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HEALTH & EDUCATION

Is the WHO Inventing Diseases?

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BY TOM CHIVERS

Can you be addicted to video games? In 2018, the WHO decided to create a new entry in its big book of recognised diseases, the International Classification of Diseases, or ICD-11. That entry was “gaming disorder” or “internet gaming disorder” (IGD), also known as gaming addiction, which involves “impaired control over gaming… gaming [taking] precedence over other life interests and daily activities… [and] negative consequences”.

You can even be treated for it. You can get specialist treatment at a dedicated NHS clinic. South Korea has gaming “rehab centres”. Gaming addicts have “lost interest in their own lives” and “​​do not feel the passing of time in the real world”, according to a doctor who treats the condition there.

But it is far from clear that “gaming disorder” or gaming addiction exists, at least as a well-defined condition separate from any other compulsive behaviour; and there is a hint that the WHO has made the decision under political pressure from China and other countries.

The WHO says that its decision was based on “reviews of available evidence and reflects a consensus of experts from different disciplines”. But when you look at WHO-commissioned evidence, the studies are completely wild. This review of the literature carried out on behalf of the WHO found that “the prevalence of IGD ranged from 0.21-57.5% in general populations”. This one was rather less crazy, but the studies it was aggregating found that between 0.16% and 14% of people had the disease. Another found 0.7% to 25%.

For comparison, about 8% of people who take opioids in the US end up addicted. So video games might, if we take those numbers at face value, be several times as addictive as opioid painkillers, which seems… unexpected. Or, equally, it could barely exist at all.

“The problem,” says Dr Pete Etchells, a psychologist at Bath Spa University and author of Lost in a Good Game, “is that depending on your definition, your understanding of who has or doesn’t have this disease varies wildly in the literature”. That is because, he says, “we don’t know what it looks like, we don’t know what it is, and we don’t know what its unique features are that separate it from other behavioural or impulse disorders”.

Obviously, some people have problems with playing video games too much. You will have read stories about South Korean teenagers wetting themselves rather than getting up from their gaming chair, or people developing blood clots. But rare anecdotes don’t tell us much about the wider problem, and people can develop problematic relationships with almost every form of enjoyable human activity — with exercise, with sex, with tanning.

The question is whether there is something unique to gaming which causes these problems. Dr Andy Przybylski, a psychologist at the Oxford Internet Institute, has worked on gaming addiction in the past, and argues that — as far as we know — there isn’t. He carried out a study in 2017, which looked at people who were classified as “addicted” to gaming at one time, and checked whether they still were six months later. If gaming “addiction” was comparable to, say, tobacco, gambling, or alcohol addiction, then you’d expect that most people would be.

But as it turned out, of the 6,000 people recruited, none of them met the diagnostic criteria for gaming disorder at both the beginning and the end of the study. That is, no one stayed “addicted” for six months. Dr Netta Weinstein, another author of the study, told me at the time that it’s “a question of whether a diagnosis is stable”, and it suggests that internet gaming probably isn’t an addiction like smoking or alcohol.

Przybylski, then, was surprised to see that the WHO decided to classify IGD as a separate illness, and has been asking the WHO whether or not they have any more evidence. Recently he received an email which said: “It is challenging, if not impossible, to document and communicate through WHO channels the rationale and justification for each decision.”

But obviously you can prove, or at least provide strong and convincing evidence for, the existence of most illnesses, and the WHO could very straightforwardly point to that evidence. There’s a reason why Covid denialists are considered crackpots and cranks: because it’s pretty straightforward to develop diagnostic tests which show you the presence of a virus, and you can tell that the presence of that virus correlates strongly with a particular set of negative health outcomes.

With psychiatric conditions, of course, the picture is often messier. You can’t swab someone and see if they have depression; you can only ask them a series of questions, or observe their behaviour. But there are established criteria by which to do so, and when you test someone with one twice, a week apart, they usually give the same answer.

But with gaming disorder, as we’ve seen, that doesn’t seem to be the case. So the WHO creating a new diagnostic category is a big deal. It gives clinicians licence to treat the disorder, and — perhaps more importantly — it tells people, and parents, that gaming disorder is a real thing. “It’s a very emotive topic,” says Etchells. “If you say suddenly that games can be addictive, so many people play them that that can be a really scary thing. We already know that parents are scared and concerned. Throwing it out there without any explanation or caveating, I feel it’s quite irresponsible.” He worries that the WHO decision will pathologise normal, healthy behaviour, like playing video games after work to destress.

The question, then, is why has the WHO done it? They didn’t need to; the American Psychiatric Association hasn’t yet added it to the Diagnostic and Statistical Manual of Mental Disorders, and the Royal College of Psychiatrists hasn’t formally recognised it.

One possible answer is that the WHO has been pressured into doing it. Professor Geoffrey Reed, a medical psychologist at Columbia University and senior project officer for the WHO’s ICD-11, told another psychologist by email in 2016 that the WHO was “under enormous pressure, especially from Asian countries” to include IGD.

There has been huge concern about video gaming in several east Asian countries. In Japan and South Korea, there have been years of worries about the “hikikomori”, young adults who shut themselves off from society, living in their parents’ homes, never leaving, eating delivery food, watching Netflix, browsing the internet and playing games. The phenomenon has also been widely reported in China, Hong Kong and Singapore. These countries are huge consumers and producers of video games, and notably of spectator e-sports, and people have been quick to blame video games for the condition.

And this has led to a widespread reaction which looks suspiciously like a moral panic. South Korea banned under-16s from playing internet games between the hours of midnight and 6am in 2011 to improve children’s sleep, a decision that was only overturned in August. Etchells says that research showed the ban was counterproductive — it increased children’s time on the internet and “had no meaningful effect on increasing sleep”. China recently enacted an even more stringent law, banning under-18s from using internet games between 10pm and 8am.

Societies are entitled to ban anything they want, of course. But the concern is that they’re hiding behind science to do it. “It’s an extreme example of people pathologising things they find distasteful,” says Dr Stuart Ritchie, a psychologist at King’s College London. “Some people find video games distasteful — they don’t like the idea of kids shooting at each other. But you have to ask what the quality of the evidence is.” Przybylski agrees: “If people want to create rules, they should create rules. But if you’re saying it’s based on evidence or science, you should show your notes.”

“We’re talking about very complex generational issues, and trying to explain them by looking at one simple factor, and that’s never the case,” says Etchells. If there was a simple causal link, he points out, given the billions of users, you’d expect to see enormous effects, not weird ambiguous trends in messy data.

The trouble is, as Przybylski says, that mental health provision is poorly resourced and expensive. If a teenager is diagnosed with a mental health condition in the UK, he says, “they can age out of being a teenager before you’re seen by a psychiatrist”. Video game addiction, on the other hand, is shiny and exciting, and it sounds cheap, because it seems like there’s an off switch — just turn off the console!

But it comes at a cost. For one thing, even if hikikomori is a real problem in China and other countries, and even if a causal link can be shown to video games, it makes no sense to create a global diagnosis for a highly region-specific problem. For another, it frightens gamers and their parents, perhaps unnecessarily, and gives cover to any old quack or charlatan who wants to promise to treat “gaming addiction” at their expensive clinic, despite there being no clear diagnostic criteria and no agreed treatment.

Most of all, though, there’s a reputational risk for the WHO. “It’s putting its credibility on the line,” says Przybylski. It’s supposed to be a neutral scientific body: it cannot be seen to be making scientific decisions for political reasons. For the last two years, it’s faced criticism of cosying up to China over Covid – praising the Chinese government for transparency and for “setting a new standard for outbreak response” even as it censured doctors for trying to spread the word about the disease. If it transpires that the WHO has put gaming disorder into the ICD-11 as a result of political pressure, whether from China or elsewhere, its credibility will be even more undermined.

The academic community and the WHO have “really dropped the ball” on gaming disorder, says Etchells, rather than being brave enough to stop, take stock, and work out whether it really exists at all as a coherent concept. “I can see how it’s difficult for the WHO to go against these strong opinions, but they need to,” he says. “They can’t come up with disease classifications built on politics.”

Courtesy; UnHerd


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HEALTH & EDUCATION

How Zakat Can Support Medical Needs and Initiatives

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In today’s world, healthcare is a crucial part of human well-being, and access to quality medical services is fundamental for every community. However, millions of people worldwide still face significant challenges in affording essential healthcare. One way to address these health disparities is through the concept of Zakat, an Islamic charitable practice that can play a transformative role in supporting medical needs and health initiatives. In this article, we will explore how Zakat can be effectively utilized to support health-related needs, alleviate financial burdens for the less fortunate, and empower community health initiatives.

What is Zakat and Its Relevance to Health?

Zakat is one of the Five Pillars of Islam, a mandatory act of charity that requires Muslims to give 2.5% of their accumulated wealth annually to those in need. The word “Zakat” means “purification” and “growth,” signifying both the purification of one’s wealth and the growth of a just and caring society. Although Zakat can be allocated to a variety of causes—including poverty relief, education, and debt repayment—its role in supporting health and medical needs is becoming increasingly recognized.

The Quran and Hadith emphasize supporting those who are struggling or in need, making healthcare an ideal focus for Zakat funds. Medical expenses, particularly for the poorest and most vulnerable communities, can be overwhelming, preventing access to basic treatments, life-saving surgeries, medication, and preventive healthcare. By directing Zakat to healthcare initiatives, Muslims can fulfill their religious obligations while directly addressing health inequalities.

The Growing Role of Zakat in Healthcare

With rising healthcare costs and an increased focus on improving public health, Zakat funds have increasingly been used to support health-related programs around the world. Islamic charities and organizations are now exploring ways to channel Zakat effectively to reach those who lack access to adequate medical care. This approach supports a wide range of health needs, including:

  1. Funding Medical Treatments and Surgeries
    For those facing critical health issues, paying for necessary treatments and surgeries can be financially crippling. Zakat funds are often used to provide financial support to those who cannot afford these expenses, covering costs for everything from life-saving surgeries and treatments for chronic illnesses to maternity care and emergency procedures.
  2. Providing Access to Medication
    Access to essential medication is a significant challenge for underprivileged communities. Zakat can be used to supply prescription drugs, vaccinations, and other medical supplies to individuals and communities in need. In many developing countries, where healthcare infrastructure may be lacking, Zakat-funded clinics and pharmacies ensure that people receive the medication they require.
  3. Supporting Preventive Healthcare and Awareness Programs
    Preventive healthcare, including health education and awareness programs, is critical for reducing the prevalence of chronic diseases and improving public health outcomes. Zakat funds can support vaccination drives, health camps, screenings for early disease detection, and public awareness campaigns on nutrition, sanitation, and maternal health.
  4. Funding Hospitals, Clinics, and Health Facilities
    Building and maintaining health facilities in underserved areas is a long-term investment in community health. Zakat funds have been used to construct hospitals, clinics, and mobile health units in regions with limited access to healthcare services. These facilities provide free or subsidized care to patients, ensuring that healthcare is accessible to all.
  5. Supporting Mental Health and Rehabilitation Services
    Mental health is often neglected, particularly in low-income communities. Zakat can be allocated to provide counseling, mental health support, and rehabilitation services to those struggling with mental health issues, addiction, or trauma. By addressing the mental and emotional well-being of individuals, Zakat helps promote holistic health.
  6. Empowering Women’s Health and Maternal Care
    Women and children are among the most vulnerable populations when it comes to health disparities. Zakat initiatives frequently focus on maternal and child health, providing prenatal and postnatal care, nutrition support, and childbirth assistance. These services ensure the well-being of both mother and child, contributing to reduced infant mortality rates and healthier communities.

Real-World Examples of Zakat-Funded Health Initiatives

Many global organizations and local charities have successfully implemented health programs funded by Zakat, providing life-changing support to those in need. Here are a few examples:

  • Humanitarian Aid and Relief Trust (HART): HART, a charitable organization, uses Zakat funds to support healthcare projects across Asia and Africa. It provides medical care, surgical assistance, and healthcare education to communities impacted by conflict, poverty, and natural disasters.
  • Imran Khan Cancer Hospital (Pakistan): The Imran Khan Cancer Hospital, one of the largest charitable cancer hospitals in the world, leverages Zakat funds to provide free cancer treatment to those who cannot afford it. The hospital has treated thousands of cancer patients, offering them comprehensive care without any financial burden.
  • Islamic Relief’s Health Projects: Islamic Relief, a global humanitarian organization, uses Zakat to finance health programs in various countries, including Yemen, Syria, and Somalia. These programs provide essential medical services, nutrition support, mental health care, and sanitation projects to improve public health in crisis-stricken areas.

Ensuring Effective Use of Zakat for Health

For Zakat to make a meaningful impact on healthcare, it’s essential to ensure that the funds are used effectively, transparently, and in compliance with Islamic principles. Below are key considerations for donors and organizations:

  1. Targeting Eligible Beneficiaries
    According to Islamic principles, Zakat should be given to specific categories of recipients, including the poor, needy, and those in debt. To maximize impact, Zakat funds should be allocated to those who are genuinely in need of medical support and cannot afford healthcare costs.
  2. Transparency and Accountability
    Donors should have confidence that their Zakat is used for its intended purpose. This means organizations must maintain transparency and accountability in their operations, regularly reporting on how funds are distributed and the outcomes of health programs.
  3. Collaborative Efforts and Partnerships
    Collaborating with local health institutions, governments, and other charitable organizations enhances the reach and efficiency of Zakat-funded health programs. By working together, these entities can provide a broader range of services, ensure better resource allocation, and meet a diverse array of health needs.
  4. Long-Term Sustainability
    Zakat should not only provide immediate relief but also contribute to sustainable development. Programs focused on building health infrastructure, training healthcare workers, and developing preventive health measures ensure that Zakat continues to benefit communities in the long term.

The Broader Impact of Health and Zakat

Beyond addressing individual medical needs, Zakat contributes to broader health improvements at a community and societal level. By ensuring access to healthcare services, it helps alleviate poverty, reduce inequalities, and foster social cohesion. Moreover, healthier communities are better equipped to thrive economically, as individuals can participate more fully in education, work, and civic life.

The intersection of health and Zakat also reflects the holistic approach to well-being promoted in Islam. The focus on both physical and mental health, as well as social welfare, aligns with the Islamic concept of Tayyib (goodness and wholesomeness), promoting a balanced and fulfilling life.

Zakat is more than a religious obligation—it’s a tool for social justice and community support. When applied to healthcare, Zakat has the power to transform lives by providing medical support, enhancing public health, and building a foundation for sustainable well-being. As Muslims around the world continue to fulfill their duty of Zakat, the potential to uplift communities, support health initiatives, and make a lasting difference grows ever greater.

By supporting health and medical needs through Zakat, we contribute not only to saving lives but also to building a healthier, more equitable, and caring world. The intersection of health and Zakat is a powerful way to extend compassion, uphold human dignity, and create meaningful change in the lives of millions.


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HEALTH & EDUCATION

Islamic Development Bank Opens Two New Hospitals in Indonesia

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By Our Special Correspondent

On August 31, 2024, Indonesia reached a significant milestone in its healthcare sector with the inauguration of two state-of-the-art hospitals by President Joko Widodo and Dr. Muhammad Al Jasser, President of the Islamic Development Bank (IsDB). This event was part of a broader initiative to introduce six new hospitals across the nation, collectively adding over 1,000 beds to address the growing healthcare demands of Indonesia’s burgeoning population. This ambitious project not only aims to expand access to healthcare but also to bridge the gap in medical service availability, particularly in underserved areas—a challenge faced by many developing nations.

Two Hospitals Indonesia: Specialized Care Advancements

These new facilities are equipped with cutting-edge medical technologies and infrastructure, emphasizing specialized care, particularly in maternal and child health. Maternal and child health is a critical focus area globally, as it impacts the core of family and community well-being. High rates of maternal and infant mortality have been persistent challenges in Indonesia, as well as in many other developing countries. The targeted approach of these new hospitals aims to address these issues head-on by providing high-quality, specialized care.

Dr. Al Jasser emphasized the transformative potential of these hospitals on Indonesia’s healthcare landscape. The specialized care units for children and mothers are expected to provide life-saving treatments that could significantly reduce mortality rates and promote healthier futures for the country’s next generation. The use of advanced medical technologies in these hospitals also sets a new standard for healthcare delivery in Indonesia, providing models that other regions may replicate.

Sustainable Development and Strategic Partnerships

The development of these hospitals aligns closely with Indonesia’s broader sustainable development goals. Enhanced healthcare infrastructure not only meets immediate health needs but also supports long-term societal growth and stability. By prioritizing health, Indonesia is investing in its human capital, which is essential for sustained economic development and societal well-being. This investment is in line with the United Nations Sustainable Development Goals (SDGs), particularly SDG 3, which focuses on ensuring healthy lives and promoting well-being for all at all ages.

Indonesia’s prominent role as the third-largest shareholder in IsDB has enabled strategic use of funds and influence, resulting in substantial developmental gains. Over the last four years, IsDB has provided US$1.4 billion in financing for Indonesian health projects, making the country’s Health Ministry its biggest institutional partner. This substantial investment underscores a strong commitment not just to building hospitals but also to enhancing overall health systems and capacities. Such partnerships are crucial for sustainable development, as they bring together expertise, resources, and a shared vision for the future.

Economic and Employment Benefits

The construction and operation of these hospitals have far-reaching economic implications. The healthcare sector is a significant contributor to employment, and these new facilities are expected to generate numerous job opportunities, from medical professionals to support staff. This boost in local employment not only contributes to economic growth but also helps to alleviate poverty, as more families gain stable income sources. Moreover, better health outcomes lead to a more productive workforce, reducing the economic burden of healthcare costs on families and the government. Healthier populations are also better able to participate in the workforce, contributing to overall economic stability and growth.

The economic benefits of healthcare investments extend beyond direct employment. Improved healthcare infrastructure can attract foreign investment and partnerships, further stimulating economic growth. In addition, the increased capacity for medical tourism, which has become a significant industry in many countries, could be a potential avenue for Indonesia to explore, especially as the quality of healthcare continues to improve.

Regional Impact and Global Relevance

Indonesia’s advancements in healthcare infrastructure have implications beyond its national borders. Southeast Asia is witnessing a surge in healthcare investments, with countries recognizing the importance of robust health infrastructure to economic resilience and growth. Indonesia’s proactive efforts serve as a model for its neighbors, demonstrating the benefits of strategic investments and partnerships in healthcare. The lessons learned from Indonesia’s experience can be applied to other developing nations facing similar challenges, particularly in terms of integrating new technologies and expanding access to underserved populations.

Furthermore, Indonesia’s approach highlights the importance of aligning national health strategies with global health and development frameworks. The collaboration between Indonesia and IsDB is an example of how international partnerships can drive progress toward achieving global health goals. As countries across the globe strive to meet the SDGs, Indonesia’s experience offers valuable insights into the role of strategic partnerships, sustainable investments, and innovative solutions in overcoming healthcare challenges.

Challenges and Opportunities

Despite these significant advancements, integrating new technologies and facilities into the existing healthcare system presents challenges. Ensuring that these hospitals are not just well-equipped but also effectively integrated with Indonesia’s broader health network is crucial. This requires comprehensive planning and coordination at multiple levels, including training for specialized care, maintenance of high-tech equipment, and ensuring sustainable operations. The success of these hospitals depends not only on their initial construction but also on their ability to function effectively and sustainably over the long term.

Moreover, addressing the healthcare needs of a diverse and geographically dispersed population like Indonesia requires ongoing efforts to expand access to quality care. This includes not only building new facilities but also improving transportation infrastructure, increasing healthcare education and training, and addressing social determinants of health. By taking a holistic approach to healthcare development, Indonesia can ensure that its investments yield lasting benefits for its population.

A Global Perspective on Health

The inauguration of these hospitals in Indonesia is more than just the opening of new facilities; it represents a forward-thinking approach to healthcare that prioritizes quality, accessibility, and sustainability. The collaborative efforts of the Indonesian government and IsDB are commendable, showcasing a commitment not only to enhancing healthcare but also to investing in the nation’s long-term development and prosperity. This initiative sets a precedent for healthcare excellence and strategic development, promising a healthier, more resilient Indonesia.

As these facilities begin their operations, they offer a hopeful glimpse into the future of healthcare in Indonesia and highlight the potential for similar advancements across the region. The success of Indonesia’s healthcare strategy could inspire other nations to pursue similar approaches, emphasizing the importance of global cooperation and the sharing of best practices in health and development.

Indonesia’s recent healthcare advancements underscore the critical role of strategic investments and international partnerships in achieving global health and development goals. By focusing on sustainability, community impact, and innovation, Indonesia is setting a new standard for healthcare in Southeast Asia and beyond. The lessons learned from this initiative can inform global health strategies, demonstrating that with the right resources, partnerships, and vision, even the most significant healthcare challenges can be overcome.

As the world continues to grapple with complex health issues, Indonesia’s example serves as a reminder of the importance of investing in health as a cornerstone of development. By prioritizing healthcare, nations can build stronger, more resilient societies that are better equipped to face the challenges of the future. The story of Indonesia’s healthcare transformation is a testament to the power of strategic planning, collaboration, and a shared commitment to improving live


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HEALTH & EDUCATION

Mpox: African Countries have Beaten Disease Outbreaks Before – Here’s What it Takes

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By Oyewale Tomori

Outbreaks of diseases like mpox aren’t new to African countries. The continent has successfully contained health threats like this in the past. But mpox, with new variants and modes of transmission, is making global headlines. It’s spreading to new countries within and outside Africa and the World Health Organization (WHO) has deemed it a global health emergency. Virologist Oyewale Tomori blames this on the failure of African governments to properly invest in their health systems and experienced health workers.

What’s the advice of WHO on managing mpox?

The WHO strategic framework for enhancing prevention and control of mpox 2024-2027 highlights the need for countries to take immediate action to ensure that surveillance, testing, treatment and vaccination responses are established and integrated with other health programmes.

This includes disease surveillance, sexual health services, risk communication and community engagement, primary healthcare, immunisation and other clinical services. The control and containment of the 2022-2023 multi-country outbreak within a year in non-endemic countries outside Africa was achieved through a combination of:

  • surveillance (detection and laboratory confirmation of cases, contact tracing)
  • isolation of cases
  • infection protection and control
  • targeted vaccination of high-risk individuals.

African health workers have over 50 years of experience dealing with different and various outbreaks of yellow fever, Ebola, mpox and COVID-19. They have acquired the relevant expertise and skills to prevent the spread of epidemics.

There are at least four instances in African countries where outbreaks were contained before they escalated to emergencies of concern. These successes were achieved through enhanced surveillance, rapid laboratory confirmation of cases, contact tracing, isolation of cases, as well as awareness campaigns on avoiding contacts with cases. Infection protection and control measures were taken.

In mid-2014, west Africa was in the grip of the largest epidemic of Ebola the world had ever seen. On 20 July 2014, a man infected with Ebola landed in Lagos, Nigeria, a city of 21 million. Infections began to spread immediately. By the end of the month, the first patient had died, an infected individual had flown to another city and one thousand contacts had been exposed to the virus. And yet, in Nigeria, the outbreak was over in less than three months. Nigeria stopped Ebola from spreading nationally, and potentially regionally, with effective communication, coordinated response activities and dedicated leadership.

In 2018, Ebola crossed into Uganda through its busy border with the Democratic Republic of Congo. Uganda rapidly mobilised its response teams and activated its health emergency response system, which stopped Ebola from spreading into the country.

Again in 2018, in a rural area of Kenya, a deadly anthrax outbreak was identified and brought under control thanks to a community-based surveillance system and a trained volunteer who acted quickly.

Health officials in Akwa Ibom, Nigeria quickly contained, within a month, an outbreak of mpox in 2021. They did this through strong collaboration with national rapid response teams, identifying and correcting weaknesses in the response and providing education and recommendations to improve future responses.

In all these instances, no vaccine was used to contain these outbreaks. Successful containment resulted from the rapid institution of disease surveillance to detect, diagnose, isolate and treat cases, and contact tracing among engaged, involved and aware communities.

Why aren’t these lessons being applied?

There are two main reasons that African governments have not taken advantage of their skilful human resources with relevant disease control experience.

Firstly, they have not provided adequate and sustained funding for an efficient disease surveillance system. Such a system needs to be backed by reliable diagnostic laboratory service for timely detection and confirmation of yellow fever, Ebola, Lassa fever, cholera and other diseases. These diseases often start as sporadic cases, later spreading and becoming large outbreaks.

Secondly, they have not created an enabling environment to carry out disease surveillance activities, such as contact tracing and isolation of cases. Disease surveillance is needed to contain the sporadic cases.

For instance, in the 2014-2016 Ebola outbreak, which primarily affected Guinea, Liberia and Sierra Leone, it took months to identify the disease after a first cluster of cases in December 2013. It took almost three years to contain, and claimed thousands of lives. The epidemic exposed the dire consequences of weak health systems, poor disease surveillance, an initially lethargic response, and inadequate community engagement. It would be far cheaper and more cost effective to provide funds for such a system than to respond to an epidemic with fatal consequences. A neglected disease outbreak can become the catalyst for gross domestic poverty.

What is the role of vaccines in preventing diseases?

Vaccines work by stimulating the immune system to recognise and mount a response against specific pathogens, such as viruses or bacteria. They are designed to mimic the infection without causing the disease itself, allowing the body to develop immunity against the targeted pathogen. Vaccines play a critical role in controlling and preventing epidemic diseases by boosting immunity and reducing the spread of infectious agents.

Great as they are, vaccines cannot take the place of rapid institution of disease surveillance to detect, diagnose, isolate and treat cases. Prevention has always been better than cure.

Are different responses needed for the different variants of mpox?

Not really. However, the mode of transmission – animal-human or human-human (sexual or non-sexual) – will determine the process to prevent or halt transmission and spread of the disease. These are two clades with variants.

Clade Ia: This is endemic in the Democratic Republic of Congo. It primarily affects children, with a case fatality rate of 3.6% in 2024. Other African countries reporting Clade Ia outbreaks in 2024 include the Central African Republic and the Republic of Congo. Clade Ia has historically been characterised by more severe disease than that associated with Clade II.

Clade Ib: This emerged after September 2023. It is spread through human-to-human transmission. It has spread rapidly in the eastern part of the DRC. The outbreak has primarily affected adults. It is sustained, but not exclusively, through transmission linked to sexual contact and amplified in networks associated with commercial sex and sex workers.

Since July 2024, cases of Clade Ib, linked (in the way it emerged and spread) to the outbreak in the eastern provinces of DRC, have been detected in four countries neighbouring the DRC which had not reported cases of mpox before: Burundi, Kenya, Rwanda and Uganda.

Clade IIaReported cases in Cameroon, Côte d’Ivoire, Liberia, Nigeria and South Africa are linked to Clade IIa.

Clade IIb: This virus caused the multi-country outbreak from July 2022 to May 2023. In 2022, mpox entered a new phase when the first case of the disease not associated with travel from Africa was reported in the UK.

This triggered the multi-country outbreak which the WHO declared a global public health emergency of international concern in July 2022. By the time it was declared over in May 2023, 118 countries (7 mpox endemic and 111 mpox non-endemic) had reported a total of 87,377 cases (1,587 in endemic and 87,377 in non-endemic countries).

Oyewale Tomori is a Fellow, Nigerian Academy of Science. 

Courtesy The Conversation


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