SymbiMUN 2017

Model United Nations Conference

WHO

Study Guide

Agenda

Steps to Reduce the Spread of Diseases like Ebola and Zika Virus in the African

Subcontinent

Sr. No.

Topic

1 Letter from the Executive Board

2 Introduction

3 Diseases that have originated or are prominent in the African Continent

4 Why is the African continent prone to diseases?

5 Why the African Continent cannot afford to have another outbreak

6 Steps to Reduce the Spread of Diseases

7 Questions a resolution must answer

8 Links for Further Reading

1. Letter from the Executive Board

Dear Delegates,

Greetings on behalf of the Executive Board for MUN 2017. At WHO, we eagerly look forward to

discussing and deliberating upon the most pressing issues facing the world today. The agenda is

entirely research driven and since this issue has been at the helm of international news for quite

a while, we implore you to be well versed with your country positions and the agenda at large.

The African continent is a diverse place with a variety of cultures and economies. There has been

a history of diseases originating from the African Continent. This has led to the prevalence of bad

health and the spread of infection all over the world. There have been severe cases recently of

diseases such as Zika virus and Ebola spread all over the world.

The African continent has be struggling to provide better healthcare and better ways of cure.

There is a need for better policies and steps to prevent the occurrence of such viruses. There

should also be public awareness and measures to ensure that people can take care of themselves.

All of this shows the need for discussion on the current status of the African continent. We look

forward to an enlightening discussion.

Regards,

Executive Board,

WHO

2. Introduction

Africa is the world's second-largest and second-most-populous continent (the first being Asia). It

covers 6% of Earth's total surface area and 20.4% of its total land area. With 1.2 billion people as

of 2016, it accounts for about 16% of the world's human population. The continent is surrounded

by the Mediterranean Sea to the north, both the Suez Canal and the Red Sea along the Sinai

Peninsula to the northeast, the Indian Ocean to the southeast and the Atlantic Ocean to the west.

The continent includes Madagascar and various archipelagos. It contains 54 fully recognised

sovereign states (countries), nine territories and two de facto independent states with limited or

no recognition.

Africa's average population is the youngest amongst all the continents; the median age in 2012

was 19.7, when the worldwide median age was 30.4. Algeria is Africa's largest country by area,

and Nigeria is its largest by population. Africa, particularly central Eastern Africa, is widely

accepted as the place of origin of humans and the Hominidae clade (great apes), as evidenced by

the discovery of the earliest hominids and their ancestors, as well as later ones that have been

dated to around seven million years ago.

Africa hosts a large diversity of ethnicities, cultures and languages. In the late 19th century

European countries colonised almost all of Africa. Africa also varies greatly with regard to

environments, economics, historical ties and government systems. However, most present states

in Africa originate from a process of decolonisation in the 20th century. African nations have

attempted to cooperate through the establishment of the African Union, which is headquartered

in Addis Ababa.

Countries in the African Continent:

Region Countries

Northern Africa Algeria, Egypt, Libya, Morocco, Sudan, Tunisia, Western Sahara

Eastern Africa Burundi, Comoros, Djibouti, Eritrea, Ethiopia, Kenya, Madagascar, Malawi, Mauritius, Mayotte, Mozambique, Reunion, Rwanda, Seychelles, Somalia, Tanzania, Uganda, Zambia, Zimbabwe

Central Africa Angola, Cameroon, Central African Republic, Chad, Democratic Republic of the Congo, Republic of the Congo, Equatorial Guinea, Gabon, São Tomé and Príncipe

Western Africa Benin, Burkina Faso, Cape Verde, Ivory Coast, Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Mali, Mauritania, Niger, Nigeria, Saint Helena, Senegal, Sierra Leone, Togo

Southern Africa Botswana, Lesotho, Namibia, South Africa, Swaziland

Africa has been a centre for infectious diseases. Communicable diseases remain a major public

health challenge in the African region, causing a significant burden of illness, disability and

mortality. ·contributing to the problem is the frequent occurrence of epidemic outbreaks driven

by multiple factors, including: weak public health systems, natural disasters or civil unrest leading

to displacement of populations and overcrowding, and poor environmental conditions favouring

disease transmission. Effective control requires strengthening national surveillance and response

systems.

3. Diseases that have originated or are prominent in the African

Continent

Type Diseases

Recurrent Disease Outbreaks

Cholera, Dysentery, Meningococcal meningitis, Malaria, Measles

Haemorrhagic Fevers

Yellow fever, Ebola haemorrhagic fever, Marburg haemorrhagic fever, Rift Valley fever, Lassa fever and, Crimean-Congo haemorrhagic fever (CCHF)

Other Epidemic Diseases

Human Monkey Pox, Plague, Chikungunya, Avian Influenza

The main factors responsible for the above epidemics include high population density and

environmental factors that promote breeding of disease transmitting vectors.

These factors are commonly associated with the long-standing civil unrest in many countries of

the region that lead to poverty and overcrowding in addition to poor public health systems. The

main risk factors for continued occurrence of diarrheal diseases (cholera and dysentery) include

lack of access to adequate safe water and sanitation.

According to a United Nations Development Programme (UNDP) report, in Sub-Saharan Africa

only an estimated 55% have access to clean water and only 18% have access to improved

sanitation.

Malaria epidemics may be precipitated by natural variables (climatic variations, natural disasters)

and man­made situations (conflict and war, agricultural projects, dams, mining, logging) that

modify the physical environment and increase the capacity of mosquitoes to transmit malaria in

non-immune populations.

Effective prevention of these epidemics is challenging, particularly in the highlands where

prediction of epidemics is limited due to lack of technical expertise and insufficient indicators

that are critical for decisions on measures such as indoor residual spraying of insecticides. An

additional challenge is the growing resistance of plasmodium, the malaria-causing agent, to

antimalarial drugs.

For measles, the contributing risk factors for outbreaks include: gaps in routine immunization

coverage, delay in supplemental measles immunization activities (SIAs) and increased cross-

border movements of populations. It is recognized that increasing and sustaining immunization

coverage, including conducting regular, periodic and high-quality follow-up supplementary

immunization campaigns, is critical for successful control of measles.

Among the main challenges for control of Ebola haemorrhagic fever are the continued contact of

rural populations with wild animals and the ritual practice of contact with deceased family

members as part of mourning and burial traditions, thereby increasing the risk of transmission.

The lack of protective gear increases the risk of transmission not only to close family members,

but also to health-care workers.

The last decade had seen increased outbreaks of yellow fever due to accelerated urbanization

with high population density, rise of rapid global transport and communication links and the

prohibitive cost of vaccines to implement mass preventive campaigns.

The practices that may increase the potential for human infection with H5NI influenza in the

region include the tradition of keeping domestic birds in backyards and the widespread practice

of home poultry slaughtering. De-feathering, butchering and preparing for cooking. The

economic impact of an outbreak will be enormous due to losses from culling of domestic birds;

and more importantly, the revenue that will be lost due to travel and trade restriction

4. Why is the African continent prone to diseases?

While outbreaks of new, exotic infectious diseases — as well as the resurgence of old killers —

have surfaced all over the globe in the past decade, no continent has been harder hit than Africa.

But with international travellers flying viruses across time zones in a matter of hours, experts

have no doubt that the emergence of menacing microbes in one locale could bring about a

worldwide pandemic.

As a continent full of diverse landscapes and ecosystems, Africa has always had disease.

But, Africa did not always have the same diseases they have now, and they did not suffer from

them in the same way. All diseases are rooted in their environment, but some are more

sensitive to environmental changes than others. One of the biggest shifts during the past

millennium is that people’s relationship to the land has changed.

Africa’s population was composed primarily of small nomadic groups engaged in hunting and

gathering. These small groups of people travelled from place to place, hunting and collecting

wild grains. They moved to a new location when the seasons changed or when a place no

longer provided food. When groups began to settle down to grow their own crops, it ushered in

a new era. With the blessings of no longer being dependent on what they could find, they also

had to endure the hardships that came with new diseases. As groups settled down to domesticate

animals and grow crops, Africans intentionally and unintentionally changed the land. And with

changes in the land came changes in the disease environment.

Domestication of animals brought about the chances of being infected through animal diseases.

In the first phase, an animal disease mutates to infect a human that is in contact with a sick

animal. In this case, an animal is sick, and a human becomes sick through contact with the

infected animal. A second transition is needed for the disease to become truly dangerous to

humans. The virus must mutate again so that it becomes a disease that can not only infect

humans, but which can be transmitted and spread from human to human. Once this transition

has occurred, the disease no longer needs the sick animal. A person can become sick with the

disease just by being in contact with a sick person.

Another way that the disease environment was changed was through the practice of agriculture.

In order to grow crops, the land had to be cleared and formerly wild grains cultivated in a single

area. The changes in the land and the flora meant that new diseases environments were created:

places for vectors to breed, and places for people to come in contact with those vectors.

Africa's tropical climate makes it a hot zone in the most literal sense. The continent is, to put it

simply, a breeding ground for emerging pathogens.

Add to that environmental changes - such as global warming and destruction of the rain forests

- rapid population growth and haphazard development, and the scene is set for microbes to

thrive, international experts have warned.

Since the mid-1970s, the world has seen the emergence of 30 new infectious diseases and the

return of such killers as malaria and cholera - many of them originating in the African continent.

When illness does strike Africa, a poor infrastructure - marked by poverty, malnutrition, crowded

living conditions, limited health care and an unstable political climate - permits disease to spread

undaunted.

1. Man-made Problem –

The destruction of the rain forests, for example, may be partly to blame for clusters of

killer outbreaks - ranging from feverish malaria to haemorrhagic Ebola.

When trees are cut down, pools of infested water are left exposed in the forest. What we

have done is set up new breeding grounds for mosquitoes that can carry disease such as

malaria.

Anne Marie Kimball, an expert in infectious disease epidemiology at the University of

Washington in Seattle, blames deforestation for recent Ebola outbreaks. As people

penetrate the forest in search of firewood, they can be exposed to the virus, which might

otherwise have been relatively contained, she said.

Destroying the rain forests also has led to a loss of wildlife that protects against infectious

diseases. As coyotes, snakes and other predators that normally prey upon disease-

carrying rodents and mosquitoes are killed off by man in his hunt for more wood, for

example, so is our natural buffer against plague and malaria. A hearty forest stocked with

birds and a healthy lake stocked with fish are important in controlling mosquitoes, which

may in part explain the resurgence of such diseases as yellow fever and malaria - the latter

all but wiped out several decades ago.

2. Global Warming –

Several aspects of climate change, all related to global warming, are contributing the emergence of new diseases and the resurgence of others, the experts say. Warming itself is allowing malaria to spread to higher altitudes, noting that the mosquitoes that carry the disease to humans can survive only at milder temperatures. Once confined to lower areas, the skin-piercing insects are now able to flourish in the African highlands of Kenya.

The outbreaks have been devastating. With poor access to health care, many residents were sickened and killed as malaria swept through several villages. El Nino-related extreme weather events also brought flooding to the Horn of Africa, chiefly Kenya and Tanzania. The results: huge clusters of mosquito-borne malaria and Rift Valley fever as well as an epidemic of the water-borne disease cholera.

The fires bring haze, choking, air particulates and respiratory ills. Membranes dry, making residents susceptible to deadly meningitis. There’s also the impact on an already shattered economy. Due to Rift Valley fever, which strikes cattle as well as humans for example, Africans couldn’t export livestock. Cholera-infested waters limited the sale of fish.

3. A Global Problem –

While the term Hot Zone may conjure up images of suited-up medical detectives working

in containment zones to stop a deadly virus at its source, nothing could be further from

reality, the experts say. Each killer microbe has the potential to make a lethal journey

across the globe, carried by migratory birds, international travellers or traded goods.

Africa is not the problem on its own. It is the possibility of potential transport of the

disease to other non-infected areas of the world, creating an epidemic that presents a

much larger problem. Travel also allows the mixing of different microbial strains when

people come together. The new strains are often not just deadlier, but also may be

resistant to the drugs usually used to eradicate them. The world is so intertwined that a

problem in one place today will be a problem in another place tomorrow.

5. Why the African Continent cannot afford to have another outbreak

1. Limited Lab Capabilities –

Firstly, the laboratory capacity to test for any new virus is limited. This means other known

diseases, such as malaria, have some - though of course not all - of the same signs and

symptoms.

Any new potential virus that may appear like several other diseases makes laboratory

testing for the virus imperative. But there are no widely available tests. This is unlike

diseases or infections such as malaria and HIV/AIDS that have clinically tested and

approved commercial laboratory tests or reagents.

Although inferior laboratories are not unique to Africa, in high income countries this

challenge is mitigated by sending the tests to a national laboratory. For example in the US

samples obtained from suspected Zika cases are now being sent to the Centre for Disease

Control. In the UK the agency responsible is Public Health England’s Rare and Imported

Pathogens Laboratory RIPL.

Although South Africa has the National Institute for Communicable Diseases, which could

manage these tests in a standardised manner, several other countries do not have this

capacity. Examples of the few comparable laboratories outside of South Africa are the

Uganda Virus Research Institute and the Centre of Excellence for Genomics of Infectious

Diseases at Redeemers University in Nigeria. But much of the continent does not have the

infrastructural and human capacity to diagnose a new virus.

2. A Lack of Experts –

Facilities are not the only challenge. There is also a lack of proactive national and regional

health experts to guide the response in case of any outbreak. This is a gap that needs

urgent attention, not only for the present viruses but also to deal with emerging and re-

emerging infections.

There is much to learn from the Ebola epidemic which swept through several countries in

West Africa in 2014 and 2015. To effectively deal with the Ebola outbreak, international

cooperation and collaboration was vital. Affected national governments, neighbouring

nations and both local and international funders all came together to stem the spread of

disease. For instance, Uganda and South Africa sent several teams of health workers to

Liberia and Sierra Leone. There was significant capacity building which would not have

taken place had this manpower not been available.

The international collaboration continues in terms of searching for a vaccine as well as

the treatment and care of Ebola patients. Fragile health systems are more susceptible to

infectious diseases epidemics.

Another challenge which the Ebola outbreak should teach Africa is that in terms of a

disease spreading, no country is an island. While there may not be local transmission in a

particular country, there is no guarantee that a country will not have individuals who

travel to or come into it carrying the disease.

3. No Unified Body –

Unlike in the US, there is not a unified body of health experts on the continent. The

available regional bodies such as the West African College of Physicians and the soon to

be launched College of Physicians of East, Central and Southern Africa have their jobs cut

out already to lead in the health sector.

The World Health Organisation’s African Regional Office, unlike its Pan American Health

Organisation (PAHO), does not proclaim advisories and guidelines apart from those

decided at headquarters in Geneva.

As early as July 2013, the African Union Summit identified the need for an African centre

for disease control modelled on the on the in the US. Among its responsibilities would be

surveillance and response, which would include an emergency operations centre.

Although the centre has been launched, it has yet to handle its first epidemic. Until the

African centre for disease control is fully active, there is no comparable entity for Africa.

4. Spending on Healthcare –

At a 2001 African Union (AU) meeting in Abuja, Nigeria, African countries agreed to

allocate 15% of their budgets to healthcare. To date, only six countries (Botswana, Burkina

Faso, Malawi, Niger, Rwanda and Zambia) have met this commitment.

Health experts now believe that even if the target is reached, 15% of a small budget is not

sufficient to make major inroads into poor health. Four of the six countries allocating 15%

of their budget still only spend 14 dollars per capita on health.

With some countries investing as little as 1-4 dollars per capita, overseas aid is a major

source of funding for healthcare. While essential, it can bring its own problems:

• High costs of co-ordinating different donors and reporting separately to each (at

one point, Tanzania was producing about 10,000 reports annually)

• Decision-making may be switched from the country’s local officials who know

what's most needed, to donor governments and organisations.

5. Not Enough Healthcare Workers –

Hospitals and clinics in Africa often find it difficult to employ enough trained medical staff

to cope with the number of people needing care.

Countries train their own medical professionals, or pay for them to learn elsewhere. Yet,

once trained, many professionals decide to work abroad, either to escape instability or to

practise where they have better working conditions and a higher salary. (The UK is one of

the few countries to have a code which prevents it from actively recruiting medical staff

from sub-Saharan Africa.) Some countries (for example, Malawi and Ethiopia) are training

health assistants to bridge the gap.

Supplies are another problem. Hospitals and clinics in some African countries lack basic

equipment and have inadequate supplies of medicines.

Half of Africans do not have access to essential drugs. With the provision of the right drugs

to treat respiratory infections, diarrheal diseases and malaria, around 10 million lives

could be saved by 2015.

6. Ritual and Herbal Remedies –

Traditional African healers have been using ritual and herbal remedies to treat people for

centuries. In some areas, communities have better access to traditional medicines than

to modern cures. For example, it is common to find herbal remedies sold in marketplaces.

Many people trust traditional treatments and find the costs more affordable.

Healers often have an impressive knowledge of medicinal plants, accumulated through

generations and learnt through years of apprenticeship. This wealth of knowledge is now

being harnessed in the fight against diseases such as HIV-AIDS.

7. Conflict Hinders Prevention –

Disruption to daily life and damage to facilities caused by conflict, mean health clinics

have an even greater struggle to offer services to local populations. Diseases then take an

even greater toll.

In Ivory Coast, the civil unrest of 2011 caused many hospitals in the west of the country

to close, during which time their equipment was looted. Now open again, some are

struggling to provide even basic services, such as blood transfusions, which are needed

for children suffering from malaria-induced anaemia

The movements of populations can also spread disease. In the past, outbreaks of sleeping

sickness have been closely associated with civil unrest in Uganda, Angola and the Congo.

6. Steps to Reduce the Spread of Diseases

Element 1. Strengthen public health fundamentals, including infectious disease surveillance,

laboratory detection, and epidemiologic investigation

Strong Public health fundamentals at the local, state, and national levels—including disease

surveillance, laboratory detection, and epidemiologic investigation—are the bedrock to protect

the public from infectious diseases and to save lives during outbreaks and other unusual health

events. These Three core activities create and sustain a flexible, multi‐purpose public health

system that reduces endemic diseases and is ready and able to respond to new threats. Priorities

of Element 1 Include working with public health and healthcare partners to sustain and

strengthen public health expertise and practice and to advance workforce development and

training, ensuring that core capacities are not eroded.

• Modernize infectious disease surveillance to drive public health action

• Expand the role of public health and clinical laboratories in disease control and prevention

• Advance workforce development and training to sustain and strengthen public health practice

Element 2. Identify and implement high-impact public health interventions to reduce infectious

diseases

Focused efforts to prevent and control high‐Burden infectious diseases can achieve dramatic

results within a short time‐ frame, reducing disease burden and health inequities while saving

lives and dollars. Priorities of Element 2 Include identifying and validating new tools for disease

prevention and control and accelerating the uptake and broad use of proven methods for

decreasing illness and death from diseases and conditions of special concern.

• Identify and validate high-impact tools for disease reduction, including new vaccines;

strategies and tools for infection control and treatment; and interventions to reduce

disease transmitted by animals or insects

• Use proven tools and interventions to reduce high-burden infectious diseases,

including vaccine-preventable diseases; healthcare-associated infections; HIV/AIDS;

foodborne infections; and chronic viral hepatitis

Element 3. Develop and advance policies to prevent, detect, and control infectious diseases

Protecting the nation from infectious diseases requires sound, evidence‐based health policies

designed to ensure appropriate development and delivery of infectious diseases prevention

measures; reduce health disparities and improve the health of vulnerable populations; and

promote engagement with global partners to reduce cross‐border disease spread and contain

outbreaks at their source. To be most effective, these policies must reflect the best science and

the best public health thinking, with broad input and consideration of varying perspectives to

ensure recognition of the complex societal factors that affect the nation’s health.

Therefore, policy development should extend beyond the public health and healthcare

communities to engage stakeholders and other partners across multiple sectors and specialties.

Priorities of Element 3 Include ensuring the availability of sound scientific data to support policy

development while working to advance established and new policies to reduce infectious

diseases.

• Ensure the availability of sound scientific data to support the development of

evidence-based and cost-effective policies

• Advance policies to improve prevention, detection, and control of infectious diseases

to help integrate clinical infectious disease preventive practices into U.S. healthcare;

increase community and individual engagement in disease prevention efforts;

strengthen global capacity to detect and respond to outbreaks with the potential to

cross borders; address microbial drug resistance; and promote “One Health”

approaches to prevent emergence and spread of zoonotic diseases

7. Questions a resolution must answer

• What measures can the WHO implement to reduce the potential spread of diseases?

• How can different countries around the world take steps to ensure their safety from an

epidemic?

• What precautions can the WHO take to prevent an outbreak in Africa?

• How can the countries of Africa improve their healthcare and environment to prevent

spread of diseases?

8. Links for Further Reading

• https://www.cdc.gov/globalhealth/dphswd/idsr/pdf/Kebede%202010.%20Trends%20of

%20Major%20Disease%20Outbreaks%20in%20the%20African%20region,%202003_200

7.pdf

• http://www.bu.edu/africa/files/pdf/Curriculum_introductory_-material1.pdf

• https://www.theguardian.com/commentisfree/2016/jan/27/zika-virus-ebola-security-

policies-poverty

• http://foreignpolicy.com/2017/01/13/the-zika-virus-just-quietly-spread-to-west-africa-

angola-outbreak/

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5349256/

• http://www.afro.who.int/

• http://time.com/4219240/zika-africa-origins-microcephaly-vaccine/

• https://theconversation.com/understanding-zikas-silent-presence-in-africa-is-key-to-

tackling-the-next-epidemic-80343

• http://www.un.org/africarenewal/magazine/december-2016-march-2017/we-can-

improve-health-systems-africa

• https://www.cdc.gov/oid/docs/ID-Framework.pdf