In the final analysis however

In the final analysis, however, the implication that there is a decision to be made (seek medical care or not) or a ‘spreader’ to be found is merely a cognitive convention that has been imposed on the PPE-bereft care-nexus by western philosophy. Such language is couched in rational choice models and other scientistic paradigms—that is, technocratic ways of thinking which elevate the formal rationality practised in modern science to a quasi-divine faculty for isolating truth, without considering the plurality of roles that reason can take—which comprise the modern missionary\'s (ie, aid worker\'s) faith and sanctify the individual at a specific point in time as opposed to webs of relations and how they GSK-J1 sodium salt change diachronically. These platonic shadows-on-the-wall, so to speak, also divert attention from outside the cave, where legacies of the transatlantic slave trade, colonialism, indirect rule, structural adjustment, and extractive foreign companies—the real superspreaders—have been, and continue to be, embodied as viral disease in West Africa, resulting in the preventable demise of large swaths of humanity. Therefore, we can view the Ebola suspect\'s dilemma as a heuristic for the most recent outbreak in West Africa. First, we must temper the fetishisation of containment-through-isolation by a greater commitment to carry out aggressive resuscitation in future infectious disease outbreaks where shock is a predominant feature (evidence for the “injection of saline solutions in extraordinary quantities” in such a scenario existed as early as 1832, but was poorly translated to the 2013–16 outbreak in West Africa). Second, we must recognise the practical and interpretive limits of rationalist epistemologies—including the categories of thought that are instilled by our training as scientists, clinicians, and public health professionals—while exploring paradigms informed by biosocial analysis and methodological relationalism.
In the past decade, Brazil has achieved considerable progress in malaria control, with 140 000 cases reported in 2015, the lowest numbers since 1980. Part of this success has been attributed to the establishment of a large network of around 3000 diagnostic and treatment units for malaria. A remarkable feature is that these services are provided for free as part of the public universal health-care system (Sistema Único de Saúde [SUS]) and cover rural and riverine areas in the Amazon region—where more than 83% of malaria transmission occurs. Populations in these areas have a low density and reduced level of mobility, and in spite of the high coverage for malaria-associated diagnosis and treatment by the SUS, scarce access to health care and other public services, characterising the precarious social conditions and relative neglectof malaria in this region, a situation unfortunately shared with other Latin American countries. In the absence of a consistent presence of the state, a creative and original acute fever surveillance system based on the use of a red flag has been put in place (figure). This consists of hoisting a red flag (or piece of red cloth) in front of a household if an inhabitant presents fever or other malaria-associated symptoms. Whenever a community health-care worker roaming their catchment area observes a red flag, they stop at that household, fill the notification form with the data from the febrile person, and collect a blood sample for malaria diagnosis through either microscopy (done at that location\'s health post) or rapid diagnostic test. If the test is positive, the species-specific treatment is provided following the national guidelines. Such a system has contributed to partly overcome the problem of large distances to health facilities, which impairs efficiency of case detection in the region, and enabled more than 60% of malaria cases to be treated within 48 h of fever onset.
I read with great interest the open letter published on Dec 9, 2016 in to solicit the ideas and views of candidates for WHO Director General on advancing the research and development (R&D) of diagnostics, medicines, and vaccines of public health importance. I have high regard for civil society\'s advocacy to address big challenges in global health. There have been significant efforts and commitments by WHO Member States and non-state actors to develop and deliver affordable, effective, safe, and quality health products for diseases that disproportionately affect developing countries and vulnerable populations and remain poorly addressed owing to market failures. These efforts include the Report of the Commission on Intellectual Property Rights, Innovation and Public Health addressing key access barriers, the TRIPS agreement allowing the use of compulsory licenses, the report of WHO\'s Consultative Expert Working Group on Research and Development, the recommendations of the UN Secretary General\'s High Level Panel on Access to Medicines proposing a deal to close the gap between health innovation and access, and a call to double the funding for R&D to US$6 billion per year. The recent global doubling of oral cholera vaccine supply demonstrated the critical role of public-private partnerships.