Zika virus – World Health Organization (WHO)

Report on Yellow Fever: A Global Health Challenge in the Context of Sustainable Development Goals

1.0 Introduction

Yellow fever is a vaccine-preventable, mosquito-borne viral disease that poses a significant threat to global health security, directly impacting the achievement of Sustainable Development Goal 3 (Good Health and Well-being). With a high potential for international spread, the disease primarily affects 40 high-risk countries across Africa and Latin America, where it causes an estimated 67,000–173,000 severe infections and 31,000–82,000 deaths annually. Addressing yellow fever is critical to fulfilling the global commitment under SDG Target 3.3 to end the epidemics of communicable diseases by 2030.

2.0 Disease Characteristics and Management

2.1 Transmission and Symptoms

The yellow fever virus is transmitted by infected mosquitoes of the Aedes, Haemagogus, and Sabethes species, which thrive in domestic, semi-domestic, and forest environments. Following an incubation period of 3–6 days, initial symptoms manifest, including:

• Fever and headache
• Nausea and vomiting
• General body aches and weakness

While most patients recover, approximately 15% progress to a severe phase characterized by high fever, jaundice, bleeding, and organ failure, which has a mortality rate of up to 50% within 7–10 days.

2.2 Diagnosis and Treatment

Early diagnosis is challenging due to non-specific symptoms that mimic other diseases like malaria and dengue fever. Confirmatory diagnosis relies on laboratory testing:

1. Early Stage: Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) testing of blood.
2. Later Stage: Antibody detection via ELISA or plaque reduction neutralization test (PRNT).

There is no specific antiviral treatment for yellow fever. Clinical management is supportive, focusing on rest, hydration, and managing organ failure and secondary infections. This underscores the importance of strong health systems, a key component of SDG 3.

3.0 Prevention and Control Strategies for SDG Attainment

Effective prevention and control are paramount to mitigating the impact of yellow fever and advancing global health targets. These strategies are central to achieving SDG 3 and building resilient communities (SDG 11).

3.1 Vaccination

Vaccination is the primary preventive measure. A single dose provides lifelong immunity, making it a highly effective public health intervention aligned with SDG Target 3.8 (Universal Health Coverage). Key aspects include:

• Immunity develops in over 99% of recipients within 30 days.
• The vaccine is safe and affordable.
• International Health Regulations (IHR) may require proof of vaccination for travellers, contributing to global health security.

3.2 Vector Control

Controlling mosquito populations is essential for reducing transmission risk, particularly in urban areas, which supports SDG 11 (Sustainable Cities and Communities). Methods include:

• Eliminating mosquito breeding sites, such as standing water.
• Applying larvicides to water storage containers.
• Promoting personal protective measures like repellents and protective clothing.

3.3 Epidemic Preparedness and Surveillance

Strengthening national capacities for early detection and response is a core requirement of SDG Target 3.d. This involves:

• Rapid detection and laboratory confirmation of cases.
• Maintaining at least one national laboratory for yellow fever testing in high-risk countries.
• Implementing emergency vaccination campaigns to contain outbreaks swiftly.

4.0 Global Response: The EYE Strategy and the 2030 Agenda

The global response to yellow fever is coordinated through the Eliminate Yellow Fever Epidemics (EYE) Strategy, a multi-partner initiative that directly supports the 2030 Agenda for Sustainable Development.

4.1 The EYE Strategy Overview

Launched by WHO, Gavi, and UNICEF, the EYE Strategy aims to end yellow fever epidemics by 2026. This partnership exemplifies SDG 17 (Partnerships for the Goals). Its strategic objectives are:

1. Protecting at-risk populations through mass vaccination campaigns and routine immunization.
2. Preventing international spread by strengthening urban preparedness and IHR implementation.
3. Containing outbreaks rapidly through early detection and response.

4.2 Alignment with Sustainable Development Goals

The fight against yellow fever is intrinsically linked to several SDGs:

• SDG 3 (Good Health and Well-being): The EYE strategy is a direct mechanism for achieving Target 3.3 (end epidemics of communicable diseases) and Target 3.d (strengthen early warning and risk reduction capacities).
• SDG 11 (Sustainable Cities and Communities): By focusing on urban preparedness and vector control, the strategy helps create safer, more resilient urban environments (Target 11.5).
• SDG 17 (Partnerships for the Goals): The collaborative framework of the EYE strategy, involving governments and international organizations, is a model for achieving global goals through partnership.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

1. SDG 3: Good Health and Well-being
   • The entire article is centered on yellow fever, a major public health issue. It discusses the disease’s causes, symptoms, high mortality rate (“About 50% of patients in this phase die”), and the significant number of annual infections and deaths. The focus on prevention through vaccination, vector control, and epidemic response directly aligns with ensuring healthy lives and promoting well-being.
2. SDG 17: Partnerships for the Goals
   • The article explicitly mentions the “Eliminate Yellow Fever Epidemics (EYE) Strategy,” which is described as a partnership “steered by Gavi, UNICEF and WHO.” This multi-stakeholder coalition working towards a common health goal is a clear example of the global partnerships required to achieve sustainable development.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Under SDG 3: Good Health and Well-being
   • Target 3.3: By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.
     • The article directly addresses this target by focusing on yellow fever, a communicable, epidemic-prone disease. The “Eliminate Yellow Fever Epidemics (EYE) Strategy” has a stated aim to “end yellow fever epidemics by the end of 2026,” which is a direct contribution to this target.
   • Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
     • The article highlights the existence of a “safe, affordable vaccine” that provides “lifelong protection with a single dose.” The EYE strategy’s objective of conducting “mass vaccination campaigns in high-risk countries” and ensuring “routine children’s immunization” is a direct effort to provide universal access to this essential vaccine.
   • Target 3.d: Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks.
     • The article emphasizes the threat yellow fever poses to “global health security” and the potential for “international spread.” It calls for “rapid detection and laboratory confirmation,” “vector surveillance,” and “strengthening urban preparedness.” The mention of the International Health Regulations (IHR) and the recommendation for high-risk countries to maintain “at least one national laboratory for yellow fever testing” are specific measures aimed at strengthening capacity for risk management and early warning.
2. Under SDG 17: Partnerships for the Goals
   • Target 17.16: Enhance the global partnership for sustainable development, complemented by multi-stakeholder partnerships that mobilize and share knowledge, expertise, technology and financial resources, to support the achievement of the sustainable development goals in all countries, in particular developing countries.
     • The article details the “Eliminate Yellow Fever Epidemics (EYE) Strategy,” which is described as a “coalition of partners” including Gavi, UNICEF, and WHO. This strategy represents a multi-stakeholder partnership designed to combat yellow fever, perfectly aligning with the description of this target.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. For Target 3.3 (End epidemics):
   • Incidence of yellow fever: The article provides baseline data, stating an estimated “67,000–173,000 severe infections” occur each year. A reduction in this number would indicate progress.
   • Mortality rate due to yellow fever: The article estimates “31,000–82,000 deaths” occur annually. Tracking this number would measure progress in combating the disease.
   • Number of high-risk countries: The article identifies “Twenty-seven African countries and 13 Latin American countries” as high-risk. A decrease in the number of countries experiencing outbreaks would be a key indicator.
2. For Target 3.8 (Universal health coverage/vaccines):
   • Vaccination coverage: The article mentions “mass vaccination campaigns” and “routine children’s immunization.” The percentage of the population vaccinated in high-risk areas is a direct indicator of access to essential vaccines.
3. For Target 3.d (Capacity for early warning and risk management):
   • National laboratory capacity: The recommendation that “High-risk countries should maintain at least one national laboratory for yellow fever testing” serves as a measurable indicator of diagnostic and surveillance capacity.
   • Implementation of International Health Regulations (IHR): The article mentions enhancing the implementation of IHR to prevent international spread. Adherence to and reporting under IHR can be monitored.
   • Outbreak response time: The emphasis on “Rapid detection” and “rapid outbreak containment” implies that the time taken to identify and respond to a confirmed case is a critical performance indicator.
4. For Target 17.16 (Partnerships):
   • Existence and operation of multi-stakeholder partnerships: The “Eliminate Yellow Fever Epidemics (EYE) Strategy” itself, steered by Gavi, UNICEF, and WHO, is a tangible indicator of a functioning global partnership dedicated to a specific health goal.

4. Summary Table of SDGs, Targets, and Indicators

Source: who.int