Epidemics that didn't happen

The COVID-19 pandemic placed massive stress on health systems around the world, wreaked havoc with the global economy, and tested our collective patience – but it was also reason to give pause to consider what might have been.

A new online, interactive feature created by Resolve to Save Lives sheds light on how countries can contribute to the prevention of future epidemics. Its Prevent Epidemics initiative highlights infectious diseases outbreaks that could have resulted in more widespread infection and caused more deaths had policymakers and practitioners not been prepared.

Brazil: Yellow Fever

Thirty to 60 percent of those infected with yellow fever do not survive. As a nation with a large populace living or working near a rainforest, Brazil has seen an exponential increase of the disease. Forest ecosystems are the perfect breeding ground for the vector. The 2015-2016 yellow fever season claimed two lives. But over 2016 and 2017, there were 792 infections and 274 deaths. The next year, yellow fever cases and deaths nearly doubled. Epidemiologists determined that an epidemic was underway and vaccines in short supply.

The country is a major producer of the vaccine and doubled its monthly output by 2018. This was supplemented by a global stockpile. According to a study conducted in concert with the Pan American Health Organization, a fifth of a dose was sufficient to arrest rampant spread. An effective campaign saw 69 million vaccine doses distributed throughout Brazil.

As of the end of the 2019 yellow fever season, just 85 cases and 15 deaths were reported.

Uganda: Ebola

Spread by contact with bodily fluids, Ebola killed nearly 2,300 people in the Democratic Republic of Congo between 2018 and 2020. Ongoing conflicts, resulting in mass migrations, increased the threat of an international pandemic. In neighboring Uganda, the government ramped up its response with treatment centers and testing capability. Testing, in particular, was scaled up – results were available within six hours of a patient getting tested.

The government's actions, including communications and vaccinating close contacts of those infected, meant that the spread was contained and Uganda reported only a handful of deaths and cases.

Kenya: Anthrax

Anthrax kills 20 percent of those who are infected. Spread by contact with or consuming infected animals, the disease is treatable with antibiotics, which can result in vastly reduced death rates. As reported by the WHO, anthrax in humans numbered as many as 100,000 per year in the 1950s. With the introduction of a vaccine, this number dropped to 2,000 by the 1980s.

In August, 2019, a Red Cross volunteer learned that three people had been diagnosed with anthrax at a health facility in southwest Kenya. They sent an SMS alert to local health and veterinary authorities, who took immediate action. The key to preventing anthrax in humans is preventing it in livestock. An investigation into the health of local livestock resulted in 25,000 farm animals being vaccinated.

Community members were kept informed by, among other strategies, radio broadcasts and education sessions. The result: raised awareness among the community of the risks of anthrax. The outbreak was controlled after four human cases and one death.

Mongolia: COVID-19

Countries grappling with the COVID-19 pandemic took containment measures in vastly differing ways. Early on, Mongolia set up travel restrictions, cancelled events, and moved education online.

Relying on technology – notably text messaging and broadcast media – officials provided fact-based information to its citizens. Contact tracing, testing, and walk-in clinics were all in place by February, 2020. Publicly funded camps were set up for those who were unable to quarantine at home. At that time, Mongolia had yet to report a single case of COVID. During the first year of the pandemic, the country experienced just two COVID-related deaths.

Senegal: COVID-19

Because Senegal has just seven physicians for every 100,000 people, preventing the spread of COVID was critical. With the appearance of its first case of COVID, the country’s Health Emergency Operations Center went into action. They established testing at labs that operated around the clock and provided digital results within 24 hours.

People who tested positive were guaranteed a hospital bed. Those who required quarantine were provided with hotels rooms and food. In March, 2020, a far-reaching lockdown, declaration of a state of emergency, and curfews limited movement among the population slowed the spread of the virus.

Social media, radio, and television became the platforms for information sharing – messages were tailored to specific demographics with the help of anthropologists, local leaders, women’s groups, and traditional storytellers. Senegal reported many fewer COVID-19 fatalities compared to other countries, with only 4.76 deaths per 100,000 people.

Vietnam: COVID-19

The first case of COVID in Vietnam was reported on January 22, 2020. Two weeks later, the government released its response plan to isolate, treat, and manage patients. The government established national guidelines and created of a national committee to manage a “whole of government” strategy.

With an ample supply of personal protective equipment, medical staff were better safeguarded than in many other countries; per capita spending on health care had increased by 9 percent year on year, beginning in 2000; 12,000 contact tracers were trained, compared with 2,200 in the United States, which has more than three times the population.

By banning public gatherings, enforcing social distancing and mask-wearing, and restricting travel – Vietnam reported fewer than 1,800 cases and 35 deaths during the first year of the pandemic.

Africa: COVID-19

Under existing burdens of diseases such as HIV, tuberculosis, and malaria, health systems across the African continent were already under enormous pressure, and COVID would only add to the strain.

An emergency management system was in place by the end of January, 2020. All African heads of state had signed off on the initiative by March, 2020. The Africa CDC established working groups focused on testing, isolation of positive cases, quarantines, social distancing, communications, infection prevention and control in hospitals, and tools to treat severe cases.

As the virus spread in the spring of 2020, many thousands of health care workers received training in best practices, testing capacity was expanded from two countries to 43, and 20,000 lab staff were trained. The cost of medical equipment and supplies was reduced by pooling resources and bulk ordering, and vaccines were made available through collective efforts.

The Africa region has shown that collaborating – rather than competing – leads to a reduced number of deaths. As of April 2021, the continent reported 120,000 deaths due to COVID – a fifth reported by the United States, despite the fact that the continent has three times more people.