WHO offers profile of Ebola epidemic and its lessons

Ebola virus
Ebola virus

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A set of nine reports published by the World Health Organization (WHO) today profiles West Africa's Ebola epidemic and draws lessons from it, including that when a deadly virus spreads out of control in a poverty-stricken region, it can threaten the entire world.

The reports trace the evolution of the epidemic in Guinea, Liberia, and Sierra Leone, the three hardest-hit countries. They paint a mostly bleak picture of those outbreaks but find glimmers of hope in recent moves to step up the international response. In addition, one report says Nigeria's success in controlling Ebola so far has "astonished" WHO experts.

Poverty and disparities

But the overall tone of the reports—released exactly 6 months after the epidemic was recognized as Ebola—is bleak. In a piece titled "What this—the largest Ebola outbreak in history—tells the world," WHO director-General Margaret Chan, MD, emphasizes what the crisis says about poverty and global economic disparities.

"The outbreak spotlights the dangers of the world's growing social and economic inequalities," she writes. "The rich get the best care. The poor are left to die."

She adds, "When a deadly and dreaded virus hits the destitute and spirals out of control, the whole world is put at risk. Our 21st century societies are interconnected, interdependent and electronically wired together as never before."

The reason no Ebola vaccines or drugs are available is that the disease has previously been confined to poor African nations, providing little incentive for pharmaceutical companies to invest in such interventions, Chan observes.

Another lesion, she writes, is that "the world is ill-prepared to respond to any severe, sustained and threatening public health emergency."

Missed chances in Guinea

An essay on the outbreak in Guinea, where it all began, recounts how the virus probably jumped to humans from wild animals killed by hunters in December and how it went unidentified for months, since it had never been seen in West Africa before.

At least three times in the early months, the prospect for controlling Ebola virus disease (EVD) in Guinea looked good, but each time it flared up again. Some drew the conclusion that the Zaire species of Ebola in the outbreak had become harder to control, but the more likely explanation is that the renewed cases represented reintroductions of the virus from Liberia and Sierra Leone, the report says.

"This more realistic explanation strongly suggests that control in Guinea will not be feasible until the Ebola caseload in its neighbours goes down," it states. "On current trends, the prospects that this will happen anytime in the near future are distinctly not good at all."

The report adds that mob violence against public health workers remains one of the biggest barriers to controlling EVD in Guinea.

Liberia is most worrisome

A report on Liberia's epidemic calls it by far the most worrisome, with exponential growth, as exemplified by 113 new cases recorded in 1 day last week. The situation is summed up in the report's title: "Liberia: misery and despair tempered by some good reasons for hope."

"The true number of deaths will likely never be known, as bodies in the notoriously poor, filthy and overcrowded West Point slum, in the capital, Monrovia, have simply been thrown into the two nearby rivers," the WHO says.

It says basic health services have been disrupted, and with the high-risk malaria season under way, supplies of medicines and bed nets have been depleted. Before the Ebola crisis, Liberia was making solid gains in reducing maternal and child mortality, but that trend has now been reversed.

On the positive side, the report notes that a 120-bed treatment center, the Island Clinic, opened yesterday, with support from the WHO, the UN Children's Fund (UNICEF), and the United States. And later this week, the US Centers for Disease Control and Prevention will set up a new lab that can diagnose Ebola cases in 4 hours.

The report also praises the "monumental" increase in support pledged by the United States last week, adding, "Many believe this announcement heralds the kind of transformational change that can let all partners in the Ebola response get a grip on the outbreak and turn it around." It says that construction of 17 planned new treatment facilities began almost immediately after the US announcement.

In addition, the report hails last week's move by the UN Security Council to establish a special UN-wide Ebola mission. It says this will free the WHO from such burdens as establishing air bridges and transporting medical supplies and personnel. And contributions by Cuba and China are also praised.

"Gradual, then likely dramatic, improvements [in Liberia] can now be anticipated," the WHO states.

Sierra Leone's epidemic is discussed in another report, which notes the "seminal role" played by a well-known traditional healer who died of Ebola and was honored with a large funeral. That event led to as many as 365 more cases, which fueled explosive growth of the outbreak by mid June, the WHO says.

Nigeria's surprising success so far

Another report says the stable Ebola situation in Nigeria has come as a major surprise, after an airline passenger sick with EVD flew into Lagos in July and touched off a chain of cases. Nigeria has confined the outbreak to 15 confirmed cases in Lagos and another 4 in Port Harcourt, with 7 deaths, including 5 in health workers.

"Nigeria's stable situation—with cases confirmed in Lagos, Africa's most populous city, characterized by a vastly inadequate and fragile infrastructure, and in Port Harcourt, the country's restive oil and energy hub—astonished experts at WHO and probably everywhere else in the world as well. No one expected an outcome as good as this one," the WHO observes.

It says the outcome shows that conventional Ebola control tools can work if cases are detected early and managed as recommended by the WHO, and that any country in the world can do it.

Still another report ticks off the many precedents set by West Africa's Ebola crisis. Titled "A fast-moving epidemic full of tragic surprises," the piece lists the following as firsts:

  • The first Ebola outbreak in a large slum (West Point in Monrovia)
  • The first importation of a case by air (in Nigeria)
  • Surprise flare-ups (in Guinea) after the disease was believed to be under control
  • "Hidden caseloads," revealed when new treatment centers open and are overwhelmed by previously unrecognized cases
  • The high toll on health workers, who make up close to 8% of all patients
  • Exponential growth in cases
  • Duration (9 months so far)
  • Major economic damage

In other Ebola developments:

  • More than 160 members of the United Kingdom's National Health Service have volunteered to help with the nation's efforts to battle Ebola in West Africa, the BBC reported today. Also, the WHO today said it welcomed UK actions to help scale up the EVD response in the outbreak region. On Sep 19 UK Foreign Secretary Philip Hammond announced that the country would provide 700 hospital beds to Sierra Leone. The WHO said 200 are being delivered, with the rest coming in the months ahead, along with trained medical workers to work in treatment units.
  • The Wellcome Trust today announced a $5.2 million grant to allow multiple international partners to speed clinical trials of experimental EVD treatments. In a statement, the group said the funding will establish a clinical trial platform allowing a consortium to evaluate the safety and efficacy of the drugs at a number of sites in West Africa. In late August, the Wellcome Trust announced a similar grant as part of a consortium to do clinical trials on an experimental Ebola vaccine.
  • Doctors treating American Rick Sacra, MD, who was infected in West Africa while working with the missionary group SIM, said yesterday that he is being treated with TKM-Ebola, an experimental antiviral, according to a statement from Nebraska Medical Center in Omaha. The drug, developed by Vancouver-based Tekmira Pharmaceuticals, was recently authorized for expanded Ebola treatment protocols by the US Food and Drug Administration. Sacra started the medication the day he arrived at the hospital and received a 7-day course. He also received convalescent serum from a doctor who recovered from EVD after working in West Africa.

Staff writer Lisa Schnirring contributed to this story.

See also:

WHO page with links to all nine WHO reports

Sep 23 BBC story

Sep 23 WHO statement on UK support

Sep 23 Wellcome Trust press release

Sep 22 Nebraska Medical Center statement


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