A year after health organizations warned of what would become the largest outbreak of Ebola in history, killing more than ten thousand people, a review of the international response offers lessons that could help prevent similar tragedies in the future, the New York Times reports.
According to the Times, the problems started with local governments and multilateral agencies, the World Health Organization in particular, failing to acknowledge and address the initial outbreak in the spring of 2014. By midsummer, treatment centers in the three most affected countries — Liberia, Sierra Leone, and Guinea — were overwhelmed and new cases were multiplying inside hospitals and among the region's already inadequate healthcare workforce.
Even after the United Nations Mission for Ebola Emergency Response was launched in September, the response effort was messy, inefficient, expensive, and often lagged developments on the ground. While, for example, the Centers for Disease Control and Prevention worked with WHO-led multinational teams in neighboring countries such as Nigeria and Senegal to prevent the disease from spreading further, medical charities with no expertise in Ebola opened treatment centers in the three hardest-hit countries staffed, in many cases, by foreign personnel with no expertise in the virus, the Times reports. In addition, thousands of local health workers, grave diggers, and student outreach groups were asked to work in dangerous conditions, often without pay and, unlike many foreign workers, without the option of medical evacuation if they became infected.
Meanwhile, a report (22 pages, PDF) from Doctors Without Borders/Médecins Sans Frontières — which was the only NGO with prior experience in specialized Ebola treatment and the first to raise the alarm in Guinea — describes how by late August the organization's treatment center in Monrovia, Liberia, was overwhelmed and forced to turn away visibly ill people. The NGO's appeals to the U.S. and other governments for trained medical staff went unanswered, however. The report also warns that, despite an overall decline in new cases, the epidemic is not over; that a global strategy to sustain research and development for Ebola vaccines, treatments, and diagnostic tools must be developed; and that access to healthcare services must be restored as a first step toward rebuilding functional health systems in the region and enabling early detection of future outbreaks of Ebola and other infectious diseases. Health authorities in Guinea, Liberia, and Sierra Leone now have the know-how to detect, investigate, and tackle an Ebola outbreak and laboratories are in place, the report notes, but deploying them will require political will, just as knowledge sharing among aid organizations and reforms at WHO cannot be implemented without a commitment to more active engagement among the parties and member states.
"The flexibility and agility for a fast, hands-on emergency response still does not sufficiently exist in the global health and aid systems," notes MSF international president Joanne Liu in the report. "Lessons that should have been learned in the mass cholera epidemic in Haiti four years ago were not."