DPH 830 Module 3 Infectious Disease Control Worldwide Example

Nets, Needles and Trust: Lessons From Malaria and Ebola for Infectious Disease Control

Student Name

Doctor of Public Health Program, Aspen University

DPH 830: Global Health

Instructor Name

Month Day, Year

Nets, Needles and Trust: Lessons From Malaria and Ebola for Infectious Disease Control

Infectious diseases still cause a large share of death and illness in low-income countries, and new outbreaks can cross borders within days. Control depends on proven tools delivered at scale and on systems that detect and respond quickly. This paper examines infectious disease control worldwide through two contrasting experiences, the decline of malaria in Africa and the Ebola epidemic in West Africa, and draws lessons for program design.

Core Tools of Control

Infectious disease control combines surveillance to detect cases and outbreaks, prevention through vaccination, vector control, safe water and sanitation, and behavior change, and case management through diagnosis and treatment. Programs succeed when these tools are matched to how a pathogen spreads and delivered reliably to the people at risk.

Five Diseases Compared

The table compares five infections on the tools that matter most and the challenges that remain.

A Success: Malaria in Africa

Between 2000 and 2015, the prevalence of Plasmodium falciparum infection in endemic Africa roughly halved and clinical cases fell by about 40%. A modeling study estimated that control interventions averted about 663 million clinical cases over the period, with insecticide-treated nets responsible for about 68% of cases averted, artemisinin-based combination therapy about 22% and indoor residual spraying about 10% (Bhatt et al., 2015).

Why Malaria Control Worked

Several factors converged: effective, low-cost tools; large increases in international funding; mass distribution campaigns that reached rural households; and national programs that tracked coverage. Nets worked because they protected people at night when mosquitoes bite, and because distribution was free and at scale rather than sold. Rapid diagnostic tests also allowed health workers to confirm malaria before treating, reducing waste of drugs and improving care for other fevers.

A Failure: Ebola in West Africa

The 2014 Ebola epidemic in Guinea, Liberia and Sierra Leone spread for months before an effective response. By the ninth month, the case fatality rate among patients with recorded outcomes was about 71%, and projections warned of thousands more cases without stronger control (WHO Ebola Response Team, 2014). Weak health systems, delayed international action and community distrust allowed transmission to grow.

Why the Early Response Failed

An independent panel concluded that the response was slowed by weak national surveillance, delays in declaring an international emergency, inadequate funding and poor coordination among agencies. It recommended reforms including stronger core capacities in every country, an independent accountability mechanism and a dedicated outbreak response center (Moon et al., 2015).

Community Trust

Ebola control improved when communities became partners. Safe and dignified burial teams that respected customs, local leaders who explained the disease and survivors who spoke about recovery helped reduce resistance. The lesson applies to all infectious disease work: technical tools fail without trust.

The International Health Regulations

The International Health Regulations, revised in 2005, require countries to build core capacities to detect, assess and report public health events and to alert the World Health Organization to any event that could amount to a public health emergency of international concern. Many countries had not met these requirements by 2014, and Ebola exposed the gap between legal obligations and real capacity.

Vaccination

Vaccines are among the most cost-effective tools in global health. Measles vaccination has prevented millions of deaths, yet outbreaks recur where coverage falls below the high levels needed to interrupt transmission. An Ebola vaccine used in later outbreaks shows how new tools can change control strategies when paired with ring vaccination around cases. Sustaining high coverage requires reliable cold chains, trained vaccinators and trust.

Antimicrobial Resistance

Resistance threatens many gains. Mosquitoes resistant to insecticides, parasites with reduced sensitivity to artemisinin, drug-resistant tuberculosis and resistant bacteria all require surveillance, stewardship of drugs and investment in new tools. Resistance is a global problem that no country can solve alone.

Financing and Sustainability

Malaria gains depended on rapid increases in funding, and they are at risk when funding plateaus. Programs that rely heavily on external donors must plan for transition to domestic financing and integration into routine health services. Domestic budget lines for commodities, even modest ones, signal ownership and ease transitions when donor support declines.

Lessons for Program Design

Four lessons emerge: match tools to transmission; deliver them free and at scale; build surveillance and response into everyday health systems; and work with communities as partners. These lessons apply to future outbreaks as much as to endemic diseases.

Surveillance Systems

Early detection depends on surveillance that reaches the community level. Health workers who report unusual illness, laboratories that confirm pathogens quickly and data systems that alert district and national officials form the backbone of control. During the Ebola epidemic, weak surveillance meant that transmission went unrecognized for months in some areas, allowing chains of infection to multiply before any response began.

Community Health Workers

Community health workers extend control tools to households far from clinics. They distribute nets, test and treat malaria, trace contacts, support tuberculosis treatment and encourage vaccination. Programs that pay, train and supervise them well achieve far higher coverage than those relying on volunteers alone.

One Health

Many emerging infections, including Ebola, originate in animals. A One Health approach links human, animal and environmental health surveillance so that spillover events are detected early. Cooperation among health, agriculture and environment ministries remains weak in many countries and is a priority for preparedness.

Integrating Programs

Separate programs for each disease can duplicate supply chains, training and reporting. Integrating services at the point of care, such as combining malaria testing, childhood vaccination and nutrition screening in one visit, reduces burdens on families and health workers while maintaining disease-specific expertise at higher levels.

Measuring Control Progress

Programs track coverage of key tools, such as the share of households owning a net or children fully vaccinated, alongside outcomes like confirmed cases and deaths. Coverage indicators show whether delivery is working; outcome indicators show whether transmission is falling. Both must be reported by district so that districts with weak coverage stand out before outbreaks follow.

Conclusion

Malaria control in Africa shows what effective tools, funding and scale can achieve, while the Ebola epidemic shows the cost of weak surveillance, slow response and distrust. Infectious disease control worldwide depends on both proven interventions and strong, trusted systems that can detect and act on threats early.

References

Bhatt, S., Weiss, D. J., Cameron, E., Bisanzio, D., Mappin, B., Dalrymple, U., Battle, K. E., Moyes, C. L., Henry, A., Eckhoff, P. A., Wenger, E. A., Briët, O., Penny, M. A., Smith, T. A., Bennett, A., Yukich, J., Eisele, T. P., Griffin, J. T., Fergus, C. A., ... Gething, P. W. (2015). The effect of malaria control on Plasmodium falciparum in Africa between 2000 and 2015. Nature, 526(7572), 207-211. https://doi.org/10.1038/nature15535

Moon, S., Sridhar, D., Pate, M. A., Jha, A. K., Clinton, C., Delaunay, S., Edwin, V., Fallah, M., Fidler, D. P., Garrett, L., Goosby, E., Gostin, L. O., Heymann, D. L., Lee, K., Leung, G. M., Morrison, J. S., Saavedra, J., Tanner, M., Leigh, J. A., ... Piot, P. (2015). Will Ebola change the game? Ten essential reforms before the next pandemic. The report of the Harvard-LSHTM Independent Panel on the Global Response to Ebola. The Lancet, 386(10009), 2204-2221. https://doi.org/10.1016/S0140-6736(15)00946-0

WHO Ebola Response Team. (2014). Ebola virus disease in West Africa: The first 9 months of the epidemic and forward projections. New England Journal of Medicine, 371(16), 1481-1495. https://doi.org/10.1056/NEJMoa1411100