenda (GHSA). Set up with an emergency appropriation of $1bn from the US Congress, the agenda helped countries scale up disease outbreak prevention in the world’s weakest health systems by funding — among others — the Centers for Disease Control, the National Institutes of Health and the Pentagon’s disease-detection and vaccine-development programs. The West African Ebola outbreak accelerated the agenda’s growth to include more than 50 nations and nongovernmental organizations in a mere three years.
The GHSA arrived too late to make a meaningful difference to the Ebola outbreak, but it helped a great deal with the Zika response by assisting the Americas with sample sharing, diagnostics, blood tests and vaccine development. It supported the World Health Organization (WHO) with improved responses to the Democratic Republic of the Congo’s recent Ebola, Cameroon’s cholera, Pakistan’s measles and Uganda’s yellow fever outbreaks. Additionally, the agenda supported the assessments of more than 50 countries’ health preparedness shortcomings and the development of plans to fix them.
With results to show and benefits to survive well into the future, the Trump administration nevertheless may scale back its commitment to the GHSA. At the July 2017 meeting of the agenda’s steering group, US officials said a working group will focus on biological defense projects. The priority is shifting to defense rather than prevention and mitigation, though homeland security and counterterrorism advisers have reassured an Aspen Institute meeting in July that the administration plans to give "full-throated" support to the agenda.
While this excuse for governance lurches on, with the media and health science community flummoxed about the lack of clear direction, there is an infectious outbreak unfolding in Yemen that the UN describes as the "world’s worst cholera outbreak in the context of the world’s worst humanitarian crisis".
The prestigious medical journal The Lancet editorialized that it was "a test for how humanity can and will organize to protect the most vulnerable among us today". It is a test we are already failing.
Words cannot adequately describe the scale of the Yemeni tragedy. Since 2015, a civil war fuelled by outside parties has left half the country’s people (14.5-million) without access to clean water or sanitation. The WHO has recorded more than 500,000 cholera cases and more than 2,000 deaths to date. Half of all suspected cholera cases and a quarter of associated deaths are children; a third of those who die of cholera are aged over 60.
What is the cause of the calamity? The Lancet says: ‘The war, unpaid worker salaries, a decimated health system, controversies around the vaccine stockpile and slow global funding efforts are all somehow to blame."
The health community knows cholera’s cause (waterborne bacteria), how to prevent it (clean water, proper sanitation, infection control and vaccines) and how to treat it (antibiotics and hydration).
The WHO is working with other international agencies and nongovernmental organizations to build emergency operations centers where health, water, food, sanitation and communication partners pool resources and jointly deliver the emergency services. Some effort is being made to secure and distribute vaccines to where they are needed. Hospitals, clinics, water and sanitation infrastructure are being rehabilitated. Still, only half the country’s medical facilities work.
The WHO provides incentives, meager as they may be, that bring out more than 40,000 community volunteers to provide public health education, distribute soaps, offer rehydration solutions and advise families how to care for the sick. The pain caused by the water-sucking cholera bacteria, as many victims would attest, is indescribable.
The Red Cross doubled its aid program recently and increased preventive efforts in waste-collection, water-cleaning systems and water-repair systems. The UN system was gearing up for a mass immunization campaign, but the 20-million doses needed could not be met because the world’s stockpile had dwindled. Put off by low profit margins, the manufacturers stopped making them.
On July 13, the WHO cancelled the shipments of vaccines it had because the Saudis refused to guarantee a ceasefire that would have allowed safe passage.
Instead, the newly elevated crown prince Mohammed bin Salman, who as defense minister has led his country’s bombing and blockading of Yemen, agreed to give $66.7m to the UN Children’s Fund and the WHO. Welcome certainly, but it is Saudi Arabia and its Gulf state allies’ merciless bombing of Yemen’s infrastructure that left almost all of the water supplies contaminated. About 8,000 people have died and more than 45,000 have been wounded since Riyadh joined the conflict. Vital ports are blockaded, leaving millions of people with limited access to food and medicine. The rebel forces are truculent.
Finding a solution is the job of the UN, but it struggles. Seven UN-brokered truces have failed to end the conflict. Its mediation efforts are led by special envoy Ismail Ould Cheikh Ahmed, who remarked at a Security Council briefing on May 30 that "the reluctance of the key parties to embrace the concessions needed for peace, or even discuss them, remains extremely troubling". The Yemenis "are paying a price for their needless delay. I very much regret to inform this council that the call for peace from Yemeni women and civil society and the international community is still falling on deaf ears," he said.
Trump authorized a Navy Seal raid on January 29 that left 25 civilians and Seals chief petty officer Ryan Owens dead. Seven months later, on August 7, US special forces are back on the ground, advising about 2,000 troops from the United Arab Emirates who are moving against an al-Qaeda stronghold in the southern part of the country. It is the largest ground offensive since 2016. The Saudi-led air campaign in Yemen that has taken thousands of civilian lives is another rebuke of the UN.
What about the cholera outbreak? Having developed its considerable resources, this is the moment to propel the agenda to give full support to the WHO to contain and reverse the outbreak under full diplomatic cover of a much more assertive and confident UN.
Looking ahead, though US Health and Human Services Secretary Thomas Price publicly supported the agenda’s efforts, the agenda cannot scale up work if future funding, up for renewal in 2019, is not assured.
Dr James is visiting professor at Columbia University’s medical centre and School of International and Public Affairs.
Source: Business Live, Edited by Website Team
