Ebola: Lessons learned
I will focus my remarks on lessons learned and the IHR.
Managing the global regime for controlling the international spread of disease is a central and historical responsibility of WHO. In a given year, WHO manages around 100 outbreaks of familiar diseases, like cholera, dengue, meningitis, and many others. This Ebola outbreak was different. It was complex in size and context, present in three countries which were unfamiliar with the disease and ill-prepared.
Since Ebola first emerged in 1976, WHO and its partners have responded to 22 previous outbreaks. Even the largest of these were controlled within four to six months.
The outbreak in West Africa has been different. The Ebola virus is well-equipped to take advantage of any weaknesses in preparedness, any gaps in control measures. The event in West Africa was a dramatic and tragic revelation of weaknesses and gaps.
Clinicians had no vaccine, no treatment, and no personal equipment specifically designed to protect them from one of the deadliest pathogens known.
All responders had difficulty finding sufficient numbers of experienced clinicians and epidemiologists. Much about the disease, including its modes of transmission, natural history, and clinical features, was poorly understood.
This is the fear factor. Let me give you a comparison. In the Philippines after the typhoon, WHO coordinated 150 medical teams. For Ebola, less than five medical teams could be deployed. On this, I thank the German government for mobilizing volunteers, its Red Cross staff, and the military. Germany was the first country to accept non-German Ebola patients for treatment at its hospitals.
The virus circulated in Guinea for three months, undetected, off every radar screen, initially misdiagnosed as cholera, later thought to be Lassa fever. This tells us the early warning system was not working. Nor was adequate diagnostic capacity available.
It took neighbouring Liberia and Sierra Leone several weeks to confirm that the virus had entered their territories. These delays gave the virus a head start with explosive momentum.
In Sierra Leone, the entire health system was overwhelmed less than six weeks after the first case was confirmed. National and international responses ran behind the virus and did not begin to catch up until late October of last year.
This is my first point. No regime for global governance can manage the invisible.
The simultaneous outbreak in the Democratic Republic of Congo operated almost like a control group. This was the country’s seventh Ebola outbreak. It was prepared.
The country had its own lab with full diagnostic capacity. Hospitals had isolation wards and stockpiles of equipment.
Clinicians were experienced. The disease was familiar to the population. The government could immediately activate well-tested emergency response plans.
The first case occurred on 11 August, the last case on 4 October. That’s a duration of less than two months. Altogether, the outbreak was limited to 66 cases and 49 deaths.
Until more countries have fundamental health capacities, services, and infrastructures in place, the international community risks running behind an emerging or re-emerging disease that can easily spiral out of control.
In fact, this is the first core capacity set out in the International Health Regulations. That is, an ability to “detect events involving disease or death above expected levels for the particular time and place in all areas within the territory.”
This capacity underscores the need to have well-functioning health systems in place throughout a country’s territory. In other words: universal health coverage.
An effective early warning system depends on fundamental capacities and good quality data at the community level. Data on the usual aid recognition of the unusual.
Compliance with IHR requirements has been dismal. Less than a third of WHO member states have put in place the core capacities needed for implementation.
Ebola in West Africa was not a worst-case scenario.
The world is dangerously ill-prepared to cope with a severe new disease that spreads by the airborne route or is contagious during the incubation period, before tell-tale signs of illness appear.
We have no time to lose. We must urgently support countries to build IHR core capacities as an integral part of a well-functioning health system.
I commend G7 leaders for their commitment to assist at least 60 countries over the next five years. I urge them to share information and use the new web portal which WHO is developing for information sharing and transparency.
The Ebola outbreak in West Africa shattered the notion that a disease of poor African nations will have no consequences elsewhere. In a world of transboundary threats, causes need to be addressed at their roots. This is the only viable approach to prevention.
For global health security, this means investing in well-functioning health systems that reach everyone with comprehensive, quality services.