Ebola breaking away from efforts to contain it


As the Ebola epidemic is claiming increasing number of victims, there is widespread concern that efforts to contain it are inadequate. New and more effective measures are needed to combat one of the most dangerous epidemics of modern times.

“Six months into the worst Ebola epidemic in history, the world is losing the battle to contain it,” stated Doctors Without Borders International President Dr. Joanne Liu.

Liberian President Ellen Johnson Sirleaf’s anguished letter to President Barack Obama, urging the U.S. Government to take a more aggressive policy to combat this deadly epidemic, stated the situation in clear terms: “Without help from your government, we will lose this battle against Ebola.”

Losing this battle means not only that the initially affected countries will lose many but also that many other countries will be affected as well.

The Liberian scenario is paradigmatic: While infections are rapidly spreading in the country, it is affecting an already weak health care system that has proven unable to contain the spread of the infection.

So far, more than half of the recorded deaths from Ebola have taken place in Liberia. In the meantime, rather than providing direct aid to the affected countries, Western countries are mainly concerned about their own safety by closing airlines, aid workers say.

“The main objective here is not to dramatically increase the person’s chance of survival; it’s to contain the spread,” said Dr. Gabriel Fitzpatrick, who is working at a Doctors Without Borders hospital in Sierra Leone.

To contain the infection, some basic public health actions should be followed: Identify those who are sick or suspected of being sick; isolate them; treat those who are sick with available means; and trace the contacts and keep them under observation.

In addition, it is critical to conduct public sensitization campaigns, informing the public of what conduct they should follow to avoid being infected and eliminating myths and misconceptions about the disease.

It is also critical to instill in West Africans a sense of trust and to assuage their unreasonable fears and sense that they have been isolated from the rest of world at a time in which their own institutions are crumbling.

As Liberia’s defense minister told the U.N. Security Council, “Liberia is facing a serious threat to its national existence.”

It is important to follow the set of guidelines developed by the World Health Organization and the U.S. Centers for Disease Control and Prevention (CDC) to help prevent and control the spread of Ebola.

The manual titled “Infection Control for Viral Haemorrhagic Fevers in the African Health Care Setting” describes how to recognize cases of viral hemorrhagic fever such as Ebola and how to prevent transmission of the infection in health care settings by using locally available materials and minimal financial resources.

Because of the variety of actors involved, coordination of actions is essential. “Coordination saves lives,” said David Nabarro, from the U.N. Secretary General’s Office in charge of coordinating the response to Ebola across the entire U.N. system.

So far, experts on infectious diseases have criticized the industrialized countries’ response to the epidemic. Although the U.S. has promised technical help, its sending troops could be seen as interference in other countries’ security affairs, in a region of the world that is particularly sensitive to these issues. Bringing in military personnel is not the best way to build confidence in the countries most affected by the infection.

Doctors and nurses are most needed as are personnel to take charge of education and communication issues.

The U.S. needs to coordinate its response with that of countries such as Cuba and China, which have promised to send health workers, as well as wit international financial institutions such as the World Bank, which has promised significant financial support.

If not properly contained, Ebola could spread out of control. As Tom Frieden, CDC’s director stated recently, “There is a window of opportunity to tamp this down, but that window is closing.”

Cesar Chelala, M.D. and Ph.D., is an international public health consultant for several U.N. agencies.