Is the Black Death Coming and Who's to Blame?
The country of Madagascar is known for its tranquil beaches, exotic wildlife and rich culture. But something else also inhabits the island that is now making headlines: The Black Death.
Perhaps best known as the Bubonic Plague that is generally associated with the Middle Ages when rats, fleas and poor hygiene resulted in the deaths of approximately 200 million people, the disease remains an enduring threat in third-world nations.
Madagascar has been one of the world’s last remaining hotspots for the plague but the illness has been mostly isolated in rural villages and self-contained... until now.
On Friday, Nov. 21, the World Health Organization announced an “outbreak of the plague” in Madagascar, with two people in the country’s capital being infected and one having died from the disease.
Cases have been reported in 16 districts of the seven regions, according to WHO, and the health ministry said there had been 138 suspected cases since the beginning of the year and warned that the death toll was likely to rise in the coming months.
Now that the disease has made it to a densely populated area, a major outbreak seems inevitable. The capital of Madagascar, Antananarivo, houses the prime conditions for a disease such as the plague to spread, similar to those in 14th century Europe – garbage is dumped in the streets and public restroom conditions are terrible. Black rats, which were the primary vector for the disease in the Middle Ages, also roam freely between buildings.
“There is now a risk of a rapid spread of the disease due to the city’s high population density and the weakness of the health care system,” the WHO said in its report, while noting that a national task force has been activated to manage the outbreak.
Contraction of the bubonic plague results in the swelling of the lymph nodes, but can be treated with antibiotics. The pneumonic version, affecting the lungs, can be spread from person to person through coughing. Death can result in as little as 24 hours. The third form of the disease, septicemic plague, is the rarest form and occurs when the blood is directly infected.
Whichever variety of the plague, as the disease progresses its victim lapses into recurrent seizures, Alzheimic confusion, coma and internal hemorrhaging.
The plague is almost impossible to eradicate from Madagascar, due to interaction of natural and sociocultural factors. According to a 2013 report by the US National Library of Medicine, the high percentage of animals carrying the disease lays the foundation for transmission, and social and economic conditions further encourage the periodic leap to humans.
Outbreaks of the plague usually occur in villages at high altitudes in the northern region of Madagascar, spiking between October and April when the warm rainy season keeps temperatures well above 70 degrees day and night.
Without funds coming in from developed nations, the country doesn’t have much to work with to fight the plague. The African Development Bank is allocating $200,000 however, but those resources could quickly dwindle in the coming months. All of these conditions leading up the outbreak mirror those that caused the Ebola virus to spread throughout West Africa.
"Belief in old practices, rampant misinformation, and apathetic, corrupt politicians have combined to make the current outbreak much more widespread than it should be," VICE correspondent Ben Shapiro said in a documentary that was released in September where he helicoptered into a village about 1,000 kilometers north of the capital that was considered a hot zone. "For Madagascar, though, it's unclear how many more people will die of plague before things start to change."
For now, the World Health Organization does not recommend any travel or trade restriction based on the current information available.
How healthcare can safeguard itself against cyberthreats
One of the most fundamental lessons from the COVID crisis is that health should always be a priority. In a similar fashion to the human body that frequently fights off viruses and foreign invaders that intend to cause it harm, the sector itself is now a prime target for another type of external threat: cyberattacks.
The figures speak for themselves: between December and January this year, hospitals in the UK were at 89% capacity, with 7,000 fewer available beds than there usually are. As the pandemic increased pressure on hospitals, clinics, and research facilities to create a treatment for patients globally, it has left the sector exposed to hackers who, like a virus, have been targeting it relentlessly and evolving their tactics.
From patient records being held ransom, to fake emails claiming to originate from the UN WHO, the NHS, or vaccine centres, through to attacks on the cold supply chain to find out the secret formula of the COVID vaccine, the healthcare industry is facing constant cyberattacks and struggling to cope. This threat is unlikely to go away anytime soon – and as such, the industry needs to take a proactive, preventative stance to stay safe in a dynamic digital world.
The responsive nature of healthcare – particularly of hospitals – means that efficiency is crucial to the industry’s standard operations. To support this, the sector has been embracing technological advancements that can improve the quality of work, enabling staff to meet pressing deadlines, and enhancing patient care. For example, the industry has been digitising records and improving its ways of working through digital means over the past few years.
This shift is critical to offer high quality patient care; yet, it also means the sector has become more dependent on IT, which can come with a risk if cybersecurity processes employed are deemed as inadequate.
Without the correct security measures in place, the desired efficiency gains realised, can be easily lost in a heartbeat. Simply put, an elementary glitch in the system can have a tremendous ripple effect on many areas, from accessing patient records and conducting scans, to maintaining physical security and protecting the intellectual property of experimental treatment development.
To prevent this, healthcare organisations need to ensure they’re considering cybersecurity as part of their overall digital transformation strategy – and setting the right foundations to create a culture where safety goes hand in hand with patient care.
Before implementing cybersecurity process, healthcare organisations need to assess the potential risks they face. Depending on how much confidential data the trust has, where it is stored, who has access to it and via which means, the cybersecurity strategy and associated solutions will change.
It’s fair to say that a medical device start-up where all employees have a corporate-sanctioned laptop and access data via a VPN will have radically different needs to a large hospital with hundreds of frontline workers connecting to the hospital’s Wi-Fi using their personal device.
These requirements will pale by comparison to a global pharmaceutical giant with offices in multiple locations, a large R&D department researching new treatments for complex diseases and a fully integrated supply chain. Considering the existing setup and what the organisations is looking to achieve with its digital transformation strategy will therefore have an immediate impact on the cybersecurity strategy.
Despite this, there are fundamentals that any organisation should implement:
Review and test your back-up policy to ensure it is thorough and sufficient – By checking that the organisation’s back-up is running smoothly, IT teams can limit any risks of disruption in the midst of an incident and of losing data permanently.
In our recent State of Email Security report, we found that six out of ten organisations have been victims of ransomware in 2020. As a result, afflicted organisations have lost an average of six days to downtime. One third of organisations even admitted that they failed to get their data back, despite paying the ransom. In the healthcare industry, this could mean losing valuable patient records or data related to new treatments – two areas the sector cannot afford to be cavalier about.
Conduct due diligence across the organisation’s supply chain – Healthcare organisations should review their ways of working with partners, providers and regulatory institutions they work with in order to prevent any weak link in their cybersecurity chain. Without this due diligence, organisations leave themselves exposed to the risks of third party-led incidents.
Roll out mandatory cybersecurity awareness training - Healthcare organisations shouldn’t neglect the training and awareness of their entire staff – including frontline workers who may not access the corporate network on a regular basis. According to our State of Email Security report, only one fifth of organisations carry out ongoing cyber awareness training.
This suggests it is not widely considered as a fundamental part of most organisations cyber-resilience strategy, despite the fact many employees rely on their organisation’s corporate network to work. By providing systematic training, healthcare organisations can help workers at all levels better understand the current cyberthreats they face, how they could impact their organisation, the role they play in defending the networks, and develop consistent, good cybersecurity hygiene habits to limit the risks of incidents.
Consider a degree of separation – Information and Operational Technology (IT and OT) networks should be separated.
Although mutually supported and reliance on each other, employees shouldn’t be accessing one via the other. This should be complemented by a considered tried and tested contingency and resiliency plan that allows crucial services to function unabated should there be a compromise. Similarly, admin terminals should not have internet access to afford a degree of hardening and protection for these critical accounts.
As the sector becomes a common target for fraudulent and malicious activity, putting cybersecurity at the core of the organisation’s operations is critical. It will help limit the risks of disruption due to cyberattacks, reduce time spent by the cybersecurity team to resolve easily avoidable errors, and ensure that institutions can deliver patient care, safe in the knowledge that their networks are safe.
Fighting future threats
With technology continuing to change the face of healthcare, the surface area and vectors available for attacks by malicious actors is constantly increasing. With the introduction of apps, networked monitoring devices, and a need for communication, the attack vector is ever expanding, a trend that needs to be monitored and secured against.
To prevent any damage to patients, staff, or the organisation they are responsible for, healthcare leaders must put security front and centre of their digital transformation strategy. Only then can the sector harness the full benefits of technology. Doing this should include implementing cybersecurity awareness training to challenge misconceptions around security, encourage conversation, and to ensure employee knowledge of the security basics and threats faced.
This ultimately allows healthcare organisations to do what they do best: provide the highest standard of patient care, safe in the knowledge that their operations, patients, and data are safe.