International Response to Ebola Crisis
The international response to the deadly outbreak of the Ebola Virus Disease (EVD) in West Africa has been described as slow and insufficient. Three countries most affected by this, Guinea, Liberia and Sierra Leone, have accused the international community for ignoring the severity of the situation on the ground and taking too long to mobilise aid to help contain the outbreak. However, unlike the previous Ebola outbreaks, one also has to consider the current geographical location and the social, political and economic constrains of the respective governments in West Africa as an important factor for the spread of the virus to such a large extent.
The present outbreak of the Ebola Virus Disease in West Africa has been the most deadly epidemic in the history of the disease since it was discovered in 1976. As of September 23, 2014 World Health Organisation (WHO) situation report, there have been 6553 confirmed cases and 3083 deaths caused by the EVD outbreak in Guinea, Liberia and Sierra Leone. The virus has taken a global dimension as there is a confirmation of the first case of Ebola in Dallas, Texas, on September 30, 2014. Calculating the total number of deaths by Ebola over the last 40 years the figures come up to approximately 1500 , which is almost one-third of the causalities caused by the virus in a span of a few months. This goes to show the severity of the crisis. Ebola is an infectious virus with a high rate of fatality if not detected between the 2 to 21 days of incubation period. The current outbreak occurred through contact with infected fruit bats or primates; and it is highly contagious if one comes in close contact with the bodily fluids (including and not limited to urine, saliva, faeces, vomit, breast milk and semen) of an infected person.
It is believed that the current situation in West Africa is a result of the delayed response and assistance from the international community to the Ebola outbreak. However, there is evidence that some international organisations have been constantly working to contain the spread of the disease since its outbreak in March 2014. The WHO’s African Regional Office had reported the first outbreak of the virus in Guinea on March 23, 2014. Since then it has deployed 400 people from across the Organisation and from partners in Global Outbreak Alert and Response Network (GOARN) to help respond to the disease in Guinea, Liberia and Sierra Leone. Doctors Without Borders/Médecins Sans Frontières (MSF) had previously contained EVD outbreaks in Africa; and in March itself, they had immediately launched an emergency response in southern Guinea to set up isolation units and despatched a team of doctors and aid workers on the ground to contain the spread of the virus. Since March, the MSF has treated more than 250 confirmed cases of the deadly disease.
Response of African Nations to the Ebola Crisis
Despite the early response from WHO and MSF to send teams on the ground to contain the spread of the virus, it is believed that the conditions in which the outbreak has occurred at present are much different when compared to the previous outbreaks. First, there is a lack of knowledge amongst the population in Guinea, Liberia and Sierra Leone about the disease; because it is the first time EVD has hit in this part of the African continent. Second, there is a high rate of mobility of people in this region that has caused the virus to spread at a much faster rate than before. Third, the three African nations that are affected are economically poor, and have recently returned to political stability following years of civil war and conflict. This has left their health systems largely destroyed or severely damaged to respond to the outbreak in an efficient manner. Esther Sterk, MSF tropical medicine adviser, had stated in March 2014 that the disease is “highly contagious” and that there is a need for isolation units which are essential to prevent the spread of the disease. Unfortunately, the wide geographic spread of cases and all of the other factors combined together has made it difficult to control the spread of the current epidemic.
In addition to the factors highlighted above, lack of financial aid and assistance from regional organisations has caused the outbreak to escalate. For example, the African Public Health Emergency Fund (APHEF) which was established in 2010 by the Regional Committee of the World Health Organisation in 2012 – to mobilise, manage and disburse additional resources from the African Member States for effectively responding to public health emergencies – acknowledges that there has always been a gap in funding as most Member States allocate insufficient resources. The consequence of this is that in the current outbreak APHEF had inadequate funds to allocate resources to the regions in West Africa. This has led West African governments to depend on donor funding which are inadequate. The initial outbreak of the EVD was reported in Guinea by the WHO’s African Regional Office on March 23, 2014. However, it was only 5 months later on August 13, 2014 that the African Union Commission (AUC) with the help of WHO urgently requested the Member States to replenish APHEF with $US 1 million to the Ebola response in West Africa. In the press release AUC said that they are working closely to mobilise the international community to respond effectively to this public health emergency. But in reality the assistance came in too late and was too little.
Delay in Mobilisation of International Aid
Even if there was a lack of coordinated assistance by the African nations to contain the crisis situation in West Africa, aid organisations like WHO and GOARN were very well aware of the situation on the ground for a long time. Hence, WHO is blamed for being slow in their efforts to mobilise other states to provide financial aid and physical assistance in terms of medical staff and other essential medical equipment to contain the spread of the disease in West Africa, and for not sharing vital information of the worsening situation in region in the early periods of the outbreak. In an interview of July 2014, MSF Dr. Hilde de Clerck and epidemiologist Dr. Michel Van Herp, who have had experience dealing with previous Ebola outbreaks in Democratic Republic of the Congo, had clearly highlighted that the current outbreak is unique and has the potential to spread at a much faster pace if not contained quickly. MSF had pleaded to all actors that there is a need to increase human resources to deal with this emergency. But unfortunately, their plea remained unnoticed. WHO only declared Ebola as a public health emergency on August 8, 2014 stating that there could be possibility of further international spread of the virus. Also, WHO’s Director-General, Margaret Chan, briefed the United Nations about the outbreak on August 12, 2014. It was only after this public announcement that financial aid and response to the Ebola outbreak from the international community intensified.
As a result of WHO’s demand for international help, United Nations’ General Secretary Ban Kimoon announced on September 19, 2014 to establish the UN Mission for Ebola Emergency Response (UNMEER). He sent two letters with the same content a day before to all the members of the General Assembly and Security Council stating that “Ebola crisis is no longer just a public health crisis, but has become multidimensional, with significant political, social, economic, humanitarian, logistical and security dimensions”. He also added that with the establishment of UNMEER “aid can be mobilised at the international, regional and national levels to ensure that resources are deployed and delivered to the places where they are most needed, in the shortest possible time frame”. Since UNMEERs’ establishment countries such as Chile and Colombia have donated $US 100,000, Estonia $US 40,000, India $US 10 million and Ghana hosted the UNMEER effort in Accra and has become a regional logistics hub for the Ebola response. In addition to this, independently Cuba have sent 165 doctors and nurses to Sierra Leone and United States promised 3,000 military engineers and 500 health personnel to West Africa to build clinic and care for patients. China have also contributed a team of 115 health workers in Guinea, Sierra Leone and Liberia and dispatched a mobile laboratory team to Sierra Leone to enhance the laboratory testing capacity for Ebola virus disease (EVD) in the country. Had this mobilisation of aid happened earlier, in a month or two after the outbreak, the chances of it spreading to other regions would have been mitigated.
International response to SARS vs Ebola
In 1996 there was a revision of the International Health Regulations (IHR) to broaden disease coverage and incorporate the use of more up-to-date communication technologies to provide real-time information based on which to formulate measures to prevent international spread of diseases. Hence, in the case of 2002 SARS (Severe Acute Respiratory Syndrome) outbreak in China, there was very strong international coordination and sharing of accurate information during the course of the outbreak. In this case the WHO was very active in collecting real-time information about the nature of the virus and monitoring its spread in Asia and henceforth, it was capable to acquire enough clinical and epidemiological information to alert the world to the occurrence of a newly identified atypical pneumonia. In addition to this during the outbreak containment effort GOARN linked some of the world’s best laboratory scientists, clinicians and epidemiologists electronically, in virtual networks and provided rapid knowledge about the causative agent, mode of transmission and other epidemiological features of the virus. The real-time information made it possible for WHO to provide specific guidance to health workers on clinical management and protective measures to prevent further spread. Hence, within four months all known chains of transmission of SARS had been interrupted the outbreak was declared contained.
The advancement in technology has been immense since 2003 but despite that WHO and GOARN failed to alert the international community about the severity of the Ebola outbreak. If they had followed their own model for the SARS epidemic, the spread of the virus could have been contained considerably. However, in the opinion of Dr. Peter Piot (the first microbiologist who was part of the team that identified the virus in 1976 outbreak in Zaire) WHO in the case of the Ebola outbreak was incapable to take a leadership role to manage the situation on the ground because their African Regional Office was not staffed with capable people but with political appointees. Also, the headquarters in Geneva suffered massive budget cuts, and as a result the department for haemorrhagic fever and the one responsible for the management of epidemics was hit hard.
Unlike SARS, EVD has been in existence since 1976 and in the various sporadic outbreaks that have happened in the last 40 years, the death rate among the cases that were reported was between 35 to 60 percent. Also, Dr. Peter Piot has said that in 1976 itself it was clear to the scientists that they were dealing with one of the deadliest infectious diseases the world has ever seen and that the rate of contamination through close contact is very high. Inspite of the virus being so deadly, there no initiative was taken to develop a cure to contain future outbreaks of the disease.
Success story of Nigeria
In contrast, the case of Nigeria is a good example of how local leadership, quick response mechanisms and collaboration of national and international organisations have helped to slowly contain the Ebola virus since its first case was announced on July 23, 2014. Nigeria is a very populated country and an escalation of the Ebola outbreak would have had a direct impact on the global community as there is a constant movement of people in and out of the country. Nigerian government ensured that there is temperature screening at all entry and exit points and extensive surveillance by public health workers. The governor of Lagos Babatunde Fashola has to be given credit to immediately take action after the first case was confirmed. Nearly, 500 contacts were traced, quarantined, checked for fever and other symptoms and their blood samples were taken and sent for testing. The number of boots on the ground helped to ensure that awareness of the virus is spread amongst the population to reduce any panic or fear. Also, Dr. Faisal Shuaib of Nigeria’s Health Ministry (who before has been an incident manager of the National Polio Emergency Centre to eradicate polio I Nigeria) took the leadership role in the Ebola Command centre. He collaborated efficiently with the local response team which also included international agencies already present in Nigeria, for example WHO, MSF and Centre for Disease Control and Prevention (CDC), to monitor each and every aspect of the aid efforts to contain the spread of the virus. The UN and the WHO were slow in mobilising the international community and sharing critical information about the outbreak. However, on the ground local initiative and leadership are important to ensure the efficient use of the international aid that has been provided. One or the other cannot work in isolation to contain an epidemic; it has to be a collaborative effort
Is India Prepared to deal with an Ebola outbreak?
A press statement by Dr. Harsh Vardhan, Minister of Health and Family Welfare, was made on August 8, 2014 in the light of World Health Organisation announcement stating that there should be no cause of panic as India is at low risk of transmission of the virus from other countries. India has also pledged financial aid of $US 12 million to the UNMEER to help the respective countries in West Africa to contain the outbreak. Dr. Harsh Vardhan also assured that preparedness measures are in place to deal with any case of virus imported to India. The Indian Medical Association was requested to inform all its members regarding the diagnostic and treatment protocol. The National Centre for Disease Control has issued an advisory to all State Surveillance officers to be vigilant about the virus and raise their awareness and knowledge regarding the virus. The government also advised against all non-essential travel to Guinea, Liberia and Sierra Leone, adding that airport authorities will screen and quarantine the travellers who are coming from or transiting through the affected areas.
The Ministry of External Affairs didn’t make any official statements regarding the outbreak in West Africa. But, is it assumed that it has postponed the India-Africa Forum Summit that was scheduled for December 2014 due to the scare of Ebola being imported to India. However, the Indian government should not be complacent and should be fully prepared to deal with any outbreak of the virus in the country. Monthly press releases by the Ministry of Health and Family Welfare show figures of how many people have been checked on the airports and quarantined, but there are many factors that one has to consider if a single imported case of virus in any region as it can stifle the public health care system and severely damage India’s economic, political and social fabric.
India is very densely populated; whether the urban or rural parts. This will make contact tracing very difficult. Also, many people do not have any form of identification or medium through which they can be traced. Therefore, tracking a potentially infected person and isolating them is going to be an impossible task for the public health workers. There is also a high rate of mobility of people within a state and between different states in India. Hence, the chances of the disease spreading quickly are very high. Sanitation in India is very poor. According to the UNICEF, 50 per cent of India’s population defecates in the open and it is known that the Ebola virus can be transmitted through any bodily fluid including faeces. The slums in the urban areas and many parts of rural India that suffer from poor sanitation are at a high risk of being contaminated in the wake of any virus outbreak
Many public hospitals are not equipped with basic facilities and many in the rural areas do not even have access to a good public hospital. Hence, it will take tremendous amount of man power and resources to ensure that hospitals are equipped and the aid workers are well trained to sophistically manage any situations of an outbreak. There are only two labs in the whole of India that can test blood samples and diagnose the disease. One is the National Centre of Disease Control in New Delhi and the other is the National Institute of Virology in Pune. For a population of more than one billion, just two laboratories are insufficient. There is also a lack of awareness about the disease. There is hardly any mention or discussion of the Ebola crisis in West Africa on the major national Indian news networks and papers. They are no updates on any measure that the government has taken to ensure the public that they are prepared to deal with an outbreak of the virus in the country. Those who are illiterate and do not have access to any form of media will be oblivious about the existence of the disease. This lack of knowledge has the potential of creating fear and panic among the communities if an outbreak takes place.
Even though international aid has intensified for containing the outbreak of the Ebola virus disease, it is important that authorities in India be vigilant. From the Nigerian example one has to learn that local leadership and proper preparedness of the public health system is very important for containing the spread of the virus.
1. “Outbreaks Chronology: Ebola Virus Disease”, http://www.cdc.gov/vhf/ebola/outbreaks/history/
chronology.html. The approximate estimation of 1500 done by adding the “Reported number (%) of deaths among the cases”.
2.“WHO-deployed health worker receiving care after testing positive for Ebola”, August 24, 2014, http://
www.who.int/mediacentre/news/statements/2014/health-worker-ebola/en/
3 “Ebola epidemic declared in Guinea: MSF launches emergency response”, March 23, 2014, http:// www.doctorswithoutborders.org/news-stories/field-news/ebola-epidemic-dec…
4 “Struggling to contain the Ebola epidemic in West Africa”, July, 08, 2014, http://www.doctorswithoutborders.org/ news-stories/voice-field/struggling-contain-ebola-epidemic-west-africa
5 “Struggling to contain the Ebola epidemic in West Africa”, July, 08, 2014, http://www.doctorswithoutborders.org/ news-stories/voice-field/struggling-contain-ebola-epidemic-west-africa
6 Ibid.
7 Ibid.
8 “Ebola epidemic declared in Guinea: MSF launches emergency response”, March 23, 2014, http:// www.doctorswithoutborders.org/news-stories/field-news/ebola-epidemic-dec…
9 “Public Health Emergencies”, http://www.afro.who.int/en/aphef/public-health-emergencies.html
10 “African Union Commission pledges 1 million to Ebola Response”, August 13, 2014, http://www.au.int/en/ content/african-union-commission-pledges-1-million-ebola-response
11 “Struggling to contain the Ebola epidemic in West Africa”, July, 08, 2014, http://www.doctorswithoutborders.org/ news-stories/voice-field/struggling-contain-ebola-epidemic-west-africa
12 “Statement on 1st meeting of the IHR Emergency Committee on 2014 Ebola Outbreak in West Africa”, August 8, 2014, http://www.who.int/mediacentre/news/statements/2014/ebola-20140808/en/
13 “Identical letters dated 17 September 2014 from the Secretary-General addressed to the President of the General Assembly and the President of the Security Council”, September 18, 2014, http://www.un.org/en/ga/search/ view_doc.asp?symbol=A/69/389
14 Ibid.
15 “WHO welcomes Cuban doctors for Ebola response in west Africa”, September 12, 2014, http://www.who.int/ mediacentre/news/statements/2014/cuban-ebola-doctors/en/
16 “WHO welcomes the extensive Ebola support from the United States of America”, September 16, 2014, http:// www.who.int/mediacentre/news/statements/2014/usa-ebola-support/en/
17 “WHO welcomes Chinese contribution of mobile laboratory and health experts for Ebola response in west Africa”, September 16, 2014, http://www.who.int/mediacentre/news/statements/2014/chinese-ebola-contri…
18 Heymann David L., “The international response to the 2003 SARS outbreak”, Philos Trans R Soc Lond B Biol Sci. 2004 Jul 29;359(1447), pg. 1127
19 Ibid., pg. 1128
20 Ibid., pg. 1128
21 “Interview with Ebola Discoverer Peter Piot: ‘It is what people call a Perfect Storm’”, September 26, 2014, http:// www.spiegel.de/international/world/interview-with-peter-piot-discoverer-…
22 “Interview with Ebola Discoverer Peter Piot: ‘It is what people call a Perfect Storm’”, September 26, 2014, http:// www.spiegel.de/international/world/interview-with-peter-piot-discoverer-…
23 “Outbreaks Chronology: Ebola Virus Disease”, http://www.cdc.gov/vhf/ebola/outbreaks/history/ chronology.html.
24 “Interview with Ebola Discoverer Peter Piot: ‘It is what people call a Perfect Storm’”, September 26, 2014, http:// www.spiegel.de/international/world/interview-with-peter-piot-discoverer-…
25 “How Nigeria has succeeded in containing Ebola”, September 22, 2014, http://www.pbs.org/newshour/bb/ nigeria-succeeded-containing-ebola/
