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PostPosted: Sat Aug 16, 2014 10:21 am 
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The NY times has come out with a scathing editorial on the response to the Ebola outbreak, including "The World Health Organization, which snoozed on the sidelines for months after the outbreak was first identified in March, has issued increasingly frantic warnings in recent days."

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PostPosted: Sat Aug 16, 2014 10:22 am 
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The Opinion Pages | EDITORIAL

A Painfully Slow Ebola Response
By THE EDITORIAL BOARD
AUG. 15, 2014

The outbreak of the Ebola virus in West Africa appears more out of control than ever. By Friday, the virus had infected more than 2,000 people in four countries and had killed more than half of them. The World Health Organization, which snoozed on the sidelines for months after the outbreak was first identified in March, has issued increasingly frantic warnings in recent days. On Aug. 8, it declared the spread of the virus “a public health emergency of international concern.” On Thursday, it warned that the reported numbers of people killed or sickened by the virus may “vastly underestimate the magnitude of the outbreak” because many sick people escape detection. The next day, it said that patients flooding into newly opened treatment centers were filling beds faster than they could be provided.

The current cases, like other Ebola outbreaks in past decades, are a regional problem that must be fought primarily by local African governments, which understand the cultural practices that foster the spread of the virus and inhibit patients from seeking help. This outbreak poses little or no danger to the United States or Europe. Unfortunately, the three countries most affected — Guinea, Liberia and Sierra Leone — are among the poorest and most war-racked in the world and have very weak health care systems. They desperately need help in organizing their responses.

The W.H.O. should be filling that role, but it has been shamefully slow. Its regional office for Africa, which should have acted first, is ineffective, politicized, and poorly managed, with staff members who are often incompetent, according to international health experts familiar with its operations. The central office of the W.H.O. in Geneva has belatedly tried to pick up the slack but is hampered by large self-imposed budget cuts, accompanied by a loss of talented professionals in its programs to control such outbreaks. These shortsighted cuts will need to be restored, perhaps by sacrificing less important items, to ensure that the next time there is an Ebola outbreak the agency can jump into action. The World Bank has said it plans to contribute up to $200 million to the fight.

There is still no drug or vaccine that has been proved safe and effective in human clinical trials, but progress is being made in pushing promising candidates forward. Two Ebola vaccines could begin initial safety testing in people as early as next month, and a drug has been judged safe enough to test in humans who are already infected. Even if these or other medicines prove effective, which is by no means a certainty, no one expects them to curb this outbreak. The goal is to find weapons to use when the next epidemic breaks out.

The battle against the Ebola virus in West Africa has been waged primarily by two nongovernmental health organizations with great experience in dealing with international health crises, namely Médecins Sans Frontières (a.k.a., Doctors Without Borders) and Samaritan’s Purse. Both have warned that their resources are stretched to the limit, their people are tiring and they can’t do much more. Samaritan’s Purse suspended its clinical care activities after an American doctor and a missionary from North Carolina were infected, given an untested drug, and brought back to this country for treatment.

The United States government has belatedly stepped in to provide help. The Centers for Disease Control and Prevention has sent 55 experts, backed by more than 300 at its Atlanta headquarters, to help the afflicted countries strengthen their systems to detect outbreaks and to trace, isolate and treat infected people. That is an unusually large effort by the agency, but its staff in the field will be spread thinly. The Agency for International Development is contributing more than $27 million to coordinate planning and logistics and pay for equipment and public awareness campaigns. The Defense Department has a small group of military and civilian personnel in Liberia and has set up diagnostic laboratories in that country and Sierra Leone. It could presumably do a lot more if it is not too distracted by its operations in Iraq and Syria.

The big unanswered question is who will be available to provide hands-on care as the number of cases continues to mount. Even without an effective drug, prompt supportive care — such as keeping patients hydrated, maintaining their blood pressure and treating any complicating infections — can keep patients alive who would otherwise die. The bulk of the health care workers will presumably have to come from the afflicted countries, but they will probably need to be helped by doctors and nurses from abroad. All must be provided with personal protective equipment and trained to recognize and treat a disease that could kill them if they are not careful.

Meet The New York Times’s Editorial Board »

A version of this editorial appears in print on August 16, 2014, on page A18 of the New York edition with the headline: A Painfully Slow Ebola Response. Order Reprints|Today's Paper|Subscribe

http://www.nytimes.com/2014/08/16/opini ... ponse.html

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PostPosted: Sat Aug 16, 2014 10:41 am 
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Liberia

Update: August 8, 2014

The situation in the Liberian capital, Monrovia, is “catastrophic,” according to Lindis Hurum, MSF emergency coordinator in Liberia. There are reports of at least 40 health workers being infected with Ebola over recent weeks. Most of the city’s hospitals are closed, and there are reports of dead bodies lying in streets and houses.

MSF teams are providing technical support for an Ebola case management center in Monrovia in conjunction with the Ministry of Health, and has started construction of a new case management center.

An MSF team based in Guékédou, Guinea, has recently launched a response in Liberia’s Lofa region, alongside the Guinean border, which has been badly affected by Ebola.

MSF is reinforcing its current team of nine international staff and 10 Liberian staff, but the organization is reaching the limits of its capacity, and there is a dire need for the WHO, Ministry of Health, and other organizations to rapidly and massively scale up the response in Liberia.

In Liberia, the situation is deteriorating rapidly, with cases now confirmed in seven counties, including in the capital Monrovia.

There are critical gaps in all aspects of the response, and urgent efforts are needed to scale up.

Already stretched beyond capacity in Guinea and Sierra Leone, MSF is able to provide only limited technical support to the Liberian Ministry of Health (MoH).

The MSF team has set up an Ebola treatment center in northern Liberia, where cases have been increasing since the end of May.

After the initial set up, the center was handed over to Samaritan’s Purse on July 8. There are currently six patients and MSF experts continue to provide technical support and training.

The team will now shift its efforts to Voinjama, in Lofa county, where there are reports of people dying of Ebola in their villages.

The team will set up a referral unit so suspected Ebola patients can be isolated and transferred to the treatment center.

In Monrovia, an MSF emergency team is building a new tented treatment center with capacity for 40–60 beds. It is scheduled to open on July 27 and will also be run by Samaritan’s Purse.

A 15 bed MSF treatment unit set up at Monrovia’s JFK hospital was handed over to the MoH in April. However, the unit has since been closed and all patients are currently cared for at ELWA hospital in Paynesville until the new center is open at the same site.

Currently there are 14 patients admitted to this center.

MSF is also supporting the MoH in the overall coordination of the Ebola response and providing technical and medical advice.

http://www.doctorswithoutborders.org/ou ... sues/ebola

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PostPosted: Sat Aug 16, 2014 11:13 am 
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Ebola: WHO rebuked for slow response as Liberia, Sierra Leone seek more helps
August 16, 2014 | Filed under: main story | Author: Editor

Two West African nations and a medical charity fighting the world’s worst Ebola epidemic chided the World Health Organisation (WHO) on Friday for its slow response, saying more action was needed to save victims threatened by the disease and hunger.

With the death toll over 1,000 and still climbing, the U.N. health agency is facing questions over whether it moved quickly enough to declare the months-old outbreak a “public health emergency of international concern”, which it did on Aug 8.

Medical charity MSF (Doctors Without Borders), which has been one of the most active groups in fighting the outbreak, said its spread had created a “wartime” situation in the worst-affected states of Sierra Leone, Liberia and Guinea. Nigeria is also facing a smaller separate outbreak.

Sierra Leone President Ernest Bai Koroma said his nation’s only two treatment centres were “overwhelmed”. In neighbouring Liberia, Information Minister Lewis Brown said Ebola-affected rural areas quarantined by troops faced serious food shortages.

“We need a more robust response to the nature of the disease and the way it is affecting us,” Koroma said in Freetown, adding he had delivered this message to the WHO, which is coordinating international efforts to try to control the outbreak.

The WHO said on Friday the death toll from this epidemic, first declared in Guinea in March, had risen to 1,145, as 76 new deaths were reported in the two days to Aug. 13 in the four nations affected so far.

“If our people are dying, the response should be an extraordinary response because it is an extraordinary situation,” Koroma told a news conference, saying his country needed more Ebola treatment centres and medics to staff them.

“Time is of the essence,” he added, saying he had seen the world respond to major humanitarian crises, such as the 2010 earthquake in Haiti, and West Africa needed similar help.

Fear of the virus, which causes fever, vomiting and, in its advanced form, severe haemorrhaging and organ failure, is curbing business in Africa and threatening to taint the continent’s image as a rising economic star.

In Liberia, which like neighbours Sierra Leone and Guinea has deployed troops to cordon off a tri-border zone which has the highest concentration of Ebola cases, Brown said his country also needed more health personnel and aid.

“The reaction quite frankly is not where we would want it to be to give any serious level of comfort,” Brown told Reuters, although he said there had been an improvement.

On Thursday, the WHO said its staff had seen evidence the numbers of reported cases and deaths vastly underestimated the scale of the outbreak and said it would coordinate “a massive scaling up of the international response”.

MSF President Joanne Liu, speaking after a 10-day trip to West Africa, compared the current Ebola outbreak to a “wartime” situation. “It’s like a front line, it’s moving, it’s advancing, but we have no clue as to how it is going to go around.”

She told reporters in Geneva that the WHO needed to “take leadership” and more experts were urgently needed on the ground. “I think the wake-up call was too late,” Liu said.

On April 1, WHO spokesman Gregory Hartl had described the West African outbreak as “relatively small still” after MSF Director General Bruno Jochum had warned it was “unprecedented” and “exceptional”.

THREAT OF HUNGER

“If we don’t stabilise Liberia, we will never stabilise the region. Over the next six months we should get the upper hand on the epidemic; this is my gut feeling,” MSF’s Liu said.

Brown said his country had “pockets all around the place reporting infection”, including the border farming county of Lofa, where a drop in agriculture output because of the outbreak and quarantine measures had created a threat of food shortages.

Liberia had requested emergency food aid from donors.

“We can establish as many checkpoints as we want, but if we cannot get the food and the medical supplies into affected communities, they will leave,” Brown said. “We can’t ask our people to starve.”

International agencies are looking into emergency food deliveries to reach people in Liberia and Sierra Leone cordoned off from the outside world, a World Bank official said.

The worst-affected countries are recovering from a decade of civil wars and have some of the weakest health systems in the world. Liberia has one doctor for every 70,000 people, Sierra Leone one for every 45,000, compared to one for every 360 people in Britain and one for every 410 in the United States.

Alarm over the risk of the disease, which can kill up to 90 percent of those it afflicts and is spread by contact with the bodily fluids of infected persons and animals, has triggered a wave of travel warnings and restrictions, cancellations of events and flight suspensions to the region by some airlines.

The International Olympic Committee (IOC) said on Friday it was prohibiting young athletes from the Ebola-affected region of West Africa from participating in certain events at the Youth Olympic Games in Nanjing, China.

“EMERGENCY WITHIN EMERGENCY”

MSF’s Liu said the “emergency within the emergency” of the current outbreak was the heavy toll inflicted on health workers.

“We found that in the four countries, in terms of healthcare workers, there were 80 deaths and 170 infected,” she said, noting that the rainy season was starting in the region.

“What we face today … is that people don’t have access to basic health care. So more today are dying of malaria than are dying of Ebola,” Liu said.

Sierra Leone has declared Ebola a national emergency as has Liberia, which is hoping that two of its doctors diagnosed with Ebola can start treatment with some of the limited supply of experimental drug ZMapp.

The WHO said it also welcomed the decision by the Canadian government to donate several hundred doses of an experimental vaccine to support the outbreak response.

Canada’s Tekmira Pharmaceuticals Corp is also exploring making more of its experimental Ebola treatment, Chief Executive Officer Mark Murray said.

“A fully tested and licensed vaccine is not expected before 2015,” WHO said.

In the United States, a Texas doctor being treated in Atlanta for Ebola after returning from Liberia has continued to improve and hopes to be released “in the near future,” the Christian relief group he worked for said.

Nigeria also has declared a national emergency, although it has so far escaped the levels of infection seen in the three other countries, with four dead and 10 infected.

http://businessdayonline.com/2014/08/eb ... -90zfldWGc

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PostPosted: Sat Aug 16, 2014 11:15 am 
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Ebola-hit states plead for more help, WHO rebuked for slow response

Reuters
Aug 16, 2014 at 11:25am IST

http://ibnlive.in.com/news/ebolahit-sta ... 01-17.html

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PostPosted: Sat Aug 16, 2014 11:34 am 
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Ebola: Official MSF response to the WHO declaring Ebola an international public health emergency

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8 August 2014
“Declaring Ebola an international public health emergency shows how seriously WHO is taking the current outbreak; but statements won’t save lives.”

Bart Janssens, MSF Director of Operations
“Declaring Ebola an international public health emergency shows how seriously WHO is taking the current outbreak; but statements won’t save lives,” says Dr Bart Janssens, MSF Director of Operations. “Now we need this statement to translate into immediate action on the ground. For weeks, MSF has been repeating that a massive medical, epidemiological and public health response is desperately needed to saves lives and reverse the course of the epidemic. Lives are being lost because the response is too slow.”

“Countries possessing necessary capacities must immediately dispatch available infectious disease experts and disaster relief assets to the region. It is clear the epidemic will not be contained without a massive deployment on the ground from these states.”

“In concrete terms, all of the following need to be radically scaled up: medical care, training of health staff, infection control, contact tracing, epidemiological surveillance, alert and referral systems, community mobilisation and education.”

“MSF currently has 66 international and 610 national staff responding to the crisis in the three affected countries. All our Ebola experts are mobilized, we simply cannot do more.”

http://www.msf.org/article/ebola-offici ... -emergency

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PostPosted: Sat Aug 16, 2014 11:46 am 
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Ebola Epidemic Is Like 'War Time' Says MSF
A medical charity pleads for the international community to unite to combat the outbreak as the death tolls climbs above 1,100.7:08pm UK, Friday 15 August 2014

Health experts have revealed they are struggling to contain West Africa's deadly ebola outbreak, and described the situation as like being in "wartime".

The charity Medecin Sans Frontieres (MSF) said if the situation in Liberia is not brought under control then the region will never be stabilised.

"The main thing I come back to is that it is deteriorating faster, moving faster than we can respond to," MSF international president Dr Joanne Liu said.

"To put it in context with my time with MSF, I really feel that it is like wartime, in terms of fear and nobody knowing what is going on.

"We need a response in terms of international organisations and states, and it needs to happen now if we want to contain this epidemic."

MSF, which employs doctors in some of the world's most difficult conditions, has struggled to help control the ebola outbreak in West Africa.

Dr Liu, who made the announcement at a news conference in Geneva following a 10-day trip to affected areas, said it will take about six months to bring the epidemic under control.

It was first identified in Guinea in March and has since spread to Liberia, Sierra Leone, and finally Nigeria - promoting increased international concern.

On Friday, the World Health Organisation (WHO) said the death toll from the ebola outbreak has risen to 1,145 - with 76 new deaths reported over two days.

The health agency said a total of 152 confirmed, probable or suspected new cases of the fever were reported in that same period in Guinea, Liberia, Nigeria and Sierra Leone.

The plea from MSF, which was founded in 1971, comes after the World Health Organisation (WHO) said the number of deaths and confirmed cases has been vastly underestimated.

The death toll from the outbreak in the region currently stands at more than 1,068 people.

There have been 1,975 confirmed, probable or suspected cases, the WHO said, with the majority in Guinea, Sierra Leone and Liberia.

"The outbreak is expected to continue for some time. WHO's operational response plan extends over the next several months," the WHO said on Thursday.

The UN World Food Programme said on Friday it would now provide food aid to a million people affected by the emergency.

Meanwhile, Olympic Games organisers have banned young athletes from ebola-affected regions of West Africa from participating in the Youth Olympic Games in China.

The International Olympic Committee (IOC) said three competitors would not be allowed to take part in combat sports and swimming pool events.

The IOC and the Nanjing Youth Olympic Games Organising Committee said it was impossible to rule out the risk of potential infection.

Those from the affected regions competing in other sports will undergo regular temperature checks and physical assessments throughout the games, which begin on Saturday.

The IOC added that there had been no suspected cases of ebola reported in China and "the risk of infection is extremely unlikely".

http://news.sky.com/story/1319044/ebola ... e-says-msf

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PostPosted: Sat Aug 16, 2014 11:50 am 
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Liberia: No Food for Ebola Victims - West Point, Dolo Town to Be Quarantined
By Morrison O. G. Sayon
Amidst positive news of the survival of persons affected by the Ebola virus, latest report says victims at the ELWA Ebola Isolation Center are leaving the camp due to lack of food.

Disclosing this at the National Ebola Task Force Meeting held at the Ministry of Foreign Affairs in Monrovia yesterday, Health Minister, Walter Gwenigale, said he had received several calls from the center that the people are hungry and need food.

According to Dr. Gwenigale, based on this latest report, most of the victims are now leaving the center which is a major threat to several communities in which those leaving are going. "I'm getting calls every day of the lack of food; the people say they are hungry and I understand that there is food there but I'm getting these calls every minute," Liberia's Health Minister Gwenigale said.

In quick clarification, Assistant Health Minister for Preventive Services, Tolbert Nyenswah, said food is available at the various Isolation Camps but those who are making the calls may need special diet. Nyenswah said the victims are being provided meal three times daily adding that the callers are the higher-ups who may need special kind of diet.

Minister Nyenswah promised that an investigation will be launched into the complaint by the Ebola victims and solution be found in addressing the issue. He also disclosed that the Ministry of Health has received seven tons of food from the World Health Organization (WHO) for those quarantined at the various isolation centers.

At the same time, the Presidential Task Force on Ebola is considering quarantining the densely populated community of West Point in Monrovia and Dolo Town in Margibi County. West Point is a slum populated community with an estimated population of over 20,000 inhabitants, while in Dolo Town report says at least 25 persons have died due to strange circumstances.

At the meeting yesterday, President Ellen Johnson-Sirleaf proposed to the Task Force the isolation of West Point and Dolo Town. The two highly populated communities have reported high rate of Ebola deaths in recent times. The task force is also considering the closing of the Waterside General Market to stop affected persons from leaving the community.

Due to the rapid spread of Ebola in the country, the Ministry of Health opened one holding center in a household in West Point on Wednesday. The Ministry is planning to open2-3 more in the next few days based upon protocols designed by MSF and the Case management team, to isolate and hold patients before moving them to the JFK or ELWA.

President Sirleaf reasoned that to isolate West Point and densely populated areas is a difficult task but the Task Force must consider and study the situation before making final decision on the issue. At the same time, the Task Force also wants the Duala Market to be cleared so as to avoid those in the Duala area from contracting the virus.

Meanwhile, Defense Minister, Brownie Samukai has called on Government to begin taking some drastic measures to stop further spread of the Ebola virus that is killing hundreds of Liberians on a daily basis. Samukai said sternly that West Point must be quarantined with the closure of the market and that another densely populated area of Duala be cleared.

The Defense Minister said if these steps are not taken, the virus will continue to spread and claim more lives in the coming days and months. He added, "If you can't contain those areas, you can't resolve the problem."

Other members of the Task Force are calling for the imposition of curfew to stop the movement of individuals in various communities. They also want Ebola message being played on radios to be changed as the right messages are not being sent out to the public.

http://allafrica.com/stories/201408151535.html

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PostPosted: Thu Sep 04, 2014 7:56 am 
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Cuts at W.H.O. Hurt Response to Ebola Crisis
By SHERI FINK
SEPT. 3, 2014

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Health workers prepared to enter a high-risk ward at an Ebola treatment center in Monrovia, Liberia, run by Doctors Without Borders. Credit Daniel Berehulak for The New York Times

With treatment centers overflowing, and alarmingly little being done to stop Ebola from sweeping through West African villages and towns, Dr. Joanne Liu, the president of Doctors Without Borders, knew that the epidemic had spun out of control.

The only person she could think of with the authority to intensify the global effort was Dr. Margaret Chan, the director general of the World Health Organization, which has a long history of fighting outbreaks. If the W.H.O., the main United Nations health agency, could not quickly muster an army of experts and health workers to combat an outbreak overtaking some of the world’s poorest countries, then what entity in the world would do it?

“I wish I could do that,” Dr. Chan said when the two met at the W.H.O.’s headquarters in Geneva this summer, months after the outbreak burgeoned in a Guinean rain forest and spilled into packed capital cities. The W.H.O. simply did not have the staffing or ability to flood the Ebola zone with help, said Dr. Chan, who recounted the conversation. It was a fantasy, she argued, to think of the W.H.O. as a first responder ready to lead the fight against deadly outbreaks around the world.

The Ebola epidemic has exposed gaping holes in the ability to tackle outbreaks in an increasingly interconnected world, where diseases can quickly spread from remote villages to cities housing millions of people.

The W.H.O., the United Nations agency assigned in its constitution to direct international health efforts, tackle epidemics and help in emergencies, has been badly weakened by budget cuts in recent years, hobbling its ability to respond in parts of the world that need it most. Its outbreak and emergency response units have been slashed, veterans who led previous fights against Ebola and other diseases have left, and scores of positions have been eliminated — precisely the kind of people and efforts that might have helped blunt the outbreak in West Africa before it ballooned into the worst Ebola epidemic ever recorded.

Unlike the SARS crisis of 2003, which struck countries in Asia and elsewhere that had strong governments and ample money to spring to action, the Ebola outbreak has waylaid nations that often lack basic health care, much less the ability to mount big campaigns to stamp out epidemics.

The disease spread for months before being detected because much of the work of spotting outbreaks was left to desperately poor countries ill prepared for the task. Once the W.H.O. learned of the outbreak, its efforts to help track and contain it were poorly led and limited, according to some doctors who participated, contributing to a sense that the problem was not as bad as it actually was. Then, as the extent of the epidemic became obvious, critics say the agency was slow to declare its severity and come up with plans, and has still not marshaled the people and supplies needed to help defeat the disease and treat its victims.

“There’s no doubt we’ve not been as quick and as powerful as we might have been,” said Dr. Marie-Paule Kieny, a W.H.O. assistant director general.

Another W.H.O. leader agreed. “Of course in retrospect I really wish that we had jumped much higher much earlier,” said Dr. Keiji Fukuda, the assistant director general in charge of outbreak response. “Of course I wish we’d poured in more and more earlier.” But, he added, “if this outbreak had been a typical outbreak, nobody would be saying we did too little, too late.”

The outbreak began close to the borders of three neighboring countries — Guinea, Sierra Leone and Liberia — and spread surprisingly fast. Since then, the W.H.O. has engaged more than 400 people to work on the outbreak, including employees of other agencies in its network, and in August the agency declared the epidemic an international emergency, hoping to stop it from crossing more borders. Dr. Chan has met with presidents in the region, and last week the W.H.O. announced what it called a road map for a “massively scaled” international response.

The current outbreak has killed more than 1,900 people and spread to the point that the W.H.O. warns that more than 20,000 people could become infected. Sick people are dying on the street. Some feel the entire model the world uses to fight outbreaks needs to be rethought, so that an agency like the W.H.O. has the structure and mandate to take command.

But Dr. Chan said that governments have the primary responsibility “to take care of their people,” calling the W.H.O. a technical agency that provides advice and support. Still, she noted that her organization, like many governments and agencies, was not prepared.

“Hindsight is always better,” Dr. Chan said. “All the agencies I talked to — including the governments — all of us underestimated this unprecedented, unusual outbreak.”

A Shift in Emphasis

The W.H.O., founded in 1948, is responsible for taking on a wide range of global health issues, from obesity to primary health care. But since the world’s health needs far outstrip the financial contributions of the W.H.O.’s 194 member nations, those priorities compete.

The threat of emergent infectious diseases jumped high onto that list 20 years ago, when an outbreak of plague in India created a panic, sending about 200,000 people fleeing. The next year in Zaire, now the Democratic Republic of Congo, Ebola killed about 245 people. With fears of cross-border infections high, a new urgency arose: improving the world’s ability to stop outbreaks.

The W.H.O. took the lead, at the request of its member nations. A crew of passionate outbreak veterans assembled a unique department, using an early form of electronic crowdsourcing to detect outbreaks and dispatching experts to the field. Three years after the effort solidified, the W.H.O. played a big role in responding to a cluster of deadly pneumonia cases in Asia. The new virus became known as SARS, and it was contained within the year, with most cases occurring in China.

To aid the fight, wealthy individuals offered the W.H.O. “literally hundreds of millions because their businesses were affected,” said Dr. Jim Yong Kim, president of the World Bank and a former director at the W.H.O. “But as SARS burned out, those guys disappeared, and we forgot very quickly.”

Soon, the global financial crisis struck. The W.H.O. had to cut nearly $1 billion from its proposed two-year budget, which today stands at $3.98 billion. (By contrast, the budget of the Centers for Disease Control and Prevention for 2013 alone was about $6 billion.) The cuts forced difficult choices. More emphasis was placed on efforts like fighting chronic global ailments, including heart disease and diabetes. The whims of donors also greatly influenced the W.H.O.’s agenda, with gifts, often to advance individual causes, far surpassing dues from member nations, which account for only 20 percent of its budget.

At the agency’s Geneva headquarters, outbreak and emergency response, which was never especially well funded, suffered particularly deep losses, leaving offices that look, one consultant said, like a ghost town. The W.H.O.’s epidemic and pandemic response department — including a network of anthropologists to help overcome cultural differences during outbreaks — was dissolved, its duties split among other departments. Some of the main outbreak pioneers moved on.

“That shaping of the budget did affect the area of responding to big outbreaks and pandemics,” said Dr. Fukuda, who estimated that he now had 35 percent fewer employees than during the 2009 H1N1 flu pandemic — more than double the cuts for the organization as a whole.

“You have to wonder are we making the right strategic choices?” he said. “Are we ready for what’s coming down the pike?”

The entire W.H.O. unit devoted to the science of pandemic and epidemic diseases — responsible for more than a dozen killers, including flu, cholera, yellow fever and bubonic plague — has only 52 regular employees, including secretaries, according to its director, Dr. Sylvie Briand, who said that could be increased during outbreaks. Before the Ebola epidemic, her department had just one technical expert on Ebola and other hemorrhagic diseases.

Across Africa, the ranks of the agency’s regional emergency outbreak experts, veterans in fighting Ebola, were cut from more than a dozen to three. “How can you immediately respond to an outbreak?” said Dr. Francis C. Kasolo, a W.H.O. director. “It did affect us.”

And a separate section of the W.H.O. responsible for emergency response was whittled “to the bone” during the budget cuts — to 34 staff members from about 94 — according to Dr. Bruce Aylward, its assistant director general.

“You can’t make a cut that big, that deep, and it’s not going to have an effect on your operational capacity,” he said.

His group, charged with responding to wars, disasters and resurgent polio, was asked in August to assist with Ebola, too. “At no time that I can think of in the recent past have we been dealing with such a scale of human misery over such a broad geography due to such a range of hazards,” he said, including enormous population displacements in Syria, Iraq, the Central African Republic and South Sudan. But, officials warn, multiple, overlapping challenges may well be a feature of the future.

The W.H.O. hoped to balance its budget cuts by strengthening the ability of countries to respond to public health threats on their own. It put out new regulations for nations to follow to help contain outbreaks. But by 2012, the deadline it set, only 20 percent of nations had enacted them all. In Africa, fewer than a third of countries had programs to detect and stop infectious diseases at their borders. The W.H.O.’s strategy was often more theory than reality.

“There never were the resources to put those things in place in many parts of the world,” said Dr. Scott F. Dowell, a specialist formerly with the C.D.C.

A Disease Finds Its Opening

The Ebola virus took full advantage of these poorly prepared nations and the holes at the W.H.O.

Given the weakness in surveillance, the outbreak was not identified until March, in Guinea, roughly three months after a villager was believed to have contracted the virus from an animal, possibly a fruit bat. The delay allowed dozens of cases to spread through villages and even to Conakry, a capital of more than one and a half million people. Right away, Doctors Without Borders declared the outbreak unprecedented in its reach, the only group to do so.

Hastening the spread, hospitals lacked basic infection-control essentials like running water, protective gowns and gloves. Many doctors and nurses caught the virus from their patients, passed it to others, and died. The vulnerability and collapse of medical facilities revealed how far there is to go in achieving the W.H.O.’s top priority — ensuring basic global health care.

“This kind of outbreak would not have developed in an area with stronger health systems,” Dr. Fukuda said.

In the crucial weeks after the discovery, daily meetings brought together national authorities and foreign responders at the W.H.O. office in Conakry. But an absence of strong leadership and professionalism was notable from the beginning, participants said.

“It’s purely improvisation,” said Marc Poncin, the emergency coordinator for Doctors Without Borders in Conakry. “There is no one to take responsibility, absolutely no one, since the beginning of the crisis.”

Stopping previous Ebola outbreaks had required meticulous tracking: monitoring people who had close contact with infected individuals and isolating them if they developed symptoms. Previously, “if we missed a case,” said Dr. Simon Mardel, a British emergency doctor deployed by the W.H.O. to help with the effort, “it was like a failure.”

This time, the number of contacts being followed was disastrously low from the beginning, only 8 percent in the epicenter of Guéckédou, Guinea, in early April, according to another doctor sent by the W.H.O. That meant the disease was silently spreading. Dr. Mardel said he thought the more experienced W.H.O. leaders who had left the agency “would have been very vocal, and they would have sought to put it right quickly, as a matter of urgency.” A single person who traveled and became sick could touch off a conflagration.

It was not that responders were not trying. Victims’ contacts were spread across a wide area, hours away on bad roads. The payment of local workers had somehow been overlooked, so they stopped doing vital, risky jobs. Essential protective equipment was not delivered to many who needed it. Bottles of bleach were given out without buckets. The W.H.O. lacked relationships with some longstanding organizations with large networks of health workers in the region.

Image
Dr. Margaret Chan, the director general of the W.H.O., with Dr. David Nabarro, left, the United Nations senior system coordinator for Ebola, and Dr. Keiji Fukuda, an assistant director general at W.H.O. Credit Michael Appleton for The New York Times

Traditions that contributed to Ebola’s spread, including funerals where mourners came into contact with corpses, were not fully recognized or confronted, said Dr. Pierre Rollin, an outbreak specialist at the Centers for Disease Control and Prevention who worked within the W.H.O. umbrella.

Some villagers blocked roads with tree trunks and drove Ebola workers away with stones, accusing them of bringing in the disease. Adding to the tension, only bare-bones clinical care was provided to try to treat patients, reducing the chances of yielding survivors who could act as ambassadors for the cause. Some doctors deployed by the W.H.O. said it should have given them more tools to care for patients.

Institutional and personal tensions flared. “Everyone’s working at a fevered pace,” Dr. Dowell said. “There’s confusion and chaos. It argues for a system that’s organized as much as possible ahead of time so people know their roles.”

One consultant thought it strange that the W.H.O. would not send Twitter messages with links to the C.D.C.’s Ebola prevention information, part of a policy not to promote material from other agencies. Various offices within the W.H.O.’s balkanized hierarchy also jockeyed for position.

The difficulties in tracking cases and gaining access to villages led many to think the outbreak was burning out. “I came home sort of thinking, with a little luck, that’s wrapped up,” said Dr. Daniel Bausch, an Ebola outbreak veteran from Tulane University, who returned in May from a W.H.O. mission in Guinea.

The outbreak was not gone, just hidden. An herbalist in Sierra Leone contracted the virus treating Guinean patients. More than a dozen mourners at her funeral fell ill and seeded Sierra Leone. Some of them traveled back to Guinea and rekindled the outbreak there. After a lull of several weeks, cases re-emerged in Liberia, too, and reached the capital, Monrovia.

Dr. Bausch flew to Sierra Leone in July. “I was like, ‘where is everybody?’ ” referring to the shortage of health workers fighting the disease. “We all recognized we were really understaffed. We needed more people in the field.”

In some treatment centers, two or three doctors, wearing stifling gowns and masks in the heat, were caring for up to 90 patients. With the only W.H.O. logistician in the country working elsewhere, Dr. Bausch did not have anyone to accompany him and manage supplies of protective equipment, he said.

Dr. Bausch worked in Kenema, Sierra Leone, where he had helped set up a research program for another hemorrhagic fever, Lassa, which was common in the region. He knew some of the nearly two dozen health workers there who died after Ebola hit.

“It would be a logical question to ask, since Lassa was there, why was it so hard to switch gears” to Ebola?, Dr. Bausch said. But research institutes provided money for science, he said, not for disease surveillance and treatment. Those tasks had been left to the government of Sierra Leone, “one of the poorest countries on earth,” he said. “I always felt bad about this.”

In late July in Liberia, two Americans working at a missionary hospital fell sick and were soon evacuated home. A Liberian-American brought the virus by plane to Nigeria, Africa’s most populous nation. Suddenly, the world seemed to understand the threat.

The question now, experts wonder, is whether the leaner, retooled W.H.O. — heavy on technical know-how, light on logistical muscle — can surge in a way that will help lead the world in bringing one of the most challenging health crises in recent history to a close. W.H.O.’s road map calls for $490 million from donors, and thousands of foreign and local health workers to contain the outbreak. Yet few foreign medical teams have answered the call so far.

“It is incumbent on the international community to really respond now,” said Dr. Kasolo, a W.H.O. director in Africa. “Otherwise history will judge us badly.”

http://www.nytimes.com/2014/09/04/world ... risis.html

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PostPosted: Thu Sep 04, 2014 7:52 pm 
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Funding, focus hamper WHO response to West Africa Ebola outbreak
Response to the West African Ebola outbreak and other global health emergencies by the World Health Organization (WHO) has been hampered by substantial budget cuts in recent years, The New York Times reported yesterday.

The agency has had to slash its outbreak and emergency response teams, eliminate scores of positions, and witness the departure of veteran leaders who have led previous Ebola outbreak response efforts, the story said.

The WHO is not geared to be a first responder against deadly outbreaks, said Director-General Margaret Chan, MD, MPH. It does not have the staffing or ability to flood the Ebola epidemic region with help, she said, so it must rely on assistance from leaders of the affected nations and from countries around the world.

The global financial crisis several years back hit the WHO hard, the story said. The agency was forced to cut nearly $1 billion from its 2-year budget, which now stands at just under $4 billion. In contrast, the US Centers for Disease Control and Prevention's (CDC's) 2-year budget is about three time that.

In addition, the WHO has recently placed more emphasis on chronic diseases, such as heart disease and diabetes.

WHO experts acknowledged, however, that the agency could have responded earlier to West Africa's Ebola outbreak. "There's no doubt we've not been as quick and as powerful as we might have been," said Marie-Paule Kieny, MD, PhD, an assistant director-general.

"Of course in retrospect I really wish that we had jumped much higher much earlier," said Keiji Fukuda, MD, MPH, assistant director-general in charge of outbreak response. But he added, "If this outbreak had been a typical outbreak, nobody would be saying we did too little, too late."
Sep 3 New York Times story

http://www.cidrap.umn.edu/news-perspect ... ep-04-2014

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