Post-Ebola reforms: ample analysis, inadequate action

Reference is made to the report on Post-Ebola reforms: ample analysis, inadequate action, published on 23 January 2017. We appreciate its clear picture of what has been achieved and the gaps that need to be filled.

We agree: most of the 11,000 Ebola deaths in West Africa could have been prevented had the world been better prepared, but profoundly so. To prevent most deaths during the next Ebola outbreak, affected countries need resilient health systems that extend to rural areas, a sensitive early warning system coupled with rapid response capacity, and a focus on communities as the first line of defence in detecting and responding to outbreaks and emergencies. Countries also need access to effective and affordable vaccines, diagnostics, and treatments, outstanding laboratory and logistics capacity, and safe and abundant treatment centres.

The world has a long way to go before reaching such a level of preparedness, with funding shortfalls repeatedly cited in the report as a main reason for inadequate action. However, as the report concludes, “substantial reforms are under way and deserve support.” Considerable progress has been made in several areas. Some new instruments and partnership models show great promise.

The WHO emergencies programme, launched in August 2016, is playing a central role in coordinating a number of activities with partners. Early warning and rapid detection systems are being strengthened, and procedures are in place to activate established mechanisms for coordination that work well in humanitarian crises during outbreaks of infectious diseases. A formal process of quality control for the training and verification of emergency medical teams is strengthening the global health emergency workforce, offering vetted surge capacity during outbreaks. Member States, at all levels of economic development, are prioritizing peer-reviewed assessments of their core capacities to implement the International Health Regulations. Our main concern is the lack of assured financing and technical assistance to fill the gaps identified during these assessments.

The January Executive Board confirmed that the Pandemic Influenza Preparedness Framework, set up in 2011, works as a bold and innovative preparedness tool that puts virus sharing and benefit sharing on an equal footing. To date, the Framework has secured access to around 350 million doses of vaccine as preparedness for the next pandemic; partnership financial contributions from industry, amounting to more than $110 million, have been largely invested to build surveillance, laboratory, regulatory, and other capacities in developing countries.

This is one successful model for better preparedness, and there are other encouraging signs. The WHO R&D blueprint, developed in response to lessons learned during the Ebola outbreak, has been immediately applied to expedite the development of new medical products for Zika virus disease. It aims to cut the time needed to develop and manufacture candidate products from years to months. As noted in the report, the Coalition for Epidemic Preparedness Innovations, which draws on the blueprint and the WHO list of priority pathogens, holds great promise for developing vaccines ahead of epidemics. But, as always, the world needs much, much more to move from ample analysis to adequate action.

Political attention nearly always wanes as time passes and a crisis loses its sting. We must not let this happen. By ensuring a joined-up approach to global health security, supported by predictable and adequate financing, the international community can once and for all internalize the lessons learned from Ebola and other recent outbreaks, making the world permanently safer for future generations. In these uncertain times, one thing is sure: the volatile microbial world will deliver many more surprises.

The recurrence of Ebola outbreaks in endemic areas by transmission from animal reservoir to humans tells us that we have not seen the last of this deadly virus. In addition, there is some evidence that the virus itself has a tendency to relapse in some patients who have recovered from the initial infection.

Although we do not as yet know where the Ebola virus hides away from the immune system and what triggers its reactivation, there is no doubt about the ability of the virus to relapse as we have learnt from the well-known cases of two patients: a British nurse, Pauline Cafferkey, and an American doctor, Ian Crozier. Both Cafferkey and Crozier were relatively young (39y and 44y), had severe illness and high viral load. Further studies will tell whether such influences have significance in predicting potential cases of relapses. Thus the fear factor of “the virus returns” needs to be addressed.

However, until such time as we are able to elucidate the underlying mechanisms responsible for virus relapses and further studies on the host reservoir interaction are done, we need to focus on public education and awareness. We need to educate public on essential basic information about this deadly virus including its infectivity, mode of transmission, symptoms recognition, incubation period, spread of disease and sensible precaution to protect themselves and others. In this day and age, the importance of public education and awareness about Ebola cannot be exaggerated.

Dr Sayed Subhan Bukhari MBBS (Hons), DGUMed, MSc, FRCPath, Cert Mt
Consultant Clinical Microbiologist
University Hospitals of Leicester NHS Trust
Leicester Royal Infirmary
Leicester LE1 5WW
Email: sayed.bukhari@uhl-tr.nhs.uk

Mr Shaun Livsey
Biomedical Scientist in Microbiology
University Hospitals of Leicester NHS Trust
Leicester Royal Infirmary
Leicester LE1 5WW
Email: shaun.livsey@uhl-tr.nhs.uk