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Global Public
Health Community Takes Stock
Level Of Readiness
To Tackle Next Epidemic Is In Question |
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Author:
Roger Bernier, PhD, MPH 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
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