OPINION: The Congo’s Ebola Outbreak Highlights A Big Mistake in Global Health Security

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Lindsay Denny Emory University
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Allegations are surfacing that women are being forced to trade sex for vaccines; health workers remain deeply distrusted; in some areas women are being blamed for the outbreak and gender-based violence has increased.

The current Ebola outbreak in the Democratic Republic of the Congo is now the second largest in history, and it’s ripping through the country uncontained. More than 900 people have been infected, including 72 healthcare workers; and nearly 600 people have died.

The much-heralded experimental vaccine that the World Health Organization, WHO, called “highly, highly efficacious” with hopes it would control the outbreak, has failed in the face of conflict and distrust. Uganda and Rwanda are bracing themselves for the possibility that Ebola will cross their borders.

It didn’t have to be this way.

Following the 2014 Ebola outbreak that put the world on edge, the World Health Organization, WHO, prioritized 10 diseases that pose the greatest public health risks, to accelerate prevention/control measures so we’d never again experience a pandemic like Ebola that cost billions as it killed thousands. This summer, the world experienced the unprecedented and simultaneous outbreak of six of those ten diseases including the DRC’s on-going Ebola outbreak.

Experts like Dr. Tom Inglesby, director of John Hopkins Center for Health Security, emphasize that we still lack licensed vaccines for “most of the deadly viral pathogens” that have sprung up in the last 40 years. Meanwhile, drug efficacy is declining and drug resistance is rising. Leaders, like Bill Gates, are rightly concerned about what is clearly ongoing global unpreparedness.

All this handwringing about pathogens, pandemics and preventable diseases leads me to the healthcare elephant in the healthcare center. I am incredibly frustrated that few experts point to the obvious: the physical environment where people are seeking care — hospitals and clinics around the world — do not have access to soap, water and sanitation, the fundamentals of disease prevention and containment.

The result is preventable illnesses and containable diseases endanger patients and staff daily; and when an outbreak like the 2014 Ebola pandemic takes root, we see the ghastly toll. The lack of access to water, soap and basic sanitation was a key reason why Ebola not only killed some 11,00 people, it was 103-fold higher in healthcare workers in Sierra Leone than in the general population, 42-fold higher in Guinea health workers, and the reason why Liberia lost 8 percent of its health workforce. Let’s remember that these professionals are also our frontline defense against pandemics.  

The absence of water/sanitation/hygiene is a daily threat. On a recent trip to Ethiopia, I stood in the neonatal intensive care unit of a major hospital and took in the scene in front of me. I’ve visited hundreds of health facilities in developing countries — this wasn’t even the worst I’d seen — but the conditions were no less jarring.

Twenty-five tiny newborns were three and four to a bed. The only sink in the Neonatal Intensive Care Unit was filled with dirty water with no soap in sight; an empty bottle of hand sanitizer sat near the door. We know that simply handwashing with soap has been shown to prevent nearly 40 percent of neonatal deaths. An intern on duty told me it wasn’t uncommon for one of the babies to contract an infection, which rapidly spread to others.

This Ethiopian NICU was in the largest hospital in the region and staff were doing their best in conditions they knew were inadequate. They can’t wash bedding between patients or adequately clean up blood from medical equipment. As a newborn, I too spent a few weeks in a NICU. I wonder what my chances would have been had I been treated in a facility without clean water or a functioning sink.

It is not some unpronounceable drug that alone will prevent or contain everything from neonatal infections to pandemics like Ebola. It’s soap and water, the single-most effective method for containing the millions of germs living within the walls of a hospital. That makes handwashing a particularly powerful and cost-effective tool for doctors, nurses and midwives around the world — as it should, quite literally, be at their fingertips. But it is not.

A landmark study published in 2018, drawing on data from 179,000 health-care facilities in 78 low- and middle- income countries, found that 50 percent of surveyed health facilities lacked piped water and 39 percent lacked soap, 54 percent lacked both. Not surprising, in developing countries nearly one-in-six patients contract an infection during hospitalization.

Even here in the U.S., what may seem like a simple oversight can turn deadly. Eleven children died last fall from an adenovirus outbreak at a rehabilitation center in New Jersey. Health officials citedhandwashing deficiencies” and “infection control issues.” On average, U.S. health-care providers clean their hands less than half of the time they should. The Centers for Disease Control says about one in 25 U.S. hospital patients contracts at least one health-care-associated infection.

“We’ve gotten lucky” is not a prevention strategy. Health security clearly requires that sustainable water, sanitation and good hygiene practice be the non-negotiable part of health care everywhere, and that certainly includes inside hospitals and health-care facilities. WASH remains the untapped and cost-effective opportunity to improve health security for our own sake as well as the tireless work of frontline health-care workers who defend us all. Its global neglect is reckless.

Lindsay Denny, MPH, is a senior public health program associate for the Center for Global Safe WASH at Emory University and a technical advisor for Global Water 2020.

The views and opinions expressed in this commentary are those of the author and do not reflect the official position of The Daily Caller.