20 November 2014
Her Majesty’s concerns about infectious diseases beyond Ebola are well-founded. Malaria and other preventable diseases cannot be neglected if we are to build strong public health security.
David Heymann

Professor David Heymann CBE

Head and Senior Fellow, Centre on Global Health Security


Children follow a mobile insecticide smoke generator used against mosquitos in Koumassi, during an operation to prevent malaria. Photo by Getty Images.
Children follow a mobile insecticide smoke generator used against mosquitos in Koumassi, during an operation to prevent malaria. Photo by Getty Images.


During this week’s visit to Chatham House, Her Majesty Queen Elizabeth II spoke with me about the Ebola outbreak in West Africa, and her concern for other infectious diseases. The Queen’s comment, widely reported in the media, was specifically about malaria and her concern for those who die each day from this and other infectious diseases still endemic in West Africa – diseases that can be prevented and controlled. In particular, the Queen expressed a concern for current malaria control efforts when attention and health resources are being heavily concentrated on Ebola. 

The Ebola outbreak in West Africa has spread across international borders, causing a collective threat to entire populations, and it has highlighted the fragile access that individual patients in this region have to healthcare. It has severely tested the preparedness of both national and global health systems, and clearly demonstrated their weaknesses. Now the global community must work together intensively to stop the sickness and death Ebola causes and, at the same time, curtail its local, regional and international spread. 

More than 25 Ebola outbreaks have been stopped in the past, including one that began in August of this year in the Democratic Republic of the Congo and was rapidly contained by the end of October. These outbreaks have all been stopped by three basic public health strategies: isolation of patients in facilities where they receive care, and where health workers are protected and hospital practices prevent spread; tracing the contacts of persons with Ebola and monitoring their temperature twice daily, with diagnosis and isolation if Ebola is diagnosed; and helping community members understand how to prevent infection, with provision of respectful community services that transport patients and bodies, ensure safe funeral practices and make households safe after patients have been removed. 

Implementing these strategies requires basic skills in public health, leadership by governments in partnership with civil society, innovation in difficult urban environments, and coordinated international support. Underlying these strategies must be a commitment to developing health systems that provide strong public health and improved access to health care.

At the same time, as the Queen pointed out, it is important not to lose sight of the fact that malaria continues to afflict millions, mainly children, in developing countries. In 2012, malaria was responsible for an estimated 627,000 deaths, worldwide.  In Sierra Leone, one of the countries hardest hit by Ebola, malaria accounts for a quarter of all reported deaths and is reported to be the leading cause of death among children under five. The rainy season in West Africa, when malaria incidence is at its highest, has just past; health facilities were hard hit by the loss of over 400 health workers from Ebola and the burden of caring for patients with Ebola. And although malaria deaths have fallen by about 30% in Africa since 2000 thanks to more intensive national and international efforts, the Ebola outbreak has significantly slowed these efforts in countries such as Guinea, Liberia and Sierra Leone where the deployment of bed nets and the diagnosis and treatment of children with malaria is reported to have come to a virtual standstill.  

Other infectious diseases also take a high toll on children in West Africa and other developing countries. Each year diarrhoeal diseases are thought to be responsible for 760,000 child deaths and pneumonia an estimated 935,000. Measles is another health threat in West Africa, and was responsible for 145,000 deaths in 2013 and 122,000 in 2012. The impact of the Ebola outbreaks on malaria and other childhood disease prevention and control programmes is likely to linger long after the Ebola outbreak ends in West Africa, even as other developing countries continue to make advances in providing access to medicines, vaccines and other goods such as bed nets. 

As alluded to by the Queen, the health security of West Africans has been severely compromised by one highly virulent infectious disease that emerged suddenly from nature, and by other lethal, but neglected, infectious diseases that have been present in developing countries for centuries. The message from the Ebola outbreak in West Africa is clear: we must develop health systems that provide strong public health and improved access to healthcare – emphasizing one over the other, or neglecting them both, will continue to compromise our collective and individual health security. 

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