Frieden on Ebola: With “no alternative but to get to zero,” challenges remain getting, staying there

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At the House Cannon Office Building for a discussion on The Ebola Crisis in West Africa: An Update on Progress, Challenges and the Road to Recovery, this morning, from left to right: Rabih Torbay of International Medical Corps, Jeremy Konyndyk of USAID office of Foreign Disaster Assistance, Moderator Gwendoloyn Mikell of Georgetown University, Dr. Tom Frieden of the U.S. Centers for Disease Control and Prevention, Saran Kaba Jones of FACE Africa

When health response leaders gathered in Washington, DC this morning to deliver updates on the Ebola crisis in West Africa, the progress gained in recent months was evident as much in what they didn’t discuss as what they did.

The panel didn’t come to describe overflowing treatment wards, health workers sweltering in protective gear as they struggle to tend to the dying and dead, the toll among the ranks of those caregivers, or the steeply rising costs of inaction — those all remain. But they have been recounted and heard, finally, in the last several months. The continuing existence of those conditions, and the threats they pose globally as well as to people living in Sierra Leone, Liberia, Guinea, went untold, but provided the backdrop for the discussion hosted by the U.S. House of Representatives Africa Subcommittee, as panelists and guests focused on a future that has moved beyond the failures of the past and the present.

“I am very confident we will get to zero,” Dr. Tom Frieden of the U.S. Centers for Disease Control and Prevention said in answer to a question about the “endgame” (he later added “We have no alternative than to get to zero”). The goal, he added, that “we need to leave behind, is staying at zero.”

The magnitude of that goal is highlighted by how far from zero the crisis is now, with still rising rates of infection and death in Sierra Leone, and new outbreaks in Guinea where efforts to control the epidemic appeared close to success several times, but where, as Freiden put it, “it came roaring back.”

The challenges remaining of getting to zero, let alone laying the groundwork for conditions that would prevent an outbreak of the present unprecedented dimensions from recurring also were highlighted by audience members, a number of whom raised questions about disparities between efforts and outcomes in Liberia and Sierra Leone stressing responses from the United States, which began with the establishment of a command center and the deployment of 3000 troops to Liberia’s capital.

Frieden responded that the U.S. is striving to “do what is needed, where it is needed,” adding that the speed with which the epidemic has moved through the region “is frankly humbling.” Agreeing that the crisis “is definitely a regional problem,” he noted that the epidemic’s greatest impact in Sierra Leone came eight weeks after the epidemic’s greatest impact in Liberia. He added that he hopes to see progress resulting from efforts in Sierra Leone soon.

SLflagThe country also highlights the challenges that lie ahead, audience members, one of who came to the microphone waving Sierra Leone’s flag, said. Ebola has killed 12 physicians — including top infectious diseases experts —  in Sierra Leone, home to only about 100 physicians to begin with, Sierra Leone Embassy Head of Chancery Isatu Sema Aisha Silla, said.

In all of the countries, staying at zero will mean building health capacities in countries where fragile care systems already meant high rates of death from preventable and treatable illnesses, to build laboratory and surveillance systems that can note and respond to infectious outbreaks, Frieden said.

Staying at zero will mean replacing, as well as building a health workforce literally decimated by the crisis, rebuilding communities, and families, caring for orphans and restoring education while responding to both national and community level economic impacts, other panelists, who included Rabih Torbay of International Medical Corps and Jeremy Konyndyk, and moderator Gwendolyn Mikell of Georgetown University said.


Rep. Barbara Lee (D-Ca)

Staying at zero also will mean revisiting the wisdom of international economic policies that have demanded austerity measures that have weakened health and education systems in already fragile countries, one audience member commented.

And staying at zero will mean incorporating  and building the capacities of community members to meet current, ongoing and future responses, said panelist Saran Kaba Jones, the Liberian-born founder and chief officer of FACE Africa, a water and sanitation focused nonprofit. The staff of her organization is entirely Liberian she said, and when they turned their attention to community outreach and education in the epidemic, they found acceptance, she said. “We didn’t look foreign.”

“Not only do we need to address the immediate crisis,” said Rep. Barbara Lee (D-Calif), who attended the event, “but also the impact, and take the opportunity to address other issues.”




2 thoughts on “Frieden on Ebola: With “no alternative but to get to zero,” challenges remain getting, staying there

  1. David Fedson

    Rigorous public health efforts will be essential if the Ebola outbreak in West Africa is to be controlled. Nonetheless, mortality could probably be reduced in individual patients by treating them with inexpensive generic drugs that do not target the virus but instead modify the host response to the infection. Ebola patients suffer from endothelial dysfunction and a dramatic increase in vascular permeability. Endothelial barrier integrity can be restored by statins and angiotensin receptor blockers. Ebola scientists and health officials who have determined the agenda for the international Ebola response have shown no interest in this approach to treatment. However, local physicians in Sierra Leone have treated small groups of Ebola patients with a combination of atorvastatin and irbesartan, and almost all of their patients survived. These exciting results need to be externally validated, but if they stand up to scrutiny, they will radically transform the response to Ebola.

  2. Pingback: Ebola: Too little, too late, lost lessons from the recent past, too much too late . . . We’re reading chronicles and updates from West Africa | Science Speaks: HIV & TB News

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