A Painfully Slow Ebola Response
By
THE EDITORIAL BOARD of the New
York Times
The outbreak of the Ebola virus in West Africa appears more out of control than
ever. By Friday, the virus had infected
more than 2,000 people in four countries and had killed more than half of them.
The World Health Organization, which snoozed on the sidelines for months after
the outbreak was first identified in March, has issued increasingly frantic
warnings in recent days. On Aug. 8, it declared
the spread of the virus “a public health emergency of international concern.”
On Thursday, it warned that the reported numbers of people killed or sickened by
the virus may “vastly underestimate the magnitude of the outbreak” because many
sick people escape detection. The next day, it said that patients flooding into
newly opened treatment centers were filling beds faster than they could be
provided.
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.
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