Disaster medicine or disastrous medicine?

What the Ebola epidemic has taught us

Most Europeans think it was a long time ago, but the residents of West Africa clearly feel the consequences of the Ebola epidemic that broke out in December 2013 and still continues today. So far, approximately 11,300 people have died as a result of the outbreak; more than 28,000 contracted the disease. And while the outbreak appears to be held at bay in many countries, there are still new cases occurring in several spots.

01/04/2016

 
The first disease cases are simply being overlooked. An infant in Guinea becomes infected and subsequently infects several villagers. These incidents are not reported at first because there is no epidemic and disease control system in the economically underdeveloped country. The virus is able to spread from one person to another until it is too late. Once the virus has reached the larger cities, it is only a small step across the country’s border. This is why in the future, an improved emergency alert system would need to be set up that takes effect faster and more accurately and contains outbreaks quicker. Even though there are a multitude of projects that focus on the outbreak, the consequences and the prevention of infectious diseases, a safe emergency alert system like the one in Europe can likely not be implemented in a speedy manner. One reason for this is the political structure of African countries. Corruption is still a big issue; funds don’t arrive where they are needed. That’s why hospitals typically are far from meeting European standards. There are nearly no rapid tests to assist in the early detection of infectious diseases. And yet they are the tools that could help to avoid major outbreaks and enormous laboratory expenses. Today’s RDTs (rapid diagnostic tests) generally work with test strips that like a pregnancy test display whether a patient has been infected with the Ebola virus or not. The advantage: the test is small enough to where it can be transported anywhere and it doesn’t cost as much as an S4 laboratory.
Photo: Pregnancy test ©panthermedia.net/anytka

The test for Ebola are similar to those for the determination of a pregnancy. A strip indicates whether the test is positive or negative; © panthermedia.net/anytka

Helping people help themselves

The Ebola epidemic would likely have claimed more lives without the extensive aid of domestic and foreign helpers. Organizations such as Doctors Without Borders/Medicins Sans Frontieres, the German Red Cross or the Robert Koch Institute to name just a few, sent medical and other personnel into these countries to help on location to keep the virus at bay. However, the main objective should always be to train experts in the countries themselves. Helping people help themselves can contribute in better preventing outbreaks. We need to continue fighting infectious diseases like malaria, HIV or dengue fever. The necessary structures need to be created to achieve this goal. At the same time, the Western world needs a better structure for its assistance programs.

The WHO, in particular, was heavily criticized during the Ebola epidemic to have failed in its response and thus also failed to declare an international public health emergency soon enough. It seems the criticism has been heard. During a press conference on November 18, 2015, Dr. David Nabarro, the UN Secretary-General’s Special Envoy on Ebola, emphasized that, "We have to remember that more than 11, 300 people have died. And so, it’s really good that there are many lessons learned exercises underway, including the Secretary-General’s High-level Panel on the Global Response to Health Crises and also the Review Committee on the Role of the International Health Regulations in Ebola Outbreak and Response. There are many other studies underway, as well. And I am pleased to see that lessons are being applied. […]WHO needs a powerful program of outbreaks and emergencies that is integrated across the whole organization with the staff and finance that it needs to respond to threats the kind we have seen with Ebola; that it has standby partnerships agreements with organizations involved in humanitarian and infectious disease work throughout the world that can be activated when needed; that it has funds that it requires that can be promptly disbursed and accessed as soon as there is an alert; and that it participates as leader of the humanitarian community in case of health threats."

Whether all involved parties have actually learned their lesson remains to be seen. Unfortunately, it takes another pandemic – which we actually hope will never come.
Photo: Simone Ernst; Copyright: B. Frommann

© B. Frommann

The article was written by Simone Ernst and translated from German by Elena O'Meara.
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