Ebola, Measles and Diarrhea killing children.

StrategyPage writes about the Ebola epidemic in the DRC/Central Africa.

The good news:

international and Congolese health workers have a new weapon in their arsenal. Two days ago 11,000 doses of the new American Ad26-ZEBOV-GP vaccine arrived in North Kivu province. North Kivu, South Kivu and Ituri are the three provinces in the epidemic’s epicenter. Another 39,000 doses will arrive shortly. As of October 20, there were 3,243 Ebola virus cases and 2,185 deaths in Congo. Uganda has had four confirmed cases and three deaths. 

the bad news:

 Sadly, in 2019 measles has killed more people in Congo than Ebola. So far over 4,100 Congolese have died this year from measles. Estimates are that Congo had over 200,000 total measles cases in 2019. Over 140,000 of those cases were children under the age of five years. (Austin Bay) 

there was a push to eliminate measles from the world (similar to how smallpox was eradicated in the recent past).

This 2014 article discussed some of the problems of getting the vaccine into the chaotic DRC (Democratic Republic of the Congo).

So what are some of these bottlenecks? First, access to routine vaccination services is extremely limited. The population is spread over large geographic areas with very limited road and public transport networks. Second, in several provinces, health clinics perform poorly due to shortages of health staff, ill-equipped health structures, irregular supplies of vaccines and inadequate cold chain equipment for vaccine storage.8,9 Third, the logistics challenge of accessing children in distant areas is overwhelming.

the article goes into details about the logistical problems.
One problem with measles vaccine is that since it is a "live" attenuated virus, it needs refrigeration. So if it gets warm, it deteriorates and doesn't work. That alone is a major problem.

and when I read in the article that there are reports of a alot of measles despite the reports of a high rate of vaccinations.

I not only wonder if the vaccine had been kept cold and had been given properly, but if the health care workers just faked the data to get paid.

and that doesn't even mention little things like roaming gangs who steal medical equipment, rob health care workers, and terrorize locals, or that many people are fleeing the war between insurgencies and government troops.

nor does it mention the propaganda war against vaccinations. This has been notorious with both polio and measles, usually in Muslim countries where the Mullahs take a half baked anti vax conspiracy theory from the web and tell their people not to get their kids vaccinated.

But these rumors are also complicating the ability to control the ebola epidemic. (something mentioned in the SP article)

The government and medical aid organizations are battling rumors that Ebola is a hoax. ... Many locals refuse to believe Ebola is what local and foreign doctors say it is. Traditional healers and the few Islamic terror groups in the area also oppose efforts to use modern medicine to treat Ebola. The traditional healers see it as a threat to their livelihoods while the Islamic terrorists believe Western medicine is really an infidel (non-Moslem) plot to poison Moslems or Africans in general.

Opponents to Ebola treatment encourage violence against those providing this treatment and that has led to some deaths and a considerable amount of violence.

Then we have this complaint: the upsurge in measles cases might have been partly because health resources have switched from vaccinating for Ebola rather than routine childhood vaccinations.

A combination of factors – increased violence, growing mistrust towards medical teams in the wake of the Ebola outbreak as well as the diversion of resources to deal with Ebola – have resulted in reduced vaccination coverage in general.

....Community mistrust towards the outbreak response team has been cited as one of the challenges. Another is the high levels of insecurity due to battles between the army and armed groups. This has affected access to health services by communities.

you don't say.

and from my experience, a lot of the "measles" deaths won't be reported: often the children would die of croup, pneumonia a week or two after the measles rash disappeared.

And then there is the problem of tuberculosis: Measles causes "anergy", meaning your resistance against tuberculosis goes down, and then you can die of TB. TB also is seen when the immune system is weakened by malnutrition, HIV, malaria, or other infectious diseases. 

and yes, malaria remains a major killer of children and adults in the area.

and don't forget that one of the major killers of young children is various forms of gastroenteritis, or diarrhea disease, usually viral, which usually is because of lack of clean water.

Sigh.

There are ways to fight all these diseases (been there, done that: baby clinics, digging wells, village health workers with WHO rehydration fluid, supplying chickens and cheap protein supplements and nutrition villages), but when there is a war and the roads are not safe, when clinics are robbed or medical personnel are killed, then the plan collapses.

been there, done that too. 

Sigh.

cross posted from my main blog