The fight against the West African Ebola outbreak continues. Three new cases were confirmed in Liberia on Friday, just days after it appeared that the outbreak was nearly over. And as front-line health care workers try to stop the virus, a report released today outlines the failures of the Ebola response and reforms needed to ensure that a similar health crisis does not spiral out of control again.
A panel of public health experts convened by the Harvard Global Health Institute and the London School of Hygiene & Tropical Medicine provided 10 recommendations they deem necessary and actionable to right the wrongs experienced in the Ebola outbreak. As has been the case with reviews of the outbreak, the World Health Organization (WHO) bears the brunt of the criticism and calls for change.
“The most egregious failure was by WHO in the delay in sounding the alarm,” said panel co-chairman Ashish Jha in a statement. “People at WHO were aware that there was an Ebola outbreak that was getting out of control by spring, and yet, it took until August to declare a public health emergency. The cost of the delay was enormous.”
The British medical journal The Lancet published the findings and recommendations today. It suggests changes that include global investments in building country health systems, better WHO governance, and more funding for research and development for diseases like Ebola. All of the recommendations are based on the fact that the three affected countries were unable to deal with the outbreak, and the global response was too slow and uncoordinated to stop the outbreak.
The WHO has served as the proverbial whipping boy during post-outbreak response analyses. It recognized its own faults in a report released in April. The mea culpa is driving reforms within the organization to address the same concerns raised by the new report. Making changes at the WHO is crucial going forward, according to the authors, but it goes beyond just the WHO.
“We need to strengthen core capacities in all countries to detect, report and respond rapidly to small outbreaks, in order to prevent them from becoming large-scale emergencies,” said Peter Piot, panel co-chairman and co-discoverer of Ebola. “Major reform of national and global systems to respond to epidemics are not only feasible, but also essential so that we do not witness such depths of suffering, death, and social and economic havoc in future epidemics.”
Weak health systems in Liberia, Guinea and Sierra Leone played a large role in the spread of Ebola. The arrival of a previously unseen virus taxed the few medical workers in the three countries. If it were not for the heroic efforts of local volunteers and existing health workers from the respective countries, things could have been much worse.
The inability of the countries to detect, report and respond rapidly to Ebola exposed the vulnerabilities of many countries. Getting global resources behind closing such gaps is vital, the panel wrote. Their very first recommendation hones in on the need for the global community to establish a clear strategy that will support government investments in health systems.
“We’ve had big outbreaks before and even careful reviews after, but often the world gets distracted. We owe it to the more than 11,000 people who died in West Africa to see that that doesn’t happen this time,” said Jha.
It is the international response that, in the end, attracts the most attention from the panel. It breaks down the outbreak into four phases: the onset in December 2013; the spread among countries in mid 2014; the peak of deaths in fall 2014; and the slow decline through today. Each phase saw an inadequate response due to lack of capacity and coordination.
Most unfortunate is that there were problems that could have been avoided or rectified – leading to fewer lives lost.
“[T]his Panel’s overarching conclusion is that the long-delayed and problematic international response to the outbreak resulted in needless suffering and death, social and economic havoc, and a loss of confidence in national and global institutions. Failures of leadership, solidarity and systems came to light in each of the four phases,” the report stated.