A new publication advocating for donor and policy reform for stronger health systems in lower income countries

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A career in global health is a peek into all that is right and wrong with the world. There are still so many people in both lower income countries (but even in marginalized communities in higher- income countries) that die from treatable diseases and preventable causes. Well meaning donor entities know this and try to rectify this problem by providing resources to Ministries of Health to sort out these issues. The problem is that the way public health interventions are developed and funded can be more disruptive than helpful and often times unsustainable. In a recent Lancet publication, my co-authors and I describe how the focus on ‘Global Health Security’ functions have become a parallel system that many times diverts funding from the main health system (i.e curative health services) to fund specialized activities around preventing, detecting, and responding to disease outbreaks. I think functions such as these are essential—but they are part of a strong health system and not the health system itself. In this paper we advocate for better strategic coordination between donors, Ministries of Health, and global health governance decision makers to ensure that the way we define and fund health systems is compatible with the way they should operate in real life. This is especially important as WHO, led by the dynamic Dr Tedros, push all countries to work toward Universal Health Coverage.

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Lessons learned from the final Ebola outbreak in Guinea

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Lessons learned from the final Ebola outbreak in Guinea

In mid-March of 2016, I was a new field epidemiologist working in the West African country of Guinea. The Ebola epidemic seemed to be over: We were just 11 days away from being Ebola-free for 90 days, which would mark the official end of the country’s epidemic. Then field coordinator Dr. Angelo Loua walked into our small World Health Organization field office in the southeast region of N’zerekore and announced that an 8-year-old girl had just tested positive for Ebola.

“Please pray for us, it’s Ebola,” I texted my friends and family with confirmation of my worst fears. 

In most accounts of the Ebola outbreak, Guinea’s experience is overlooked. Yet it was in Guinea in March 2014 that that the plague began, gripping seven of its eight regions, and from where it spread to Liberia and Sierra Leone. Ebola infected more than 28,000 people and killed more than 11,000 before it was declared over on June 9, 2016.

By early spring of 2016, most of the international organizations that had mobilized to fight the Ebola pandemic had called home their workers. Our field team managed to grow quickly from fewer than 20 staffers to more than 100, including local Guineans and international responders such as my teammates from the US Centers for Disease Control and Prevention. Most of the responders had worked in the region throughout the three-year outbreak. I was fresh out of grad school, completely frightened but ready to help.

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Adding health systems to the pandemic preparation equation

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Adding health systems to the pandemic preparation equation

I originally published this blog post in the Huffington Post on 7 March 2017 under the title: Solving the next global pandemic (probably a bit catchier than this post title...)

In his latest annual letter, Bill Gates warned of the imminent threat of a deadly pandemic to the global community. Yet, while his message also lauds the accomplishments of vaccine coverage, he has consistently lacked the emphasis on a crucial element of global health security: If we truly want to prepare for the next pandemic we need to invest in health systems, not just vaccine development.

Gates is not alone. Vaccines as the solution to major global health problems is emerging as a theme for global health in 2017. A new multi-million dollar initiative, the Coalition for Epidemic Preparedness and Innovation (CEPI), is an admirable solution to build an arsenal of vaccines against diseases that may not turn a profit but would protect thousands of lives. In a global health funding environment with an uncertain future due to President Trump’s plans for budgetary cuts, this could be a wise investment. However, pandemics will not be beaten without the participation of the people most affected. And the critical component currently being overlooked is the value of resourcing health systems in countries most under threat.

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In a room of World Changers: Aspen Institute New Voices Fellowship

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In a room of World Changers: Aspen Institute New Voices Fellowship

When I was selected to be an Aspen Institute New Voices Fellow back in late December 2016, I knew that I was entering another level of favour and opportunity but I really had know idea what it would look like. When I stepped into Johannesburg the on 19th of February, the first impressive human being that I met was an entomologist/geneticist who works at Oxford University.  She had brilliance and a beautiful inheritance and so she was the full package to me. She was Kenyan and speaking to her as a fellow New Voices Fellow-- I realised that I shared several spaces with her: expat living in the UK, malaria researcher, and African citizen. The latter is something that I am, yet I had not fully occupied my entire life. This is because its difficult to define yourself as something without continuously experiencing that thing.

During our one-week training, the experiences of, mostly , Africans across social class, religious background, and most pertinent: across social causes, totally engulfed and... accepted me! The first day of the conference was all about leadership... Our host Akaya Windwood, president of Rockwood Leadership Institute, used her perfected peaceful presence and thoughtfully crafted questions to make all us, Fellows and the Aspen Institute staff and Mentors alike, reflected on those in our lives who made the space for us to be where we were. We also had to think of those that we had influenced and how our presence had affected their lives-- this of course made me weep like a baby as I thought of my siblings, and in particular my younger brother. Throughout that first day we...

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The "simple" challenge of malaria elimination: a response to Ken Opalo's post

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This post was originally written on 10 November 2016.

I recently read an article from Ken Opalo, a prominent African political blogger who I admire, entitled: How to eliminate malaria. Mr. Opalo (who I will now, respectfully refer to as Ken) lauded the success of the Sri Lankan government’s efforts that combined vector control strategies with persistence even during the civil war.  This was all well and good until this statement: “Someone tell African policymakers that bed nets and behaviour change are not enough”. He continued with this reproof and concluded with emotive, albeit factual, malaria statistics that highlight that nine in ten malaria deaths are in sub Saharan Africa.  After reading this post, I found myself very frustrated with Ken—who is generally someone who I often referred to for a smart analysis of African issues. 

To start, in this post he erroneously juxtaposes a country of 20.5 million to a continent of 1.2 billion. As an infectious disease epidemiologist it pained me to see Ken cast uniform blame on 54 countries without any mention of the variable factors that influence malaria persistence and the unique epidemiological characteristics that influence malaria transmission and risks. These factors include, but are not limited to: the strength of the health system, issues of insecticide and drug resistance, differences in climate, amount of existing infrastructure, even rainfall… I could go on and on. Instead, I would like to highlight a few areas where Ken missed the mark with his criticism.

In order to eliminate a disease the government must first contain it. Malaria spreads when a mosquito bites...

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