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Could Angola have prevented its yellow fever epidemic? 0

Angola is in the midst of a yellow fever outbreak that has caught worldwide attention. Between December 5, 2015 and Monday of this week the World Health Organization reported 298 deaths and the majority of these have occurred in the capital city of Luanda.

While this is the official figure, the actual number of deaths is likely much higher. Many of those who are ill never make it to a hospital or a health clinic.

The rapid spread of this rare, but deadly, disease — which can be prevented with the administration of a highly effective vaccine — is part of “ordinary,” “everyday” life in post-war African countries. As in post-war Liberia, Sierra Leone or Guinea where Ebola claimed the lives of many in 2014 (and is reportedly rising again), Angola suffers from a shortage of hospitals and hospital beds, clinics, doctors, nurses, trained technicians, vaccines, tests, and testing facilities. Like other countries that have experienced long civil conflicts (Angola’s conflict, which only ended in 2002, lasted for 27 years and was preceded by 14 years of anti-colonial war), the country presently does not have the capacity to deal with “the extraordinary” such as a yellow fever outbreak.

Diagnostic capacity is also weak in post-conflict Angola. An assessment conducted by Norway’s Christian Michelsen Institute (CMI) in 2011 of the ability of health care workers to correctly diagnose a number of common illnesses in Angola produced alarming findings. Using patient simulation cases whereby health workers were asked to make a diagnosis based on a set of common symptoms exhibited by a hypothetical patient, CMI found that half the time, diagnoses by a sample of health workers in Luanda were incorrect.

Two thirds of the time, health workers in Uíge, a city in the northeast of Angola, incorrectly diagnosed simulated cases of acute diarrhea with dehydration, malaria, pneumonia and other “typical” diseases.

The health care system in Angola may be even worse off than many other post war countries because the usual assortment of humanitarian aid from non-governmental organizations and donors that arrives after a conflict have barely materialized. After helping to bring under control a terrible outbreak of Marburg virus, a hemorrhagic fever almost as deadly as Ebola,Medecins Sans Frontières reportedly packed up and closed its offices in Angola in 2007.

In December, 2015, USAID officials in Luanda indicated to me that they were facing budget cuts which would likely affect American aid to Angola’s health sector.  Indeed, USAID’s projected budget in Angola for 2017 indicates a reduction of 17% available revenue over the past two years. At the same time, it doesn’t appear that USAID has shifted its funding priorities in response to the recent yellow fever outbreak. Its webpage for Angola — last updated two months ago — makes no mention of support for addressing the outbreak of yellow fever.

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by Anne Pitcher

Photo Credits: Getty Images

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Direttore Responsabile Giuseppe Frangi