Hello from Nairobi.

I had a fascinating last week! I drove up to Ol Pejeta wildlife conservancy in central Kenya, and saw the last two northern white rhinos on Earth. I was a bit surprised to find that the story wasn’t exactly the tragedy I was expecting.

While the last male rhino died in 2018, there’s hope. Scientists preserved his sperm, and now there’s a few dozen embryos that are being kept frozen in a lab in Italy. The researchers are attempting to implant those embryos into females of a sister species (because they’re not willing to risk pregnancy complications in the final two) in a last-minute bid for de-extinction.

Anyhow, this week’s stories are a bit more of an emotional mix: some genuinely hopeful, others tougher to sit with. We cover some surprising resilience in setting up national public health agencies around the world, the spread of measles in one of the world’s most densely populated countries, and the shadow of war on health systems in Gaza and Sudan, among other stories.

My name is William Herkewitz, and I’m a journalist based in Nairobi, Kenya. This is the Global Health Checkup, where I highlight some of the week’s most important stories on outbreaks, medicine, science, and survival from around the world.

With that, as we say in Swahili: karibu katika habari — welcome to the news.

Public health agencies … rarer than you’d think

Our first story starts with a stat that genuinely surprised me: Of 195 countries, only 101 have a national public health agency, like the U.S. Centers for Disease Control and Prevention. Naively, I had thought them to be nearly universal. 

Sure, all countries have something akin to ministries or agencies responsible for health and well-being. (Nobody’s truly flying blind.) But in about half the world, there is still no single institution that oversees disease surveillance, labs, or outbreak response during emergencies, like a pandemic.

That’s a core point of a Think Global Health essay by two World Health Organization officials who are advocating for more of these agencies. The WHO officials argue that they are often the deciding factor in whether outbreaks are contained early in a given country. 

They cite Ethiopia’s rapid response to the Marburg outbreak last year, which was centrally coordinated by The Ethiopian Public Health Institute. As we covered in January, within just weeks, Ethiopian authorities “conducted 3,800 diagnostic tests, airlines screened 4.8 million travelers, and health officials ran a prevention-awareness campaign that reached more than 20 million households.” In sum: It was wildly successful.

In countries without a single public health agency, all those functions may have been scattered across various ministries, regional or state governments, or even research institutes. That fragmentation can slow decision-making at exactly the moment when speed matters most. As the authors write:

I reached out to Chikwe Ihekweazu, one of the authors and the head of the WHO’s health emergencies program, to ask whether the crunch in global health funding has slowed the momentum behind building these agencies, and what it takes to stand one up.

First, they thankfully haven’t slowed down. “Despite the current global health landscape” of funding cuts, Ihekweazu said, his team is helping “20 countries” establish these agencies right now. It’s a geographically diverse list that includes “Kuwait, Namibia, Sri Lanka, and Zimbabwe,” among others. 

That’s steady progress, especially given that back in 2000, only 51 countries had one of these agencies.

Today, “the majority countries without a national public health agency are small island states in the Caribbean or the Western Pacific” that have historically banded together to share a regional health body, like the Caribbean Public Health Agency, he told me.

I was surprised to learn that the biggest deciding factor for these agencies isn’t so much about funding, Ihekweazu says, but countries recognizing what they're missing after a crisis. In many ways, the latest countries on the docket are part of the long tail of Covid.

As for what it takes to stand up one of these agencies, Ihekweazu pointed me to a framework the WHO published just this year, which lays out 12 things countries need to get right, from leadership and funding to the nuts and bolts of detecting and stopping outbreaks. (It’s classic WHO: dry, quite lengthy … but technically excellent.)

Strip that framework down, and it points to something simple: In a crisis, a country has to be able to act as one. As Ihekweazu put it, “the next pathogen is sure to emerge, and either clarity or confusion will define the response. For the sake of the world's health, let every country have the public health agency it needs.”

A measles outbreak in Bangladesh

Bangladesh is scrambling to contain a fast-moving measles outbreak that has killed more than 100 children in less than a month, the Associated Press reports. 

The country, which is one of the most densely populated in the world, has launched an emergency vaccination campaign targeting “children age 6 months to 5 years old” in several high-risk districts. So far, “900 cases of measles have been confirmed … since March 15.”

• Disease breakdown: Measles is one of the most contagious viruses on Earth. It spreads through the air when an infected person coughs or breathes. It causes fever, cough, a distinctive rash, and can lead to death, especially in young children. Two doses of the 50-year-old measles vaccine is 97% effective and remains the only viable way to stop the spread of the disease.

It’s worth noting that the current emergency surge of vaccinations is essentially the only path forward for the country. (Well, the only path that’s not a downward spiral.) 

As Healthbeat has been reporting, measles’ level of contagion means outbreaks can take off quickly wherever vaccination rates slip. In the United States, cases have surged past 1,600 this year, with officials warning that infections are likely being undercounted and continuing to spread across multiple states.

In Bangladesh, the outbreak is likewise exposing deep gaps in immunization coverage, “particularly among zero-dose and under-vaccinated children, while infections among infants under 9 months, who are not yet eligible for routine vaccination, are especially alarming,” Rana Flowers, UNICEF’s representative in Bangladesh, told the AP.

Troublingly, the outbreak is also colliding with political fallout from an uprising last year, where “the vaccination campaign for measles was disrupted.”

My takeaway? What’s particularly terrifying about this story is the math. 

Measles requires about 95% vaccination coverage to stop the spread of the disease. Bangladesh has come a long way, from 2% coverage in 1979 to 81.6% today. But with a virus this contagious, that remaining gap is everything.

Gaza: amputees and hypothermia

This week there are two health stories out of Gaza that are worth reading.

The first, from The Guardian, follows Palestinians who managed to leave for treatment in Egypt after losing limbs in the war. The story has both dramatic photos and some fairly shocking figures. 

“More than 6,000 adults and children have undergone amputations since October 2023,” including children who were, at one point, losing legs at a rate of 10 per day. But the story isn’t just about the horrors of those injuries. It’s also about what comes after. 

Many amputees are currently stranded in Egypt, without legal status, unable to work, and cut off from long-term care. As one patient put it (which put a pit in my stomach,) “I want to return to Gaza because my daughters are there … When I am allowed to leave, I will go back to my daughters.”

The second story, from Think Global Health, is not much better. A health worker from Project HOPE describes this year’s winter in Gaza, where children died of hypothermia in tents, and where wet blankets and fuel shortages turned cold snaps into repeated medical emergencies. Part of this exposure stems from the fact that “81% of all structures in the Gaza Strip” are estimated to be damaged. 

The author writes that hypothermia “acts not in isolation but as a deadly multiplier,” worsening malnutrition and disease in a system where most hospitals no longer function, even after the fighting has ceased. 

I thought about both these stories when I listened to a podcast Tuesday morning, on a conversation about the “permanent” state of Palestine between commentator Ezra Klein and political scientists Marc Lynch and Shibley Telhami. 

Ultimately, the medical situation in Gaza is no longer some acute crisis. The children freezing in tents, amputees stranded across the border, families packed into ruins, and endless limbo with no real horizon for relief…

That is now the baseline. It is daily life. 

Famine in Sudan

I’m always a little hesitant about where to draw the line between humanitarian crises and global public health in the Checkup. But I have to include this next story, because I don’t think we truly appreciate what’s unfolding in Sudan right now. 

According to Reuters, “millions of people in Sudan are surviving on just one meal a day” as the country’s war grinds into its third year. All told, nearly 29 million people, about 62% of the population, are unable to consistently access enough food to live a normal, healthy life.

The reporting draws on a new analysis from a group of aid organizations, including Action Against Hunger, CARE International, and the International Rescue Committee.

“In the two areas worst hit by the conflict,” the aid organizations found that millions of families often “miss meals for entire days,” with many people resorting to “eating leaves and animal feed to survive.” 

The takeaway (and the trajectory here) is unmistakable. It’s the “f” word.

Famine thresholds have already been crossed in parts of the country, with child malnutrition rates “nearly double the famine threshold” in some areas. 

This is shaping up to be a catastrophe on a scale the world has not seen in years, potentially decades, if conditions continue to deteriorate. It's worth noting, the three NGOs I linked to above are taking donations, and saving lives with them. 

’Molecular surgery’

I’ll leave you with an op-ed published in the New York Times, written by Jeff Coller, a scientist who works on gene-editing technology. It is a hopeful-but-frustrated letter on what Coller says may be “the most important medical story of the decade.”

Coller opens with a striking vignette from last year. 

A baby is born with a rare and deadly genetic disorder, stemming from a single DNA error. A liver transplant could fix the issue, but only after many months, and likely after “irreversible neurological damage” had set in. So, instead, doctors and medical researchers designed a custom, DNA-altering therapy specifically for the rare disease in this one child. The drug was injected into his blood and the DNA error was permanently rewritten.

Coller’s point is that the age of truly personalized genetic medicine is no longer theoretical. It has already begun. And today, we are capable of eliminating entire categories of rare genetic diseases, most of which still have no approved treatments.

Ok ok, that was the hopeful bit. Now for the frustration. 

As Coller sees it, even if the constraint today isn’t technological, “I believe that the biggest obstacle, however, is structural,” he says. Globally, our medical approval systems simply aren't built for these kinds of custom treatments. In the United States, each one is treated like a brand-new drug, requiring its own approval process. As he puts it:

That’s the shift Coller is calling for. To stop treating these therapies like traditional drugs, and start approving them more like a platform, or even like a kind of “molecular surgery.”

After all, “radically new science demands radically new thinking about how we regulate, manufacture, pay for, and deliver treatments,” he says. 

Ten years from now, if children are still dying of conditions we know how to correct, it will not be because the science wasn’t ready.

Until next week,

William

Thumbnail image by Getty Images