From fighting Ebola to ending TB: stretched health systems need new partners

The people of the Democratic Republic of Congo (DRC) are painfully familiar with the way disease, poverty and conflict combine to cause misery and death. The Ebola outbreak authorities are struggling to control is a powerful illustration of this fact.

Efforts to stem Ebola, which has already claimed more than 2,000 lives over the past year, are being hampered by security problems and attacks on health workers.

The response is being further hindered by the profound weaknesses of a health system already overstretched by diseases like malaria, which killed nearly 50,000 people across DRC last year alone, as well as a severe measles epidemic.

This interaction of deadly pathogens, insecurity and extreme poverty is by no means unique to this latest Ebola outbreak. We have seen time and again that diseases thrive in conflict and chaos.

Diseases are fuelled by poverty, as people with little to live on often lack proper nutrition, sanitation and access to even the most basic health services, making them much more likely to catch infections and much more likely to die if they do so.

The interaction works both ways. Disease often makes social instability and poverty much worse. The fear and rumours that accompany infectious disease outbreaks can foster distrust and spark social disorder. Communities afflicted by heavy disease burdens find it extremely difficult to escape poverty: sick children don’t go to school; sick adults can’t work.

The future of disease prevention – and global health security – depends on our ability to improve health for the most vulnerable populations, including those living in war zones or fleeing fighting. This is especially challenging given that the number of people fleeing war and persecution exceeded 70 million worldwide last year, a record high.

The experience of the Global Fund to Fight Aids, Tuberculosis and Malaria and the United Nations Development Programme (UNDP), which work together in some of the world’s most challenging operating environments, has shown that fighting diseases in such environments requires sustained efforts and strong partnerships.

Such cooperation draws upon the expertise of a wide range of actors including governments, civil society, the WHO, other parts of the United Nations System as well as bilateral development agencies.

We learned many lessons from the Ebola outbreak in West Africa in 2014. One is how quickly weak health systems can be overwhelmed. Another is the vital importance of community engagement. A third is the importance of shoring up defences to other diseases when something like Ebola strikes.

During the 2014 outbreak, there were at least many deaths from malaria as there were from Ebola itself. Prevention programmes were disrupted and those falling sick from malaria were too scared to seek treatment.

Perhaps the most fundamental lesson is that the best protection from infectious disease outbreaks is a resilient health system.

Without the ability to rely on key capacities – such as health workers, a functioning supply chain, diagnostic labs and a disease surveillance system – an infectious disease outbreak is hard to prevent, difficult to detect and extremely challenging to control.

Without established arrangements for community engagement, it is much more difficult to sustain the trust that is so vital to any emergency health response.

Moreover, the most effective way to build and sustain such capabilities and infrastructure is to invest in fighting the diseases that are already killing vulnerable people.

For example, the investments that UNDP and the Global Fund are making in countries like South Sudan, Chad and Burundi to fight malaria are putting in place the support systems and health workers that have the ability to counter other health security threats.

For instance, sophisticated molecular diagnostic devices provided by the Global Fund as part of the programme to fight TB are now being used to diagnose Ebola in DRC.

The need for sustained effort and strong partnerships in conflict-affected areas is not limited to Africa. Conflict in Afghanistan has caused over two million people to flee their homes in search of safety. TB is a massive threat to refugees and displaced people, and it is challenging to identify and treat those affected when people are on the move.

Working with UN partners like the United Nations High Commissioner for Refugees, the International Organization for Migration and others – the Global Fund and UNDP are working to deliver comprehensive health services to refugees and displaced people across Afghanistan, Pakistan and Iran.

Such collaborative approaches require robust and reliable funding. The Global Fund will hold its Sixth Replenishment Conference in October 2019, with a call to secure at least US$14 billion for the next three years.

This would allow the Global Fund partnership to accelerate the fight against HIV, TB and malaria, while stimulating domestic investments in health.

Since the Global Fund often channels its investments through UNDP, particularly in conflict-ridden areas, a successful replenishment would enable UNDP and other partners to deliver health programmes to the most vulnerable while simultaneously tackling immediate challenges such as HIV, TB and malaria.

It will also allow them to build stronger defences against other health threats and contribute to the ultimate goal of building resilient and sustainable systems for health.

Such partnerships underscore the logic of the WHO-led Global Action Plan for Health, through which the 12 multilateral agencies most involved in tackling these challenges have committed to working together to accelerate progress toward Sustainable Development Goal Number 3 in order to ensure health and well-being for all.

Complex crises require multifaceted responses. Conflict, poverty and disease present a triple threat that exacerbate each other. To make the world a better, safer place – we must understand these complex interactions, commit sustained effort and resources, and work in partnership. That’s how we can overcome these tough challenges, save lives and truly leave no one behind.

Peter Sands is the executive director of the Global Fund to fight Aids, Tuberculosis and Malaria; Achim Steiner is administrator for the UN Development Programme.

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