The recent separation of some 2,300 migrant children from their families under the Trump administration’s “zero tolerance” policy on illegal border crossers has thrust this invisible industry into the spotlight in recent weeks, as images of toddlers and teenagers taken from their parents and detained behind locked doors have set off a political firestorm. President Trump’s order on Wednesday calling for migrant families to be detained together likely means millions more in contracts for private shelter operators, construction companies and defense contractors.
A small network of private prison companies already is operating family detention centers in Texas and Pennsylvania, and those facilities are likely to expand under the new presidential directive, should it stand up to legal review, analysts said.
The range of contractors working in the migrant-shelter industry varies widely.
BCFS, a global network of nonprofit groups, has received at least $179 million in federal contracts since 2015 under the government’s so-called unaccompanied alien children program, designed to handle migrant youths who arrive in the country without a parent or other family member. Many of the contractors, some of which are religiously affiliated organizations and emergency-management agencies such as Catholic Charities, see their work as humanitarian aid to some of the most vulnerable children in the world.
But several large defense contractors and security firms are also building a presence in the system, including General Dynamics, the global aerospace and defense company, and MVM Inc., which until 2008 contracted with the government to supply guards in Iraq. MVM recently put up job postings seeking “bilingual travel youth care workers” in the McAllen area of South Texas. It described the jobs as providing care to immigrant children “while you are accompanying them on domestic flights and via ground transportation to shelters all over the country.”..
The shelters’ rush to house, and cash in on, the surge of children has made them a new target for Democrats, immigrant advocates and a vocal chorus of local, state and federal officials and community leaders…
Some have raised concerns that the rush to expand will make it difficult to properly manage the housing and care of infants, toddlers and teenagers, all of whom have a host of complex emotional, health and legal issues. In recent years, a number of migrant youth shelters have run into problems unseen by the public: fire-code violations, lawsuits claiming abuse, and complaints from employees alleging wrongful termination and unpaid wages.
To read the full article, The Billion-Dollar Business of Operating Shelters for Migrant Children, by Manny Fernandez and Katie Benner, highlight and click on https://www.nytimes.com/2018/06/21/us/migrant-shelters-border-crossing.html
“My older daughter began having nightmares that “the people” would take her away from us and give her to another family. She was inconsolable. “If it could happen to them,” she asked with the cleareyed logic of a 7-year-old, “why can’t it happen to us?”.. (A)
“The Trump administration has set up at least three “tender age” shelters to lock up babies and other young children who have been forcibly separated from their parents at the U.S.-Mexico border, The Associated Press has learned…
The United Nations, some Democratic and Republican lawmakers and religious groups have sharply criticized the policy, calling it inhumane.
Not so, said Steven Wagner, an official with the Department of Health and Human Services.
“We have specialized facilities that are devoted to providing care to children with special needs and tender age children as we define as under 13 would fall into that category,” he said. “They’re not government facilities per se, and they have very well-trained clinicians, and those facilities meet state licensing standards for child welfare agencies, and they’re staffed by people who know how to deal with the needs — particularly of the younger children.”…
“The shelters aren’t the problem, it’s taking kids from their parents that’s the problem,” said Dr. Marsha Griffin, a South Texas pediatrician who has visited many.
“The facilities that they have for the most part are not licensed for tender age children,” said Michelle Brane, director of migrant rights at the Women’s Refugee Commission, who met with a 4-year-old girl in diapers in a warehouse in McAllen, Texas, where Border Patrol temporarily holds migrant families.
“There is no model for how you house tons of little children in cots institutionally in our country. We don’t do orphanages, our child welfare has recognized that is an inappropriate setting for little children.” (B)
“The American Medical Association urged the Donald Trump administration to stop its “zero tolerance’ policy that is separating migrating children from their “parents or caregivers.”
The nation’s largest doctor group said the Trump administration needs to end the policy and should instead focus on supporting “the health and well-being of the children within those families.”
“Families seeking refuge in the U.S. already endure emotional and physical stress, which is only exacerbated when they are separated from one another,” AMA executive vice president and CEO Dr. James Madara said in a letter to U.S. Secretary of Homeland Security Kirstjen Nielsen, Attorney General Jeff Sessions and U.S. Secretary of Health and Human Services Alex Azar.
“It is well known that childhood trauma and adverse childhood experiences created by inhumane treatment often create negative health impacts that can last an individual’s entire lifespan,” AMA’s Madara said. “Therefore, the AMA believes strongly that, in the absence of immediate physical or emotional threats to the child’s well-being, migrating children should not be separated from their parents or caregivers.”” (C)
“The United Nations Children’s Fund warned of the dangers faced by children who are separated from their parents at the border.
“There is a documented impact of being detained. There is fear and anxiety, and we must not forget that these are children first,” Caryl Stern, CEO of UNICEF USA said in a previous statement. “Parents and caregivers are a steady force in these children’s lives, so when they are effectively ripped from the arms of their protector, of course that is extremely worrisome.”
Stern points to the additional health effects related to releasing these minors to sponsors who may not be suitable caregivers — and the risk of releasing minors into the custody of human traffickers. The Department of Health and Human Services documented the issue and the need for protections of unaccompanied refugee minors in report to the U.S. Senate.
In addition, there are something called ‘push’ factors that have caused migrants to flee their home countries. Ashley Ham Pong, an Associate Attorney at Montagut & Sobral in Washington DC, has worked with detained children for more than three years and now works with both accompanied and unaccompanied children.
“In many cases these migrants are fleeing immense risks in their home countries — for instance gang violence in Central America — is a major push factor which we know affects children’s health,” Ham Pong told ABC News…” (D)
“The Trump administration’s policy of separating migrant children from their parents has alarmed child psychologists and experts who study human development…
Institutions — even the best and most humane — by their nature warp the attachments children long for, the visceral and concentrated exchange of love, tough and otherwise, that comforts, supports and shapes a child’s heart and mind.
In orphanages and other institutional settings, “turnover rate of caregivers is high, as is the number of children per caregiver,” Marinus van IJzendoorn, a professor of human development at Erasmus University Rotterdam, said in an email.
“This causes impersonal, unstable and fragmented care, which not only impacts on attachment or stress regulation but also on physical growth parameters such as height, weight and head circumference, and brain development.”…
“So many of these parents are fleeing for their lives,” Dr. Colleen Kraft, president of the American Academy of Pediatrics, wrote in a public statement after a recent trip to the border. “So many of these children know no other adult than the parent who brought them here.”” (E)
‘On Wednesday, the public pressure from both Democrats and Republicans — and private entreaties from his own family — seemed to have finally worked on the president. Trump announced he will sign an executive order to address the issue, though he didn’t elaborate on how families detained at the border would be kept together or how detentions would be handled going forward.
“We’re going to keep families together but we still have to maintain toughness or our country will be overrun by people, by crime, by all of the things that we don’t stand for and that we don’t want,” Trump said.” (F)
“As with so many Trump decisions, this one has been a moment-by-moment proposition, driven by, and reactive to, the media.”
“Sources who’ve been in the room with Trump tell me he realizes the overwhelming weight of the imagery of the children means he can’t just ride this out as he might have originally thought he could. Anybody saying Trump thinks the family separation issue is a political winner hasn’t been talking to him.” (G)
(A) ‘If It Could Happen to Them, Why Can’t It Happen to Us?’, by Jeanine Cummins, https://www.nytimes.com/2018/06/19/opinion/children-border-separated-foster-care-trauma.html
(B) At least 3 shelters set up for child migrants, https://apnews.com/
(C) AMA To Trump: End ‘Inhumane’ Child Separation Border Policy, by Bruce Japsen, https://www.forbes.com/sites/brucejapsen/2018/06/20/ama-to-trump-end-inhumane-child-separation-border-policy/#21a92e5c60cf
(D) What to know about the negative health effects of separating kids and parents, by AMITHA KALAICHANDRAN, https://abcnews.go.com/Health/negative-health-effects-separating-kids-parents/story?id=55974081
(E) A Troubling Prognosis for Migrant Children in Detention: ‘The Earlier They’re Out, the Better’, by Benedict Carey, https://www.nytimes.com/2018/06/18/health/migrant-children-mental-health.html
(F) Melania Trump Pressured President Trump To Change Family Separation Policy, by Jessica Taylor, https://www.npr.org/2018/06/20/621930721/melania-trump-pressured-president-trump-to-change-family-separation-policy
(G) Axios PM: Trump to end child separation crisis he created; June 20, 2018
The president of the American Academy of Pediatrics on Monday said President Trump’s “zero tolerance” policy separating families at the U.S.-Mexico border “amounts to child abuse.”
“I can’t describe to you the room I was in with the toddlers,” Kraft said. “Normally toddlers are rambunctious and running around. We had one child just screaming and crying, and the others were really silent. And this is not normal activity or brain development with these children.”
Kraft stated that Trump’s policy amounts to “government-sanctioned child abuse” when asked by CNN host Kate Bolduan, saying that the U.S. government is taking away the one constant in these children’s lives. “ (A)
“…the Trump administration’s policy (is) to forcibly remove children from parents caught trying to enter the U.S. illegally as they are seeking asylum from violence, presumably to deter people from entering the country illegally.
Their children, including babies and toddlers, are then labeled “unaccompanied alien children” (a phrase never intended to be applied to children who could not yet walk) and placed in the custody of the Office of Refugee Resettlement (ORR)…
Many of these families are fleeing trauma and violence in their home countries, only to be faced with the new trauma we have inflicted through forcible separation. The impact of these traumas on young children and their developing brains is real. Trauma is different from the typical stressors children experience in their normal daily life; those are the healthy stresses from which children learn and grow.
This trauma, the trauma of being forcibly separated from a parent by strangers and then transported to other strangers for prolonged periods of time, is different. This kind of trauma overwhelms the body. It causes feelings of terror and helplessness. Stress hormones flood the body.
Without the nurturance and calming support of a caring adult who is known to the child, these traumas can alter the structure of the developing brain. Long term, we know that this toxic level of stress can affect other organ systems, leading to long term adverse health outcome such as mental illness, substance abuse, cardiovascular disease, and premature death…” (B)
“Pamela Florian is an attorney at the Florence Immigrant and Refugee Rights Project, a nonprofit that provides free legal services to immigrants who have been detained in Arizona
“Our social-services program trains us to understand biological and brain development. We really focus on trauma-informed interviewing, so we don’t traumatize the children any more than they are. We talk about stress reactions, and how to work specifically with different age groups. We also get ethics training for working with kids, and we take into consideration cultural differences. If the child is younger, we see that he or she may speak a different language, and we try to figure out what it is so that we can call an interpreter. There are children who speak indigenous languages, so we can’t assume that everyone speaks Spanish.” (C)
“A report from the New York Times over the weekend highlighted another layer of the situation: the fact that some immigrant parents are being deported without being able to recover their children first. They try to cross the border, are separated, and then are sent back to their home countries without their children.
The Times highlights the story of Elsa Johana Ortiz Enriquez, a Guatemalan woman who tried to enter the country with her 8-year-old son, Anthony. The 25-year-old Ortiz was sent back to Guatemala, but her son is still in the US. Immigration officials say this isn’t supposed to happen, but apparently, it does. And then parents only have two options, per the Times:
They can have a family member who is living in the United States take sponsorship and custody of the child, or the child can be flown home and delivered into the custody of the authorities in the parent’s home country — and from there to the parent.
Parents are given a hotline to try to find their kids.” (D)
“The Trump administration has created a policy that is abusive to children and intentional in its cruelty. It is using this assault on a defenseless population as leverage against parents seeking to enter the U.S. without documentation. More than 1,500 boys are being held in a detention center in Texas. Other children have been placed into foster care while their parents are incarcerated hundreds of miles away.
Being wrenched from parents is every child’s worst nightmare. In addition to being traumatized by a forced separation, these children are at risk for further abuse and exploitation as the government ward system is imperfect in protecting children. This policy inflicts psychological injury on children, and its malicious intent may lessen the provision of compassionate treatment by those holding these children.
What is even more disturbing to me is that these family separations are occurring in full public view, as if they are done with honor or pride instead of with shame. Such brazen and unflinching cruelty against a highly vulnerable group — immigrant children — suggests that any group could be a target for unjust and cruel treatment by our government.” (E)
(A) American Academy of Pediatrics president: Trump family separation policy is ‘child abuse’, by JUSTIN WISE, http://thehill.com/latino/392790-american-academy-of-pediatrics-president-trumps-family-separation-policy-is-child
(B) Toxic effects of stress on children separated from parents, by DEBORAH GROSS, ELLEN OLSHANSKY AND SARAH OERTHER, http://thehill.com/opinion/immigration/392724-toxic-effects-of-stress-on-children-separated-from-parents
(C) An Immigration Attorney on What It’s Like to Represent Small Children Taken from Their Parents, by Alexandra Schwartz, https://www.newyorker.com/news/as-told-to/an-immigration-attorney-on-what-its-like-to-represent-small-children-taken-from-their-parents
(D) The past 72 hours in outrage over Trump’s immigrant family separation policy, explained, by Emily Stewart, https://www.vox.com/2018/6/18/17475292/family-separation-border-immigration-policy-trump
(E) Separating families at the border isn’t just bad policy — it’s horrible for children’s health, by OSCAR J. BENAVIDEZ, https://www.statnews.com/2018/06/19/separating-families-border-children-health/?utm_source=STAT+Newsletters&utm_campaign=641b1008a8-Daily_Recap&utm_medium=email&utm_term=0_8cab1d7961-641b1008a8-149527969
“Over the last year, as a result of a new policy established by top officials in the Trump administration, U.S. Customs and Border Protection has separated at least hundreds—and possibly thousands—of families at the border with Mexico who are seeking asylum in the United States…
Our field recognizes the importance of avoiding Adverse Childhood Experiences for the healthy growth and development of children. Trauma early in life contributes to a broad range of serious health outcomes, including social impairment, disease and disability, and early death. The harsh treatment of children at the border will affect their health and their lives for many years to come. The trauma to their parents is also devastating, and the lasting consequences to thousands of families will be profound.
These family separations violate the most widely ratified of all human rights conventions, the Convention on the Rights of the Child. Last week, the human rights office of the United Nations objected to forced separations at the U.S. border, stating “the use of immigration detention and family separation as a deterrent runs counter to human rights standards and principles,” and “there is nothing normal about detaining children.” “ (A)
“Studies overwhelmingly demonstrate the irreparable harm caused by breaking up families. Prolonged exposure to highly stressful situations — known as toxic stress — can disrupt a child’s brain architecture and affect his or her short- and long-term health. A parent or a known caregiver’s role is to mitigate these dangers. When robbed of that buffer, children are susceptible to learning deficits and chronic conditions such as depression, post-traumatic stress disorder and even heart disease. The government’s practice of separating children from their parents at the border counteracts every science-based recommendation I have ever made to families who seek to build, and not harm, their children’s intellectual and emotional development.
These parents are given two untenable options. They can return with their children to their home country and the conditions that forced them to flee in the first place. Or they can endure being detained sometimes halfway across the country from their children. Contact is often limited. The separation makes it hard for parents to provide support for the child’s asylum request. In some cases, parents have been deported, leaving a child behind in government custody.” (B)
“As public health professionals we know that children living without their parents face immediate and long-term health consequences. Risks include the acute mental trauma of separation, the loss of critical health information that only parents would know about their children’s health status, and in the case of breastfeeding children, the significant loss of maternal child bonding essential for normal development. Parents’ health would also be affected by this unjust separation.
“More alarming is the interruption of these children’s chance at achieving a stable childhood. Decades of public health research have shown that family structure, stability and environment are key social determinants of a child’s and a community’s health.
“Furthermore, this practice places children at heightened risk of experiencing adverse childhood events and trauma, which research has definitively linked to poorer long-term health. Negative outcomes associated with adverse childhood events include some of society’s most intractable health issues: alcoholism, substance misuse, depression, suicide, poor physical health and obesity.
“There is no law requiring the separation of parents and children at the border. This policy violates fundamental human rights. We urge the administration to immediately stop the practice of separating immigrant children and parents and ensure those who have been separated are rapidly reunited, to ensure the health and well-being of these children.”” (C)
“In 1997, the government settled a class-action suit brought by unaccompanied minors against INS. That case, Flores v. Reno, established three mandates for the government’s handling of unaccompanied minors. First, that detention should be as brief as possible, with immediate efforts being taken to find a parent, relative or qualified adult with whom the children could live. Second, that children should be treated with dignity and respect that recognized the vulnerabilities that accompany childhood. And, third, that the detention should be in the least restrictive facility possible — a facility less like a jail than a day care….
Flores “doesn’t come close to saying what the administration says it says,” Motomura said. There have always been some criminal prosecutions for people who are crossing the border illegally, he added. “I just never heard that this resulted in a blanket policy of family separation in this way.”
“The reality is, even though theoretically they have the authority to do that, through the immigration laws, to prosecute the parent, in the past that was truly the exception to the rule,” Young said. “The administration stating that they’re required to do this law flies in the face of a long-standing history of treating families like families and recognizing that the children, whether attached to a family or arriving unaccompanied, have particular vulnerabilities that need to be addressed.”..
Young blamed the administration directly. “They are imploding the system themselves,” she said. “It doesn’t have to happen.” (D)
“The use of criminal charges against parents caught crossing the border triggers a legal situation that necessitates separating children, while the use of civil immigration detention and removal does not require this to occur. When adults are detained and prosecuted in the criminal justice system for immigration offenses, their children cannot, by law, be housed with them in criminal jails, so the family unit is separated. The children are placed with the Department of Health and Human Services in shelters until they can be released to a family member, guardian, or foster family in the United States.
Previous administrations used family detention facilities, allowing the whole family to stay together while awaiting their deportation case in immigration court, or alternatives to detention, which required families to be tracked but released from custody to await their court date. Some children may have been separated from the adults they entered with, in cases where the family relationship could not be established, child trafficking was suspected, or there were not sufficient family detention facilities available. Both the Obama and Trump administrations have tried to establish more capacity to detain families and children, rather than releasing them until their hearing date. However, the zero-tolerance policy is the first time that a policy resulting in separation is being applied across the board.” (E)
(A) Separating Families at U.S. Borders is a Public Health Issue, by Ellen J. MacKenzie et al, https://www.jhsph.edu/about/dean-mackenzie/news/separating-families-at-us-borders-is-a-public-health-issue.html
(B) Separating parents from their kids at the border contradicts everything we know about children’s welfare, by Colleen Kraft, www.latimes.com/opinion/op-ed/la-oe-kraft-border-separation-suit-20180503-story.html
(C) Separating parents and children at US border is inhumane and sets the stage for a public health crisis, https://www.apha.org/news-and-media/news-releases/apha-news-releases/2018/parent-child-separation
(D) Why the Trump administration bears the blame for separating children from their families at the border, by Philip Bump, https://www.washingtonpost.com/news/politics/wp/2018/06/15/why-the-trump-administration-bears-the-blame-for-separating-children-from-their-families-at-the-border/?noredirect=on&utm_term=.1144174165f2
(E) Why Are families Being Separated at the Border? An Explainer, by Tim O’Shea, Theresa Cardinal Brown, https://bipartisanpolicy.org/blog/why-are-families-being-separated-at-the-border-an-explainer/
“A statement late Friday said the confirmed cases are in Mbandaka city, where a single case was confirmed earlier in the week.
There are now 17 confirmed Ebola cases in this outbreak, including one death, plus 21 probable cases and five suspected ones.
Three new cases of the often lethal Ebola virus have been confirmed in a city of more than 1 million people, Congo’s health minister announced, as the spread of the hemorrhagic fever in an urban area raised alarm.
The statement late Friday said the confirmed cases are in Mbandaka city, where a single case was confirmed earlier in the week.
There are now 17 confirmed Ebola cases in this outbreak, including one death, plus 21 probable cases and five suspected ones. It was not immediately clear what link the new cases might have to others…
Health officials are trying to track down more than 500 people who have been in contact with those feared infected, a task that became more urgent with the spread to Mbandaka, which lies on the Congo River, a busy traffic corridor, and is an hour’s flight from the capital.” (A)
“The next global plague is coming…
The big picture: The total number of outbreaks every 10 years “has more than tripled since the 1980s,” Yong says. Bill Gates told Yong that if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days.
“Boy, do we not have our act together.” — Bill Gates…
Preparing and confronting a pandemic relies on multiple moving parts, from the doctors to the nurses, appropriate hospital isolation for infected patients, vaccine delivery, Congress appropriation, and more. The director of the National Institute of Allergy and Infectious Diseases, Anthony Fauci, told Yong: “It’s like a chain—one weak link and the whole thing falls apart. You need no weak links.”” (B)
Although Chattanooga’s health care systems have never treated anyone for Ebola virus, Africa’s latest outbreak is a reminder that in today’s world, emerging infectious diseases are only a plane ride away.
In the event that a rare, deadly pathogen should strike the region, there’s a network of behind-the-scenes health care professionals — hospital workers, emergency medical services providers, health department staff — trained and prepared to handle the situation. They also know that there’s risk involved…
Following the 2014 Ebola outbreak in West Africa, the United States government sought to beef up the nation’s ability to respond and treat patients infected with Ebola and other emerging infectious diseases in the event they traveled into the country.
Every hospital in Tennessee became a “front-line” facility, and six hospitals around the state — one of which is Erlanger’s main campus — were chosen as assessment facilities, meaning the hospital would provide the first 96 hours of supportive care to patients with suspicious symptoms and diagnose the illness through screening and lab tests. If test results are positive, EMS would transport the patient to a treatment facility in Atlanta.”
Dr. Jay Sizemore, an infectious diseases specialist and medical consultant for the team, said the first step is to know current pathogen activity around the world and where and when the patient traveled. (C)
(A) Congo says 3 new Ebola cases confirmed in large city, https://www.cnbc.com/2018/05/19/congo-says-3-new-ebola-cases-confirmed-in-large-city.html
(B) What we’re reading: U.S. is unprepared for a global plague, by Haley Britzky, https://www.axios.com/america-unprepared-global-plague-pandemic-cfd85278-eea5-49e2-a6f1-58e76ee34171.html
(C) Should Ebola or another infectious disease strike Chattanooga, a team of health care professionals is ready, http://www.timesfreepress.com/news/local/story/2018/jun/17/should-ebolor-another-infectious-disease-stri/473216/
“On average, in one corner of the world or another, a new infectious disease has emerged every year for the past 30 years: mers, Nipah, Hendra, and many more.
…Despite advances in antibiotics and vaccines, and the successful eradication of smallpox, Homo sapiens is still locked in the same epic battle with viruses and other pathogens that we’ve been fighting since the beginning of our history. When cities first arose, diseases laid them low, a process repeated over and over for millennia. When Europeans colonized the Americas, smallpox followed. When soldiers fought in the first global war, influenza hitched a ride, and found new opportunities in the unprecedented scale of the conflict. Down through the centuries, diseases have always excelled at exploiting flux…
Perhaps most important, the U.S. is prone to the same forgetfulness and shortsightedness that befall all nations, rich and poor—and the myopia has worsened considerably in recent years. Public-health programs are low on money; hospitals are stretched perilously thin; crucial funding is being slashed. And while we tend to think of science when we think of pandemic response, the worse the situation, the more the defense depends on political leadership.
When Ebola flared in 2014, the science-minded President Barack Obama calmly and quickly took the reins. The White House is now home to a president who is neither calm nor science-minded. We should not underestimate what that may mean if risk becomes reality.” (A)
“Disease tends to spread more easily and more rapidly among denser populations. And as populations grow, they can put a greater strain on already stretched resources, from sanitation to medical resources such as vaccines. Over the last few years, we have seen demand for emergency stockpiles of vaccines for diseases like cholera and yellow fever increase dramatically. While we can currently meet this demand, the growing number of mega-cities with populations of 10 million or more, and the increasing risk of urban epidemics that come with them, could deplete these stockpiles very quickly…
While stockpiles are essential, they remain only part of the solution. As cities continue to grow, our best defense will be anticipating outbreaks before they occur. For some diseases, that means making childhood immunization and pre-emptive vaccination campaigns a priority. In other cases, it may mean greater investment in sanitation infrastructure, which can help prevent not just cholera but other water-borne diseases, like the diarrhea-causing rotavirus. And many poor countries are in desperate need of basic diagnostics and surveillance capabilities, enabling them to detect an outbreak as early as possible gives them an opportunity to quickly respond.
All too often with infectious diseases, it is only when people start to die that necessary action is taken. To avoid this, the answer is simple: All countries must step up their long-term efforts to prevent and, wherever possible, eliminate infectious disease. If we keep waiting until outbreaks occur, we may soon find that our ability to respond, contain, and end them is gravely inadequate.” (B)
“Even for outbreaks with excellent vaccines, supplies cannot always be ready fast enough. Once supplies are ready to bring to market, they still need to be fitted into the supply chain, stored properly, and transported to the appropriate individuals — wherever they are.
The logistical issues can be enormous. We are seeing those issues with the experimental Ebola vaccines in the Democratic Republic of the Congo now as aid workers use small boats or motorbikes carrying portable freezers of vaccine to reach remote villages. Vaccines must be administered properly. That means recruiting and training medical professionals and educating the public so that people seek out and receive a vaccine. It also means tracking doses and side effects.
This is why preparedness is vital. Vaccines have a very specific function for containing disease. But even if we develop a vaccine for every possibility, they still have limitations. Local communities must therefore be prepared to prevent and contain outbreaks and limit the impact of those outbreaks on health care and public services.
Preparation means having comprehensive, resilient primary health care services and systems in place with working components: strong leadership, engaged communities, laboratories and hospitals, pharmaceutical systems, supply chains, and disease surveillance systems.”
“Disease outbreaks start and end at the community level, so focusing efforts there is critical. At the global health nonprofit where I work, Management Sciences for Health, we help local authorities develop preparedness plans so that leaders know how to react, communicate risks and lead residents in adopting preventive behaviors.” (C)
“In early May, a strange disease began to affect people in the southern Indian state of Kerala, killing 17 people. The cause was an almost unknown virus called Nipah virus. Even though the virus has been contained, for the moment, WHO is concerned about the Nipah virus which might indeed become the Disease X.
Many of the disease experts consider Nipah to be the most frightening and worrying ’emerging’ virus of the last decades, at least. It is no coincidence that WHO has it as one of the eight priority viruses for which a vaccine should be developed.
According to The New York Times, Nipah infection causes flu symptoms, such as fever, body aches, and vomiting, which often progress to acute respiratory syndrome and encephalitis, or brain inflammation.
Some survivors show persistent neurological effects, including personality changes.
WHO is concerned that Nipah virus might become the Disease X. (D)
“American researchers have developed a platform capable of delivering single-dose vaccines that fully protect against infectious diseases such as Zika, Ebola and Lassa fever…
The vaccines are suitable for repeated use, stable at refrigerator temperatures or lyophilized for non-cold chain needle-free application, and amenable to rapid and affordable scale-up for use in both epidemic response and routine vaccination, according to Basu.
In proof-of-concept studies, the researchers tested three independent vaccines against three different families of viruses. Each vaccine demonstrated full protection after a single dose, using various lethal challenge models. (E)
“The head of the World Health Organization (WHO) on Tuesday cautioned against declaring victory too early in Congo’s Ebola epidemic, despite encouraging signs that it may be brought under control.
“The outbreak is stabilizing, but still the outbreak is not over,” WHO chief Tedros Adhanom Ghebreyesus told journalists on a visit to Democratic Republic of Congo’s capital Kinshasa. “We are still at war, and we need to continue to strengthen our surveillance and … be very vigilant.” (F)
(A) The Next Plague Is Coming. Is America Ready?, by ED YONG , https://www.theatlantic.com/magazine/archive/2018/07/when-the-next-plague-hits/561734/
(B) Do we keep waiting for the next pandemic or try to prevent it?, by Seth Berkley https://www.statnews.com/2018/06/14/pandemic-prevention-ebola-drc-vaccines/?utm_source=STAT+Newsletters&utm_campaign=e1055e5b9f-MR_COPY_07&utm_medium=email&utm_term=0_8cab1d7961-e1055e5b9f-149527969
(C) Let’s not rely on vaccines, here’s how we can prepare for epidemics now, by MARIAN WENTWORTH, http://thehill.com/opinion/healthcare/391889-Lets-not-rely-on-vaccines-heres-how-we-can-prepare-for-epidemics-now
(D) WHO Is Concerned About Nipah Virus, As It Might Become The “Disease X”, by Joe Blair, https://www.healththoroughfare.com/disease/who-is-concerned-about-nipah-virus-as-it-might-become-the-disease-x/9110
(E) Platform developed for single-dose vaccines to treat viruses like Zika, Ebola, https://news.cgtn.com/news/3d3d674e3151444d78457a6333566d54/share.html
(F) ‘We are still at war’ with Ebola: WHO chief, https://www.srnnews.com/we-are-still-at-war-with-ebola-who-chief/
(G)
“Paul Jawor, who has just returned home from the African nation, admitted he was ‘very scared’ about the killer virus in a written account of his time on the ground…
Mr Jawor, a Doctors Without Borders and Médecins Sans Frontières water and sanitation expert, was sent to the DRC on May 20…
The current Ebola outbreak began in the poorly-connected region of Ikoko-Impenge and Bikoro – in the north east of the DRC.
It has since travelled 80 miles (130km) north to Mbandaka, a port city on the river Congo – an essential waterway – with around 1.2 million inhabitants.
Virologists fear there is a ‘major concern’ it will spread to Kinshasa – 364 miles (586km) south on the river, where 12 million people live.
The city, which is the capital of the DRC, has an international airport with regular flights to European cities Zurich, Frankfurt and Brussels.” (A)
Medical investigators will need to overcome the rural region’s extreme logistical hurdles to reconstruct transmission chains, vaccinate contacts and halt the spread…
Epidemiologists working in the remote forests have not yet identified the first case, nor many of the villagers who may have been exposed. Investigators will need to overcome extreme logistical hurdles to reconstruct how the virus was transmitted, vaccinate contacts and halt the spread.
“For an epidemic to be under control, you need a clear epidemiological picture,” said Dr. Henry Gray, the emergency coordinator for Doctors Without Borders.
“If you don’t know the stories of the people involved — who their families were, what their jobs were, where they went to weddings and funerals — then you don’t know the epidemic.”..
The W.H.O. is monitoring more than 900 contacts throughout Équateur province. As the vaccination program expands to the Bikoro and Iboko communities, where most cases have been reported, teams are relying on contact tracing to identify the most urgent recipients.
“This is where everything gets more complicated,” …The villages surrounding Bikoro and Iboko are among the most isolated and densely wooded pockets of Congo. Aid workers must use motorbikes to navigate cratered dirt roads that flood during the rainy season. Maps of some regions are incomplete, and vast gaps in cellular service thwart efforts to report data to central operations.
“Following the virus’s narrative may sounds easy to do on a suburban street outside Chicago,” said Dr. Salama. “But when you’re traveling hundreds of kilometers in a forest by motorbike to find each person, that’s very different epidemiological work.” …
Until investigators identify the index case, it is impossible to discern whether the first patient detected in April was truly the first human case or the hundredth, according to Dr. Gianfranco Rotigliano, the regional director of Unicef. Until then, it is impossible to quantify the crisis.
“These are the early days of the outbreak,” Dr. Salama said. “There can be lulls. We’ve seen that before. But there only needs to be one event — a super-spreader, like a funeral — to cause an explosion.”” (B)
“Globally, we must address three issues to tackle Ebola and other deadly pathogens. One is community engagement. Lack of trust between responders and communities has resulted in patients fleeing isolation, as well as likely missed cases and contacts. Ebola emerged in a remote community; it is essential to understand community perspectives and structure and to gain trust and enlist the community’s strengths to stop the disease.
Another issue is WHO’s effectiveness. The African Regional Office of WHO now has many staff with the needed technical and operational excellence, and the Geneva-based emergency program is more effective than before. But WHO country offices in DRC and elsewhere are not nearly as effective as they need to be. Tedros Adhanom Ghebreyesus, coming up on his first anniversary as WHO Director General, has unveiled a potentially transformative general program of work. His leadership will be essential for these ambitious goals and inspiring rhetoric to overcome operational and managerial weaknesses at WHO headquarters in Geneva, as well as in some regional and many country offices.” (C)
“The Trump administration has walked back its proposal to reclaim $252 million in unspent Ebola funds on Tuesday, which experts lauded as a welcome shift in the administration’s approach to global health leadership ― especially amid the new Ebola outbreak…
When President Donald Trump moved to cut the money the same week the current Ebola outbreak was announced in the Democratic Republic of the Congo, the public outcry from global health experts and Congress was swift. They argued that Trump was undermining the U.S. leadership role in world health issues.
Their concerns were compounded by the early May departure of Rear Adm. Tim Ziemer, formerly the National Security Council’s head of global health security; the breakup of his team into other divisions; and the April departure of White House homeland security adviser Tom Bossert, another champion of global health investment.
As Ronald Klain, the former Ebola czar under President Barack Obama, told HuffPost at the time: “Proposing a rescission of Ebola contingency funds on the very day that a new Ebola outbreak is announced is badly misguided; forcing out the two top officials in charge of epidemic response at the White House ― Tom Bossert and Tim Ziemer ― is even worse. Doing it all at the same time shows a reckless disregard for the dangers we face.””
Also disquieting was the fact that the U.S. waited a full two weeks after the first announcement of U.K. funds for the latest Ebola outbreak to announce its own full contribution of $8 million from the U.S. Agency for International Development.” (D)
“Companies and other players involved in the development of experimental Ebola drugs are jockeying to have their products tested in the outbreak in the Democratic Republic of the Congo, part of a chaotic and politically charged effort to use them in the midst of a crisis….
Experts say the maneuvering for space in which to try vaccines and drugs brings to mind the frantic days of the West African Ebola outbreak, when there were so many research teams in the field that a free-for-all of experimental testing ensued. Most of the clinical trials produced little in the way of insight into what actually might work against Ebola.
There’s a “rush to evaluate [treatments] because the window of opportunity for evaluating these interventions is always going to be short,” said Ross Upshur, a physician and ethicist who was on the WHO panel…
“If we don’t use the opportunity to learn in this situation, we’ll never be able to know which is better than the other in terms of the drugs,” said Dr. Peter Salama, the WHO’s deputy director-general for emergency response…
“It’s not a simple effort to do this sort of trial in this kind of environment,” Salama said.” (E)
(A) Ebola outbreak in the Democratic Republic of Congo that is feared to have killed 27 people is a ‘race against time’, aid worker warns, by STEPHEN MATTHEWS, http://www.dailymail.co.uk/health/article-5821781/Ebola-outbreak-DRC-race-against-time-aid-worker-warns.html
(B) As Aid Workers Move to the Heart of Congo’s Ebola Outbreak, ‘Everything Gets More Complicated’, https://mobile.nytimes.com/2018/06/01/health/ebola-congo-outbreak.html?rref=collection%2Ftimestopic%2FEbola&action=click&contentCollection=timestopics®ion=stream&module=stream_unit&version=latest&contentPlacement=1&pgtype=collection
(C) Still not ready for Ebola, http://science.sciencemag.org/content/360/6393/1049.full
(D) Trump Walks Back A Disastrous Ebola Funding Cut And Experts Sigh In Relief, by Lauren Weber, https://www.huffingtonpost.com/entry/trump-walks-back-ebola-funding-cut_us_5b183d68e4b0599bc6dffd4d
(E) Ebola outbreak opens way to chaotic jockeying to test experimental drugs, by HELEN BRANSWELL, https://www.statnews.com/2018/05/30/ebola-experimental-treatments/
