Devex CheckUp: Afghanistan’s health system reaches ‘breaking point’

As the Taliban took power in Kabul on Sunday, effectively toppling the government, Afghanistan was thrown into a new crisis — but it was already fighting COVID-19, measles, and a rising tide of trauma injuries from weeks of conflict. The country’s new reality raises questions about whether the already fragile health system can handle the repercussions of Taliban rule.

• According to the World Health Organization, field reports in Kabul and other large cities indicate “increasing cases of diarrhoea, malnutrition, high blood pressure, COVID-19-like symptoms and reproductive health complications.” Though reported COVID-19 cases have been declining, political upheaval has forced people to move quickly and en masse — conditions that may spread the coronavirus.

• “My concern is that the Afghan health system is basically at a breaking point. And that is a major, major concern,” Martine Flokstra, operations manager for Médecins Sans Frontières in Afghanistan, tells Jenny. This is likely to be exacerbated if donors pull funding from the country, as many already have.

• WHO-supported health facilities in Afghanistan dealt with more than three times the conflict-related trauma cases in July 2021 than they saw in July 2020. And while international humanitarian agencies are struggling to get funding for their operations in the country, the situation may be more dire for local health NGOs. “Our message is — particularly to the World Bank and maybe other international organizations — to step up, engage with the NGOs directly,” one NGO official says.

• Despite concerns about the impact of Taliban rule on Afghanistan’s polio program, Dr. Hamid Jafari, WHO’s polio director in the eastern Mediterranean region, tells Jenny that they expect all actors — including the Taliban — to support the program. He said the Taliban has historically supported polio vaccinations, and the ban it has placed on house-to-house vaccinations “was mainly for security reasons.”

Read: Amid Afghanistan’s political crisis, a health system at ‘breaking point’

+ Devex Pro subscribers can explore the data on top donor spending in health from 2010 to 2019 in Afghanistan. Not yet a Pro subscriber? Sign up and start your trial today.

Ebola is back

Last week, Côte d'Ivoire declared its first Ebola case in more than 25 years after an infected person traveled from Guinea to Abidjan, where she is hospitalized and is receiving treatment.

• The patient traveled on a bus with 70 other people — 33 of those arrived in Abidjan and the others dispersed in other directions. A representative of the Côte d'Ivoire Ministry of Health said during a press briefing Thursday it is difficult to trace all of these contacts. The government is working to notify communities that received passengers from all of the four bus trips that left Guinea, so they can be on alert and receive vaccinations.

• Guinea sent 5,000 Ebola vaccine doses, as well as treatment — which declared the end of an outbreak of its own in June — to Côte d’Ivoire, which has begun to inoculate its front-line health care workers and other at-risk populations.

• “The speed with which Côte d'Ivoire has ramped up vaccination is remarkable and shows that with effective sub-regional solidarity we can quickly take measures to extinguish lethal infections that can potentially flare up into large outbreaks,” said Dr. Matshidiso Moeti, WHO’s regional director for Africa.

• Beyond the positive case in Côte d'Ivoire, there were three suspected cases that later tested negative. Six high-risk contacts have been quarantined, and another 131 have been listed.

• Investigations are ongoing into the source of the outbreak in Guinea, where 49 contacts have been listed, and health authorities are preparing to start vaccinations.

Read: Côte d’Ivoire declares Ebola outbreak after traveler arrives from Guinea

But why Guinea?

With Guinea now linked to both West Africa's first-ever confirmed case of Marburg virus disease and Côte d'Ivoire’s first Ebola case in decades, concerns are growing about the threat the country poses to global health, especially in terms of hemorrhagic fevers.

But Georges Ki-Zerbo, WHO’s representative in Guinea, tells Devex that there is a silver lining to the news. He says the country’s detection of Marburg is a testament to its improved disease surveillance and highlights the need for Africa to take a “one health” approach, recognizing the interconnection between people, animals, plants, and their shared environment. Paul Adepoju reports.

Read: How Guinea is dealing with emerging and reemerging disease outbreaks

No magic number

Since the onset of the pandemic, public discussion has largely focused on reaching herd immunity — a collective state of protection against the spread of COVID-19, allowing life to return to normal. But the percentage of the population that would need to be vaccinated for that to happen remains unknown. Instead, the obsession with herd immunity comes at the expense of equity, Shabir Madhi, director of a vaccine and infectious disease research unit at Johannesburg’s University of the Witwatersrand, tells Sara Jerving.

Use the data

Silicon Valley startup Zenysis Technologies is working with Mozambique’s government “to strengthen national childhood vaccination programs and outbreak response capabilities.” With this project, Catherine Cheney reports, it aims to bring together a large volume of disparate data sources and then use its open-source platform to integrate them into a single point of access.

But technology alone is not enough. “The technology is the easy part,” says Sara Pacque-Margolis, the company’s vice president of growth. “Turning the technology into applications requires a lot of other interactions: diplomacy, understanding the political economy, behavior change.”

Don’t give up the ship

Despite pleas from WHO to prioritize equitable global access,the United States has announced it will give its population booster shots of COVID-19 vaccines.

Read: 1 billion doses: The cost of COVID-19 booster shots

What we’re reading

• As the COVID-19 delta variant batters Israel, some fear it’s a sign that vaccine immunity wanes quickly. [Science]

• Free masks and nagging more than tripled mask-wearing in an experiment in Bangladeshi villages. [NPR]

• Medical students in the U.K. are demanding that their schools teach about climate change and its attendant health challenges. [The Guardian]