10 threats to global health in 2018

From Mosul to Cox’s Bazar, cholera to plague, 2017 was full of health emergencies caused by conflict, natural disasters and disease outbreaks. But 2018 could be even worse if we don’t prepare, prevent and respond in time. The World Health Organization continues to tackle disease outbreaks and other health emergencies worldwide in 2018, but operations are underfunded and needs continue to grow. These are just some of the threats to global health that we are likely to face. Many of these crises are entirely preventable, and often man-made.


Pandemic Influenza

A presentation about influenza in Nepal (2010)

Another influenza pandemic is inevitable. In this interconnected world, the next global flu outbreak is a matter of “when” not “if” — with far reaching consequences. A severe pandemic could result in millions of deaths and destroy over 1% of global GDP.

We have come a long way in the hundred years since the Spanish Flu killed as many as 100 million people. We now have the means to detect and respond to influenza when it strikes. Every year, WHO recommends candidate vaccine viruses to protect people from seasonal flu worldwide. More than 150 public health institutions in 110 countries work together on global surveillance and response. But nothing about influenza is predictable, including how and where the next pandemic will emerge.

WHO is monitoring other high threat respiratory pathogens with pandemic potential, including MERS CoV.


Health in conflict

A doctor in a health facility in the Democratic Republic of the Congo (2005)

Conflict continues to ravage health systems across the world — from Yemen to Ukraine, South Sudan to the Democratic Republic of the Congo. Warring parties are increasingly attacking health facilities and healthcare workers, as well as vital infrastructure. In many of these places, more people die of treatable and preventable diseases and chronic illnesses, than of bullets and bombs. Humanitarians often lack access to deliver the lifesaving food, water, and medicines that people so desperately need. Chemical and biological attacks are also a significant risk in warfare.


Cholera

Posters being hung on a wall as part of social mobilization efforts to support an oral cholera vaccination campaign in Kinshasa (2016)

More than 2,000 years after its first recorded mention by Hippocrates, the disease caused by the Vibrio cholerae bacterium is thriving across the world. Although easily prevented and treated, cholera kills nearly 100,000 people annually in communities weighed down by poverty and conflict.

Read about the Global Task force on Cholera Control m

In 2017, oral cholera vaccines were used to protect 4.4 million people in nine countries: Bangladesh, Cameroon, Haiti, Malawi, Mozambique, Nigeria, Sierra Leone, Somalia and South Sudan. In 2018, WHO will support similar campaigns alongside access to safe water and sanitation and improved hygiene.

Read about the global taskforce to end cholera epidemics by 2030

Diphtheria

Rohingya children in Jamtoli settlement, Bangladesh (2017)

The widespread use of the diphtheria vaccine as part of routine immunization programmes has eliminated the infectious respiratory disease in most parts of the world. But diphtheria is making an alarming comeback in countries suffering from significant gaps in healthcare provision. Venezuela, Indonesia, Yemen, and Bangladesh (Cox’s Bazar) all reported diphtheria outbreaks in 2017, requesting support from WHO for response operations, technical guidance and supplies of diphtheria medicines and vaccines.


Malaria

Children in bed under insecticide treated bed nets in Timor Leste (2013)

Each year, WHO estimates more than 200 million cases of malaria worldwide, with over 400,000 deaths. Approximately 90% of deaths caused by the mosquito-borne disease occur in sub-Saharan Africa, with the rest occurring in South-East Asia, South America, the Western Pacific and the Eastern Mediterranean. In Central African Republic and South Sudan, malaria kills more people than war. Other countries struggling with malaria include the Democratic Republic of the Congo, Nigeria, and Somalia.


Natural Disasters

A WHO health worker at the site of mudslides on Sugar Loaf Mountain in Freetown, Sierra Leone (2017).

Disasters from natural hazards like floods, hurricanes, earthquakes and landslides can cause immense suffering and have far-reaching health consequences for millions of people. In 2017, hurricanes Harvey, Irma and Maria caused widespread destruction in the Caribbean and the United States, monsoons in Bangladesh, India and Nepal affected more than 40 million people, and devastating mudslides in Sierra Leone prompted fears of a cholera outbreak. Droughts leading to food insecurity and malnutrition are often associated with outbreaks of disease, while heatwaves cause excess mortality, particularly among the elderly.


Meningitis

Children in southern Malawi (2015)

A virulent new strain of meningococcal meningitis C is circulating along Africa’s meningitis belt — threatening 26 countries — at a time of acute global shortages of the meningitis C vaccine. The risk of large-scale epidemics is dangerously high and more than 34 million people could be affected. More than 10% of people who fall ill with meningitis C die. Survivors often face severe neurological consequences. WHO and partners support a global emergency stockpile, which counts 2.5 million doses of meningitis C-containing vaccine. However, an additional 10 million doses will be needed to avert a major epidemic before 2019.


Yellow Fever

Health workers prepare vaccines on the first day of a yellow fever vaccination campaign in Kinshasa (2016)

Acentury ago, yellow fever was a source of terror — decimating populations and destroying economies. Mass vaccination campaigns led to a dramatic drop in cases worldwide — but the early 2000s witnessed a resurgence of the acute viral hemorrhagic disease in Africa and the Americas, where 40 countries are considered at highest risk.

In 2016, yellow fever outbreaks in Angola and the Democratic Republic of the Congo were only contained after mass vaccination drives reached 30 million people. In 2018, Nigeria and Brazil are tackling major outbreaks threatening urban areas.

Read about the Eliminate Yellow Fever Epidemics (EYE) Strategy

Other viral hemorrhagic fevers to look out for include Ebola and Marburg Virus Disease, Crimean–Congo Hemorrhagic Fever, Rift Valley Fever, Lassa Fever, Hantavirus diseases, and Dengue Fever.


Malnutrition

The arm of a child is measured as part of screening for malnutrition at a mobile clinic in Marawi, Philippines 2017 (WHO/F. Tanggol)

Globally, 45% of deaths among children under 5 are linked to undernutrition. WHO has developed kits for malnourished children with medical complications.

Shortages of food will remain a serious challenge in the Horn of Africa in 2018. In South Sudan in 2018, 1.1 million children under 5 are expected to be malnourished, and nearly half the population faces severe food insecurity. In Yemen, 7 million people are at risk of malnutrition and 17 million remain food insecure.


Food poisoning

A food inspector conducts a random inspection at a market in the Philippines (2017)

Every year, 600 million people — almost 1 in 10 people in the world — fall ill and 420,000 die after eating contaminated food.

South Africa is currently battling the world’s largest listeriosis outbreak on record. In 2017, an outbreak of salmonellosis led to the recall of a French brand of contaminated baby formula from more than 80 countries and territories around the world.


In 2018, WHO will pursue its policy of ‘no regrets’ in responding to health emergencies — guided by the knowledge that outbreaks are inevitable, but epidemics are preventable.