The #exacerbation of #Ebola #outbreaks by #conflict in the #DRC (Proc Natl Acad Sci USA, abstract)

[Source: Proceedings of the National Academy of Sciences of the United States of America, full page: (LINK). Abstract, edited.]

The exacerbation of Ebola outbreaks by conflict in the Democratic Republic of the Congo

Chad R. Wells, Abhishek Pandey, Martial L. Ndeffo Mbah, Bernard-A. Gaüzère, Denis Malvy, Burton H. Singer, and Alison P. Galvani

PNAS first published October 21, 2019 / DOI:

Contributed by Burton H. Singer, September 9, 2019 (sent for review August 14, 2019; reviewed by David Fisman and Seyed Moghadas)



There is limited understanding of what ramifications conflict events have on disease transmission and control in regions plagued by civil unrest and violence. Furthermore, the multifaceted nature of the conflict events during an epidemic is yet to be characterized. Using conflict data, ethnographic appraisal, and a mathematical model, we provide a descriptive timeline of the events during the ongoing Ebola outbreak in the Democratic Republic of the Congo. We quantified the unrest preceding a conflict event and its subsequent impact on control activities to demonstrate how conflict events are contributing to the persistence of the epidemic. Our model framework can be extended to other infectious diseases in areas that have experienced chronic conflict and violence.



The interplay between civil unrest and disease transmission is not well understood. Violence targeting healthcare workers and Ebola treatment centers in the Democratic Republic of the Congo (DRC) has been thwarting the case isolation, treatment, and vaccination efforts. The extent to which conflict impedes public health response and contributes to incidence has not previously been evaluated. We construct a timeline of conflict events throughout the course of the epidemic and provide an ethnographic appraisal of the local conditions that preceded and followed conflict events. Informed by temporal incidence and conflict data as well as the ethnographic evidence, we developed a model of Ebola transmission and control to assess the impact of conflict on the epidemic in the eastern DRC from April 30, 2018, to June 23, 2019. We found that both the rapidity of case isolation and the population-level effectiveness of vaccination varied notably as a result of preceding unrest and subsequent impact of conflict events. Furthermore, conflict events were found to reverse an otherwise declining phase of the epidemic trajectory. Our model framework can be extended to other infectious diseases in the same and other regions of the world experiencing conflict and violence.

insecurity – healthcare workers  – epidemiology – humanitarian crisis

Keywords: Ebola; DRC; Wars; Society.


Is #war a man-made #publichealth problem? (Lancet, summary)

[Source: The Lancet, full page: (LINK). Summary, edited.]

Is war a man-made public health problem?

Oliver Razum, Henrique Barros, Robert Buckingham, Mary Codd, Katarzyna Czabanowska, Nino Künzli et al.

Published: October 16, 2019 / DOI:



Wars and armed conflicts have devastating consequences for the physical and mental health of all people involved, for the social life within and surrounding the war-affected regions, and for the health of the environment. Wars destroy health infrastructure, undoing years of health advancement, and severely compromise health systems’ capacity to respond to the direct and indirect health consequences of fighting. Millions of people have been internally displaced or forced to flee their countries because of armed conflict. Forced migration creates further physical and mental health problems during transit, in enforced encampment, and because of restricted entitlement to health care in countries hosting refugees.1,  2,  3



Copyright © 2019 Bakr Alkasem/Getty Images

OR, HB, RB, MC, KC, NK, KL, and CS are the executive board members of ASPHER; RO is director at ASPHER; JM is president of ASPHER.

Keywords: Wars; Society; Public Health.


Rapidly expanding #nuclear #arsenals in #Pakistan and #India portend #regional and #global #catastrophe (Sci Adv., abstract)

[Source: Science Advances, full page: (LINK). Abstract, edited.]

Rapidly expanding nuclear arsenals in Pakistan and India portend regional and global catastrophe

Owen B. Toon1,*, Charles G. Bardeen2, Alan Robock3, Lili Xia3, Hans Kristensen4, Matthew McKinzie5, R. J. Peterson6, Cheryl S. Harrison7,8, Nicole S. Lovenduski9 and Richard P. Turco10

1 Laboratory for Atmospheric and Space Physics, Department of Atmospheric and Oceanic Sciences, University of Colorado, Boulder, CO 80303, USA. 2 Atmospheric Chemistry Observations and Modeling Laboratory, National Center for Atmospheric Research, Boulder, CO 80307, USA. 3  Department of Environmental Sciences, Rutgers University, New Brunswick, NJ 08901, USA. 4 Federation of American Scientists, 1112 16th St., N.W. Suite 400, Washington, DC 20036, USA. 5 Natural Resources Defense Council, 40 West 20th St., 11th Floor, New York, NY 10011, USA.6 Department of Physics, University of Colorado, Boulder, CO 80309-0390, USA. 7 School of Earth, Environmental, and Marine Sciences, University of Texas Rio Grande Valley, Port Isabel, TX 78597, USA. 8 Institute of Arctic and Alpine Research, University of Colorado, Boulder, CO 80309-0450, USA. 9 Department of Atmospheric and Oceanic Sciences, Institute of Arctic and Alpine Research, University of Colorado, Boulder, CO 80309-0450, USA. 10 Department of Atmospheric and Oceanic Sciences, University of California, Los Angeles, Los Angeles, CA 90095, USA.

*Corresponding author. Email:

Science Advances  02 Oct 2019: Vol. 5, no. 10, eaay5478 / DOI: 10.1126/sciadv.aay5478



Pakistan and India may have 400 to 500 nuclear weapons by 2025 with yields from tested 12- to 45-kt values to a few hundred kilotons. If India uses 100 strategic weapons to attack urban centers and Pakistan uses 150, fatalities could reach 50 to 125 million people, and nuclear-ignited fires could release 16 to 36 Tg of black carbon in smoke, depending on yield. The smoke will rise into the upper troposphere, be self-lofted into the stratosphere, and spread globally within weeks. Surface sunlight will decline by 20 to 35%, cooling the global surface by 2° to 5°C and reducing precipitation by 15 to 30%, with larger regional impacts. Recovery takes more than 10 years. Net primary productivity declines 15 to 30% on land and 5 to 15% in oceans threatening mass starvation and additional worldwide collateral fatalities.

Keywords: Environmental disasters; Environmental Pollution; Wars; Radiations; WMD.


Long-term #dynamics of #measles in #London: Titrating the impact of #wars, the 1918 #pandemic, and #vaccination (PLoS Comput Biol., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

PLoS Comput Biol. 2019 Sep 12;15(9):e1007305. doi: 10.1371/journal.pcbi.1007305. eCollection 2019 Sep.

Long-term dynamics of measles in London: Titrating the impact of wars, the 1918 pandemic, and vaccination.

Becker AD1, Wesolowski A2, Bjørnstad ON3,4, Grenfell BT1,4,5.

Author information: 1 Department of Ecology and Evolutionary Biology, Princeton, New Jersey, United States of America. 2 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America. 3 Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, Pennsylvania, United States of America. 4 Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America. 5 Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, New Jersey, United States of America.



A key question in ecology is the relative impact of internal nonlinear dynamics and external perturbations on the long-term trajectories of natural systems. Measles has been analyzed extensively as a paradigm for consumer-resource dynamics due to the oscillatory nature of the host-pathogen life cycle, the abundance of rich data to test theory, and public health relevance. The dynamics of measles in London, in particular, has acted as a prototypical test bed for such analysis using incidence data from the pre-vaccination era (1944-1967). However, during this timeframe there were few external large-scale perturbations, limiting an assessment of the relative impact of internal and extra demographic perturbations to the host population. Here, we extended the previous London analyses to include nearly a century of data that also contains four major demographic changes: the First and Second World Wars, the 1918 influenza pandemic, and the start of a measles mass vaccination program. By combining mortality and incidence data using particle filtering methods, we show that a simple stochastic epidemic model, with minimal historical specifications, can capture the nearly 100 years of dynamics including changes caused by each of the major perturbations. We show that the majority of dynamic changes are explainable by the internal nonlinear dynamics of the system, tuned by demographic changes. In addition, the 1918 influenza pandemic and World War II acted as extra perturbations to this basic epidemic oscillator. Our analysis underlines that long-term ecological and epidemiological dynamics can follow very simple rules, even in a non-stationary population subject to significant perturbations and major secular changes.

PMID: 31513578 DOI: 10.1371/journal.pcbi.1007305

Keywords: Pandemic Influenza; Spanish Flu; Wars; Society; Measles.


Pervasive #Arctic #lead #pollution suggests substantial #growth in #medieval #silver production modulated by #plague, #climate, and #conflict (Proc Natl Acad Sci USA, abstract)

[Source: Proceedings of the National Academy of Sciences of the United States of America, full page: (LINK). Abstract, edited.]

Pervasive Arctic lead pollution suggests substantial growth in medieval silver production modulated by plague, climate, and conflict

Joseph R. McConnell, Nathan J. Chellman, Andrew I. Wilson, Andreas Stohl, Monica M. Arienzo, Sabine Eckhardt, Diedrich Fritzsche, Sepp Kipfstuhl, Thomas Opel, Philip F. Place, and Jørgen Peder Steffensen

PNAS first published July 8, 2019 / DOI:

Edited by Eric W. Wolff, University of Cambridge, Cambridge, United Kingdom, and accepted by Editorial Board Member A. R. Ravishankara June 13, 2019 (received for review March 15, 2019)



Detailed lead pollution measurements in an array of 13 ice cores spanning nearly half the Arctic showed surprisingly similar temporal variability during the past 2 millennia until the Industrial Revolution. Lead pollution increased by 250- to 300-fold from the Early Middle Ages to the 1970s industrial peak, reflecting large-scale emissions changes from ancient European silver production, recent fossil fuel burning, and other industrial activities. Pronounced decadal-scale increases coincided with exploitation of new mining districts, technology development, and periods of economic prosperity, while decreases coincided with climate disruptions, famines, major wars, and plagues. Despite midlatitude pollution abatement policies that reduced Arctic lead pollution by >80% since the 1970s, recent levels remain 60-fold higher than at the start of the Middle Ages.



Lead pollution in Arctic ice reflects large-scale historical changes in midlatitude industrial activities such as ancient lead/silver production and recent fossil fuel burning. Here we used measurements in a broad array of 13 accurately dated ice cores from Greenland and Severnaya Zemlya to document spatial and temporal changes in Arctic lead pollution from 200 BCE to 2010 CE, with interpretation focused on 500 to 2010 CE. Atmospheric transport modeling indicates that Arctic lead pollution was primarily from European emissions before the 19th-century Industrial Revolution. Temporal variability was surprisingly similar across the large swath of the Arctic represented by the array, with 250- to 300-fold increases in lead pollution observed from the Early Middle Ages to the 1970s industrial peak. Superimposed on these exponential changes were pronounced, multiannual to multidecadal variations, marked by increases coincident with exploitation of new mining regions, improved technologies, and periods of economic prosperity; and decreases coincident with climate disruptions, famines, major wars, and plagues. Results suggest substantial overall growth in lead/silver mining and smelting emissions—and so silver production—from the Early through High Middle Ages, particularly in northern Europe, with lower growth during the Late Middle Ages into the Early Modern Period. Near the end of the second plague pandemic (1348 to ∼1700 CE), lead pollution increased sharply through the Industrial Revolution. North American and European pollution abatement policies have reduced Arctic lead pollution by >80% since the 1970s, but recent levels remain ∼60-fold higher than at the start of the Middle Ages.

ice core – lead pollution – Arctic  – plague – Middle Ages



1 To whom correspondence may be addressed. Email:

Author contributions: J.R.M. designed research; J.R.M., N.J.C., A.S., M.M.A., S.E., D.F., S.K., T.O., P.F.P., and J.P.S. performed research; J.R.M., N.J.C., A.I.W., and A.S. analyzed data; and J.R.M., N.J.C., A.I.W., and A.S. wrote the paper.

The authors declare no conflict of interest.

This article is a PNAS Direct Submission. E.W.W. is a guest editor invited by the Editorial Board.

This article contains supporting information online at

Published under the PNAS license.

Keywords: Arctic; Environmental Pollution; Middle Age; Plague; Wars.


#US #sanctions in #Venezuela: #help, hindrance, or #violation of #humanrights? (Lancet, summary)

[Source: The Lancet, full page: (LINK). Summary, edited.]

US sanctions in Venezuela: help, hindrance, or violation of human rights?

Tanya L Zakrison, Carles Muntaner

Published: June 13, 2019 / DOI:


We read with interest the Review about Venezuela’s public health crisis1 and could not agree more emphatically with the authors. However, the root causes of this economic crisis, specifically, the impact of the US economic sanctions, deserve further inquiry. Since 2014, 43 unilateral, coercive measures have been applied against Venezuela by the US Administration. These have effectively paralysed the economy, blocked oil exportation globally, and frozen Venezuelan financial assets abroad while denying access to international financial systems. This loss in oil revenue and assets has amounted to a shortfall worth billions of US dollars, prohibiting the importation of essential, lifesaving products.



We declare no competing interests.

Keywords: Public Health; Venezuela; USA; Wars; Politics; Society; Poverty.


The Ongoing #Ebola #Epidemic in the #DRC, 2018–2019 (N Engl J Med., abstract)

[Source: The New England Journal of Medicine, full page: (LINK). Abstract, edited.]

The Ongoing Ebola Epidemic in the Democratic Republic of Congo, 2018–2019

Oly Ilunga Kalenga, M.D., Ph.D., Matshidiso Moeti, M.D., Annie Sparrow, M.B., B.S., M.D., M.P.H., Vinh-Kim Nguyen, M.D., Ph.D., Daniel Lucey, M.D., M.P.H., and Tedros A. Ghebreyesus, Ph.D.



The international response to the evolving Ebola epidemic in eastern Democratic Republic of Congo (DRC) has had interim successes while facing ongoing difficulties. The outbreak has occurred in an area of intractable conflict among multiple armed groups at a time of contentious national elections. Despite porous international borders and considerable population movement, however, transmission has been confined to North Kivu and Ituri provinces. Factors potentially contributing to this containment include conduct of about 55 million screenings, surveillance of contacts (12,591 under surveillance currently), testing of 280 samples per day, provision of safe and dignified burials for most deaths, vaccination of high-risk people (112,485 vaccinated as of May 7, 2019), and medical treatment including four investigational therapies. Major challenges remain. Since late February 2019, a sharp rise in cases and increased transmission have been observed. These coincide with organized attacks by armed groups targeting response teams, deteriorating security, and the population’s increasing distrust of the response effort. The risk of local and regional spread remains high given the high proportion of deaths occurring outside treatment facilities, relatively low proportions of new patients who were known contacts, ongoing nosocomial transmission, and persistent delays in detection and reporting. Stopping this epidemic will require the alignment of the principal political and armed groups in eastern DRC in support of the response.

Keywords: Ebola; DRC; Society; Poverty; War.