Management of Endemic Diseases

Answer

Management of Endemic Diseases

Question 1

Smallpox and malaria are known as endemic diseases that did not only claim millions of lives but also interfered with economy of the world. What is surprising is the differences in managing the diseases where one (small pox management) strategy was successful while another strategy (malaria management) awfully failed. Particularly, in smallpox eradication, a mass vaccination was conducted where experts and clinical officers were distributed all over the world in order to prevent the spread of the disease that could wipe human population like Spanish flu did (Garrett, 1994). Most significant was the unexpected productivity of negligibly educated staff members who had been trained and whose performances were well supervised. On the same note, there was political goodwill where all parties as well as the superpower nations willingly funded the campaign to ensure that vaccines were available for every individual. Another issue that ensured complete eradication is the timeline. With the knowledge of then virologists and scientists that viruses have the ability to mutate and become resistant, the phase of the eradication took place at the same time within the shortest time possible which ensured that the strain of the virus at that particular time was suppressed or eradicated with no possibilities of mutating to another strain.

On the other hand, eradication of malaria had no political goodwill of all nations as the Dichlorodiphenyltrichloroethane, the chemical that was found to be effective faced several challenges such as its ability to eliminate other insects hence destruction of the food chain and ecosystem. Unlike smallpox eradication where there was mass vaccination, there was no mass removal of anopheles mosquito that was the vector behind malaria transmission (Garrett, 1994). Instead of global distribution of experts and health workers as it was in the case of small pox, the program concentrated in certain areas, especially the developed countries that had enough money to kill the mosquitoes and produce chloroquine, the medication for Malaria. On the same note, just like small pox, a huge amount of money was needed to ensure the program was successful; however, this did not happen in the case of malaria as big donors to the World Health Organization withdrew from contributing towards malaria eradication citing that it was an “impossible program”, a factor that hindered the success of malaria eradication.

The case definition of smallpox is a disease with an acute onset of fever of more than 38.3°C which is followed by rashes characterized by deep-seated and firm vesicles or boils in the same stage of development without other ostensible causes (Robertson et al., 2018). On the other hand,  the case definition of malaria are the first symptoms that are usually fever, sweats, chills, headaches, nausea, muscle pains, and vomiting. The disease also presents with physical findings that are often not specific such as perspiration, elevated temperature, and tiredness (O'Donnell et al., 2019). In severe malaria which is caused by P. falciparum, the clinical findings are confusion, neurologic focal signs, coma, respiratory difficulties, and severe anemia are more striking and can increase the suspicion index for malaria.

Question 2

I think the two methods were chosen based on the regions that were affected by malaria as well as the effects of Dichlorodiphenyltrichloroethane on other insects. According to Enserink (2019), there is still a belief that malaria has not been fully eradicated since it has very little impact on the developed countries and only affects the developing countries. It is about this reason that most of the developed countries particularly the United States, which was the biggest donor towards these pandemics cut off their donations to the World Health Organizations claiming that the program would not be successful. The United States was strongly in support of the campaign at its beginning as a forthright strategy of stopping and eradicating malaria in both developed and developing countries during the Cold War. Conversely, when over one decade of an in-depth campaign efforts were met with declining rates of success instead of far-reaching success, the operation faced worldwide criticism. According to Garrett (1994), the moment that it was realized the disease had little impact on the developed countries, the political goodwill that was noticed during smallpox eradication could not be achieved since they were not severely affected.

On the same note, the effect of dichlorodiphenyltrichloroethane on other insects as well as plants hindered the mass eradication of malaria as some developed countries and scientists believed that dichlorodiphenyltrichloroethane was harmful as it killed other insects hence interfering with the ecosystem.  On the same note, total eradication of the disease could not be achieved because of the diagnosis process of malaria (Enserink, 2019). For malaria to be eradicated, not only did infected individuals need to be identified and treated, but infected mosquitoes also needed to be eliminated. Malaria-infected individuals were difficult to identify because common first symptoms of malaria include headache, chills, fever, and vomiting are symptoms that are similar to other many infections.

Question 3

Populations in developing countries are at risk of acquiring smallpox.  It is important to note that developing communities do not have good healthcare facilities and enough capital to speedily respond to the outbreak as compared to developed countries. According to the study conducted by Carlin et al. (2017), poor countries and communities will rely on aid and grants from health organizations as well as developed countries in order to control or eradicate fast spreading diseases. This hinders speedily containment of the diseases which then can spread very fast when the funds have not been released by donors or other countries to curb the spread. Immunosuppressed communities are likely to be affected with smallpox. Some of the immunosuppressed individuals are people living with HIV/AIDs. Africa being one of the regions that are effected with HIV consists of communities that are highly immunosuppressed hence is likely to be affected with smallpox. According to the study conducted by Adeola et al. (2016), East and Southern Africa and several regions in Africa are the most affected by HIV in the world and is home to the largest number of people living with HIV. Similarly, Africa is one of the continents with poor communities hence responding to the disease may take them longer time than developed communities in developed countries.

On the same note, several communities in Africa and the countries along the tropical are more likely to suffer from malaria than other communities or countries. It is important to note that the most infections of malaria are caused by the vector known as plasmodium falciparum, which is one the difficult species to control and is widely spread in tropical regions particularly in Africa. Additionally, Africa, being one of the developing regions still has not established enough and effective primary care facilities to deal with cases of malaria. According to the study conducted by Adeola et al. (2016), although there was no total eradication of malaria in developed countries, the regions established effective primary care that has highly reduced the cases of malaria to zero in some countries.

Question 4

            "What is required is a new paradigm in the way people think about disease." Is a statement in which the author advices individuals, communities, and countries to approach the disease differently in new models or campaign strategies in order to control the diseases. One of the notable way of analyzing the statement is that the microbes are with us throughout the lives of human, as such, even if one species or strain of microbes is completely eliminated, there is another one or some that will emerge, potentially more lethal than the previous ones hence it is the role of healthcare, scientist, and nations to establish effective mechanisms of dealing with such diseases. For example, emergence of Spanish flu prepared populations to handle smallpox and other diseases that emerged (Garrett, 1994). Notably, eradication of small pox did not prevent the emergence of malaria and now the COVID-19. In addition, the new paradigm require all communities, particularly countries to get prepared and be able to manage diseases without majorly depending on the health organizations and developed countries. This is one of the reason that despite the efforts, malaria has not been eliminated since it does severely affect the developed countries that have money to handle the disease. It simply requires all countries and communities to establish and create capacity to develop national disease control strategies to assess the impact and cost effectiveness and design financing schemes to combat the fast spreading diseases. According to Carter et al. (2020), in order to defeat future lethal diseases, countries will have to access an array of technical and analytical skills and adopt a health technology assessment frameworks that are able to contain the diseases even during the time that vaccines and antibiotics are on trials.

Question 5

In few years to come, there are several changes that are going to occur as a result of the impact of COVID-19. The first health policy will divert funds on the research of SARS genomes. According to the study conducted by Hartley and Perencevich (2020), SARS have become a major challenge not only to scientist but to healthcare as a whole and strike the population when least expected hence there is a need to research and establish more laboratories to understand the genomic properties of these viruses so that if another strain appears in future then it will be easy to handle. This move will probably reduce funding of other diseases such as malaria and even AIDS that is likely to affect their management.

Additionally, states are likely to review their health policies as well as budget to prepare for any health emergency. The change in the budget will be meant to correct the challenges that have been witnessed not only in states but in several countries. For example, Italy one of the developed countries, have fallen short on health professionals as well as healthcare facilities to take care of the COVID-19 patients (Carter et al., 2020). This is one of the concerns of most countries and healthcare systems so that the demand for patients are met if any case such incidence occurs in future. As earlier discussed, the microbes live with people and eradication of one probably sets an opportunity of introduction to another one as a result of their adaption as well as evolution.

Lastly, healthcare system is likely to review its policies on responding to endemic communicable diseases.  As it is in the public domain, China has been accused by certain countries such as the United States of concealing crucial information about COVID-19 that would have been very important in its containment (Hartley & Perencevich 2020). Additionally, China has also bee accused of providing wrong statistics about the disease. It is in this context that there is likely to be a review of health policies on how to respond to epidemics to curb their spread.