2009 flu pandemic in Africa

The 2009 flu pandemic hit Africa two months later than other continents with the first case reported in Egypt on 2 June 2009. As of December 1, 30 countries in Africa have reported cases and 7 countries in Africa have reported 108 death.

 Algeria

A first case of swine influenza has been detected in Algeria on June 20. This is an Algerian national, resident in Frankfurt in Germany and coming from Miami, United States of America.

This first case was detected at Houari Boumediene Airport, thanks to a major health system of detection and control put in place since the spread of the virus in several countries around the world.

Many Algerian immigrants and tourists will be arriving during this holiday period, increasing the risk of spreading the virus of swine influenza. The woman suffering from flu was immediately transferred to the hospital of El-Kettar’ in Algiers. The latter had just arrived from the United States of America with her two children.^[5]

 Benin

As of May 2, 2009 there was one suspected case of swine flu in Benin.^[6]

 Egypt

The Egyptian government has increased numbers of medical officers at Cairo Airport and will monitor passengers from Mexico during their stay.^[7]

The government ordered the mass slaughter of all pigs in Egypt on April 29,^[8] even though the current strain is a human-human transmittable, human influenza that has already previously hybridized with avian and swine flu.^[9] The World Organization for Animal Health called the swine killing "scientifically unjustified".^[9]

Egypt commenced the slaughter on 2 May 2009.^[10] On the next day in Cairo, an estimated 300 Coptic Christian residents of the Manshiyat Nasr district set up blockades on the street in attempt to keep government officers from confiscating their pigs,^[11] which led to clashes with the police.^[12] Al-Ahram, a widely circulated Egyptian newspaper, reported that owners of destroyed pigs will receive 1000 Egyptian pounds (approximately US$177.70) per animal in compensation,^[13] but Reuters reported that the issue was still "under discussion", citing an Egyptian cabinet spokesman.^[13] The first case of the novel H1N1 virus was discovered in Cairo, Egypt on the second of June, in a 12-year-old girl coming from the USA with her mother. Only the girl was infected, and the officials caught the case before getting out of the airport.

A second and third case were discovered on Sunday 7 June, they're 2 students at the American University of Cairo.^[14]

As of June 9, there has thus been 8 confirmed case of swine flu in Egypt.

On June 11, 2 more cases were discovered, along with 2 cases discovered a day earlier, bringing the total number of swine flu cases to 12.^[15]

As of December 3, the confirmed cases were 3558 and the deaths 24. As of January 31, there have been 258 confirmed deaths from A/H1N1 influenza in Egypt, and in excess of 15,800 confirmed cases of H1N1.^[16]

Analysis of the Egyptian health policy for the H1N1 flu pandemic control

By Sameh Seef 2009

Introduction

This article analyses the Egyptian health policy for controlling the pandemic H1N1 flu, exploring its context, content, process, and actors. In purpose of evaluating it based on data collected from literature review and policy documents. According to Leichter Context refers to systemic factors – political, economic and social, both national and international – which may have an effect on health policy. (1) Novel H1N1 “swine flu” or H1N1 is a new influenza virus that was first detected in people in April 2009. Globally the WHO uses a series of six phases of pandemic alert as a system for informing the world of the seriousness of the threat and of the need to launch progressively more intense preparedness activities. The world is presently in phase 6: a new influenza virus subtype is causing disease in humans, and spreading efficiently and sustainability among humans. (2) On July 16, 2009, the WHO the World Health Organization stopped producing global tables showing the numbers of confirmed cases for all countries. So the 2009 influenza pandemic has spread internationally with unprecedented speed. In past pandemics, influenza viruses have needed more than six months to spread as widely as the new H1N1 virus has spread in less than six weeks.(2) In Egypt several hundred thousand pigs were killed in May, in spite of advice from global health authorities that this was unnecessary. Where are pigs are raised and consumed mainly by the Christian minority, which some estimates put at 10 % of the population. Health Ministry estimated there are between 300,000-350,000 pigs in Egypt. (3) Generally in societies where formal hierarchies important, it may be difficult to question or challenge high officials or elder statesmen. The position of ethnic minorities or linguistic differences may lead to certain groups being poorly informed about their rights, or services that do not meet their particular needs. (4), (1) Specifically in Egypt under the present conditions and the activation of emergency law, power is mainly presented by the government and top officials and expressed as thought control. In other words, power is a function of the ability to influence others by shaping their preferences. Reality which might be done through the control of information, the mass media and or through controlling the processes of socialization. Which are hidden under the name of Arab Republic of Egypt and its democratic system and not shown to outsiders. It is an example of elite which can manipulate the values of the masses to reflect their own. Interest groups exist but they are not all equally powerful and do not have equal access to the policy making process. The values of the elite are conservative and consequently any policy change is likely to be incremental. (5)

Political systems: participation, benefits and openness

Egypt is constitutionally a democratic republic based on a multiparty system. The 1971 Constitution provides for the separation of powers between the Executive, Legislature and Judiciary. No constitutional changes have taken place in Egypt since 1980. In the 1980 referendum, the current president, Hosni Mubarak, assumed office with a two-thirds majority vote of the People’s Assembly (PA). (The president is currently in his fifth presidential term.) He holds wide-ranging authorities and is the supreme commander of the armed forces, chair of the higher council for police agencies, and the higher council for judicial entities. The president nominates ministers, appoints 10 of the 454 members of the PA and 88 of the 264 members of the Shura Council, appoints and dismisses governors, university chairs, and other high ranking officials. The president is also the chair of the ruling National Democratic Party (NDP), which has been in power since it was established by former President Anwar Sadat in 1978 and effectively controls local government, the media, and the public sector. (6) Egypt’s 16 legally registered opposition parties’ ability to compete has been frustrated by the NDP’s dominance in the PA with a large majority of almost 90% (Figure 1). However, NDP has experienced a disappointing result in the parliamentary elections of 2000, which has prompted the substantial changes introduced to reform the party led by the President’s son Gamal Mubarak. (6) In terms of openness of the political system the issue currently predominating public discussions is that of “banned” political groupings, i.e. Islamic groups, in particular the Muslim Brotherhood. Standing as independents during the 2000 parliamentary elections, and despite government efforts to discourage participation, the Brotherhood emerged with 17 seats—the largest opposition grouping. Extremist Islamists were responsible for the 1992-99 insurgency aimed at overthrowing the regime and instituting an Islamist state. Drawing followers from the younger and middle classes, the power base of the militants lies in the slums of Cairo and Upper Egypt where poverty and unemployment are widespread. But, weakened by internal divisions and a sustained campaign against militants by the state security forces, as well as a public backlash following the Luxor attack in 1997—where 58 tourists and 4 Egyptians were killed—the militants announced an unconditional ceasefire in March 1999, which is still in force. (6) The results of a household survey showed that the public has little trust in the representational mechanisms of the political system. The mainstream political culture in Egypt still considers public affairs to be governmental a. airs, under the sole authority of central administrators who decide without being accountable to public “demands”. Moreover, representative institutions are unable to mobilize public awareness and gain public trust. Hence, 97% of the household survey respondents do not attend political party meetings or rallies, whilst 94% of them do not discuss community problems with their local representatives, and 99% have never wrote to a newspaper to press for their interest. (6) Women’s representation in the political system is marginal. The current People’s Assembly includes only 11 women (2.43%). Youth participation is also a matter of interest at the national and local level. In late 2000, the President declared a new policy to encourage youth participation in public life. (6) Almost all political parties tend to be elitist, male-dominated and ageing entities, which are dominated by “historic” leaders (e.g. the Unionist, the Labour, and the Umma parties) causing internal splits between “younger” and older generations (e.g. the Nasserist and the Wafd parties). None of the parties explicitly exclude social groupings, for the law regulating political activity preconditions that all parties should be open to all Egyptians. However, most of the established parties are characterized by social classes, (e.g. the NDP being “the government” party, the Wafd representing the upper strata of professionals and liberal entrepreneurs, the Unionist party the radical leftists, and the adjourned Socialist Labour Party representing the Social Islamists).(6)

Problem identification and issue recognition

H1N1 has swept around the world in weeks, infecting millions and killing more than 4735 by official counts. It could worsen as temperatures cool in the Northern Hemisphere, making conditions better for viruses. H1N1 (also referred as "swine flu") is a new influenza virus causing illness in people. This new virus was first detected in people in the United States in April 2009. (2) As of 11 October 2009, worldwide there have been more than 399232 laboratory confirmed cases of pandemic influenza H1N1 2009 and over 4735 deaths reported to World health organization. (2), (3) The WHO Regional Office for the Eastern Mediterranean (EMRO) reported 13855 cases and 90 deaths. As of 10 October 2009, 23:00 hours, Cairo time, 13,855 laboratory-confirmed cases of Pandemic (H1N1) 2009 were reported to WHO by 21 out of 22 Member States of WHO Eastern Mediterranean Region. Djibouti became the latest country in the Region to report cases of pandemic (H1N1) 2009. There are 90 related deaths from Pandemic (H1N1) 2009 reported, so far, from 12 member states in the Region. These deaths were reported from Saudi Arabia (28), Oman (21), Yemen (11), Kuwait (9), Islamic Republic of Iran (7), Bahrain (4), Egypt (2), Lebanon (2), Syrian Arab Republic (2), Iraq (2), Palestine (1) and Qatar (1). (7) With the increasing incidence rate and wide spreading of the H1N1 flu all over the world with its fatality the Egyptian government considered the issue as high political issue to be place in the political agenda for the taking the necessary measure . The pandemic flu was perceived as crises which open the window for policy, where problem stream, policy stream and political stream all are met together. According to Kingdon’s model, the three streams work along different, largely independent channels until at particular times, which become policy windows, they flow together, or intersect. This is when new issues get onto the agenda and policy is highly likely to change. (8) According to the position map most power was to the side of the government and policy maker and majority of the Egyptian society presented by Muslims, and low power was presented by the poor farmers and pork industry represented by almost half million Egyptian most of them are from Coptic minority from the Egyptian population, where the church, WHO and NGOs reflected medium power but with no effect as well. As mentioned before how complex is the health system in Egypt and its branching providers, the ministry of health and population developed the national plan for pandemic control with the other concerned ministries and this plan to be conducted at all the country levels . At the 4th of March 2009 it was discussed at the Egyptian parliament generating a law of prohibiting raising of pigs and dealing with its products in all parts of the Egyptian region, and at the same session the parliament agreed on that law to be directed to the concerned authorities to be discussed. At the 27th of April the minister of health and population presented the plan for facing this pandemic flu and mentioned the main aims of this plan and its objectives to be presented and shared by all the concerned ministries including the ministries of education, transportation, environment, agriculture .to control the spreading of the disease and preventing its mortalities. During the 27th session parliament members mentioned that Egypt is an Islamic country and it is logically to not practice such actions ‘‘requesting killing all the pigs in the country, with compensating the farmers for that .others recommended strongly use of the emergency law that is activated in Egypt since the terrorists attacks, and it should be used even it will not be easy for the people to accept it. That all reflecting the pressure of the interest group for certain policy to be formulated and shows how interest groups differ in the way they are treated by governments. Some are given high legitimacy, ‘insider’ status and are regularly consulted. Sectional groups often fall into this category because they are typically powerful and can employ sanctions if they do not approve of a government’s policy. In contrast, cause groups may be highly regarded and consulted but have less recourse to sanctions. They may be perceived as ‘outsider’ groups or even deliberately pursue an ‘outsider’ strategy organizing demonstrations and ensuring a high level of media coverage in a bid to embarrass or put pressure on government.

Policy implementation

At the 28th of the same months after days of the previous discussion, the Egyptian parliament decided to pass the law concerning killing all the pigs, to be done as soon as possible and to be carried out it places where it is exist not in special places or farms as was suggested before . The parliament sent the decision to the government specialists to be acted and giving feedbacks about that. At the 30th of April 2009 Egypt began slaughtering the roughly 300,000 pigs in the country as a precaution against swine flu even though were no cases had been reported there. At the 17th of May 2009 it was discussed by the parliament urgent request of some member about compensating the farmers in satisfactory ways, after they been badly treated from the officials and the way they slaughtered their pigs, that affect the way how Egypt presented for the international society, after slaughtering all the pigs in Egypt that were the main income resource for more than half million of the poor Egyptians, the decision that were acted without discussing its consequences reflecting the community worries about this population of waste collector in the Egyptian society. The policy implementation had been carried out through top-down approach where the entire policy process passed as a linear sequence of activities in which there was a clear division between policy formulation and policy execution. Goals had been clearly defined and widely understood, the necessary political, administrative, technical and financial resources were available, a chain of command had been established from the centre to the periphery, and a communication and control system had been in place to keep the whole system on course. But pig farmers _ overwhelmingly Christian - were angered. Government efforts to start the slaughter Wednesday were met with farmers who hurled stones at Health Ministry trucks. Also to be mentioned that WHO’s role as policy adviser and broker is emphasized rather than simply contributing to the implementation of routine public health activities in the country. Policy evaluation For evaluating the Egyptian health policy for swine flu pandemic control, we need to look at some important aspects and look carefully in the process of making and implementing the policy which mainly discussed and carried out in few days even were no cases reported in Egypt, affecting many poor Coptic Egyptian families mainly living at the little income coming from raising the pigs. Egypt's government was hoping to look strong and proactive in the swine flu scare with its decision to slaughter all the country's pigs, after taking heavy criticism at home for poor planning and corruption in past crises .But instead, some Egyptians called the move a knee-jerk overreaction that even the World Health Organization said was unnecessary. Egypt, which has no swine flu cases, is the only country in the world to order a mass pig slaughter in response to the disease. The move mirrored Egypt's battle with bird flu, in which the government killed 25 million birds within weeks in 2006. But international health officials said the swine flu virus that has caused worldwide fear is not transmitted by pigs, and that pig slaughters do nothing to stop its spread. The WHO stopped using the term "swine flu" to avoid confusion. In Egypt, even the editor of a pro-government newspaper criticized the order to slaughter the estimated 300,000 pigs, which was pushed by parliament and issued by the government. Conclusion The extinction of the Egyptian pigs is an example of how a health issue can be used to persecute a minority within a country. Although the current influenza has nothing whatsoever to do with pigs, the previous name of the epidemic was used as an argument to violate the rights of the Christian minority in Egypt.

References

1-Leichter H (1979), a Comparative Approach to Policy Analysis: Health Care Policy in Four Nations. Cambridge: Cambridge University Press. 2-WHO, Global Alert and Response (GAR), http://www.who.int/csr/en/ 3-WHO, Global Alert and Response (GAR), Egypt, http://www.who.int/csr/don/archive/country/egy/en/ update sept 2009. 4- Walt G and Gilson L (1994). Reforming the health sector in developing countries, The central role of policy analysis. Health Policy and Planning 9: 353–70. 5- Lukes S (1974). Power: A Radical Approach. London: Macmillan. 6- United Nations, economic commission for Africa, governance profile, Egypt, 2004, www.uneca.org/dpmd/publications/countryprofiles/Egypt-Final.pdf 7-WHO, Global Alert and Response (GAR), Pandemic (H1N1) 2009 - update 70, http://www.who.int/csr/don/2009_10_16/en/index.html 8- Kingdon J (1984). Agendas Alternatives and Public Policies, Boston: Little Brown & Co.

 Ethiopia

On June 19, 2009 the Ethiopian government reported two cases of swine flu. They were both in girls who had returned from school in the United States for summer break.

 Ghana

Ghana has banned the importation of pork and pork products.^[17]

 Kenya

Kenya health authorities started screening travellers at Jomo Kenyatta and Moi international airports on April 28.

Public Health and Sanitation minister Beth Mugo said travellers from Mexico, and those from Texas, California and New York were being screened as new cases appear in the United States.^[18]

On June 29, British medical student has become the first confirmed case of swine flu in Kenya, east Africa. The student, who was in a group of 33, was in Kenya to attend a series of medical camps in Nyanza province. The whole group is currently quarantined in their hotel in Kisumu while undergoing treatment.

Over the weekend there was panic in Nairobi as mobile text messages circulated warning people to stay away from Sarit centre, a popular commercial establishment where another suspected case had been diagnosed. The patient's test results however came back negative for the H1N1 virus.^[19][20][21]

 Libya

On 6 July 2009, Libya had its first confirmed case of swine flu.

 Morocco

Morocco confirmed the first case of novel human swine flu (A/H1N1-2009) on 12 June, in an 18-year old woman returning from Canada, where she studies university.^[22]

 Namibia

Namibia has confirmed its first two cases of swine flu, health officials announced last July 20.

Both cases involved young adults who had been traveling in other countries. The cases are a 13-year-old boy from Rehoboth who returned from a rugby trip with 20 other students in South Africa and the other being a young student returning from Europe. The latter was taken by ambulance to hospital directly from the international airport in Windhoek due that she has showed severe signs of flu.^[23]

 Nigeria

Nigerian Health Minister Babatunde Osotimehin said that the country is stockpiling antiviral treatments, informing the public and increasing surveillance.^[7]

The first A/H1N1 death was confirmed in Nigeria on 5 January 2010, with the victim being a 38 year old woman from Lagos who was infected in the US, Health Minister confirmed.

 Tunisia

Tunisia confirmed the two first cases of swine flu (A/H1N1-2009) on June 22. Both cases were returning from the United States, and are in good health now.^[24]

 South Africa

On April 29, South Africa reported two possible cases of swine flu from two women who had recently travelled in Mexico.^[25] On June 18, the first case was confirmed. Later, on 29 June the South African National Department of Health confirmed 7 cases of swine influenza in the country.^[26]

The principle of the King David School in Linksfield maintains that despite two confirmed cases of swine flu at the school there is no need to panic as the situation is under control.

Mark Falconer said a number of learners travelled abroad recently, which is where they may have contracted the virus.

The school is in contact with the Institute for Communicable Diseases as well as medical experts and Falconer said ill pupils were being sent home.

"According to the recommendations of the National Institute for Communicable Diseases the idea is that the quarantine of healthy people is not recommended," he said.

"Those people who are showing symptoms of flu, as is the case of any strain of flu, would be sent home because it's in no ones interest to have the pandemic spreading," explained Falconer.

Last week the Red Hill Private School in Sandton suspended all classes, at its campus, a week before its official winter holiday because of several suspected cases of swine flu.^[27]

The first death in South Africa was confirmed on 3 August.The victim was a student at the University of Stellenbosch.A few days later the second confirmed death was announced a male in Durban, Mount Edgecombe^[28]

The H1N1 virus was a concern for the 2010 FIFA World Cup, which took place in June 2010.^[29][30]

Sudan

The first case of swine flu in Sudan was confirmed in mid July 2009. At the end of November the first case was confirmed in Southern Sudan.^[31]

As of Dec. 28, 2009 there had been five deaths and over 150 confirmed cases of swine flu in Sudan.^[32]

 Zambia

An emergency task force has been set up by the Zambian government.^[7]

Timeline

References

See also