Three Stories to Watch in 2015
January 3, 2015
As we head into the new year, here are three global health stories to keep an eye on in 2015.
The often fatal hemorrhagic fever dominated the news in 2014, culminating in Time magazine’s selection of Ebola fighters as “Person of the Year.” It’s hard to imagine the same level of sustained media attention through 2015. But if the Ebola epidemic does fall off the front page, it will say more about reader fatigue and editorial priorities than an end to sickness and suffering in West Africa.
As of late December, CDC is reporting nearly 20,000 cases and more than 7,500 deaths to date in Guinea, Liberia, and Sierra Leone. (The largest previous Ebola outbreak, in Uganda in 2000-01, totaled 425 cases.) Peter Piot, who helped discover Ebola in 1976 and who now directs the London School of Hygiene & Tropical Medicine, told the BBC, “We need to be ready for a long effort, a sustained effort [for] probably the rest of 2015.” To that end, the appropriations omnibus passed by the U.S. Congress in December includes $5.4 billion to address Ebola in fiscal year 2015, $3.7 billion of which is tagged for international efforts.
In the same interview, Dr. Piot—as he urges patience and describes an epidemic with “a very long tail”—offers hope that the outbreak may have peaked, first in Liberia and soon in Sierra Leone. Because Ebola transmission requires more intimate contact than flu and other epidemic diseases, there are fewer unreported cases than originally feared; worst-case estimates predicting as many as 1.4 million infections aren’t coming to fruition. The number of American soldiers deployed to West Africa has likely peaked at 2,900, and if trends hold, some may come home as early as January.
Even as the epidemic slows, however, it remains a humanitarian crisis of shattering scale. With doctors and nurses hard-hit by the epidemic, one task for 2015 will be rebuilding and strengthening local health systems; what condition will healthcare be in when the emergency money and Ebola fighters leave?
2. U.N. Development Goals
In 2000, the nearly 200 governments of the United Nations committed themselves to the Millennium Declaration, which grew into eight Millennium Development Goals (MDGs) to be achieved over fifteen years. From halving extreme poverty and hunger (goal 1) to establishing a global development partnership (goal 8), every MDG intersects with global health, and three are explicit public health goals: to reduce child mortality by two-thirds from 1990 levels (goal 4); to reduce the maternal mortality ratio by three-quarters and achieve universal access to reproductive health (goal 5); and to halt and begin reversing the incidence of HIV/AIDS, malaria, and other major diseases (goal 6).
We are entering the final year of that fifteen year commitment. According to the 2014 MDGs Report, the goals on extreme poverty and access to drinking water were achieved in 2010, and the world is on course to meet its goals on malaria and tuberculosis in 2015. Substantial decreases from 1990 in child mortality (47%) and the maternal mortality ratio (45%) are encouraging but will fall short of MDG targets.
Closing the books after fifteen years is an opportunity to debrief, take account of what is and isn’t working in global development, and conclude negotiations on the post-2015 agenda. In September, the U.N. will convene to adopt the Sustainable Development Goals (SDGs), successors to the MDGs. At the Rio+20 Conference in 2012, which launched working groups to define these new goals, U.N. members agreed that the SDGs must be “concise, easy to communicate, and limited in number.” In practice, however, the U.N. has proposed 17 goals to be measured against 169 targets (compared to 8 goals and 18 targets with the already somewhat arcane MDGs). A 2013 CSIS paper reported a fear among development experts of “goals that are too numerous and broad to be effective.” That fear appears prescient, and U.N. members have nine months to negotiate these draft SDGs into a shorter, clearer list of galvanizing priorities.
In early 2014, after three years without a polio case originating in India, the World Health Organization (WHO) certified the nation of 1.3 billion people free of the disease—a major milestone in the global effort to send polio the way of smallpox. Dropping India from the list leaves three countries with endemic polio: Afghanistan, Nigeria, and Pakistan.
But as 2015 begins, Nigeria has gone more than five months without reporting a new polio patient. The six cases recorded nationally in the last year represent a 90% decline from 2013, a triumph of “hit-and-run vaccination” in conflict areas. And as goes Nigeria—the continent’s sole source of endemic poliovirus—so goes Africa, which could be on course to eliminate polio altogether.
Worldwide, 2015 will see what the Global Polio Eradication Initiative (GPEI) calls “one of the most ambitious vaccine roll-outs in history,” with 119 countries joining the 75 that already use inactivated polio vaccine (IPV). IPV, which uses killed virus, ultimately will replace oral polio vaccine (OPV), which uses weakened virus and, in very rare cases, actually causes polio. With wild poliovirus disappearing, OPV presents a late hurdle to the disease’s complete eradication, as Nellie Bristol describes in a recent CSIS report. WHO’s Bruce Aylward, quoted in the report, says of the IPV rollout: “We'll be trying to do something that's never been done in terms of speed.”
While far from exhaustive, these three stories suggest the breadth of global health work over the next year: responding to an unforeseen epidemic of plague-like proportions, even as the publicity fades; writing the overarching objectives for the next fifteen years in global development; and consolidating and extending gradual gains in the long struggle against a historical and present scourge.
Discussing the IPV rollout, the GPEI press release strikes a tone that rings true from Ebola to U.N. negotiations to polio. “The progress made in 2014 is real,” it says, “but it is fragile.” On that note, we enter 2015.