by Elhadj As Sy, International Federation of Red Cross and Red Crescent Societies
An outbreak of yellow fever in Angola is threatening to surge out of control
Imagine. A deadly disease is stalking terrified mothers, fathers, children and grandparents. People are sick. Many are dying. An information vacuum is overflowing with rumour and misinformation. Suspicion and lack of trust are rife. Hospitals and health centres are overwhelmed even though many of the sick are reluctant to seek medical help. Families believe the best thing for loved ones is care at home. As things spiral out of control, the rest of the world goes about its business.
Sound familiar? This was the dangerous cocktail that helped fuel the Ebola crisis in West Africa, which killed more than 11,000 people and took more than two years to contain. Disturbingly, these same conditions seem to be emerging in Angola, where an outbreak of yellow fever is threatening to surge out of control.
The current yellow fever outbreak began in Angola in December 2015. Since then it has grown and spread further. Today, more than five months on, some 3,137 suspected cases have been recorded and 345 people have died. The disease has already spread, including to the Democratic Republic of the Congo, China and Kenya, and suspected cases are being investigated in other countries.
Anyone familiar with the West Africa Ebola crisis might be experiencing some déjà vu.
Three important lessons emerged from the West African Ebola crisis. First, invest in local health systems and community surveillance. Second, engage local communities in developing and driving the response. Third, early response targeted to local circumstances is critical.
But it is hard to see how these lessons are being applied in response to Angola’s yellow fever outbreak.
Angola, like the countries affected by Ebola, has emerged from a long and devastating civil war. Despite significant gains made since 2000, life expectancy is under 50, and infant mortality rates are among the highest in the world. Health infrastructure is centred in major cities, leaving many rural communities with little or no access.
Yellow fever vaccine campaigns have lagged consistently behind the spread of the disease this year, and limited surveillance has resulted in poor visualization and understanding of its spread. As a result, vaccine campaigns have struggled to contain the disease. All of Angola’s 18 provinces are now reporting suspected cases.
Weak health surveillance, particularly in rural areas, is aggravated by a lack of trust and poor access to health care services, with much of the population relying on traditional medicine or private clinics.
Where surveillance is happening, it is often hampered by a lack of laboratory capacity, which, in turn, delays any response. Here we can see that a country’s limited ability to detect and declare yellow fever cases is hampering the operation, just as it did in the first 12 months of the Ebola response.
Limited community engagement in Angola is mirroring early miss-steps in the Ebola response. Lack of community trust and misunderstanding of how to prevent and treat Ebola drove much of the early spread of the virus in West Africa. Now, in Angola, false rumours and misinformation about vaccines are severely curbing community participation in urgently needed mass vaccination campaigns. Coverage is patchy, allowing the virus to continue to spread.
Looking at the two diseases there are some key differences. Unlike Ebola, there is no evidence of human-to-human transmission of yellow fever virus – it is spread by mosquitoes, and with collective community action on vector control families can help protect themselves and contribute to the control of outbreaks. And unlike at the beginning of Ebola, we already have an effective vaccine against yellow fever.
Here is another major difference between this current situation and Ebola: we can still avert a large-scale outbreak in Angola, but we must act now. The international community and the Angolan authorities can still put the lessons of Ebola into real action and prevent this crisis from surging out of control.
Ebola has shown us that public health solutions must begin and end with local communities. Community engagement is essential. National Red Cross and Red Crescent Societies are an integral part of local communities everywhere. In Angola and surrounding countries, the International Federation of Red Cross and Red Crescent Societies is supporting National Societies to work with communities to stop yellow fever transmission. Community-driven solutions to vector control, health promotion and vaccination are the key.
But communities cannot solve every problem themselves. Weak surveillance, limited vector control, and poor health care are some of the root factors behind the outbreak and these must be addressed through a broad range of partners. The people of Angola need an urgent and coordinated response, where support is targeted to local needs and concerns and made available now.
Elhadj As Sy is secretary general of the International Federation of Red Cross and Red Crescent Societies