What this – the largest Ebola outbreak in history – tells the world
Deadly pathogens exploit weak health systems-Ebola at 6 months
WHAT DOES THIS outbreak, that has been making media headlines for
months, tell us about the state of the world at large? What does it
tell world leaders, and the citizens who elect them, about the state
and status of public health?
WHO Director-General, Dr Margaret Chan, sees 6 specific things.
First, the outbreak spotlights the dangers of the world’s growing
social and economic inequalities. The rich get the best care. The poor
are left to die.
Second, rumours and panic are spreading faster than the virus. And
this costs money. Ebola sparks nearly universal fear. Fear vastly
amplifies social disruption and economic losses well beyond the
The World Bank estimates that the vast majority of economic losses
during any outbreak arise from the uncoordinated and irrational
efforts of the public to avoid infection.
Third, 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.
This became clear when the virus entered Nigeria’s oil and natural gas
hub, the city of Port Harcourt. Nigeria is the world’s fourth largest
oil producer and second largest supplier of natural gas. If that
outbreak flares up again, it could dampen the economic outlook
Fourth, decades of neglect of fundamental health systems and services
mean that a shock, like an extreme weather event or a disease run
wild, can bring a fragile country to its knees.
These systems cannot be built up during a crisis. Instead, they
collapse. A dysfunctional health system also means zero population
resilience to the range of shocks that our world is delivering, with
ever greater frequency and force – whether from a changing climate,
armed violence and civil unrest, or a deadly and dreaded virus.
Deadly pathogens exploit weak health systems
WHO is aware that, in the three hardest-hit countries, high numbers of
deaths from other causes are occurring, whether from malaria and other
infectious diseases, or zero capacity for safe childbirth.
The size of this “emergency within the emergency” is not precisely
known, as systems for monitoring health statistics – not good to begin
with – have now broken down completely.
It is, however, important to understand one point: these deaths are
not “collateral damage”. They are all part of the central problem: no
fundamental public health infrastructures were in place, and this is
what allowed the virus to spiral out of control.
In the simplest terms, this outbreak shows how one of the deadliest
pathogens on earth can exploit any weakness in the health
infrastructure, be it inadequate numbers of health care staff or the
virtual absence of isolation wards and intensive care facilities
throughout much of sub-Saharan Africa.
WHO has been making these arguments for at least two decades. Some
signs are beginning to suggest that they are now falling on more
When presidents and prime ministers in non-affected countries make
statements about Ebola, they rightly attribute the outbreak’s
unprecedented spread and severity to the “failure to put basic public
health infrastructures in place”.
No incentive for research
A fifth especially striking issue is this: Ebola emerged nearly 40
years ago. Why are clinicians still empty-handed, with no vaccines and
no cure? Answer: because Ebola has been, historically, geographically
confined to poor African nations.
The R&D incentive is virtually non-existent. A profit-driven industry
does not invest in products for markets that cannot pay.
Again, WHO has been trying to make this issue visible for more than a
decade, most recently through the deliberations of the Consultative
Expert Working Group on Research and Development: Financing and
Now people see the reality of this R&D failure, this market failure,
on TV screens and in the headline news: the world’s empty-handed
clinicians in their hazmat suits, trying to help Africa’s desperate
poor, putting their own lives at risk, and losing them.
Fast action on new therapies and vaccines
On the issue of experimental therapies and vaccines, WHO has moved
fast in securing ethical approval and coordinating worldwide
collaborative efforts to move the most promising products forward.
Three weeks ago, the Organization brought together more than 100 of
the world’s leading experts on the many complex issues surrounding the
use of these experimental medical products. As a result, this could be
the first Ebola outbreak in history that can be tackled with vaccines
For vaccines, testing on human volunteers has already begun. If all
continues to go well, 2 vaccines could be ready for progressive
introduction near the end of this year. Some 5 to 10 drugs are also
being developed as quickly and safely as possible.
For vaccines, the projected year-end quantities are considered large
enough to have at least some impact on the future of the outbreak’s
Blood from survivors holds hope
The experts also debated the pros and cons of treating Ebola patients
with transfusions of whole blood taken from patients who survived
their infection. This form of treatment has been used empirically in
the past, in a small group of patients, with promising results.
Convalescent plasma was also considered as an alternative treatment
option. Of the two options, use of convalescent plasma is technically
more complex and more demanding in terms of facilities and skills. The
eventual use of this experimental therapy in Guinea, Sierra Leone and
the Democratic Republic of Congo will depend on the availability of
skilled technical expertise.
The experts decided that both treatment options should be prioritized
for further investigation. WHO is already in discussions with health
experts in the Democratic Republic of Congo, Guinea, Liberia, Nigeria
and Sierra Leone. These joint discussions are currently looking at the
practicalities of using whole blood transfusions and convalescent
plasma from survivors.
Finally, the world is ill-prepared to respond to any severe, sustained
and threatening public health emergency. That statement was one of the
main conclusions of the Review Committee convened, under the
provisions of the International Health Regulations, to assess the
response to the 2009 influenza pandemic.
The Ebola outbreak proves, beyond any shadow of a doubt, that this
conclusion was spot on.