The spread of diphtheria is highly contagious and fatal in West Africa, says Louise Ivers, a physician with a shortage of vaccines
Simar Bajaj is an American journalist who has previously written for The Atlantic, TIME, The Guardian, Washington Post and more. He is the recipient of the Foreign Press Association award for Science Story of the Year and the National Academies award for Excellence in Science Communications.
As of December 2023, there have been around 25,000 cases of diphtheria in West Africa and 800 deaths. In Siguiri, the country’s northeast, there were clusters of cases with most occurring in children under the age of 5.
However, shortages of both vaccines and antitoxins continue to hamper a full-scale response to the diphtheria outbreak, according to Louise Ivers, an infectious disease physician and the director of the Harvard Global Health Institute. Presently, only two or three companies make the antitoxin, and each batch of 1,500 doses takes about four weeks to prepare, harvested from horse blood. “Because of how often this antitoxin is used, and how impoverished communities are, nobody is going to make it,” says Ivers. “That puts it into the category of low likelihood of commercial profit.”
The vaccine is almost completely preventable because of the disease which was a global epidemic in the 20th century. After the World Health Organization included the diphtheria inoculation on its essential vaccine list in the 70s, cases decreased around the world. “Now, it’s an almost forgotten disease,” says Shyaka.
“This can kill by suffocating the patient,” says Adélard Shyaka, medical coordinator for Doctors Without Borders in Guinea. “But also the toxin moves through the body and can damage the heart, the kidneys, the nervous system.” It’s possible that diphtheria is fatal in 50% of cases without treatment.
Diphtheria is a highly contagious bacterial infection spread through direct contact with infected sores or ulcers but primarily through breathing in respiratory droplets. A thick mucus-like substance (called a “pseudomembrane”) can develop at the back of the throat, if there is inflammation that blocks the airways.
Malaria is a global burden, but a child’s risk is greater than ever: Why children under five are likely to be killed by malaria
“When you look at the enormous burden of malaria, 39% efficacy seems low, but this could mean a huge reduction in cases and deaths,” said Dr. Samuels, director of the CDC’s Kenya Malaria program.
Indeed, in 2022, there were an estimated 249 million cases of this mosquito-borne disease globally and 600,000 deaths. Africa was home to almost half a million deaths, including children under the age of 5.
As an example, he notes that contracting malaria makes you more likely to get salmonella disease – the most common bloodstream infection in Africa with a case fatality of up to 20-25%. A study out of Eastern India shows that over half the bacteremia cases were caused by Malaria, with more than 50 percent of these cases attributable to Malaria.
In an email to NPR, Hamel also describes how children who have HIV or face chronic malnutrition are at higher risk of severe malaria, which in turn can exacerbate HIV and malnutrition, potentially leading to death. She says the reduction in mortality is more than one would expect from a decrease in the number of malaria deaths, when compared to trials where children were given nets and preventive anti-malarial tablets.
The parasites are plastic and they can quickly evolve all these interventions. “If you let up pressure, it will evolve, it will change, it will come back.”