A Global Perspective on Social Determinants

Question: Discuss about the Global Perspective on Social Determinants. Answer: Introduction Ebola is a condition with global dimensions attributed to factors such as its rapid and devastating transmission, and high fatality rate. The condition is yet to get a vaccine, hence making it a primary public health management and prevention challenge. Source and Transmission of Ebola Ebola is caused by Ebola virus (a filovirus), which affects humans and other primates (Gunn, 2008). It is a zoonotic disease; however, the natural reservoir is yet to be known regardless of extensive investigation. The primary source of infection has been determined to be non-human primates; but they are not reservoirs of the virus (Public Health England, 2016). According to Public Health Englands 2016 update on Ebola, the first cases in Ebola outbreaks are acquired through human contact with blood, body fluids, secretions or organs of infected animals. The virus has been found in people who handled infected wild animals such as antelopes, either alive or dead, in regions of outbreaks in Africa. Among humans, the virus is transmitted through close and direct physical contact with infected bodily fluids, of which blood, vomit and faeces being the most infectious (WHO, 2014). There are also reports of the virus being detected in urine, semen and breast milk. There is also some risk in saliva and tears, but there are no confirmatory study findings on them. According to WHO (2014), the virus can also be transmitted indirectly through contact with surfaces and objects that have been previously contaminated with infected secretions. Why the Condition Does Not Have a Vaccine Yet One of the most evident reasons hampering the development of the vaccine is attributed to the socio-economic and political forces in regions where the outbreaks often occur. Ebola outbreaks often occur in poor regions of the world, especially West Africa. The local facilities are limited in terms of medical research. Additionally, main pharmaceutical companies worldwide have no interest in vaccine development during the early phases of the disease. It is true that most tropical infectious diseases in poor tropical nations evoke little interest in funding and research for the development of vaccines by pharmaceutical companies (MacNeil Rollin, 2012). The Ebola virus has been detected for several decades but it seems to be neglected (Geisbert Jahrling, 2003). Geisbert and Jahrling further argue that there is minimal commercial interest for the development of this vaccine. Due to the minimal possibility that it may be a worldwide pandemic, there is minimal research and development dir ected for such. The second issue hampering the process is challenges in production cost and logistics. There are complex regulatory and liability issues surrounding the development. There is disagreement among major players such as the US, UK, and France regarding the issues of regulation and liability. Countries such as the UK suggest that producers and distributors of the vaccines should be provided with some form of relief from liability in order to fast-track the process (Cohen Kupferschmidt, 2014). This is however not the same views held by all countries involved in the development. Financing issues also exist. Economic powerhouses of the world are divided between unilateral financing or the use of a multi-donor club strategy (Cohen Kupferschmidt, 2014). In addition, logistical challenges in aspects such as the availability of storage facilities and cold chain capacity of receiving countries, are also inevitable Third, developing treatments for viral diseases proves more challenging compared to developing other treatments such as antibacterial therapy. This is attributed to the fact that viruses produce a few proteins, hence there are fewer targets for treatment. Due to this, it is challenging to develop a vaccine against the virus as the persons immune system has a small target. In addition, the evolution of the virus poses more challenges. Ebola viruses do evolve at a rapid pace; hence it is not certain whether vaccines developed today would be able to offer the same protection against future outbreaks. Still, on laboratory practices, another reason for the lack of a vaccine for the Ebola virus may be attributed to it being a dangerous virus. The virus has a very high mortality rate as high as 90 percent (Public Health England, 2016). Being that such dangerous requires that researchers work with the virus in special facilities equipped with the highest level of safety precautions. This li mits the number of experiments that can be done by researchers around the world. Working with the virus requires a biosafety level 4 laboratory (Rettner, 2014). Lastly, development of a vaccine for a viral condition such as Ebola may be hampered by the lack of human study subjects. Relatively few people do get infected with this condition, and even fewer of these do survive, hence making it difficult to study the virus in human subjects. In addition, there is the lack of new vaccine trial candidates (Wiwanitki Viroj, 2015). Comparing Public Health Management and Prevention of Ebola in Wealthy Vs. Poor Nations For purposes of comparison in this context, United Kingdom will serve as the wealthy nation whereas Uganda will be the poor nation. The UK has never experienced an Ebola outbreak, further, the risk for the same is quite negligible (NHS Choices, 2015). However, the government has always been vigilant whenever outbreaks have occurred anywhere else in the world. Other than local management interventions, the country has also participated in international management at the sites of outbreaks. On the other hand, Uganda has a record of Ebola outbreaks, the latest being the five outbreaks between 2000 and 2012 with 425 cases and 224 deaths occurred (Okware, et al., 2015). In an event of an Ebola outbreak anywhere, the UK government closely monitors the spread of the virus and also takes action both at home and abroad. The initial response is to prepare the NHS by developing and testing the systems for the management of unusual infectious diseases (UK government, 2016). In addition, screening at UKs ports of entry is heightened. Anyone coming into the country and who had a chance of being exposed to the virus is referred for screening. Any passenger coming from the affected countries are also followed up for risk assessment (UK government, 2016). In its response to outbreaks in Africa, UK works with the WHO and the wider international community in combating the infection at the source. On the countrys government website, it also offers support to international agencies such as the world bank, directly offers medical help on the ground, deploys teams of experts from the NHS to offer support, trains frontline workers, supports scientific research and tes ting, and also fast-tracks vaccine trials (UK government, 2016). Ugandas response to the manage the outbreak and also prevent further spread was based on early detection and action, community mobilisation, and international collaboration (Okware, et al., 2015). The countrys efforts were focused on treatment and not just quarantine in an effort to enhance public trust and also promote health seeking behaviours. Early detection and action lead to favourable outcomes and results. This is evidenced by the ability to easily contain the rural outbreaks. Community-imposed quarantines further prevented the spread and introduction of the virus into neighbouring districts. Community mobilisation and leadership were well-adapted to support early case detection and isolation, and also for the purposes of public education and contact tracing (Okware, et al., 2015). Early detection and action facilitated containment of the outbreak to the source. Outbreak control efforts were further supported by the elements of community mobilisation and leadership. Internatio nal support was also sought to augment the nations efforts in containment and management. Survivability was also improved through palliative care measures. Ugandas efforts in isolation and case management in managing the outbreak especially in cases such as the Gulu outbreak evidenced by a reduction in mortality (Lamunu, et al., 2004). As reiterated by Okware, et al., (2015), in summary; Ugandas efforts were; first, strengthening of leadership at the community level, second, strengthening of laboratory capacity for early detection, third, the improvement of supportive treatment and not just quarantine and isolation, fourth, elimination of gaps in barrier nursing through the institutionalisation of infection control policies, and lastly the development of human resource policy and plans to attract and retain workers. References Cohen, J., Kupferschmidt, K. (2014, October 23). Leaked documents reveal behind-the-scenes Ebola vaccine issues. Retrieved from Science: https://www.sciencemag.org/news/2014/10/leaked-documents-reveal-behind-scenes-ebola-vaccine-issues Geisbert, T. W., Jahrling, P. B. (2003). Towards a vaccine against Ebola virus. Expert Review Vaccines, 2(6), 777-789. Gunn, S. W. (2008). Understanding the Global Dimensions of Health. New York: Springer Science Business Media. Lamunu, M., Lutwama, J. 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