In a perfect world, the outbreak and devastating disruption of the novel coronavirus should be heightening Ghana’s awareness of internal zoonotic epidemic threats. Alas, our world is anything but perfect.
Once upon in time in 2020, Wuhan, China and its wet markets were public enemy number one. But Ghana isn’t far away from a scenario where people around the world point, somewhat ignorant, fingers at it claiming it is the epicentre of a deadly epidemic.
Three-quarters of emerging human infectious disease outbreaks are said to be zoonotic; they originate from viruses that infect certain animals and then cross species to infect humans. This has happened throughout recorded history.
The past few years have seen concerns over non-communicable diseases rise with the hypertensions and cancers posing more of a threat. But the current pandemic is a reminder that infectious diseases remain a clear and present danger.
For centuries, East and Southeast Asia have been the hotspots of influenza and other emerging zoonotic diseases with pandemic potential. Scientist, however, say Africa is catching up.
Africa has the fastest-growing population in the world and the accompanying density has made the rapid spread of an epidemic possible. This is also compounded by weak health systems which are being overlapped by the needs of growing populations.
Ghana closer to a disaster than we think
The prospect of Ghana becoming the epicentre of a pandemic isn’t far from the minds of some scientists. For Dr. Richard Suu-ire, a Specialist Wildlife Veterinarian who works with the University of Ghana, the gaps in our socialisation, domesticity and public health systems ring like alarm bells.
Ghana has had to deal with diseases like Anthrax, rabies and trypanosomiasis in the past. But like the novel coronavirus, it is the threat of emerging diseases that we should keep watch for.
“The emerging diseases are the new ones we don’t know anything about and they are the diseases that are likely to create pandemics.”
The nuances in the vulnerabilities to an epidemic are clearer for people like Dr. Suu-ire and are evident in areas like the desire to rear pigs in forest areas because of easier sources of water to even the way we handle food from livestock.
“You see people drink milk without even boiling. But there is [the threat of] zoonotic tuberculosis,” he notes as an example.
Dr. Suu-ire’s research work has even highlighted how perilously close we are to the Ebola virus and Marburg’s virus disease, an Ebola adjacent infection.
He partook in some research work with some PhD students in the Brong Ahafo Region in 2014 which revealed that some bats in a community there (he did not name) carried the Ebola and Marburg’s viruses.
“That was something that was very frightening. We detected these bats and their caves were being used as a tourist centre,” Dr. Suu-ire recalled
But such is nature; 75 percent of zoonotic diseases stem from the wild, generally outside our control. It was rather the gaps in human behaviour in this community that gave Dr. Suu-ire real chills.
Whether the Ghana Health Service would be able to track people in the area if they were exposed to an infection “before it explodes and becomes a national issue or a pandemic,” was one of the questions on Dr. Suu-ire’s mind.
The answer was no.
Most of the Ghanaians on that threshold of Ebola infection had no regard for modern healthcare systems. Tracking and contact-tracing at the epicentre of a potential pandemic in the short term would have been impossible. Dr. Suu-ire was dumbfounded by this finding.
“Almost getting to 100 percent of Ghanaians in that area, when seriously sick, don’t go to the hospital. They rather go to shrines,” he recalled.
During the first study, he was confident some people in that community had been infected with Ebola “only that it doesn’t leak out into the larger community.” A further test for Ebola antibodies confirmed this.
“We tested a number of hunters and they were positive. There are [unpublished] findings that showed that they reacted to antibodies.”
So the next step for Dr. Suu-ire and his team was sensitisation, which bore fruit. “I am happy today that those caves and all those things are no more used.”
A missed opportunity
Education must be prominent on the vanguard against zoonoses. This is Professor Audrey Gadzekpo’s main concern when assessing Ghana preparation for potential epidemics.
The Dean of the School of Information and Communications Studies at the University of Ghana hammers on the deficit of awareness creation as she laments the fact that knowledge about zoonoses is not mainstream.
There has not been any public education and mainstream discussion around the general threat of zoonotic diseases despite the past scares with diseases like Avian Influenza and the “great” opportunity the ongoing novel coronavirus pandemic presents.
“There was almost no discussion, beyond the fact that it [COVID-19] came from China and spread throughout the world, about the fundamental reason why there was an outbreak in the first place,” observes Prof. Gadzekpo.
In her vision of an ideal world, the current pandemic would be a “learning peg” for Ghana’s unique zoonotic vulnerabilities.
“…there is also the Ebola and bats threat and people ought to be careful about that,” she warns.
Stakeholders appear to be in agreement that bats present the greatest threat to Ghana. Their threat has become a special burden on Prof Gadzekpo, who contributed in a Steps Centre paper on the issue.
The paper noted that the case of bats in Ghana raises questions about how policy is made around these unique disease threats. But the way forward remains unclear given the extent of the risk is not yet known.
Prof. Gadzekpo’s level of awareness has come with its own burden. She feels very vulnerable and ponders the fine balance between safeguarding ecology and ensuring human health.
“There are bats now on Legon campus. Sometimes I get the chills,” she admits.
Health Service banking on One Health
The Ghana Health Service is keenly aware of the various threats and wants to anchor its education efforts on the One Health policy.
The problem, and irony, is that the pandemic rather slowed down these efforts, according to Head of the Disease Surveillance Department at the Ghana Health Service, Dr. Franking Asiedu-Bekoe. He also chairs the One Health implementation committee in Ghana.
“COVID moved our timelines off… the idea was to have completed the policy at the end of the first of quarter of 2020.”
The policy is expected to outline the plan for sensitisation across Ghana’s Northern, Middle, and Southern zones, as demarcated by the service.
It is of the view that the policy has to be in place “to make sure you have a well-structured guide about how you want One Health to work in the country.”
“As I speak now, the document is very close to completion,” he assured, whilst keeping details close to his chest. But he was emphatic that with some training, media will be key to sensitisation efforts.
“We have a plan to make sure that we actually train the media people because we need them to actually sensitise the population.”
The need for research remains
Whilst education on zoonoses will be welcome, research will be needed to provide a strong foundation. Dr. Suu-ire unsurprisingly harps on this point.
At this point, he does not need to reiterate the need for funding into research. Many a scientist have done so in the last five months. The fear is we heard but did not listen.
As wildlife is displaced by mining, deforestation and other human activity, the contact between domesticity and the wild will increase. Research into the implications of these changing dynamics is paramount.
“We don’t know enough about the roles humans are playing [in the spread of zoonoses],” Dr. Suu-ire says in a concerned tone.
In the meantime, the way forward is to learn to live with the threats to zoonoses; the bats especially, whose ecological importance cannot be denied.
But all roads eventually lead to the education track with Dr. Suu-ire who reminds that “it is all about managing the risk.”
“Our duty is to educate on how to live with the bats. That is the most importing thing,” says the wildlife specialist.
But the ultimate goal, which Prof. Gadzekpo stresses is that “we should get to a point where most Ghanaians, whether you are in the rural area or you are in the cities, understand the concept of zoonoses.”