Yellow Fever in Central Africa: A Preventable Epidemic

Gabriella Meltzer is a research associate in the Council on Foreign Relations Global Health program.

From Ebola to Zika, recent global health crises have been defined by unpredictable outbreaks of mysterious pathogens. However, the yellow fever epidemic currently sweeping across Angola and the Democratic Republic of the Congo was not only predictable, but could have been stopped by the World Health Organization (WHO) with the necessary political will and logistical organization.

Like Zika, yellow fever is carried by the Aedes mosquito, and is endemic to tropical parts of Sub-Saharan Africa, along with South and Central America. Most cases are asymptomatic or mild with fever, chills, nausea, and fatigue, but roughly 15 percent become more severe. About half of these cases prove fatal.

Similar to other mosquito-borne diseases, yellow fever is typically transmitted between infected mosquitos and non-human primates in jungle environments. However, deforestation and general climate change often create more hospitable breeding grounds closer to human populations. Yellow fever then enters an urban cycle, whereby people and mosquitos infect each other. Unlike in the jungle, the virus is no longer naturally contained—transmission occurs quickly in overcrowded environments ripe for mosquitos where people are constantly in motion.

The Central African cities of Luanda, Angola and Kinshasa, Congo have been at the epicenter of the most recent outbreak. Since December 2015, there have been 3,818 suspected cases and 369 deaths in Angola, and 2,051 suspected cases and 95 reported deaths throughout Congo. Both of these nations are plagued by weak health systems with average life expectancies of fifty-three and sixty, respectively. The collapse of global oil prices has forced Angola to cut public spending by 40 percent over the past two years, allowing Luanda’s trash collection and water sanitation services to fall by the wayside and mosquitos to proliferate. Meanwhile, Congo has only one lab with diagnostic capabilities for a country with a population of nearly sixty-eight million, ten million of whom are located in densely populated Kinshasa.

It is shocking and disappointing that this epidemic continues to escalate while a yellow fever vaccine exists—one that not only provides lifelong immunity, but is safe and inexpensive to produce. There are five manufacturers worldwide, and production costs are just over one dollar. The WHO-led International Coordinating Group for Yellow Fever Vaccine Provision (ICG) only maintains a small emergency vaccine stockpile of six million in the event of an outbreak. In 2015, UNICEF reported a 42 percent shortage of supply relative to global demand before this epidemic even began.

The WHO, plagued by mismanagement and lack of accountability, has once again found itself scrambling to contain a quickly spreading virus in Sub-Saharan Africa. Not only have administered doses been diluted by 80 percent to maximize emergency coverage, but of the six million emergency doses sent to Angola in February, one million disappeared entirely—a claim the agency has publicly denied. Many of the shipments that did reach the region were sent to areas with no cases, arrived without proper materials, or were not kept cold enough to ensure effectiveness.

Angola, Congo, and many other at-risk countries throughout Sub-Saharan Africa must take proactive measures to strengthen their weak health systems to counter the growing threat of mosquito-borne and other viruses. But in the interim, these nations must rely upon the support of a WHO that is failing them.