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Global Public Health Community Takes Stock
As Ebola Epidemic Ends

Level Of Readiness To Tackle Next Epidemic Is In Question
 

Author: Roger Bernier, PhD, MPH

Just hours after the WHO declared the West African Ebola epidemic had come to an end on January 14th, the disease had reemerged with the confirmation of a new case in Sierra Leone.  This most recent case underscores the continuing risk of new flare-ups throughout the region and the importance of looking back on what has been learned over the last 2 years fighting the largest public health disaster in recent history.  Compiled from a series of recent meetings and articles about Ebola in Nature and elsewhere, here are some of the key lessons scientists and public health officials are relying on as they make recommendations for the future (4).
 

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
By far the largest in history, this Ebola outbreak surprised the public health community with its length and scope and in the process exposed the weaknesses in the global health system.  In November of 2015 a joint panel of more than 20 experts from the Harvard Global Health Institute and the London School of Hygiene and Tropical Medicine authored an assessment of the global response to the epidemic in which they argued that we are no better prepared to handle another epidemic today than we were 2 years ago (3).  In response to these they argued that we are no better prepared to handle another epidemic today than we were 2 years ago (3).  In response to these shortcomings and the lessons learned, the panel laid out what it called “10 Essential Reforms” aimed at improving prevention, detection and response to outbreaks in the future.  In addition, panels have been convened by other organizations including the WHO and UN to make specific assessments and recommendations.  Z


It appears critical that the world learns from these lessons and takes recommended actions to correct systemic shortcomings in the infrastructure and leadership of the world’s health systems before the next global health emergency strikes.

References
(
1.) https://tinyurl.com/qeyjzor
(2.) https://tinyurl.com/jmjdau4
(3.) https://tinyurl.com/zklsj74
(4.)
https://tinyurl.com/hm82cau

 

 

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