Dec 10, 2013, 9:52 AM
The current cases, like other Ebola outbreaks in past decades, are a regional problem that must be fought primarily by local 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 three 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 desperately need help in organizing their responses.
The W.H.O. 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, with staff members who are often incompetent, according to international health experts familiar with its operations. The central office of the W.H.O. 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 will need to be restored, perhaps by sacrificing less important items, 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 up to $200 million to the fight.
There is still no drug or vaccine that 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, and a drug has been judged safe enough to test in humans who are already infected. Even if these or other medicines prove effective, which is by no means a certainty, no one expects them to curb this outbreak. The goal is to find weapons to use when the next epidemic breaks out.
The battle against the Ebola virus in West Africa has been waged primarily by two nongovernmental health organizations with great experience in dealing with international health crises, namely Médecins Sans Frontières (a.k.a., 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 a missionary from North Carolina were infected, given an untested drug, and brought back to this country for treatment.
The United States government has belatedly stepped in to provide 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 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 presumably 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 — such as 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 personal protective equipment and trained to recognize and treat a disease that could kill them if they are not careful.
Guest editorial published for the benefit of our readers, obtained from “Editorial” issued on 15 August by the New York Times Editorial Board
“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 personal protective equipment and trained to recognize and treat a disease that could kill them if they are not careful”.
New York Times Editorial Board