ALMOST EVERYTHING that could go wrong did go wrong in the world’s early response to the outbreak of the Ebola virus in West Africa in 2014. Before it was over, the virus infected some 28,634 people and claimed more than 11,000 lives. It could happen again — and the world is still not ready.
Guinea had a weak health-care system when the virus took root in its remote regions, making it easier for the virus to spread to neighboring Liberia and Sierra Leone. Guinean authorities played down the seriousness for fear of creating panic and disrupting business. The World Health Organization declared the outbreak “relatively small still” in April 2014, and expert teams that had been sent in to the region were pulled out prematurely in May. WHO outbreak response teams had been “disproportionally” cut in a wave of headquarters layoffs. Margaret Chan, director general of the WHO, did not use her authority to declare a public-health emergency of international concern until five months after Guinea and Sierra Leone had notified the organization. Even after the emergency was declared, and a substantial global response was mobilized, “this response arrived late, was slow to deliver funds and health workers, was inflexible in adapting to rapidly changing conditions on the ground, was inadequately informed about cultural factors relevant to outbreak control, and was poorly coordinated,” according to a new study. “The result was, in essence, a $5 billion scramble.”
This is a sample of the findings contained in a report made public Nov. 22 by an independent panel of 19 experts who examined responses to the outbreak, particularly by the WHO, an agency of the United Nations. The report describes a cascade of failures and serves as a reminder that the existing methods of coping with infectious disease outbreaks are fragmented and fragile. The panel, launched by the Harvard Global Health Institute and the London School of Hygiene and Tropical Medicine, found that during the Ebola outbreak, the WHO fell down in all of its core functions: helping nations build up health-care capacity, providing early warning, establishing technical norms and mobilizing resources. The agency now faces an “existential crisis of confidence,” is “starved” of resources and “seems to have lost its way,” the experts write. “Confidence in the organization’s capacity to lead is at an all-time low.”
Before another bacterium or virus goes on a rampage, the panel recommends bolstering the WHO’s ability to respond quickly, including with a worldwide research and development fund for diagnostics, drugs and vaccines for diseases that have been neglected by the pharmaceutical industry. In many poor countries, basic health-care systems are still lacking, hampering their ability to fight outbreaks. It is also essential that governments give early warning of disease, regardless of the consequences. Response teams must take into account not only health and science concerns but also the beliefs, traditions, cultures and fears of local populations. The world fails to learn these lessons of Ebola at its peril.