‘MOST deadly yet’. ‘Calls for urgent action’. ‘Nation in crisis’.
These are headlines we’ve read repeatedly in 2017, and they all relate to flu outbreaks. During the month of July in Hong Kong, Chief Executive Carrie Lam called for local health authorities to take ‘urgent measures’ to cope with one of the city’s worst flu outbreaks on record. Meanwhile, in Northeast Asia, avian flu has swept across the region, from South Korea to Japan to the Philippines.
Epidemics and outbreaks happen very quickly – anywhere and without warning. While advancements in science have equipped us to better handle the flu, Asia’s continued growth in recent years and lack of sufficient infrastructure have made it difficult to handle large scale outbreaks, cope with hospitalisation numbers and contain transmission between individuals. These factors have made it easier for viruses to spread within local communities and across the region, putting everyone at risk.
Asia specifically has suffered the consequences of headline-grabbing flu outbreaks in its recent history:
Severe Acute Respiratory Syndrome (SARS) infected more than 8,098 and caused 774 deaths. The Asian Development Bank estimates that the economic impact of SARS was around US$18 billion in East Asia alone. Seven Asian nations were included among the top-ten countries affected.
The Swine Flu (H1N1) outbreak of 2009, which spread from Mexico to over 200 countries, reached Thailand, China and South Korea, caused an estimated 284,500 deaths.
Among the 15 countries that reported human cases of infection of the H5N1 virus, four countries were in Southeast Asia with 228 reported cases and 181 fatalities in 2004.
Despite all these incidents with the influenza virus, Asia still has a long way go to in preparing for the next viral flu outbreak. When it does come, it will have the potential to affect masses of the region’s population.
Risk factors & challenges
Globalisation has led to larger movements of people, improved modes of transportation, and greater interconnectivity between countries, further enabling the spread of viral flu. By 2020, close to 400 million business travellers and tourists are expected to travel through the region annually. Asia is also continuing to experience population growth and rapid, uncontrolled urbanisation.
The United Nations projects that by 2050, half of the world’s urban population of 6.3 billion will be concentrated in Asia, undoubtedly having an impact on the number people who could be infected by future outbreaks.
Additionally, shifting demographics are an important consideration. The elderly population is labelled as a high-risk age group for seasonal influenza, and this segment of the population is projected to reach nearly 923 million in Asia alone, by the middle of this century. This is bound to add increased pressure on healthcare systems, which, in many cases, are already struggling.
To this day, vaccination remains the most effective measure, second only to water, which in turn, enables proper hygiene and sanitation, as well as being identified as one of the most cost-effective tools of prevention by the World Health Organisation (WHO). For this reason, continued research and development is important in ensuring the necessary preventative action is taken early.
Although the efficacy of vaccines as a mode of prevention cannot be denied, increased challenges come with administering them. The logistics of developing and sourcing the vaccine, as well as delivering the adequate doses of anti-influenza medication make exercising them difficult during epidemic times.
Moreover, an overall sense of nonchalance among the population has been shown to hinder prevention efforts. The lack of awareness of influenza prevention whether coming from masks, hand hygiene or vaccination, all play a contributing role to the failed attempts at adequately preventing outbreaks.
Increased collaboration is therefore essential to alleviate the human, social and economic ramifications of these outbreaks across the region.
Initiatives are in place at a broader global and regional level, with the World Health Organisation acting as a leader for better disease prevention by providing frameworks to its member nations to help pre-empt and better manage health emergencies such as flu outbreaks. Asean too has been a key player in increased regional collaboration, recently reiterating its commitment to making communicable and emerging health threats a priority area of collaboration for 2017 to 2018.
More can be done at the national level, however. Countries should aim to replicate Sri Lanka’s successful eradication of malaria, also an infectious disease with high burden, which was achieved through joint efforts from multiple agencies collaborating with the countries healthcare system.
The lack of preparedness in Asia and the relatively porous borders for infections make the region the prime target for any outbreak. After all, an infection in all but the most remote corner of the region can make its way to a major city, such as Singapore or Hong Kong, in a day or less.
Everyone has a part to play in ensuring a safe, public health environment for all, and in reducing the public health and socio-economic burden of influenza. Although a lot still needs to be done to actively face future outbreaks, continued collaboration, emphasising prevention and education, will help alleviate the burden of flu outbreaks across the region, remembering that vaccination has the power to greatly reduce disease, disability, death and inequity worldwide.
By Dr Leong Hoe Nam, Infectious Disease specialist practising at Mount Elizabeth Novena Hospital, Singapore.