Commentary: The most concerning outbreak right now isn’t Ebola or hantavirus
Despite being the leading cause of vaccine-preventable child deaths worldwide, measles doesn’t garner much attention, says Hsu Li Yang of the Saw Swee Hock School of Public Health.
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SINGAPORE: Two rare and deadly infectious diseases drew significant international coverage and public attention in May: the Andes hantavirus on board the cruise ship MV Hondius and the Bundibugyo Ebola virus outbreak in the Democratic Republic of the Congo (DRC).
Meanwhile, an ongoing outbreak has been linked to the deaths of more than 500 children over the last two months – but has received far less attention.
Bangladesh is experiencing one of its worst measles outbreaks in decades, with over 78,000 suspected and confirmed cases so far. Most deaths have occurred in unvaccinated young children under 5 years of age.
The contrast is striking. The Andes virus outbreak has so far caused 13 cases and three deaths. As of May 29, there are over 1,000 cases and 220 deaths (suspected and confirmed) in the Ebola outbreak in the DRC and neighbouring Uganda.
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In an ideal world, attention would reflect the true scale of harm. In reality, diseases that are unfamiliar or poorly understood command more attention, while routine killers fade into the background.
WHAT COMMANDS MORE ATTENTION
This asymmetry is, unfortunately, easy to comprehend. After the trauma of COVID-19, infectious disease threats tend to be seen through the lens of whether they could be the next pandemic.
The Andes virus outbreak strikes all the right notes for public and media attention: The virus is rare and deadly, the only known rodent-borne hantavirus capable of transmitting between humans. The outbreak happened on a polar cruise ship, something many people might have on their “bucket list”.
Passengers and crew disembarked or were repatriated to multiple countries, including France, Spain and Canada where a few isolating individuals subsequently tested positive for the virus. Two Singapore residents who were passengers tested negative and were quarantined for 30 days from the date of last exposure as a precaution.
Ebola (of which the Bundibugyo virus is one species) is equally deadly and, scientifically and operationally, far more challenging to deal with. There are no approved vaccines or treatment for the Bundibugyo virus, and the outbreak is in a longstanding and volatile conflict zone.
It picked up more attention after May 17, when the World Health Organization declared the outbreak a Public Health Emergency of International Concern (PHEIC). This formal declaration does not mean there is a global pandemic threat. Rather, it reflects the severe impact to affected communities, high regional risk and the need for a coordinated international response.
But as this is the ninth Ebola outbreak in Africa this decade, seven of which have been in the DRC alone, it is perceived as being of lower risk outside those areas.
LEADING CAUSE OF VACCINE-PREVENTABLE CHILD DEATHS
Measles, on the other hand, feels much more familiar – a known disease with a known vaccine.
So despite being the leading cause of vaccine-preventable child deaths worldwide, measles doesn’t garner much attention.
Bangladesh’s outbreak has been linked in part to its political instability in the last two years, which disrupted routine vaccination activities, including a quadrennial mass campaign that last occurred in 2020. But it represents a global trend, a quiet resurgence in most parts of the world after the COVID-19 pandemic, including Asia.
In 2024, 59 countries reported disruptive measles outbreaks, nearly triple the number in 2021. WHO estimated that there were 95,000 measles deaths worldwide in 2024, mostly among unvaccinated or under-vaccinated children under five years of age, and that more than 30 million children remained under-protected.
Even in Singapore, where our vaccination rates are above the herd immunity threshold of 95 per cent, the number of reported measles cases this year (37 cases as of May 23) is already higher than the 2025 total (27 cases) and threefold higher than the whole of 2024 (11 cases). This is largely due to imported cases with occasional short-lived local transmission, a reminder that measles resurging elsewhere does not stay there.
DON’T TREAT PREPAREDNESS SEPARATELY
This imbalance of attention and disease burden comes with potential costs. One is alert fatigue, where people become less responsive to real threats over time.
Another is the opportunity for misinformation. The Andes virus outbreak has spawned a host of misinformation narratives, most particularly COVID-era claims of vaccine harm and lab bio-engineering.
Attention does not translate linearly into budgets and aid, but it can shape allocation. This creates a potential risk of misallocation of finite resources.
An OECD analysis of international health aid found that prevention, preparedness and response-related funding rose between 2019 and 2022, even as funding for basic and primary healthcare fell. While this is understandable during a pandemic, international aid has come under increasing pressure since. Low- and middle-income countries risk face further reductions and strain on the systems at the frontline of preventing, detecting and containing outbreaks.
This is not an argument against pandemic preparedness, but against treating such preparedness efforts as a vertical agenda detached from and competing against investments in primary care and universal health coverage. Genomic sequencing platforms, surveillance dashboards, and emergency operations centres are useful infrastructure, but only when built on and integrated with functioning public health, primary care, hospitals, supply chains and a trained workforce.
RESILIENCE IS UNGLAMOROUS
Steady investment in improving the health of the population in all ways is unglamorous.
Nonetheless, such long-term investments – like the One Health Masterplan and the establishment of the Communicable Diseases Agency – are the foundations that quietly underpin Singapore’s resilience against outbreaks and pandemics.
Outbreaks are complex and evolving situations. Public health authorities, experts and the media have to explain them quickly while the facts are still being gathered.
The real challenge – and arguably necessity – is to communicate in a measured way: expressing uncertainty when science is unclear, explaining rare pathogens without overstating risks, and maintaining attention on preventable but familiar diseases.
Those who write about epidemics often invoke English poet John Donne: “Never send to know for whom the bell tolls; it tolls for thee.” Applied to public health, it is used to convey that an outbreak elsewhere is never entirely someone else’s problem, that it affects all of us.
Perhaps we should pay more attention to the bells that don’t sound as loud – the slower tolls for children who die of diseases that we already know how to prevent.
Dr Hsu Li Yang is Director, Asia Centre for Health Security at the Saw Swee Hock School of Public Health, National University of Singapore.
Source: CNA/ch
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