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Jul 27, 2016 | 09:00 GMT

Yellow Fever: An Overlooked Outbreak in Africa

In Kinshasa, a man receives a vaccination against yellow fever, which has spread to the Democratic Republic of the Congo from Angola, where an outbreak began in late 2015. Though it has attracted far less attention than the Zika virus, an outbreak of yellow fever could turn into a global concern if it spreads along economic lines from Angola and the Democratic Republic of the Congo to China.
(EDUARDO SOTERAS/AFP/Getty Images)

For much of the past year, the Zika virus has dominated the news cycle and commanded international attention. With the Summer Olympics in Rio de Janeiro less than two weeks away, and two cases of the virus that could be unrelated to travel reported in Florida, that is unlikely to change any time soon. But another mosquito-borne disease, yellow fever, is working its way (albeit more quietly) through the African nations of Angola and the Democratic Republic of the Congo. Though it has attracted far less attention than the Zika virus, yellow fever nevertheless could disrupt economic activities in and beyond those countries, a key consideration in assessing the geopolitical risk of a disease outbreak. What's more, a large number of foreign workers in Angola and the Congo as well as a vaccine shortage worldwide could conspire to turn the latest outbreak of yellow fever — a disease that has been preventable for nearly 80 years — into a more global concern.

Angola's economic ties with China could prove to be a conduit for transmitting yellow fever.

Angola's latest outbreak of yellow fever began in December 2015. Since peaking in early 2016, the incidence of new cases has dropped off. But that does not mean the outbreak is under control. Containing the spread of the disease remains an issue; though about 70 percent of Angola's population (around 15 million people) has been vaccinated against yellow fever, transmission continues. Furthermore, as recently as May, incidences of the disease were popping up in regions previously unaffected by the epidemic.  

In neighboring Congo, the outbreak is still developing. Having crossed the porous border with Angola, the disease has already reached five Congolese provinces, causing nearly 2,000 suspected cases. Vulnerable areas in the country include its capital, Kinshasa (home to a significant Angolan population), as well as the districts of Kasai and Lualaba, according to the World Health Organization (WHO).

A Complicated Containment Strategy

To combat the disease, the WHO is launching a massive campaign to vaccinate another 15.5 million people — more than half of them in Kinshasa — in both countries before the end of August. This will be no easy feat. Beyond the logistical difficulties of transporting, storing and delivering the vaccine to remote areas of Angola and the Congo, the vaccine itself may not be readily available. The world's supply of yellow fever vaccines might not be enough to support such an ambitious inoculation drive while sustaining vaccination rates elsewhere. Typically, the global stockpile is about 6 million doses, but it has already been depleted twice in 2016. Worldwide, only four manufacturers pre-approved by the WHO produce the vaccine, and UNICEF expects supplies to stay strained through 2017. In the meantime, doctors plan to administer partial doses, which will provide immunity for a limited amount of time, to try to ensure coverage for the duration of the outbreak.

Angola's latest outbreak of yellow fever began in December 2015. Since peaking in early 2016, the incidence of new cases has dropped off. But that does not mean the outbreak is under control.

Angola's economic ties with China, however, could also prove to be a conduit for transmitting yellow fever. Angola sends roughly half its crude oil exports to China, and Chinese direct investment, in turn, has buoyed not only Angola's oil sector but also its construction industry. Along with the money, hundreds of thousands of Chinese citizens have gone to Angola for work; more than 250,000 resided there in 2012. Similarly, China has invested a substantial amount of money and manpower into mining projects in the Congo, where at least 5,000 Chinese workers live.

The Risk of Further Spread

Considering the size of the population overlap, it is not at all surprising that China reported 11 confirmed cases of yellow fever originating from Angola in April. Though no further incidences of the disease have been traced back to Angola, China still faces the threat of large-scale outbreak. As the disease continues to spread in Angola and the Congo, more cases could be brought back to China. In addition, many parts of China have an environment conducive to hosting the mosquito that transmits the virus. Coupled with high population density, these factors put mainland China at risk of a yellow fever epidemic should the disease spread within its borders. Angola's mandate that all workers in the country get vaccinated against the virus will help China to keep the risk low. Reports of falsified records, however, cast doubt on the strength of that safety net.

As long as Angola's oil production and the Congo's mining activities continue as expected, yellow fever's effect on the global economy should be minimal. But given the limited supply of yellow fever vaccine, if the disease takes hold in China, it could have wider economic consequences.

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