South Africa and other African nations such as Uganda, Burkina Faso and Senegal were identified by the U.S. Centers for Disease Control and Prevention as countries with “very high” public health and infectious disease threats to Americans, despite periodic efforts to improve the health systems and reduce risk of disease outbreaks.
South Africa, the CDC reported, has a lengthy history of poor governance, corruption and weak government accountability, a culture of compliance with an unwritten “national loyalty” policy that fosters immunity to medical treatments and public health measures, and lax public health standards.
The U.S. Embassy in Pretoria responded to the report on its Twitter feed Monday evening.
South Africa needs US support to improve public health systems. Recent outbreak of Crimean-Congo hemorrhagic fever underscores other challenges. — US Embassy Pretoria (@usimambob) February 5, 2019
A traveler to Uganda, another country identified in the report, could die of hemorrhagic fever; there are no vaccines for it, and the outbreak was not under control, according to the CDC. Burundi also had a recent outbreak.
With Burundi and Uganda, the CDC found that the public health infrastructure was “poor or nonfunctional in several instances.” Ebola deaths “typically occur during outbreaks from deliberate disease-spreading activities.”
Those findings prompted travel warning red flags and prompted the government of Uganda to advise citizens to refrain from travel to “Southeast Uganda, especially the cases of Crimean-Congo fever and Zika virus.”
In western Africa, Burundi and Swaziland and Madagascar are considered particularly dangerous at the moment, since the outbreak of Lassa fever has raised health and public safety concerns in these countries, the CDC reported. Lassa virus is a highly contagious hemorrhagic fever caused by the same Lassa bacteria found in rodent excrement. It was last seen in Africa in 2014, during the Ebola outbreak in Liberia, Guinea and Sierra Leone.
South Africa and Uganda were listed as carrying very high risk public health threats based on previous outbreaks. While neither nation was designated as a high risk country, South Africa had a history of epidemics of Lassa fever and a multi-partner cross-border outbreak of haemorrhagic fever in 2017, when there were more than 500 reported cases.
Uganda had 14 deaths due to Lassa virus outbreak in 2014 and an Ebola outbreak in 2015, the CDC said.
This is not the first time these nations have made the CDC’s list.
The region is home to numerous potential public health threats, including simultaneous outbreaks of the cholera and plague viruses. The United States implemented cholera-specific vaccine and treatment programs at its embassies in South Africa and Botswana after heavy losses in the region of nine Americans treated for the disease.
Uganda saw a multi-year outbreak of the plague between 1999 and 2004.
The CDC didn’t list Zimbabwe as a “very high” risk country on its list. Zimbabwe had an Ebola outbreak in 2015, and the nation suffered a cholera outbreak from June to November of that year.
More recently, Zimbabwe was hit by a severe food crisis and saw political unrest as political power transition and political protests played out.