After disproportionate media attention on Ebola’s negligible risk to people in Western and Asian countries, the focus seems at last to be shifting towards how to stop the outbreak in West Africa. The grim reality is that medical organizations are struggling: the flood of new cases far outpaces available beds and treatment centres. Many of those who are ill are not receiving the basic health care that could keep them alive.
The tragedy is that we know how to stop Ebola. Well-informed communities can reduce the main routes of spread by avoiding unprotected home-based care of infected people and by modifying traditional burial practices. Infection-control measures protect health-care workers. Together with rapid identification and isolation of ill people, and tracing and monitoring of their contacts for 21 days (the maximum incubation period of the disease), such measures have stopped Ebola outbreaks in the past.
But the dysfunctional health-care infrastructure of the three countries at the centre of the outbreak — Guinea, Sierra Leone and Liberia, which are poor and struggling to emerge from years of war — is simply not up to the task. The nations need help, and urgently.
The international community must mobilize now. Aid is increasing, but most of those involved, from governments and the World Health Organization (WHO) to researchers, all initially underestimated the threat. This is perhaps because most past outbreaks have been small and relatively straightforward to control.
The WHO has a part to play, but contrary to a widespread assumption, it does not have the in-house capacity to send large teams into the field. The agency’s funding for outbreak responses has been slashed, and it has shifted focus to helping countries to reinforce their health systems so that they can respond better themselves. How the international community should best react to outbreaks, and what role the bureaucratic WHO should have, is a debate for after this outbreak is over. The pressing need now is to bring all available resources and talent to bear.
“The pressing need now is to bring all available resources and talent to bear.”
It is a sign of how desperate the situation has become that on 2 September, Joanne Liu, international president of medical group Médecins Sans Frontières (or Doctors Without Borders), called on countries to immediately deploy their military and civilian biodefence teams — units that have been developed to respond to bioterror attacks. The crucial priorities, she said, are to scale up isolation centres, deploy mobile diagnostic labs (see page 145), build a network of field hospitals and establish dedicated air links to shift staff and equipment to where they are needed. In short, a military-style response, with its associated strong chain of command, logistical capacities and speed. The concept makes a lot of sense and is an approach that governments should consider adopting — or explain why, if they choose not to do so. US President Barack Obama indicated last weekend that he would deploy the US military to assist in the outbreak.
It cannot be repeated enough that public-health measures and good old-fashioned epidemiological tracking of the infected and their contacts will bring this outbreak to an end. The priority must be to scale these up, alongside establishing more Ebola treatment centres on the ground. For instance, Ebola’s high death rate could be slashed by better patient care, in particular by giving intravenous rehydration.
A highly effective Ebola vaccine would be a game-changer. A WHO-convened meeting on 4–5 September agreed on an unprecedented set of measures, including relaxing regulatory requirements so that experimental drugs and vaccines can be quickly tested under the difficult field conditions of this outbreak, and perhaps even widely deployed. The measures will, for example, permit expedited vaccine trials and informal clinical studies of drugs that could produce useful initial data within months.
Regulators and researchers should be applauded for their speed and pragmatism in exploring innovative methods for conducting trials during this outbreak. Crucially, all those who organize trials must be willing to standardize and share the data they collect to maximize their scientific and medical value, and to allow rapid decisions to be made on which products to prioritize.
West Africa’s outbreak illustrates the serious weaknesses in the international community’s ability to respond to outbreaks of emerging diseases, despite years of debate. It should also hammer home a truism for future planning — the costs of setting up infrastructure to ensure an early response are small compared with the huge social and economic costs of a large deadly disease outbreak.
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