Vaccine Science Diplomacy: Expanding Capacity to Prevent Emerging and Neglected Tropical Diseases Arising from Islamic State (IS)--Held Territories.

Abstract

War and the ensuing health system breakdowns in the Islamic State (IS)–occupied Syria and Iraq significantly increase the risk of a new wave of infectious disease epidemics in the Middle East and North Africa (MENA). Proactive engagement to enable health system capacity and resilience—including expanding immunization programs and building biotechnology capacity for vaccines that specifically target diseases in the region—would help minimize the impact if and when outbreaks occur. A program of vaccine science diplomacy with selected countries in the MENA region could help to avert an international public health crisis possibly similar in scope and magnitude to the 2014 Ebola virus outbreak in West Africa. The 2014 Ebola outbreak emphasized strong links between the forces of poverty, depletions in public health and environmental degradations as a result of long-standing conflicts in West Africa, and the emergence of a catastrophic neglected tropical disease (NTD). A stark reality is that such links between poverty, war, and NTDs are not new, but have been reoccurring for decades [1]. For example, beginning in the 1970s and lasting throughout much of the 20th century, hundreds of thousands of people may have perished from African sleeping sickness—human African trypanosomiasis, a parasitic infection transmitted by tsetse flies—in Angola, Democratic Republic of Congo, and Sudan because of civil wars in those countries and the inability to mount effective public health control measures [2]. Kala-azar—visceral leishmaniasis, another parasitic infection but transmitted by sandflies—killed an estimated 100,000 people in conflict-ridden southern Sudan between 1986 and 1995 [3]. Because journalists had limited access to these war-torn areas, both epidemics went mostly unrecorded and unacknowledged. The latest example is the collapsed health systems of post-conflict Liberia and Sierra Leone that were unable to cope with an Ebola epidemic that infected more than 20,000 people and caused approximately 10,000 deaths by the early part of 2015.