The Ebola outbreak in West Africa has been described as the most severe acute public health emergency of modern times, a threat to global peace and security, and a public health risk of great proportions, particularly to the hardest hit countries, Liberia, Sierra Leone and Guinea. This disease has now taken the lives of nearly 5000 people and threatens more, in so doing exposing what can happen when the health systems of vulnerable developing countries are not resilient enough to withstand a public health emergency of such proportions.
This Ebola Virus Disease having been transmitted to Europe and the United States of America, quickly established itself as global virus requiring global public health emergency interventions for its containment. Meanwhile, the disease is still ravaging the communities of the three most affected West African Countries, although there reports that the earlier observed exponential-increase infection rates, are beginning to wane off.
It is therefore prudent for the international community to start asking what went wrong for this dreadful virus with its known mode of transmission, to get out of control. Were the global health governance institutions ineffective in responding in time to assist the affected countries to contain this Ebola outbreak?
There is need to reflect on the effectiveness of the assistance provided by these global institutions/organisations, such as the World Health Organisation (WHO), the Centres for Disease Control and Prevention (CDC), Médecins Sans Frontières (MSF), the International Federation of the Red Cross and Red Crescent Societies, and other Development Partners, to vulnerable developing countries for their preparedness for outbreaks of epidemics, which might have global public health implications.
We acknowledge that the science and epidemiology of viruses such as the Ebola Virus, has advanced, but still these viruses are able to inflict such suffering in poor nations which are Member States of global health governance institutions such as the WHO.
The shortcomings in the health systems of the Ebola affected countries, reminds us that despite the progress observed globally and in several countries of the ACP region, a majority of ACP countries are not on track to meet the three health-related Millennium Development Goals. Accelerated and focused interventions therefore, need to be developed and properly implemented by those countries which are not on track, particularly within the context of the post-2015 development agenda. In particular, the strengthening of national health systems, to enable these countries to effectively respond to the collective actions of the international community in face of a global public health emergency. Such interventions must include the strengthening of human resources for health, as there is a strong relationship between the ratio of health workers to population and the progress toward the Millennium Development Goals.
As an inter-government organisation representing 80 developing countries, the ACP Group of States held a Symposium on the Ebola outbreak in West Africa on 17 October 2014 at ACP House in Brussels. The main objective of the Symposium was to deliberate on the current situation of the Ebola outbreak as well as on the control efforts in the affected countries and in the West African region as a whole. The Symposium was addressed by representatives from the Embassies and Missions of the ACP Group of States based in Brussels, the European Union, WHO, the International Federation of the Red Cross and Red Crescent, UNICEF, the World Bank Group, Médecins Sans Frontières (MSF), the Pharmaceutical Industry, Universities, UNOPS, and Brussels Airlines.
The deliberations at the Symposium mainly underlined the following:
•The Ebola Virus Disease continues to rapidly spread in Sierra Leone, Guinea and Liberia, in addition to a heavy burden of diseases the three countries are already shouldering.
•The international community, in particular, the volunteers on ground in the affected countries, should be commended for their contributions towards the containment of the Ebola outbreak.
•There is need to support the strengthening of national health systems in the affected countries, particularly the training of health workers.
•The international community should urgently provide direct aid to the affected countries, particularly the necessary materials, and personnel particularly health workers.
•There is urgent need for proper coordination of the response efforts at all levels to avoid duplication and waste.
•There is need to support preparedness of all countries especially those sharing land borders with intense transmission areas and with international transportation hubs.
•The halting of some commercial flights to the affected countries, has resulted in a drop in hotel activities and layoffs, as such contributing to the deteriorating social and economic situation in these countries.
The Symposium also noted that the three affected countries continue to face numerous challenges in the efforts to contain the Ebola Virus Disease. These include:
•Inadequate investigation teams due to increasing number of cases and deaths in the communities in the urban areas as well as in the affected counties, as such most of the contacts are either lost to be followed up or not captured in the tracking system;
•Slow burial of dead bodies either confirmed or suspected of Ebola, a potential for further exposure of people at the community level;
• Safe and dignified burials and disinfection of houses;
•High exposure of health workers as a result of weak infection control measures, inadequate universal precaution practices, and probably inadequate medical supplies and protective equipment;
•Denial, mistrust and rejection of proposed public health interventions arising from misinterpretation of the cause of the new disease, resulting in high exposure to Ebola virus in the community through household care and customary burial procedures, in turn resulting in high community deaths;
•The provision of information preventing stigmatization when survivors are discharged from the hospital; and
•The adverse effects to women and children and the devastating effects to the national economy as a whole.
Further, in acknowledging the efforts of the international community towards the containment of the Ebola Virus Disease in West Africa, the Symposium reiterated the concern that the pace of response by the international community to the current Ebola outbreak, is still not up to speed with the rate of infection of the virus.
These challenges indeed demonstrate that the complex nature and processes of the spread and transmission of communicable diseases and epidemics, necessitate highly efficient national health care systems and efficient global partnerships. Further they underline that, ensuring the rapid development and dissemination of: information, health technologies, medicines and vaccines, and ensuring accessibility by the world’s poor and most vulnerable populations, remains a serious challenge for the international community.
It is also important to note that, the first-ever UN emergency public mission, UN Mission for Ebola Emergency Response (UNMEER) has been established, based in Accra, Ghana, to address this unprecedented Ebola Virus Disease (EVD) outbreak. The Mission’s strategic priorities are to stop the spread of the disease, treat infected patients, ensure essential services, preserve stability, and prevent the spread of EVD to countries currently unaffected by the disease. However, one would argue that this Mission was put in place a bit late and probably it should have been based in one of the affected countries. Whether this has had implications to the effectiveness of the response efforts by the global partners, is matter for future analysis.
In its report on this Ebola outbreak the World Bank underlines that, limiting the human costs and economic impacts of the Ebola Virus Disease, will require significant financial resources, coordination between international partners and the affected countries, and commitment. To this end, the report recommends the following measures:
•Supporting the humanitarian efforts to finance medical equipment, emergency treatment units and personnel salaries;
• Helping countries bridge the $290 million fiscal gap for 2014 and continue as the gap grows in 2015;
•Providing infrastructure and financing to countries’ international transportation links; and
•Strengthening the surveillance, detection and treatment capacity of African health systems.
As has been discussed elsewhere in the context of the post-Ebola period, the lessons from this Ebola outbreak must inform the negotiations of the Sustainable Development Goals (SDGs) underway at the United Nations in the context of the post-2015 Development Agenda. The development of the SDGs within the UN framework provides an opportune moment for high-level political commitment, to focus on health development at national and global levels, particularly for developing countries.
In conclusion, let me quote Dr. Margaret Chan, Director-General of WHO, she states that “ the risks of neglecting healthcare in developing countries are global, as when a deadly and dreaded virus hits the destitute and spirals out of control, the whole world is put at risk.”
By Alhaji Muhammad Mumuni
Secretary General, ACP.