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Column: Public health concerns (too) far away from home. Who cares?

January 22, 2015 - 19:47 -- Alvaro Pemartin
The column below was contributed by Alvaro Pemartin.
The current Ebola outbreak was headline news for some weeks.  Public health was a hot topic on TV and radio and in the social media. There was an eager request for technical advise from epidemiologists, virologists, and vaccine experts, among others. Surprisingly, in the 21st century, when potential complex emergencies as cyber terrorism and weapons of mass destruction pose a serious global threat, the biggest threat of all for humanity now seems to be a microscopic virus.
Some malariologists, both in the lab and in the field, fear that the focus on Ebola diverts the political momentum (and public and private funds) away from malaria. Other malaria fighters believe that any attention that is paid to public health issues will eventually increase public awareness about malaria and neglected diseases.
The debate about ‘how to draw attention to malaria’ has already been well covered by various MalariaWorld authors. Therefore I have decided not to go into further detail in this column. What I want to share with you here are the results of basic social study of public interest during several public health crises and the effect that this interest had on these crises. I compared the results of Google searches on four diseases: malaria, avian flu, swine flu and Ebola at different places and times. This search does not provide complete data but provides an indication of how many people searched for information about certain diseases and how the interest of the public may affect public health crises.
Graphic 1: 2004 – present, an overview
The first graphic shows a comparison between the relative numbers of searches on the four diseases during the past 10 years (2004 – 2014). In general, malaria is the most searched term during the entire period but there were some peaks in particular years when other diseases were more popular. These peaks were, not surprisingly, related to disease outbreaks.
Graphic 2: 2005 the year of A(H5N1)
During 2005 several patients, mainly in Southeast Asia, became infected with a novel type of avian influenza: the A(H5N1) strain. This  ‘pandemic’ was responsible for 43 deaths and 93 confirmed cases. During that same year malaria infected around 400 million people and killed more than 900.000 patients. In spite of this reality, we can observe a peak of searches regarding the avian flu.
Geographical location and search terms.
People from the following countries conducted the most searches on the specific diseases.
Malaria: India, Australia, UK
Avian flu: Canada, USA, UK
Ebola: Thailand, USA, Canada
Swine flu: No data available
On a different note… Overall, the 5 most popular search-terms in 2005 were: Myspace, Ares, Baidu, Wikipedia and orkut.
Graphic 3: 2009 the year of the Swine flu
The H1N1 influenza virus killed a total of 12.799 people from a total of 1.632.258 cases. The number of patients caused by the virus and the scope of the outbreak, with cases in more than 50 countries, caused a worldwide concern. On the other hand, malaria killed more than 800.000 people in 2009 and more than 240 million people were infected. Yet again there was a peak in the searches on ‘swine flu’ showing the public concern about the swine flu pandemic.
Geographical location and search terms.
People from the following countries conducted the most searches on the specific diseases.
Malaria: Kenya, Nigeria, South Africa
Avian flu: Canada, USA
Ebola: Thailand, Mexico, USA
Swine flu: Trinidad & Tobago, UK, Ireland
Overall, the 5 most popular search-terms in 2009 were: Michael Jackson, Facebook, Tuenti, Twitter and Sanalika.
Graphic 4: 2014 the year of Ebola
Finally, during the past year, several West African countries (Sierra Leone, Liberia, Guinea-Conakry, Mali, Nigeria and Senegal) suffered from an outbreak of the Ebola virus. This highly contagious, infectious disease has a mortality of around 70% and currently there is no specific treatment. Several infected patients were evacuated from Africa to Spain and USA. This triggered the interest of the wider public as shown in graphic 4.
The data of the Ebola outbreak on November 14, 2014 were: 5.177 reported deaths and 144.110 reported cases (confirmed, probable, and suspected cases of Ebola) of which 8.920 were lab confirmed cases. The most recent WHO data about malaria (2013) show that malaria caused a minimum of 473.000 deaths and more than 135 million cases.
Geographical location and search terms.
People from the following countries conducted the most searches on the specific diseases.
Malaria: Mozambique, Ghana, ZAmbia
Avian flu: USA
Ebola: Liberia, Sierra Leona, Guinea
Swine flu: Australia, South Africa, USA
Curiously, Goldsby in Oklahoma, USA is listed as the city where more searches on ‘Ebola’ were made.
And the winners of the most popular search terms for 2014 are: Robin Williams, World Cup, Ebola, Malaysia Airlines, ALS Ice Bucket Challenge
Final Considerations 
Malaria is a public health issue. Hence the public is a stakeholder in the fight against malaria and its effects. As mentioned above, malaria is of constant concern but it is obvious that other public health issues get more attention from the media, the public and policy makers at the time of an outbreak. It would be interesting to analyse the reasoning behind this attention. Apparently it is not the real effect of these diseases that captures everybody´s attention. I have shown the very basic statistics that reveal how the global burden of any of these threats is far lower than the losses caused by malaria.
One probable cause is the selfish concern of people in ‘developed’ countries with their own health. Indeed most public health issues only get attention when there is a (remote) chance of transmission to western and northern countries. The other reason could be a true concern; a sudden rise of deaths causes an actual concern in the health of other people.
In both cases, advocates of malaria eradication have a potential ally. In the first case, from the perspective of peoples’ health in a global context, I can support the thesis that the eradication of malaria will eliminate a global health threat and it will improve the health systems in less developed countries. And all this will benefit global health because it reduces the risks of global pandemics. On the other side, concerns about the effects of Flu or Ebola on the affected population are important but. However, the public needs to see the morbidity and mortality numbers of disease in the wider global health context. It is essential that we keep on emphasizing the real burden of malaria every day, every month, every year and focus on the countries still affected by the disease.
Understanding how the public and influential people look at public health issues will be helpful to improve the efficiency of our efforts towards a malaria free world.

Alvaro Pemartin (Spain) Prehospital Emergency and Remote Site Doctor. My daily tasks are providing emergency and primary care in Remote Sites (Sierra Leone, Guinea-Conakry, Mauritania) Volunteer in my local Civil Protection Agency, Interested in Emergency and Disaster Management and in scientific ways of improving this management (Lessons Learned, Operational Research, Simulation, Modelling)…  Member of International Association of Emergency Managers and Member of the Editorial Board of Crisis Response Journal.



Submitted by Andrew Durso on

Very interesting article! It's a bit like snakebite—people are so frightened of snakes, yet they are oblivious to dangers that are much more common/likely.