Direct Relief has a unique vantage that comes with its work supporting health providers and communities in extraordinary situations. Their stories make clear that the circumstances of disaster or misfortune, while tragic and unfair, don’t define them.

It’s a privilege to highlight their work and experiences.

Below are the 10 most read, originally reported stories from Direct Relief in 2019.

10. Rags Instead of Tampons. Here’s What Period Poverty Looks Like in the U.S.

Many women in the United States aren’t able to buy period products, and are forced to go without each month. Direct Relief Audio Journalist Amarica Rafanelli spoke with women who experience “period poverty,” as well as health providers and policy makers working to end it. The story was Direct Relief’s second-most listened to podcast of 2019.

Listen here.

9. Waters Rise in East Texas as Tropical Storm Imelda Drenches Communities

Tropical Storm Imelda dropped enormous volumes of rain earlier this year, inundating communities, including some still recovering from Hurricane Harvey in 2017. Direct Relief Journalist Noah Smith interviewed leaders at the region’s community health centers working to serve vulnerable patients, even as waters rose.

Read more.

8. Hurricane Dorian Rakes Treacherous Path through the Caribbean

Hurricane Dorian’s path through the Caribbean was unpredictable as the storm gathered strength. Residents in Puerto Rico, Dominica, Florida and on the U.S. East Coast all watched warily as forecasters worked to determine exactly who would be in the path of hurricane-force winds and flooding. Direct Relief Journalist Talya Meyers tracked the storm in its early days, as residents and emergency responders planned to react.

Read more.

7. The U.S. Is in Danger of Losing Its Measles Elimination Status. Here’s What That Could Mean for the Rest of the World.

After significant public health gains decades in the making, the United State was very close to losing it’s measles elimination status. Direct Relief Journalist Talya Meyers interviewed experts who reported that the U.S. was the first country to eliminate measles, and that a change in elimination status could discourage public health efforts in other places.

Read more.

6. Haiti Is Facing a Humanitarian Crisis. This Doctor Is on the Front Lines.

Civil unrest of enormous proportions unfolded in Haiti this year, with political turmoil resulting in disruption of daily life, as well as dangerous consequences for people caught in the middle. Health providers were working heroically to continue services, including the staff at St. Luke’s Hospital in Port-au-Prince. Direct Relief Audio Journalist Amarica Rafanelli interviewed Father Rick Frechette, the founder of St. Luke’s, who talked about the reality of providing care in Haiti, resulting in Direct Relief’s most listened to podcast of the year.

Listen here.

5. It’s Becoming a Busy Hurricane Season, and Every Storm Matters

2019 proved to be an active hurricane season in the Atlantic Ocean, and Direct Relief Journalist Talya Meyers found that a storm’s true impact is often overlooked, especially on vulnerable communities. Rather than just looking at wind speed or direction, experts said that even smaller storms can have disproportionate impacts on the people least able to weather the storm.

Read more.

4. Disasters Go, Hurricanes are Predictable. That’s Not Saying Much.

There’s only so much a storm’s “cone of uncertainty” can tell people potentially in its path. Hurricane Dorian turned out to be a much more unpredictable storm, gathering strength and ultimately diverting away from Florida and striking the Bahamas with devastating winds and storm surge. Direct Relief Journalist Talya Meyers spoke with hurricane experts and discovered what we don’t know — and the limits of what we do — with any given storm.

Read more.

3. Ebola Continues to Spread, Even as Medicine Advances

Since August 2018, health workers in the Democratic Republic of the Congo have been grappling with the world’s second largest Ebola epidemic on record. More than 2,200 people have died as a result of the disease, and the dangerous circumstances that faced health workers have complicated efforts to contain the disease. Direct Relief Journalist Noah Smith interviewed experts that responded to the West Africa Ebola outbreak of 2014, and lessons learned that could guide the way forward.

Read more.

2. The Global Measles Epidemic Isn’t (Just) About Measles 

In 2019, countries across the world experienced outbreaks of measles, once a common and deadly childhood illness which had been declared “eliminated” from many parts of the world, including the United States. Andrew Schroeder, Direct Relief’s Vice President of Research and Analysis, examined the cause of the outbreaks, the historical context, and what health professionals and policymakers could do to stop the spread of the disease.

Read more.

1. Hurricane Dorian: Population Movement – A Live Story 

Hurricane Dorian confronted the Bahamas with the most devastating storm to ever hit the island nation. In the days after Dorian swept ashore, it became crucial to map not only where the storm had been, but where people were moving to. Direct Relief’s Research and Analysis team analyzed anonymized data sets from Facebook mobile users to show where people were moving to, in order to better understand where needs were. Direct Relief Journalist Noah Smith worked in concert with the organization’s staff to track movement and share findings.

Read more.

The post The Most Read Stories of 2019 appeared first on Direct Relief.

The call went out on a Monday. Early Wednesday morning, Dr. Sehgal, the director of pediatric services at Waianae Coast Comprehensive Health Center, was on a plane from Hawaii to Samoa.

With her, she hand-carried a Direct Relief Hurricane Preparedness Pack, which contained antibiotics, sterile water, and Pedialyte, among many other supplies.

She was one of more than 70 volunteers, she said, primarily pediatricians and registered nurses, who heeded Samoa’s call. “Our goal…was really to assist with this mass vaccination campaign,” she said.

Samoa is in the throes of a measles epidemic that has thus far infected 2% of the country’s population. The death toll has risen to 70, and most of those deaths have been young children.

The Samoan government announced last week that it was shutting down government offices and public services for two days to divert all attention – and its public servants – to a door-to-door vaccination campaign aimed at immunizing anyone from 6 months to 60 years old.

By mid-morning on Wednesday, Dr. Sehgal was heading one of more than 100 teams whose job it was to travel from village to village, looking for red flags, often made from T-shirts or scarves, outside of buildings – a sign that there were people inside who needed vaccinations.

Although the teams were made up of government employees from all walks of life – Dr. Sehgal chuckled when she recalled that there was an information technology specialist on her team – vaccines were administered by a doctor or registered nurse.

“There’s still a fair amount of mistrust,” Dr. Sehgal said. When the measles epidemic broke out, vaccination rates in Samoa were startlingly low – 31%, compared to about 69% worldwide.

The mistrust is thought to stem from an episode last year: Two infants died after receiving the measles vaccine, improperly mixed with an expired muscle relaxant instead of water. Although efforts have been made to educate the public about the mistake, vaccine hesitancy remains high.

However, when the team’s van pulled up to a red-flagged building, Dr. Sehgal said, people were so eager that they’d come running out to meet them. Like any experienced pediatrician, she traveled with stickers for the children she immunized.

“People were very willing to be vaccinated. In fact, we had to turn down a couple of people who were older than 60,” she recalled. “Quite a few of the people we vaccinated were very grateful that we came to them. They were afraid to go to the hospital to be vaccinated.”

People with confirmed cases of measles are being treated at local hospitals, they are being kept separate from the rest of the population. Nonetheless, Dr. Sehgal said, the people she encountered were afraid of potentially being exposed to measles.

There were some challenges. The measles vaccine has to travel under cold-chain conditions – repeatedly checked to make sure that it is staying within a narrow temperature range – in order to be safe and effective.

“It was hot and humid in Samoa,” Dr. Sehgal recalled. “We were working very quickly to…administer the vaccine without breaking the cold chain.”

At the end of the first day, they had a terrible surprise. They visited a house where two children needed vaccinations and then were told there was another, ill child.

“There was a 15-month-old female who had never been vaccinated because of the fears,” Dr. Sehgal said. The baby had been sick with measles for several days, had a fever, and was dehydrated.

“We immediately put her in our van…We drove as fast as we could, it was about a 45-minute drive.”

Dr. Sehgal said she was impressed by her team members, who intently hunted out every red flag they could find. And she was impressed by the Samoan government’s well-organized response – and their willingness to ask for volunteers.

“Samoa is a very proud country. I’m grateful that they asked for help, and I’m grateful there was such an outpouring of help on such short notice,” she said.

And as a doctor, she was delighted by the “hundreds” of people – many with smiling faces – that she was able to vaccinate. “It’s just wonderful to feel that you are welcomed, that you are wanted.”

The post On the Frontlines of Samoa’s Measles Epidemic appeared first on Direct Relief.

53 people, the vast majority of them children under the age of four, have been killed thus far by a measles outbreak that struck Samoa in October.

Nearly 4,000 cases have been recorded on the Southern Pacific island nation, which is home to about 200,000 people. According to the Samoan government, none of the people who have contracted the disease thus far were vaccinated.

The shutdown is Samoa’s most recent attempt to fight an outbreak that the government declared on November 15 to be a national emergency. 58,000 people have been immunized as part of a mandatory vaccination campaign. Schools are closed indefinitely.

On December 5 and 6, civil servants will set aside their normal duties in order to aid in vaccination efforts.

Measles vaccination rates in Samoa are unusually low. A survey published by the WHO and UNICEF on November 29 showed that only 31% of Samoan children were immunized, as opposed to about 69% worldwide. (Vaccination levels vary widely by nation.)

In 2018, two young Samoan children died after receiving the MMR vaccine, causing widespread alarm. The vaccine in that case was improperly mixed with an expired medication instead of with water.

Measles, a respiratory illness with a characteristic rash, is extremely contagious. Although most people who contract the disease will recover, a small fraction of young children go on to develop more severe complications, including pneumonia and encephalitis, a swelling of the brain that can cause permanent brain damage or even death.

Direct Relief is currently coordinating with the WHO about providing needed medical materials. The organization has also offered support to the Deputy Secretary General of the Pacific Island Forum Secretariat and the Pacific Island Community Health Division.

The organization will continue to monitor the situation and offer support as needed.

Additional reporting contributed by Gordon Willcock.

The post As Measles Death Toll in Samoa Mounts to 53, Government Focuses on Vaccination appeared first on Direct Relief.

Now, that may be changing. The Centers for Disease Control and Prevention announced on May 30 that the country is in danger of losing its measles elimination status. It’s currently experiencing its highest levels of the disease since 1992, with more than 1,000 cases reported so far this year. In other words, measles is in danger of becoming endemic in the United States again.

The next few months will be critical, said Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine. Thus far, outbreaks have been confined to individual pockets scattered around the country. Over the next few months, scientists will be watching to see whether transmission begins to occur between the pockets.

But in any case, “the fact that we’ve potentially allowed it to come back is profoundly demoralizing,” Hotez said.

Why Elimination Status Matters

Losing an official status may seem more symbolic than practical. But experts say the change could have serious consequences for the future of measles in the country. It could even hurt vaccination campaigns in countries where measles is a significant cause of death. A full-on global effort to vaccinate children cut the number of measles deaths worldwide by 80% from the 545,000 deaths in 2000. But that still means more than 100,000 people, mostly children younger than five, died from the disease in 2017.

Because of the United States’ leadership role – it was the first country to eliminate measles – a change in status may discourage public health officials from focusing valuable resources on immunization efforts.

How the U.S. Got Here

The elimination of measles in the United States is a remarkable success story.

Before the 1960s, nearly every child in the country fell sick with the disease before adolescence. Many developed complications, including ear infections, pneumonia, even encephalitis. And every year, approximately 400 to 500 people in the States died of measles-related complications.

An effective vaccine was developed in the 1960s, and rates immediately began to decline. Beginning in the late 1970s, in a widely supported public campaign, the CDC set out to eliminate measles from the country entirely.

It worked. In 2000, measles was declared to be officially eradicated from the country. While people occasionally brought the disease back from international travel, widespread vaccination prevented the disease from gaining a foothold.

The U.S. may have done too good a job. “The vaccine has been a victim of its own success,” said Paul Offit, a professor of vaccinology at the University of Pennsylvania and co-developer of the rotavirus vaccine. “We’ve not only eliminated disease, we’ve eliminated the memory of disease.”

The loss of that memory – of miserably sick children and hundreds of yearly deaths in the United States – means that parents persuaded by vaccine hesitancy don’t know what they’re up against. Among other techniques, anti-vaccination activists argue that measles isn’t a severe enough disease to be worth the risk of vaccination.

That’s simply untrue, according to William Schaffner, a professor who studies infectious disease and immunization at Vanderbilt University School of Medicine. “In many parts of the developing world, [measles] remains a substantial killer of children,” he said.

And in ways, more sophisticated medical care in the United States has made measles more of a threat, Schaffner said. Cancers and other serious health issues aren’t always the death sentence for children they once were. That means we have many more children who are alive but struggling with weakened immune systems. They’re not well enough to be vaccinated, but they’re more vulnerable to the very diseases that vaccinations exist to prevent.

What Happens Next

According to Hotez, the summer could see an easing off of measles cases – or new outbreaks. On the one hand, measles epidemics have historically peaked in the spring and ebbed in the summer, which means the U.S. is heading into a measles off-season. But summer brings a lot of international travel, which is the primary way that measles is introduced here. If travelers bring measles back with them to communities with low vaccination rates, the disease could begin to spread more widely. “We’ll have to see which force wins out,” Hotez said.

Preventing transmission will be an important part of the process. Direct Relief stocks Gamastan, an effective post-exposure medication, in case of measles outbreaks. The organization recently sent supplies to Butte County, where cases were confirmed.

The world is currently experiencing several major measles outbreaks, each with its own complex causes. Two factors that are most common: lack of access, when families can’t get to a clinic or afford the vaccine; and vaccine hesitancy.

We export our culture, our music, our movies. Now we’re exporting our anti-vaccine movement,” Hotez said.

“We were the models” for measles elimination, said Schaffner. The vaccine was an American invention, and the elimination of measles an American success story. “I think the concern in public health is that other countries may see what’s happening and say the juice isn’t worth the squeeze.”

In other words, if the United States’ measles effort ultimately fails, other governments might be hesitant to pour money, time, and energy into their own vaccination campaigns.

What’s Different This Time

So once again, public health leaders find themselves trying to stop the spread of measles. But it’s different this time around. The outbreaks are smaller and more contained, thanks to generally high vaccination rates across the country. However, public trust, vital to the success of the 20th century’s measles elimination campaign, is lacking. Misinformation is rife. “We’re much more cynical than we were back then,” Offit said.

Offit divides people who don’t vaccinate into two groups. In the first, larger group are parents who have heard the arguments against vaccines and are concerned, but not necessarily convinced. If they’re given reliable information in a “passionate, compassionate, compelling way,” they can generally be persuaded.

But for people who are completely convinced by anti-vaccine rhetoric, Offit’s experience tells him that education won’t work. That’s where public health legislation can step in, through the elimination of personal-belief and religious exemptions or even, in the case of New York’s Rockland County, banning unvaccinated children from public spaces.

In Offit’s eyes, the country no longer deserves its elimination status. “We can say right now that measles is endemic in the United States,” he said. The numbers are “a blip” compared to what they were, but statistically speaking, one in every thousand measles cases results in a death. “We’re on the verge of seeing people die of measles again,” he said.

The post The U.S. Is in Danger of Losing Its Measles Elimination Status. Here’s What That Could Mean for the Rest of the World. appeared first on Direct Relief.

Over 112,000 cases were reported to start this year, as opposed to just over 28,000 from the beginning of 2018. That year likewise saw a significant gain as compared to 2017. Although still not close to the shocking levels of the mid-20th century, when tens of millions of children were infected and millions died, the trend for new measles infections seems to be inexorably and frustratingly on the rise.

This trend places children under the age of 10, particularly in poor and conflict-affected parts of the world, at increasing levels of entirely avoidable risk.

The Global Measles Resurgence

One of the most common explanations in the media for the measles resurgence has to do with a set of beliefs promoting reluctance to follow through with childhood vaccinations. The WHO earlier this year labeled this emerging reluctance one of the world’s “top ten” threats to global health.

The spread of misinformation about childhood vaccination is leading to a wave of what the World Health Organization calls “vaccine hesitancy.” Over time, declining tendencies to follow through on evidence-based public health recommendations may threaten long-established successful practices, which have improved the health of children since the mid-20th century.

In parts of California, New York and Washington State, for instance, there is evidence that relatively small outbreaks have been correlated with reduced vaccination rates due to anti-vaccine misinformation combined with novel introduction of the virus, often through travelers.

Globally, however, how can the disease’s resurgence be explained? Without question, the world needs to remain vigilant to any possibilities that the consensus around childhood vaccination may be undermined over time by rising “vaccine hesitancy.” However, large numbers of people around the world are still not able to access the vaccinations they both want and need.

Measles, Conflict and Health Systems

In addition to the effect of vaccine hesitancy, we need look no further than the WHO’s own country-level data on the locations and growth trends of measles cases.

Almost all the enormous jump in measles cases from 2017 until the beginning of this year is attributable to a handful of places. This year, almost two-thirds of the entire reported global measles caseload is attributable to just two countries: Ukraine and Madagascar.  These two countries are highly instructive as to the true reasons why we should pay attention to measles as something like a “canary in the coalmine” for the underlying weaknesses of public health systems.

Let’s start with Ukraine, which may appear, at first glance, to be the most puzzling.

Why should a middle-income country on the edge of Europe, with a historically reliable, near-universal public health system, suddenly become a kind of poster child for the rampant spread of infectious childhood illnesses for which immunization exists? The answer is pretty simple: conflict.

Prior to 2014, Ukraine maintained a measles vaccination rate of 95 percent, generally considered the gold standard level for herd immunity. Then, conflict broke out between Ukraine and Russia. As a result, the Ukrainian Ministry of Health budget was frozen and measles vaccination procurement largely ceased until late 2015. By 2016, Ukraine’s vaccination rate had plunged to just 41 percent, one of the lowest rates on the planet.

In subsequent years, the vaccination rate in Ukraine crept back up close to its pre-conflict levels, with about 91 percent coverage achieved last year. But the damage had been done. A multi-year cohort of Ukrainian children had lost their immunity to the disease. Combined with widespread disruption of the primary health care system, and the physical effects of conflict on large numbers of communities, measles took root again quickly and began to spread.

Some of the migration of measles from the Ukraine epidemic has apparently gone international, with cases in New York, Israel and elsewhere traced directly to index cases of travelers from Ukraine.

Elsewhere, in places from Yemen to Nigeria, one can also detect the sharply negative impact of conflict on basic health system capacities and measles infection rates. The lessons of the Ukrainian measles epidemic, as is also the case with these other countries, are not only that it doesn’t take much to fundamentally disrupt a well-functioning health system and produce an otherwise preventable outbreak. Disruptions to health systems in one country, given high levels of global mobility through air travel, can quickly be felt in many places throughout the world.

The Peril of Under-Funding Health Care

The ongoing situation in Madagascar, which Direct Relief continues to respond to with local partners including the Ministry of Health, is quite different from that in Ukraine. Madagascar is one of the least developed countries, with a Human Development Index (HDI) that ranks 161st out of 189 measured countries. Its public health budget has been constantly under pressure for many years simply due to the tradeoffs required to manage multiple emerging health threats to rapidly changing communities. As a result, the measles vaccination rate in Madagascar has fallen to one of the world’s lowest at 58 percent.

Vaccination is not the only element of the health system that leads to increased likelihood of measles contagion.  Poor nutrition leads to weakened immune systems for children and diminished capacity to resist infection. This is one of the key reasons why Direct Relief has been assisting with distributing of high-dose vitamin A to strengthen immune systems for vaccinated and unvaccinated children alike.

Weak primary care systems also present challenges to ensuring that all children are regularly seen by a physician and that suspect cases of measles are quickly identified and treated. Combined with low vaccination rates and persistent under-nutrition, weak primary care and disease surveillance can allow cases to multiply well before there is a chance to identify and intervene.

The Kindling that Sparks an Outbreak

Measles is well suited to epidemics given these system weaknesses. The reproduction rate for measles, the number epidemiologists use to measure the likelihood that one infected person infects others in the absence of counter-measures, is very high.

A systematic review in The Lancet from 2017 confirmed an average reproduction rate of 18, with considerable observed variance depending on contextual factors including poverty and the strength of health systems. That means a single measles infection may commonly produce at least 18 new infections in the absence of counter-measures. Likewise, measles is infectious for 7 days prior to the individual becoming symptomatic, which means that infections can easily spread undetected. That astonishing rate of transmission, including challenges with early detection, is what constantly threatens to transform measles outbreaks into exponentially growing epidemics.

In addition to defending the core public health value and practice of mass vaccination, we still have a long way to go to achieve genuine universality of vaccine access, not to mention the related health systems interventions that maximize the chances of children to resist infectious diseases. That lack of equitable access threatens the most vulnerable in those countries most of all. But it threatens communities far outside their borders too given the fluency of global trade and travel.

Weak primary health systems, whether born of conflict, poverty or, as is often the case, a combination of both, remain among the greatest threats to human health everywhere.

The post The Global Measles Epidemic Isn’t (Just) About Measles appeared first on Direct Relief.

Butte County Public Health, which has reported six measles cases in the county as of April 7, received a batch of 20 vials of the medicine Gamastan on Tuesday, with Direct Relief covering the cost.

Gamastan strengthens the immune system against measles among people exposed to the disease within the previous six days. The medication is intended for use by people who haven’t been vaccinated and haven’t previously had measles, especially children under one year old.

While vaccines spur the body to develop disease antibodies, medications like Gamastan contain the antibodies themselves, which offer specific and immediate protection against the virus.

Butte County Public Health intends to use the medication to treat eligible individuals, mostly infants, who may have been exposed to a measles carrier.

Direct Relief is also offering to help other California counties recently reporting measles cases or warning of potential exposure, including San Francisco, San Mateo, Santa Clara, Alameda, Yolo, Placer, Tehama and Los Angeles.

While Direct Relief has provided large-scale emergency shipments of measles supportive treatments such as antibiotics and vitamin A during international emergencies — including to Madagascar, where measles has killed more than 1,100 people since October — this is the first Direct Relief shipment in response to a measles outbreak in the U.S. since the country declared the disease eliminated in 2000.

The post Measles Medication Arrives in California County to Suppress Outbreak appeared first on Direct Relief.

Over 1,200 miles of Mozambique’s midsection, including some of the country’s most fertile agricultural lands, were inundated with salty flood waters just prior to harvest. Conditions now exist for one of the world’s worst food security crises.

Hundreds of people, and potentially many more, were killed in the initial impact. Tens of thousands were displaced from their homes. Thousands more structures were badly damaged or destroyed including at least 57 critical health facilities. Roads, bridges and other logistical routes were cut off for many days, severely hampering the search and rescue and relief efforts.

Long term risks from cholera, malaria and measles to safe delivery for pregnant mothers continue to rise throughout an enormous area including not only Mozambique but parts of neighboring Zimbabwe and Malawi as well.

By some estimates, at least $1 billion in property damage has been inflicted upon these three countries. Each is more poorly placed than most countries to bear the burden of sudden shocks from natural disasters, particularly tropical cyclones. In terms of financial and human costs the 2018-19 cyclone season is now the worst ever recorded for the southern Indian Ocean region.

Tropical Cyclones and Climate Change in the Southern Indian Ocean

There is little doubt about the scale of impact from Cyclone Idai. But what made this cyclone so powerful, high-impact, and in many ways unusual, relative to most of the recorded past of the southern African continent?

Southern Africa is not subject traditionally to significant cyclone events. Prior to 1994, Category 5 storm events were entirely unknown in this region, according to research published in the Southern African Journal of Science. This relative paucity of strong storm events stands in stark contrast to the northern Indian Ocean and particularly the northeastern Bay of Bengal which is one of the most active storm zones on the planet.

Unlike these more northern waters the southern Indian Ocean is a vast expanse of open water, containing far more water volume, requiring significantly more energy to heat up. This area lies closer in proximity to the Antarctic ice shelves which cool the ocean temperatures and temper the likelihood of storm occurrence. The presence of the enormous Madagascar land mass further diminishes wind shear and makes massive storm formation in the area where Idai struck even less probable.

Nevertheless, research published in the journal of the American Meteorological Society strongly indicates the presence of an unusual and accelerating warming trend throughout the western Indian Ocean over the past century. In “The Curious Case of Indian Ocean Warming,” Mathew Roxy and other authors argue that the likelihood of sea-surface temperatures at or above 28 Celsius, where storm events tend to increase in frequency and strength, has increased steadily along the entire African coastline for a complex combination of reasons. The increase in sea surface temperatures is correlated with increase since the early 1990s in the number and severity of southern African cyclones.

Cyclone Idai made landfall as a Category 3 storm, which would have been serious under any scenario. What made this storm so catastrophic was the extremely high atmospheric moisture content leading to heavy rains, on top of an immediately prior storm which had already caused flooding throughout the Zambezi River basin.

Echoing many of the reasons for Hurricane Harvey’s devastation of eastern Texas in 2017, the issue with Cyclone Idai was less the presence of high winds than the sheer amount of water pushed into the area through overlapping storm systems and coastal surge over an area of low-lying topography. This is the reason for describing the post-storm landscape as a kind of “inland ocean.”

Many climate models indicate that the combination of factors making tropical cyclones more likely in the southwestern Indian Ocean which saw very few such events in the past will tend to increase over time. This means that countries like Mozambique, Malawi, Zimbabwe and South Africa are looking at a future under climate change where even within global mean temperature increases in the 1.5C range, well below what the Intergovernmental Panel on Climate Change recommends as a “safe” limit for climate change mitigation, Cyclone Idai level events must be factored regularly into the risk horizon.

How Prepared is Southern Africa for Increasing Natural Disasters?

Disaster preparedness always involves some degree of transference of present resources to reduce the risk from events that have not yet happened, in the future. To prepare for an event which hasn’t happened yet means spending scarce resources now to avert future impacts that would conceivably be far worse without the present investment in preparedness.

This is one of the key reasons why disaster preparedness is such a wrenching debate in the poorer areas of the world, like southern Africa. Countries like Mozambique and Malawi must make tough choices in terms of development priorities, with current public budgets already under “normal” scenarios being insufficient to provide adequately for necessities like full-scale vaccination, affordable housing, strong public health systems, universal access to clean water and effective sanitation. The more serious the future risk horizon looks then the more challenging these present allocation problems will appear to be.

To some degree, smart public investments can double as disaster preparedness. Basic primary health care is a good example. During the response to Cyclone Idai, public health care workers have played key roles, with local clinicians essentially being drafted dynamically into the role of “first responders.”

Likewise, the more the primary health system under non-disaster conditions can reduce exposure to health risks such as safe delivery and reduction of childhood diarrheal illness the more resilient those populations will tend to be in times of crisis. Investing in basic primary care is therefore not only smart on its own terms, it’s also a good argument for effective disaster preparedness.

Not every investment choice is the same as primary care though in terms of its dual impacts. Countries throughout southern Africa also need to build up the specialized emergency management capacities required to respond effectively to events like Cyclone Idai, regardless of how frequently those capacities may be utilized in any given year. Mozambique’s emergency management agency, INGC, has been a leader in the field, as it looks to strengthen core operational capabilities and add innovations like drone mapping which proved essential in the recent flood response by enabling rapid assessment and targeting of affected areas. Even INGC though is under-resourced compared with wealthier countries, and still has a long way to go to meet basic standards of disaster readiness. Neighboring countries are struggling perhaps even more seriously than Mozambique.

The Imperative to Build Southern African Disaster Resilience

Six days following Cyclone Idai, the government of Zimbabwe announced that it had gotten the message loud and clear and would be creating for the first time a national emergency operations center in Harare. Local Government Minister July Moyo is urging rapid innovation in disaster management for Zimbabwe. “We want to set a permanent disaster management center so that we have all the information systems including the technology that other countries are now using, to predict or retrieve information when a disaster occurs,” Moyo said.

Elsewhere local, national and international groups are urging investments in early warning systems, improved training and technologies for better coordination. Broad popular education in how to react to emergency events is critical, much like public health education campaigns have helped to increase basic preparations like hand washing and vaccination. Each of these elements is crucial and should be thought of in concert as a package of interventions to boost social readiness.

International organizations can play key support roles as well, as the current cyclone response displays in abundance. Yet it’s clear that priorities in emergency resilience need to be driving from the local and national level for greatest effectiveness. Organizations like Direct Relief seek to bolster those local capacities as they develop but ultimately cannot and should not substitute for developing locally-driven resilience efforts.

As we look towards a shared future in southern Africa where events like Cyclone Idai become more likely, it’s incumbent upon us in the international community, just as for national governments, to boost key investments and innovations that will make countries like Mozambique, Zimbabwe and Malawi more resistant to the worst impacts of disasters. Even so, the immediate health and development priorities which countries must deal with on a daily basis also need to be understood in part as a way to reduce the costs of trade-offs between present needs and future risks.

Direct Relief is working with local partners to help make sure not only that current needs are met in the aftermath of Cyclone Idai, but also that we aid with rebuilding in a way that ushers in more disaster-prepared systems for the next storms.

The post Rethinking Disaster Preparedness in Southern Africa After Cyclone Idai appeared first on Direct Relief.

Measles is one of the most contagious viral diseases known, and can result in serious complications, such as pneumonia, encephalitis, and blindness. In severe cases, it can also be fatal, particularly in young children.

Since October, the disease has already claimed the lives of 1,141 individuals, and 70 percent of the deaths are of children, 14 and under. Madagascar’s Ministry of Public Health and its civil society partners have launched an aggressive vaccination campaign across the country in hopes of slowing the spread of the disease.

This is an alarming situation,” said Dr. Ali Ouenzar, National Director of PIVOT, a prominent health sector NGO and Direct Relief partner on the front lines of the epidemic. Preventive measures must be accelerated to prevent the spread of the disease, he said. The group just completed a vaccination campaign effort that reached 65,000 children, ages 6 months to 9 years, in the district of Ifanadiana.

The weather may complicate continued vaccination efforts this week, as a hurricane-force storm system from Cyclone Idai is expected to bringing flooding and high winds to many places in Madagascar already suffering from the measles outbreak.

While progress on measles vaccination has been made, funding gaps remain a serious concern for the campaign effort — as does the lack of adequate medicine and supplies for healthcare facilities to properly treat the rising number of cases.

Resurgence of Measles as a Global Threat

Prior to the introduction of the measles vaccine in 1963, measles caused an estimated 2.6 million deaths globally each year.  Through an extended global vaccination effort since the introduction of the vaccine, the number of cases of measles, and therefore deaths due to complications from measles, has drastically declined over the last half-century.

However, the reality is that measles remains a deadly threat.

WHO reports that 110,000 deaths occurred due to measles infection in 2017. Measles infections in 2018 have doubled globally since 2017, with extended outbreaks occurring across regions and in countries that had previously achieved measles elimination. Those numbers are difficult to come to terms with given that the disease is 100 percent preventable and had been eliminated until recently from many parts of the world.

Patterns of immunization coverage may be one reason for the recent spike in cases and deaths. Madagascar’s health sector, like many of the poorest countries, has struggled in recent years to meet widely accepted vaccination targets. Estimated measles immunization coverage in Madagascar prior to the outbreak was only at 58 percent, far below the 95 percent needed to protect against an epidemic.

Further complicating the outbreak in Madagascar, the country has the highest proportion of malnutrition among children under the age of five in the African region, leaving roughly half of the country’s children especially vulnerable to the disease.

Supporting Local Partners on the Front Lines of the Outbreak

In response to an urgent request from PIVOT Works and the Ministry of Public Health of Madagascar, Direct Relief is equipping health centers and hospitals in the region of Vatovavy-Fitovinany with essential medicines and supplies needed to treat both pediatric and adult measles cases. Included in this request is Vitamin A, which studies have shown to reduce morbidity and mortality in measles, and is a recommended treatment for all children with severe measles, whether or not they are thought to have a nutritional deficiency.

Direct Relief has been supporting maternal and child health in Madagascar since 2013 through the United Nations Population Fund, Freedom from Fistula Foundation, and the Sarobidy Maternity Center.

In 2017, the country experienced an alarming pneumonic plague epidemic, which Direct Relief responded to by providing the Ministry of Public Health with personal protective equipment and medicine supplies to support plague treatment centers and maternity centers.

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