Lessons of the Ebola outbreak

Finally we are seeing a response commensurate with the scale of this crisis. But there is much more to be done

Wednesday 15 October 2014 23:41

The news on Ebola only gets worse. The World Health Organisation warned on Tuesday that we should prepare for a tenfold escalation in cases by December, from the current 1,000 a week to 10,000 a week in the affected countries, which are already reeling under the impact. As the numbers rise, so does the risk that the infection will be carried by travellers from West Africa to the rest of the world.

Bruce Aylward, the WHO assistant director general who has been diverted from the campaign to end polio to fight the new threat, warned that the death rate is even higher than has been reported – at 70 per cent, not 50 per cent. No other disease kills like Ebola kills (rabies is a rare exception, but there is a vaccine and treatment against that), and consequently no other disease spreads panic in the way that Ebola does.

The international community, led by Britain and the US, is finally responding to the crisis with cash, equipment and trained staff. The arrival of infected individuals on foreign shores has galvanised the response. But there is much, much more to do, and other European countries have so far contributed little. This is a global emergency and demands a global response. As the world begins to mobilise against the lethal epidemic, there are already vital lessons emerging that must be learnt so that countries may respond more swiftly and effectively to similar threats.

First: prepare for the unexpected. Nothing about this outbreak has been like its forerunners, stretching back almost 30 years. Nobody expected Ebola to pop up in West Africa, yet this is the biggest outbreak ever. It has spread the furthest and lasted longest. Only this week the WHO reported an “unusual characteristic” of what is now an epidemic, which was marked by “dips in the number of new cases followed by sudden flare-ups” not seen before.

Second: put early warning systems in place. The WHO was, by its own admission, slow to respond to the outbreak, only taking serious action in August, almost six months after the first alert in March. A key factor was the decision by member states, including the UK, to cut the WHO’s budget for emergencies in response to global austerity, undermining its capacity for surveillance and response.

Third: ensure good communication. There is no vaccine or drug against Ebola. The virus is transmitted by touch. The only defence is basic hygiene – wash your hands. Some efforts to communicate this message have been effective – a roadside billboard in Liberia says: “Don’t be the next victim: stop washing dead bodies, stop touching sick persons, stop travelling with the virus.” Others have not.

Fourth: provide guidance for countries on how to prepare for an outbreak. The WHO will today publish a checklist against which governments can assess whether they are ready with infection control, contact tracing, surveillance, laboratories and safe burial. No country can any longer pretend it is safe from Ebola.

Fifth: fund research into a vaccine and treatments. Ebola is, even now, a rare (though lethal) disease that principally affects the poorest countries on earth. It is unrealistic to rely on the global pharmaceutical industry to take the commercial risk in developing and testing new treatments. Governments, academic institutions and medical charities must step in.

Sixth: when help is needed, respond swiftly and generously. One of the most dismaying features of the crisis is how Western nations only reacted when their own populations were threatened. We live in a globalised world, and viruses are no respecters of borders. If we remember nothing else, we should remember this: we are all in it together.

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