Plug this hole in regional planning

One particular area where a regional approach is so desperately needed is in reacting to emergencies and coping with wide-scale disaster.

On the political and military side a great deal of progress has been made. SADC was able to respond swiftly and positively when the DRC was invaded from Rwanda. Appalling floods in the lower Zambezi Valley have seen South African and Zimbabwean helicopters rescuing hundreds of Mozambicans. South African forces were able to suppress a mutiny and attempted coup in Lesotho.

Military chiefs meet fairly regularly and have drawn up contingency plans for a wide variety of potential emergencies. They have ensured that their tactical commanders and senior staff officers have been trained together and know each other.

But in other areas, just as critical, there has been a lot less co-operation and a lot less planning.

The recent polio outbreak in Namibia has highlighted a hole in regional health planning. It took more than a fortnight for health ministers to meet and there does not appear to be any regional planning as yet to cope with any spread of this outbreak. Namibia decided, sensibly, to vaccinate its entire population. But southern Angola and north-west Botswana are closer to the outbreak area than the Orange River and surely spreading the vaccination zone to those areas would make sense.

A possible case of avian flu in Livingstone sent another warning to health authorities that time is running out to set up a proper integrated procedure to deal with health emergencies. Within a 100km of Livingstone there are parts of four countries ‘ Zambia, Zimbabwe, Botswana and Namibia ‘ and many birds could flap a bit further to Angola in just a day.

Avian flu outbreaks are not impossible to deal with, but they require a lot of manpower very quickly and if the virus spreads to humans then there is need for a quarantine cordon and mass vaccinations. The sooner this is done, the smaller the quarantine zone needs to be, the fewer people need vaccinations and the potential risk can be considerably reduced. There will be no time to plan on the day. Unless just about everything is worked out in advance, and officials just have to grab a file and deploy already trained staff, epidemics could spread like wildfire.

SADC is doing solid work in making trade and movement of people a lot easier. Progress can be a bit plodding but every year it becomes easier and easier for, say, a Cape Town businessman to do business in northern DRC. And much movement is unofficial. The SADC borders leak with smugglers, people visiting their granny on the other side of an arbitrary line on a map, farmers rescuing a cow, and old women selling tomatoes to a neighbour.

Thanks to the dramatic reduction in security risks, another SADC success, fewer and fewer troops and police are patrolling borders and preventing such continuous traffic.

Yet this desirable progress makes the spread of an epidemic so much easier. Already we have seen minor outbreaks of cholera jump borders as if they did not exist. And malaria and tsetse control programmes are hampered because mosquitoes and tsetse flies cross rivers, mountains and lines of latitude and longitude with ease.

The time has come for the health authorities to do what their generals have already been doing: draw up proper emergency plans to cope with epidemic outbreaks, ensure that the people who will implement these plans know each other fairly well, and have a system of continuous consultation that will allow the plans to be activated properly within hours of an emergency.

Stocks of some of the most critical vaccines should be kept in a regional centre. For example, an avian flu outbreak might need 1 million doses of a particular vaccine; the only problem is that no one knows whether the next outbreak will be in east Tanzania, central DRC, southern Angola, Zambezia in Mozambique, the Zambezi Valley in Zimbabwe or Cape Town itself.

But if the vaccine is in store, and regional staff are trained, it will be easy to fly the people and their medicines to the area within 24 hours and contain the outbreak before it becomes a regional threat. In fact it might be an idea, in these planning stages, to link up with the military planners. Armies and air forces are very good at getting lots of people swiftly to remote areas and good at making sure they have food, tents and equipment when they get there.

The polio outbreak and the flu scare are warning shots; now is the time for the health authorities to prepare for a far worse event. It may not happen this year, or this decade. But one day it will happen and on that day it can be stopped if everyone is ready.

June 2006
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