Meanwhile, crisis continues, while future readiness remains an open question
Ebola had already hit the big time, making its first appearance in a capital city nearly two months earlier, when the 67th World Health Assembly convened last year. Still, the highly infectious and deadly viral disease, which by then had been reported in three west African countries, got but a passing mention as World Health Organization Director General Margaret Chan gave her opening remarks in May 2014. A few weeks earlier, she told the gathering, she had declared the spread of polio a public health emergency of international concern. The spread of a disease once contained, she added, was due to factors “largely beyond the control of the health sector.” Those, she said, included migrant populations, civil unrest, and weak border patrols.
“Changes in the way humanity inhabits the planet,” she said in her fleeting reference to Ebola “have given the volatile microbial world multiple new opportunities to exploit.” Confirmation of an Ebola outbreak in Guinea two months earlier, she added, “brought to four the number of severe emerging viruses” making the rounds. Two months later the virus traveled with a man who had gotten sick in Liberia, from the capital of that country to Lagos, Nigeria, the most populous city in Africa. A month after that, the World Health Organization issued an announcement that Ebola, too, was a public health emergency of international concern.
As the 68th World Health Assembly opened this week, Dr. Chan used the first person singular as she announced reforms in response to failures the ongoing Ebola outbreak continues to illustrate. “I am creating a unified WHO program for health emergencies, accountable to me,” she began, naming the first of “five changes.” The others included “clear performance metrics,” a “global health emergency workforce, “new business processes to facilitate a rapid and effective response,” and the proposal of a $100 million contingency fund.
All have been cited as needed improvements in the months leading up to the assembly as the scope of the disaster in west Africa continued to demonstrate the consequences of the agency’s delayed response. Still, they only begin to address shortfalls that Ebola both highlighted and worsened, with its toll on health workforces and economies.
Dr. Robert Schooley of the University of California, San Diego, discusses some of those in the most recent issue of Clinical Infectious Diseases. His commentary, “All’s (almost) Quiet on the Western Front: Will We be Ready for the Next War,” responds to the outcomes of two Ebola patients treated in the United States and described in another article in the same issue of CID. Both arrived very sick and experience organ failure, both received intensive supportive care that included fluid replacement, mechanical ventilation and dialysis, and both survived. Both also received investigational treatment that may have given them an edge over the virus, but that remains unclear. What is clear is that the supportive therapy available to those two, and still unavailable to the great majority of west African Ebola patients is responsible, generally, for the far greater survival rates among those receiving it and those who don’t.
Opportunities to determine the effectiveness of experimental treatments and vaccines in large trials are already diminishing as the outbreak declines, Schooley notes. For that reason, and more, readiness to apply research will be essential when the next outbreak emerges. But funding cuts had already slowed research and development efforts at the National Institutes of Health, the Centers for Disease Control and Prevention, and the Food and Drug Administration, he adds. And even when the needed tools to save patients and stop the spread of disease exist, he writes, the health care capacities to administer them fall far short of what is needed. Efforts to develop those systems in partnership with the countries that need them have been advanced by initiatives that include the NIH and the President’s Emergency Plan for AIDS Relief Medical Education Partnership, but that also calls for continued commitment.
In the year since the last World Health Assembly and this one, the recognition that commitment is critical has grown. That the factors Chan cited a year ago, though “largely beyond the control of the health sector,” are among those the health sector must be prepared to confront has become, this year, at least, a starting point.