Ebola: Officials Sound the Alarm

Thomas W. Geisbert, Boston University School of Medicine - PLoS Pathogens, November 2008 direct link to the image description page doi:10.1371/journal.ppat.1000225
Color-enhanced electron micrograph of Ebola virus particles.

(Above image: Color-enhanced electron micrograph of Ebola virus particles. Courtesy: Thomas W. Geisbert, Boston University School of Medicine)

Public health and policy officials believe a big part of their job is preventing panic: Panic breeds behavior that can spread infectious disease. So when some of these health professionals begin speaking in alarming terms, there is reason to stand up and take note.

“We have to work now so this is not the world’s next AIDS,” said CDC Director Thomas Frieden today at a Washington D.C. meeting of officials from the United Nations, World Bank and International Monetary Fund.

“Failures in leadership have allowed a preventable disease to spin out of control,” write Lawrence Gostin and Eric Friedman in the current issue of the medical journal Lancet. Gostin, a Georgetown Law professor, is Director of the World Health Organization Collaborating Center on Public Health Law & Human Rights. Friedman is Project Leader for the Joint Action and Learning Initiative on National and Global Responsibilities for Health.

If nothing changes, public health officials estimate there will be 1.4 million Ebola cases worldwide by January. There are no current projections as to how many of those might be in the U.S.

U.S. officials have repeatedly stated that we “will” have more Ebola cases here. How do they know?

“It’s inevitable,” one official told me. He asked not to be quoted by name.

An open letter to European governments on behalf of 44 signatories declares the Ebola epidemic “has now spiraled utterly out of control.”

“Today, the virus is a threat not only to the countries where the outbreak has overwhelmed the capacity of national health systems, but also to the entire world,” say the letter also published in Lancet. The lead author is Jose Martin-Moreno, Professor of Preventive Medicine and Public Health University of Valencia and advisor to the WHO Regional Office for Europe.

Martin-Moreno and his colleagues urge European governments to “step up to contribute in line with their capacity and potential” by deploying trained healthcare professionals to west Africa.

There is across the board concern about an extreme shortage of funds to respond to the Ebola crisis.

That’s despite the fact that, in the U.S., Public Health Emergency Preparedness (PHEP) Cooperative Agreements have provided public health departments nearly $9 billion tax dollars since 2002 to upgrade their ability to respond to a range of public health threats, including infectious diseases. Apparently, money is no guarantee of competence. The Dallas Ebola case was mishandled nearly every step of the way with health officials displaying a “learn-as-we-go” mentality. A “glitch” at the hospital was blamed for sending the infected patient back home where he came into contact with others. And there was a shocking lack of preparedness in disposing of the patient’s infectious waste.

“They blew it,” one official told me. Another official acknowledged that such examples of incompetence make it more difficult to convince the American public that their health is in good hands.

The Ebola patient, a Liberian man, died Wednesday. None of his contacts have come down with Ebola.

World Health Organization flag

World Health Organization flag

Worldwide, Gostin and Friedman fault, in part, the World Health Organization (WHO) for lack of leadership in the failure to contain the Ebola outbreak when it was small.

“WHO relied on misplaced confidence that it could mobilise funds rapidly in the face of a crisis, but waiting for donations has led to costly delays. WHO has been constantly catching up in mobilising resources for Ebola: in April, 2014, it sought $4·8 million, by July 31 it set a $71 million goal; and in August made a $490 million appeal, with the UN launching a $988 million appeal weeks later,” say Gostin and Friedman in Lancet.

They also point out that the world seems not to have learned from crucial past lessons.

After the 2009 H1N1 swine flu influenza epidemic, an independent Review Committee concluded that “The world is ill-prepared to respond…to a global, sustained and threatening public-health emergency”, with health capacities “not now on a path to timely implementation worldwide.”

“The Ebola epidemic represents a public health imperative; unchecked, it might very well become a geopolitical crisis,” warn Martin-Moreno and his colleagues.



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