Global Public
Health Community Takes Stock As Ebola Epidemic Ends
Level Of Readiness
To Tackle Next Epidemic Is In Question
Just hours after the WHO declared the West African Ebola epidemic had
come to an end on January 14th, the disease had reemerged with the
confirmation of a new case in Sierra Leone. This most recent case
underscores the continuing risk of new flare-ups throughout the region
and the importance of looking back on what has been learned over the
last 2 years fighting the largest public health disaster in recent
history. Compiled from a series of recent meetings and articles about
Ebola in Nature and elsewhere, here are some of the key lessons
scientists and public health officials are relying on as they make
recommendations for the future (4).
1. The world is not adequately prepared to deal with
international epidemics.
There was a general failure on the part of public health officials and
international organizations to respond quickly and effectively to the
outbreak. Delays both in identifying initial cases of the disease and
in declaring the outbreak a public health emergency allowed it to grow
out of control. At the same time, the resources necessary to contain
the initial spread of the disease were not deployed rapidly enough.
After the WHO received much of the blame, director-general Margaret
Chan told the New York Times, “We are not the first responder….
the government has first priority to take care of their people and
provide health care.” However, the Ebola outbreak has shown that the
global health community cannot rely on the governments of some of the
poorest countries in the world to handle outbreaks of this nature
alone.
2. The true extent of the weaknesses in the health
systems of some of the world’s poorest countries.
A
shortage of healthcare workers as well as a lack of proper equipment,
training and information-sharing systems in West Africa enabled the
rapid spread of Ebola. Large-scale investment in the health systems
of these countries is urgently necessary as future outbreaks of Ebola
and other diseases are likely to strike the region.
3. Support of community leaders is absolutely critical
in overcoming cultural challenges
Ebola raised many unique cultural challenges related to social,
traditional and religious practices in the affected regions. A lack of
trust and clear communication led people to resist quarantines, travel
bans and sending the sick to treatment centers. In addition,
traditional funerals and burial methods involve extensive contact with
family members and the bodies of victims, promoting further spread of
the disease. Local religious leaders, village chiefs and elders were
by far the most effective at educating communities about Ebola
transmission and gaining compliance with measures that proved
essential to containing and controlling the epidemic.
4. It is possible to conduct rapid clinical trials during an epidemic.
Under normal circumstances it takes years to complete all the phases
of approval and testing involved in controlled trials of new drugs or
vaccines. Outbreaks tend to be over too quickly for clinical trials
to take place and conditions in the field have generally been thought
too challenging to make quality trials possible. Despite early
failures to get various clinical trials underway rapidly, a
WHO-supported fast-track approach to testing an experimental Ebola
vaccine was ultimately successful, finding the vaccine to be safe and
highly effective within the limited scope of the study (1).
Not only are these results promising in terms of controlling further
Ebola outbreaks, this study can also serve as a model for the rapid
development of drugs and vaccines in future epidemics. In fact, the
WHO announced in the September Ebola Newsletter the development of a
“blueprint action plan” intended to “reduce the time between
identification of a nascent outbreak and final testing of the most
advanced products”.
5. The world must remain vigilant
As
this most recent case in Sierra Leone demonstrates, there is a
high-risk for continuing small outbreaks of Ebola throughout the
region. Scientists are still learning to what extent the virus
persists in survivors. Some evidence suggests that in rare instances
the virus can be sexually transmitted by male survivors for up to a
year. While the epidemic transitions to a new phase in which in which
the focus shifts to controlling the risk of new infections, bolstering
disease surveillance and identifying the animal reservoirs for the
virus (a topic that remains controversial) (2) will be essential.
Actions Stemming From
Lessons
By far the largest in history, this Ebola outbreak
surprised the public health community with its length and scope and in
the process exposed the weaknesses in the global health system. In
November of 2015 a joint panel of more than 20 experts from the
Harvard Global Health Institute and the London School of Hygiene and
Tropical Medicine authored an assessment of the global response to the
epidemic in which they argued that we are no better prepared to handle
another epidemic today than we were 2 years ago (3). In response to
these shortcomings and the lessons learned, the panel laid out what it
called “10 Essential Reforms” aimed at improving prevention, detection
and response to outbreaks in the future. In addition, panels have
been convened by other organizations including the WHO and UN to make
specific assessments and recommendations.
It appears critical that the world learns from these lessons
and takes recommended actions to correct systemic shortcomings in the
infrastructure and leadership of the world’s health systems before the
next global health emergency strikes.
References
(1.)
https://tinyurl.com/qeyjzor
(2.)
https://tinyurl.com/jmjdau4
(3.)
https://tinyurl.com/zklsj74
(4.)
https://tinyurl.com/hm82cau
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