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Posted by on Sep 25, 2014 in Disasters, Featured, Health, International | 7 comments

WHO, Obama and the Ebola riddle

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The so far limited Ebola crisis has the makings of a global epidemic to which the international community, including the World Health Organization and United States, do not have credible solutions. The virus is not contagious but is extraordinarily lethal with a 50% kill rate and is becoming endemic in a few countries. [icopyright one button toolbar]

The US Centers for Disease Control and Prevention has already warned that 1.4 million people may be affected in the world’s poorest countries within a few months, up from about 5,500 currently.

In addition to its potential for human misery, the tragedy lies in the confusion over response and the WHO, the organization on which the world relies for early warnings and plans for remedies, has lagged in epidemiological and scientific research. Its communication has been amateurish and the world had to wait for a national organization, the CDC, to ring the alarm bells required to arouse world leaders to Ebola’s potential for devastation.

The United Nations and WHO are suggesting a billion dollar fund and a globally coordinated fight on war footing. That prompted President Barack Obama to give his response the urgency of war by deciding to send about 3,000 soldiers to help Liberia, Sierra Leone and Guinea, which are the worst hit nations so far. But these are belated responses and their efficacy is unclear, apart from throwing a lot of money at a problem currently afflicting very poorly administered regions.

In principle, about half the affected persons can be saved by isolating them and letting the disease runs its course. There is no effective drug and medical protocol for those already stricken or vaccination to prevent others from falling to it.

There are some experimental drugs but none has been fully tested on humans or can be made available in enough quantities to save those already affected or the strengthen immunity of others. The few Western aid workers who have received the drugs may have improved but there is no telling what harmful side effects might strike them later.

Potentially, Ebola is another perplexing HIV-AIDS style epidemic that could spread through physical, though not necessarily sexual, contact. That is why persons treating Ebola patients have to dress like cosmonauts and equipping them to do their work is very expensive.

Isolating those who might have had contact with Ebola carriers is also very cumbersome and costly because the isolation must be nearly hermitic. Achieving such conditions in poor countries when thousands (or hundreds of thousand under CDC’s worst case scenarios) must be protected is nearly impossible. Very few formal health care facilities exist there and most poor people are cared for by families and friends using traditional herbal and similar remedies.

Keeping track of who touched who to properly understand the epidemiology is a herculean task especially as most African countries do not have clear administrative structures in small towns and rural areas where new Ebola cases might incubate.

So the costs of prevention and treatment will be high but results may be uncertain. Although the virus has received increasing attention over the past 12 years, it has not been thoroughly researched either for epidemiology or for remedies because it was restricted to a few thousand people in the poorest West African countries. Many others may have died from it without being identified because of the poverty and isolation surrounding its incubators.

There is vital need to fight this potentially catastrophic humanitarian emergency but efficacy should get as much cool headed attention as the emotional responses.

The international response now being organized with some urgency stems partly from fear that carriers will enter a much wider range of countries, including the US, through travel and immigration. So, early attention has focused on restricting or banning entrants from Liberia, Sierra Leone and Guinea. The entry curbs are also creeping towards other nearby countries.

For the WHO and United Nations such curbs are discriminatory and should be discouraged. But they are themselves partly to blame because funds cannot be rustled up without creating widespread fear among donor governments. Fear is also a useful ally to motivate other governments to move quickly to create isolation centers and train enough workers to deal correctly with care for Ebola patients.

The crucial work of prevention often means cutting off people from their families and traditional support systems by containing them in care facilities, which may become breeders of other infections in poor countries when hundreds are herded together in small spaces. Stigmatization and discrimination in the community is also hard to prevent without thorough and large scale public health education programs. It took decades of expensive work to reduce such stigmatization for HIV/AIDS.

Obama’s recent measures to fight Ebola in West Africa have created the impression that US tax payers will pay for and sort out this vast health issue, in addition to “destroying” Islamic terrorism and other threats to Americans.

Whatever Obama’s humanitarian reasons for getting involved, this is not an issue that US experts, soldiers and their allies can handle without comebacks. The governments on the front lines should be the first carriers of sacrifice. So far, they seem to be more focused on seeking external financial and expert help than quickly building their own “armies” of frontline health workers to face the disease.

As usual, all the frontline governments insist that they will take lead responsibility for fighting the Ebola wars but none has moved forcefully after the early actions that caused many of their own doctors, nurses and other health workers to get infected and die for lack of sufficient precautions. Currently, there seems little forward movement, awaiting cosmonaut style protection gear, equipment for isolation wards and leadership from foreign donors and aid workers.

The WHO is staffed by international employees, usually with diplomatic immunity and very high living and insurance costs. It employs many local staff on much less costly terms but sending them to risk acquiring infection while protecting its international staff seems ethically questionable. So it is opting for prudence on the ground.

There is a recent suggestion to create a new international fund probably managed by WHO (perhaps with private sector partners) to fight Ebola similarly to a fund established in the early days of HIV/AIDS. The battle against HIV/AIDS was fairly successful because it had become a disease of celebrities in the West, leading to a lot of media and political attention. Research on the virus was well funded partly for this reason.

But Ebola is a different disease with no victims yet in Hollywood or among high profile and well organized Western groups like the gay communities. It is a tragic disease in its third generation in isolated parts of the world.

If the CDC worst case scenarios are prophetic, Obama will need to make Ebola the topmost health priority and push all governments to provide funds and cooperate much more closely. So far, for instance, the rich Saudi government that receives over three million devotees mostly from Africa and Asia for to its annual Hajj pilgrimage has done little to help the global effort.

Its health ministry banned Hajj visas for Sierra Leone, Guinea, and Liberia but has offered no large scale financial or other help to prevent or treat Ebola victims even in Muslim communities of affected countries. Obama is the only knight in shining armor so far.

graphic via shutterstock.com

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