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Friday, March 06, 2015
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Published: Tuesday, 8/19/2014

Guest editorial

Slow Ebola response

The outbreak of the Ebola virus in West Africa appears more out of control than ever. The virus has infected more than 2,000 people in four countries, and has killed more than half of them.

The World Health Organization (WHO), which snoozed on the sidelines for months after the outbreak was identified in March, has issued increasingly frantic warnings in recent days. Last week, it warned that the reported numbers of people killed or sickened by the virus may “vastly underestimate the magnitude of the outbreak” because many sick people escape detection. It said that patients flooding into newly opened treatment centers were filling beds faster than they could be provided.

The current cases, like Ebola outbreaks in past decades, are a regional problem that must be fought primarily by African governments, which understand the cultural practices that foster the spread of the virus and inhibit patients from seeking help. This outbreak poses little or no danger to the United States or Europe.

Unfortunately, the countries most affected — Guinea, Liberia, and Sierra Leone — are among the poorest and most war-racked in the world and have very weak health-care systems. They need help in organizing their responses.

WHO should be filling that role, but it has been shamefully slow. Its regional office for Africa, which should have acted first, is ineffective, politicized, and poorly managed. Staff members are often incompetent, say global health experts who are familiar with its operations.

WHO’s central office in Geneva has belatedly tried to pick up the slack, but is hampered by large self-imposed budget cuts, accompanied by a loss of talented professionals in its programs to control such outbreaks. These shortsighted cuts need to be restored to ensure that the next time there is an Ebola outbreak, the agency can jump into action. The World Bank has said it plans to contribute as much as $200 million to the fight.

No anti-Ebola drug or vaccine has been proved safe and effective in human clinical trials, but progress is being made in pushing promising candidates forward. Two Ebola vaccines could begin initial safety testing in people as early as next month; a drug has been judged safe enough to test in already-infected humans.

Even if these or other medicines prove effective, no one expects them to curb this outbreak. The goal is to find weapons to use during the next epidemic.

The battle against the Ebola virus in West Africa has been waged primarily by two nongovernmental health organizations that have great experience in dealing with global health crises: Doctors Without Borders and Samaritan’s Purse. Both have warned that their resources are stretched to the limit, their people are tiring, and they can’t do much more.

Samaritan’s Purse suspended its clinical-care activities after an American doctor and missionary were infected, given an untested drug, and brought back to this country for treatment.

The U.S. government has belatedly stepped in to help. The Centers for Disease Control and Prevention has sent 55 experts, backed by more than 300 at its Atlanta headquarters, to help the afflicted countries strengthen their systems to detect outbreaks and to trace, isolate, and treat infected people. That is an unusually large effort by the agency, but its staff in the field will be spread thinly.

The Agency for International Development is contributing more than $27 million to coordinate planning and logistics, and to pay for equipment and public awareness campaigns. The Defense Department has a small group of military and civilian personnel in Liberia, and has set up diagnostic laboratories in that country and Sierra Leone. It could do a lot more if it is not too distracted by its operations in Iraq and Syria.

The big unanswered question is who will be available to provide hands-on care as the number of cases continues to mount. Even without an effective drug, prompt supportive care — keeping patients hydrated, maintaining their blood pressure, and treating any complicating infections — can keep patients alive who would otherwise die.

The bulk of the health-care workers will presumably have to come from the afflicted countries, but they will probably need to be helped by doctors and nurses from abroad. All must be provided with protective equipment — and trained to recognize and treat a disease that could kill them if they are not careful.

— New York Times


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