Devi Sridhar writes about some of the global public health responses to the outbreak of hantavirus centred on the MV Hondius, but her conclusions as to how the world avoided another global outbreak failed to recognise the real reason disaster was averted (Right now, we could be living through a hantavirus disaster. The world avoided that, and this is why, 15 June).

The UK Overseas Territories (UKOTs) programme funded by the Foreign Office and managed by the UK Health Security Agency supports health services in all UKOTs around the globe. These are small and vulnerable communities with very limited medical services in most cases. The key success of this lean but effective programme lies in close communication and strengthening the health services.

The astute doctor on Ascension Island recognised a cluster of cases on the MV Hondius when a sick passenger was brought ashore for treatment. Newly developed diagnostic equipment on the island was able to exclude common causes. We knew we were dealing with something unusual.

Possible causes were reviewed during a meeting across continents between Ascension, the UKOT programme infection doctor, the ship company medical adviser and a colleague in the National Institute for Communicable Diseases in South Africa, who tracked down samples from two cases medevaced to South Africa. The diagnosis of hantavirus was made.

It was this that alerted the World Health Organization and national public health organisations, and averted disaster. Without this, the ship would have sailed on to Cape Verde. Passengers incubating hantavirus would have disembarked and travelled to their home countries. The outbreak would have been much wider.
Dr Matthew Dryden
Consultant in infection, UKOTs programme, UKHSA

The good fortune that was with the hantavirus cruise ship, discussed in the excellent article by Devi Sridhar, doesn’t necessarily apply to those in the Democratic Republic of the Congo or neighbouring countries, like the Batwa pygmies, a highly vulnerable, marginalised and endangered group of people in Uganda currently fighting the Bundibugyo strain of the Ebola virus, a rare variant for which there is currently no approved vaccine or specific treatment. Until all people throughout the world have equal access to public health measures against novel infectious diseases, we will all be vulnerable to the next unexpected product of a world stressed by inequality and a privileged elite.
Dr Brian Jones
Yarcombe, Devon