WFPHA Newsletter December 2014


If you can't see this e-mail properly, view it online

   
wfpha-newsletter-hdr
 
 

Special Issue on the Ebola Outbreak

In this Newsletter:

 

 
  ---  
 

1. Overview of the Outbreak

The outbreak of Ebola hemorrhagic fever in West Africa is unprecedented in scale. As of the end of November 2014 an estimated 7,000 deaths had been officially recorded.

The response to the outbreak has been criticised for its lack of urgency following initial reports of the outbreak. In May 2014, 149 deaths had been registered since March. The following few months would however show a significant increase in the speed of new infections.

The international community mobilised to support local relief efforts. Military forces have been used extensively in Liberia and Sierra Leone to implement quarantines, sometimes facing strong community resistance. In November 2014 President Obama asked Congress to approve funding of over 6 billion USD to help fund the international relief effort.

As of November 5th, 2014, 310 healthcare workers had died fighting the spread of the virus and treating people who had contracted it.

Timeline

19th March 2014

Health officials in Guinea announce the deaths of 23 people from an undetermined hemorrhagic fever

25th March 2014

Ministry of Health in Guinea notifies WHO of an outbreak of Ebola virus disease (EVD) in Guinea, with inclusion of 86 suspected cases and 60 deaths, including reports of suspected cases in Sierra Leone and Liberia

2nd May 2014 

African Regional Office of WHO registers a cumulative total of 226 clinical cases of EVD including 149 deaths

20th July 2014 

Nigeria registers first Ebola case

4th August 2014

The military is deployed in Liberia and Sierra Leone to implement quarantines

11th August 2014

WHO says death toll has passed 1,000

29th August

Article published online in Nature, claims testing of ZMapp drug to be 100% at reversion of advanced Ebola in primates

16th September 2014

US commits 3,000 military personnel to construct 17 new Ebola treatment centres

19 September 2014

8 members of a team raising awareness about Ebola killed when conducting their work in the community of Nzerekore, Guinea. The 8 people included health workers, local officials, and journalists

20th October 2014

WHO declares Nigeria Ebola outbreak to be over. 19 people contracted the virus, of whom 7 died

24th October 2014

Mali confirms first Ebola case

12nd November 2014 

New outbreak declared in Mali, with second person contracting the virus. Authorities had previously thought they had isolated the first case

30th November 2014

WHO announces official death toll at 6,928, up significantly from previous reports, suggesting prior under-reporting

Mapping

Exercise conducted at point of 6,388 reported deaths, mapped how the countries in West Africa had been impacted to date:

  • Liberia – 3177
  • Sierra Leone – 1768
  • Guinea – 1428
  • Nigeria – 8
  • Mali – 6

Source: World Health Organisation. 11 Dec 2014.

4th November – 25th November new cases reported as the following:

  • Sierra Leone – 612
  • Liberia – 160
  • Guinea – 76

Source: United Nations Office for the Coordination of Humanitarian Affairs, The Humanitarian Data Exchange. 11 Dec 2014.

Treatments

No FDA-approved vaccine or medicine is available for Ebola.

Symptoms of Ebola and complications are treated as their appearance. Some basic interventions such as providing intravenous fluids and balancing electrolytes, maintaining oxygen status and blood pressure and treating other infections, if occurring, can significantly improve the chances of survival when used early.

Recovery from Ebola depends on good supportive care and the patient’s immune response. People who recover from Ebola infection develop antibodies that last for at least 10 years, possibly longer. It is not clear if Ebola survivors are immune for life or if they can become infected with a different species of Ebola. 

The epidemic of Ebola in West Africa is the most severe known to date. The need for a vaccine and new remedies became more and more insistent.
Two experimental vaccins supported by the World Health Organization are tested.

 

The first of these two vaccines, the «VSV-EBOV», developed by the Health Office of Canada is tested at the University Hospitals of Geneva (HUG). It is based on the virus causing vesicular stomatitis, a disease that affects animals. This virus has been weakened and genetically modified to express the glycoprotein of Ebola Zaire (ZEBOV) and thus inducing an immune response against the real Ebola virus. This candidate vaccine, whose licence is owned by the american company NewLink Genetics, is already the subject of a clinical study phase I in the United States where ten volunteers were recruited. During this first stage, only the safety and immunogenicity of the vaccine, and not its effectiveness, are tested by injection in non-sick people. Others of these tests of phase I will be launched in Germany, Gabon, the Kenya out of a total of 250 volunteers. Five different doses of the Canadian vaccine will be evaluated to determine the dose that will be used for the test of effectiveness.

Vaccinations against the Ebola virus under test at the University hospitals of Geneva (HUG) have been suspended. Joint pain appeared in four volunteers led the medical team to stop the injections as a precaution.Vaccinations should resume on January 5. "It is unexpected, but nothing really new, in the case of viral infections", explained Dr. Marie-Paule Kieny, Deputy Director General at the World Health Organization.

 

The second, the «cAd3-EBOZ» produced by the British company GlaxoSmithKline (GSK), is tested at the « Centre hospitalier universitaire vaudois » (CHUV) in Lausanne. The same total number of volunteers — 250, have been called to participate in the test phase I for the GSK vaccine, half in Lausanne. This corresponds to a (avirulent) attenuated form of a chimpanzee adenovirus which produces a piece of the Ebola virus. Similar tests are currently underway in the United States, England and Mali.

"There is no risk for volunteers of the Ebola disease, because only an inactive piece of virus is injected," said Marie-Paule Kieny.

The first results of the study of phase I are expected for the end of the year, which would "very likely" launch at the beginning of 2015 efficiency tests in three African countries affected by Ebola.

 

Sources: WHO website, Le Temps, CDC website

Marta Lomazzi and Chris Jenkins

 
  ---  
 

2. Message from WFPHA President

Let us use evidence based facts over fear in managing the Ebola Epidemic

The 2014 Ebola epidemic is the largest in history, affecting multiple countries in West Africa. This concentrated epidemic in West Africa with a global impact has already infected close to 18,200 people and taken away the lives of around 6,580 patients as of December 12, 2014. Different institutions from around the world including the united nation agencies, international organizations, charitable organization, foundations, and individuals have responded to help stop the ongoing Ebola virus epidemic in West Africa. In addition different countries has responded to the epidemic as measures to protect their national security, as being bordering countries of affected countries, and as a humanitarian response. With the limited initial analysis of the situation the failure in the public health system those highly affected countries and the limited early response to the outbreak has played the major role in the spread of the deadly disease. 

 

Today everyone is concerned about the possibility of a widespread Ebola epidemic. Although it is very important to take threats of disease outbreaks seriously, it is also essential to keep an informed and reality-based perspective in order to reduce stress and anxiety associated with the fear around the issue. The best way to fight fear is with facts. The fact is that many viruses are easily transmitted, but Ebola is not one of them. You can get infected with the flu, the common cold, chicken pox and measles from someone who doesn’t even know that he or she is sick. That is one reason those viruses can spread so quickly. To get infected with Ebola, you need direct contact with the bodily fluids of a patient who is symptomatic of the disease — someone very sick indeed. Despite these facts the fear has even made politicians and policy makers to make decisions contrary to the existing public health evidence in the prevention and control of the epidemic. As public health professionals, we need to concentrate on facts, not fear, by sharing evidence based information by using people working to help bring this epidemic under control. Transparency, truth and constant communication should be used as weapons to attack the fear.

 

The World Federation of Public Health Associations (WFPHA) has been expressing its solidarity with the people in the countries affected by the Ebola outbreak right from the start of the epidemic and will continue to work with its member associations and partners in bringing a long lasting solution to this human catastrophe. WFPHA in collaboration with concerned institutions and individuals will ensure that emergency/pandemic preparedness is a topic to be discussed at its triennial event the 14th World Congress on Public Health to be held from 11-15 February, 2015 in Kolkata, India. 

The Federation and its leadership regrets the suffering and pain experienced by those infected and affected and salute the dedication of thousands of champion public health professionals who are working under difficult circumstances to contain the deadly pandemic. It also calls for the use of evidence based public health facts over fear in managing the current epidemic and other public health disasters.

Mengistu Asnake

---

3. Joint WFPHA/AFPHA Statement on Ebola Outbreak

 

The World Federation of Public Health Associations and the African Federation of Public Health Associations (AFPHA) have issued a statement to call on mobilizing public health resources and revitalizing primary health care for a sustainable response to the current Ebola situation and public health emergencies.

After having expressed their solidarity with the people in the countries affected directly by the Ebola outbreak, the WFPHA and AFPHA have called for different interventions to face the epidemic:
1. Call upon the African Union to remind Member States with a strong voice about the urgency to operationalize the framework for implementation of the Ouagadougou Declaration on primary health care and the health systems in Africa, developed by WHO AFRO in 2010 to strengthen their institutional capacity to act on the social determinants of health in a concerted manner, to take care effectively the double burden of communicable and non-communicable diseases while preparing for the risk management of the disease outbreaks such as cholera and Ebola which have become recurrent and devastating;
2. Call upon all National Public Health Associations to get involved in national and inter-African efforts to respond and contain the epidemic;
3. Appeal to all African countries, all African organizations and the international community for a greater solidarity with the countries directly affected and at risk;
4. Encourage African countries, friends of African countries and organizations as well as WHO to intensify efforts to contain the advance of the epidemic with full respect of human rights and ethical practice;
5. Call upon National governments to develop and implement strategies and tools including adequate resource allocation which enhance disaster/emergency response risk management so as to improve the capacity of national health care systems to respond to public health emergencies, such as Ebola;
6. Call upon sister health professions’ federations worldwide for an active solidarity in terms of their capacity-building and technical support and those of their member associations in the fight against public health emergencies like the Ebola epidemic.

 

To read the statement click on the corrsponding language:

English - French

 
  ---   
 

4. Reflection on a succesfull containment

Nigeria’s Public Health Association and the Ebola epidemic

Ebola haemorrhagic fever had first occurred globally in 1976in the Democratic Republic of Congo as well as the Sudan and had remained virtually confined to the Central African region as an endemic disease since then. The current epidemic entry into West Africa started in December 2013 and started to acquire a pandemic dimension by March; yet reasonably confined to the West African countries of Guinea, Liberia and Sierra Leon. On July 20th, an infected American Librarian diplomat travelled from Liberia to Nigeria against previous medical advice and brought the disease to the country. On the whole, primary contacts of this index case, in the plane in which he travelled and the hospital in which he was treated, visited 3 others of the 36 Nigerian states and its Federal Capital Territory, namely Cross River, Enugu and Rivers States; but the disease was only transported to just one of those states – Rivers State. Totally 20 cases of the disease occurred and only 8 deaths recorded before the disease was contained. All the primary, secondary and tertiary contacts of the primary and infected contacts have been traced and their blood tested and quarantined or other surveillance exercised over the 21 days incubation periods necessary for these contacts to develop the disease if the infection occurred. WHO has declared Nigeria Ebola free of the disease on October 20th, 2014. Two of the infected contacts who died were those who refused to show up early in the disease symptomatology due to the ilness stigmatization, showing the value of early reporting and supportive treatment in the disease for survival.

 

nigeria

Ebola entry point screening procedure (now in all 170 land entry points and at all airports)

 

The Society for Public Health Professionals of Nigeria (SPHPN) as the umbrella all-comers PH associations in the country and her members played most of the active parts in the control of the disease. The president of the SPHPN (Prof. MC Asuzu) was designated the Nigeria Medical Association Chairman of its national committee for the EVD and all other future medical and health emergencies in the country henceforth beginning from the middle of the epidemic. One of our members and immediate past state Chairman of one of the corporate disciplinary PH associations, Prof. AT Onajole, was made the Lagos State Chairman of the Surveillance and Contact Tracing Committee for Lagos State as the epicentre of the epidemic. Their committee traced all the primary, secondary and tertiary contacts of the index case as well as managed all the false rumours and unhealthy fears about the disease. The other members from the other corporate members of the Association of Public Health Physicians of Nigeria also served in this committee as well. The Director of the Nigerian Centre for Disease Control as well as of our International and Port Health Services and their members of staff, all or mostly members of the SPHPN, were involved in the laboratory services and the field epidemiological work and staff trainings on personal hygiene and personal protective equipment usages for the epidemic control.

The experiences of our members is now being used to beef up our national preparedness for all future medical and health emergencies in the country.

MC Asuzu

 
   ---  
 

5. WFPHA Members response to the Ebola Outbreak

African Federation of Public Health Associations & Ethiopian Public Health Association

In addition to the joint WFPHA/AFPHA statement on Ebola reported above, the African Federation of Public Health Associations has participated to a dedicated panel.

Dr Tewabech Bishaw, AFPHA Secretary General, has made a presentation at the panel discussion on the current Ebola Outbreak organized by the Ethiopian Public Health Association (EPHA) in collaboration with the Ethiopian Academy of Science (EAS) on November 19th 2014. 

 

EAS pic2

Panelists of the panel discussion on the Ebola Outbreak

 

The half day panel discussion was attended by more than 400 participants and led to a joint Statement on the Current Situation of Ebola Virus Disease.
To read the EPHA /EAS joint statement, click here.

 

EAS pic

Participants of the panel discussion on the Ebola Outbreak

Dereje Tilahun

Public Health Association of Australia

The Public Health Association of Australia (PHAA) has been working with others to bring pressure on the Australian Government to urgently respond to calls from the World Health Organisation and the United Nations to offer assistance in West Africa.In the last media release, PHAA Chief Executive Officer (CEO) Michael Moore said, “The Government deserves congratulations on working closely with the British Government to find a way to assist Australian health volunteers to pitch into fight the spread of this awful disease" and acknowledged the Australian Government for:

• The commitment of an additional $20 million over the next eight months for the treatment facility in Sierra Leone 

• Additional funding of $2 million to RedR Australia for technical expertise in front line roles in West Africa • Ensuring Australian readiness for any cases that come to this country 

• The financial contribution of $18 million dollars already committed to the crisis 

• Commitment to supporting any need within our region including o using Australian Medical Assistance Teams (AUSMAT) in the region if needed o $2 million to train health officials in Papua New Guinea, Timor-Leste and the Pacific Islands 

• Supporting volunteers who are willing to staff the British field hospital in Sierra Leone.  

 

“However, the PHAA has major concerns that although this is a big step forward, this significant contribution may still be too little too late,” added Mr Moore. The PHAA continues to call on the Australian Government to do the following:

• Provide Australian troops and equipment and other logistical support 

• Deploy our Australian Medical Assistance Teams in West Africa 

• Directly assemble, train and support appropriately qualified health professionals and other skilled civilians who are ready and waiting to help. 

The PHAA supports the statement from the Prime Minister which explains the risk to Australians, which needs to be kept in perspective: “While Ebola is a serious disease, it is not highly contagious. The risk of an outbreak of Ebola in Australia remains low, including from returning aid workers”. 

 

For more information, click on the corresponding document:

PHAA Statement on Ebola Response

PHAA urges action on Ebola response

More Australian action needed on Ebola

Professors' call to action - Letter to PM to increase international efforts to control Ebola outbreak

Australian Health Professors call for more Government action

Ebola Comprehensive Approach

Ebola PHAA welcomes next step by Government

African Federation of Medical Students' Associations

FAMSA collaborate with Global MOOC to provide Ebola training in French

A free online course on avoiding the Ebola virus has been taken by more than 10,000 people across the worst affected countries in West Africa, and is set to reach millions more, thanks to a French translation project involving medical students across the continent. 

The course, entitled ‘Understanding the Ebola Virus and How You Can Avoid It’, was launched last August, by global MOOC (Massive Open Online Course) provider ALISON in response to the worsening Ebola crisis. 

The training program, which dispels the myths surrounding Ebola and imparts practical knowledge and advice on avoiding transmission, is now being offered free-of-charge in French, as a result of a ground-breaking collaboration with FAMSA, the Federation of African Medical Students' Associations.

 

ALISON CEO and Ashoka fellow Mike Feerick said that, as one of Africa’s largest educators, with more than one millions learners on the continent, the company felt a responsibility to become involved in the fight against Ebola. 

“Our learners in West Africa have been telling us, in their thousands, how important access to accurate information on Ebola is,” Mr Feerick said. “Translating the course into French is enabling us to reach many more millions of people in West Africa and worldwide. FAMSA has provided invaluable translation and specialist review services to assist in reaching as many people as possible.”

Dr Eric Corbett, Head of Content at ALISON described the FAMSA collaboration as a fruitful one.

“FAMSA provided both the medical and linguistic expertise to ensure an accurate translation of the course content, enabling us to create a dynamic interactive learning experience for French speakers worldwide.”

FAMSA members Adelard Kakunze (Burundi); Moumini Niaone (Burkina Faso); Hashim Hounkpatin (Benin); and Mahutin Adonis Siegried Logbo (Benin) volunteered their skills to help French speakers across Africa. 

The translation work was coordinated by Dr Dorcas Naa Dedei Aryeetey, Chairperson FAMSA-SCOMER (Standing Committee on Medical Education and Research). 

Feedback from ALISON learners in West Africa highlights the fact that numerous community activists who took the course shared their knowledge with family, friends and work colleagues, as well as with the wider community through public meetings and presentations. 

Gus Flomo, a community activist based in Monrovia, Liberia, said the ALISON course filled a knowledge gap on Ebola.

“In the midst of limited educational materials and support in Liberia where I work, the course was essential,” Mr Flomo said. “I personally passed this knowledge on to many people when I was involved with education about Ebola in rural towns and villages.  I made maximum use of the knowledge gained and it helped me to be more prepared to help my family understand and my county understand the risks.”

The course was developed using as core content guidelines from the WHO (World Health Organisation), and the US-based CDC (Centre for Disease Control and Prevention).

Public Health Foundation of Bangladesh

Social Mobilization: a Social Vaccine  in Ebola Virus Disease 

The people in the globe are now at threat of Ebola Virus Disease (EVD) that is prevailing especially in countries of West Africa. On the other hand the infected persons are at serious threat of social stigma imposed by non-infected persons in those countries. Infected persons are thrown out from the house and family. Finally deaths become inevitable.

 

Bangladesh has been put into the least threatened countries comparing to the states with Ebola transmission, states with a potential Ebola case and unaffected states with land borders with affected states. Bangladesh had already taken effective preventive measures suggested by the international organization. The measures include careful screening of the people returning from Ebola-affected countries and also giving adequate safety training on the threat of Ebola exposure to the people going to those countries. Measures taken by the Government of Bangladesh include:

1. Opening of  a 20 bedded  Ebola ward in Kurmitola General Hospital, Dhaka 

2. Medical team formed in 25 point of entries (POE) – 20 land ports, 3 airports & 2 sea ports

3. PPE provided to all Medical teams including UN Missions in the infected country – 200 sets

4. People coming from infected countries are being followed for 21 day on arrival to Bangladesh – 202 passengers screened

5. EDCR/DGHS conducting training for the Rapid Response Team members, Clinicians, and Nurses – Total - 3953; EBOLA - 1606

6. All essential medicines kept ready

7. Thermal scanner procurement in progress

 

In addition various health science institutes including medical colleges and public health institutes organized seminar and poster presentation for building awareness at the community level.

Professor Dr. Sharmeen Yasmeen, conducted presentation on “Pandemicity of Ebola Virus Disease : a Global Threat” on 6 November, 2014 at Bangladesh Medical College, Dhaka and on 7 December, at icddrb in the scientific conference of Public Health Foundation of Bangladesh

 

prof.shrmeen20

 CME programme of BMC on EVD

 

Also Mohammad Alveed Shahid,  Asir Mohammad Sharif, Nuzaira Nahid, Sakib Sarwat Haque, and Fahim Abrar Hossain, final year MBBS student of Bangladesh Medical College and volunteer of Public Health Foundation of Bangladesh participated in the poster presentation on “Ebola Virus Disease: a Review” in the same conference.

 

poster20and20participants 

Poster presentation on “Ebola Virus Disease: a Review”

 

High case fatality with the presence of social stigma in our country can worsen the situation significantly when other factors are in association like weak health infrastructure, lack of knowledge, poverty, malnutrition, poor health seeking behavior and various other socio-cultural barriers. Until now no vaccines and no chemoprophylaxis are available. But in the last and current epidemic of EVD, social mobilization with supplementation of social networking has proven miracle. In west Africa this social or community mobilization is fighting to win over social stigma due to EVD.

Education and training are the important tools for creating awareness if these are compatible with the suitable communication system towards the mass people. So let us realize and recognize  this social mobilization as revolutionary social vaccine against social stigma resulting from EVD and other deadly diseases.

Sharmeen Yasmeen

Burkina Faso Public Health Association

Contribution of African National Public Health Associations in the preparedness of non-affected West-African countries to the Ebola epidemic: Burkina Faso Public Health Association                      

The Ebola virus disease epidemic began in Guinea in December 2013 and on March 23, 2014 the World Health Organization (WHO) has officially notified of the outbreak. A “public health emergency of international concern” was declared 5 months later.1 Unaffected West African countries have mobilized with the world health organization to put in place strategies and action plans to respond to the Ebola Virus Disease (EVD). As specified in the Ebola Response Roadmap, the objective is to strengthen preparedness in those countries to rapidly detect and respond to an Ebola exposure, especially those sharing land borders with areas of active transmission and those with international transportation hubs.2 

 

In this mobilization, national public health organizations have a crucial role. As mentioned in the Joint statement of the World Federation of Public Health Associations (WFPHA) and the African Federation of Public Health Associations (AFPHA), “they are part of the solution”. In Burkina Faso, Association Burkinabe de Santé Publique (ABSP), the national member organization of the World Federation of Public Health Associations, initiated and designed a national consultation of civil society organizations active in health sector to reinforce prevention measures against Ebola epidemic. A landmark meeting held on October 22, 2014 at ABSP’s office designed a three days consultation to be held by mid-January 2015 in Ouagadougou and targeting nationwide organizations active in health sector. This activity aims at reinforcing organizations’ knowledge with the latest evidence on the EVD and build synergies in their specific ground interventions as it pertains to the disease prevention. With confirmed active support and participation of experts from the world health organization and the Ministry of Health, the consultation will have as main outcome a budgeted 2015 national roadmap for strategic engagement of 126 targeted organizations coming from 63 sanitary districts across the country to support the Ministry of Health’s actions.As a landlocked country sharing borders with six West African countries, Burkina Faso is a crossroad in the region and as such, is at great risk of imported case of EVD. This unique feature was taken into account in the consultation design to put emphasis on sanitary districts sharing boarders with neighboring countries as well as districts covering mining extraction industries and their ecosystems. It is expected that this activity will also pave the way towards a strong involvement of civil society organizations in Burkina Faso in a national epidemic preparedness capability building. As the matter of fact, other diseases such as dengue fever occurring sporadically in epidemics in Burkina Faso need more research and public health interventions3

  1. Ebola Virus Disease in West Africa — The First 9 Months of the Epidemic and Forward Projections. N.Engl.J.Med. 2014 09/22; 2014/10. 

  2. Ebola Response Roadmap- World Health Organization 28th August 2014 

  3. Ridde et al. (2014) The need for more research and public health interventions on dengue fever in Burkina Faso. PLoS Negl Trop Dis 8(6)

Mathias Some

Cameroon Public Health Association

The Cameroon Public Health Association has submitted an advocacy statement to the Presidency of the Republic of Cameroon, the Ministry of public health and other allied sectors in the government, since April 2014, calling the Executive and Legislative powers supported by bi and multilateral partners, the private sector, the civil society and councils, to invest on health system’s strengthening and the reduction of health inequalities in Cameroon by 2035.

This Statement is particularly timely when considering that the African continent is facing a terrible Ebola outbreak and with Cameroon being a neighboring country to Nigeria.

The issues of health system strengthening and primary health care revitalization are the main challenges to tackle alongside with the response to the Ebola epidemic as the Joint WFPHA/AFPHA statement recalled.

 

To read the Statement, click here (available in French only).

Dominique Kondji Kondji

International Federation of Medical Students' Associations

Medical Students Worldwide vs Ebola

‘We do not organize group gatherings; we do not have religious burials anymore;we do not shake hands with our friends but wave from distance.’ A medical student from Sierra Leone

 

The Ebola outbreak in Sierra Leone, Guinea and Liberia has directly affected the health system, by causing thousands of deaths and indirectly by disturbing other health priorities, such are maternal and child health, and HIV/AIDS management. With only 25-45 doctors graduating annually in Sierra Leone, the closing of the university and only medical school in the country will have severe influence in months and years to come, showing the need for change in the education of healthcare professionals. 

After the closure of Sierra Leone’s only medical school, Sierra Leone medical students (SLeMSA) felt responsibility as future health professionals to take the lead by founding a KickEbolaOut (KEO) Campaign. The campaign has caused a mobilisation wave through International Federation of Medical Students’ Associations (IFMSA) and a big number of international medical students are now supporting their colleagues in the Ebola affected countries. A similar campaign is undertaken by students in Guinea, with the support from UNICEF.

In late August 2014, local officials from Sierra Leone Ministry of Health and Sanitation provided training for 50 volunteers from SLeMSA. The volunteers performed a community outreach in Freetown, the capital of Sierra Leone. Not only was it a valuable learning opportunity, the students made and are still making a substantial contribution to the control of the outbreak through raising awareness among the community, busting the myths and spreading messages in preventive measures against Ebola. 

With this success, the global KickEbolaOut Working Group has been established in September, with members from more than 20 countries helping steward the campaign for maximum impact and thinking strategically about further steps needed to tackle Ebola and monitor the outcomes of the work. Through IFMSA the goal to fight Ebola has mobilized over 50 medical students from Brazil, Canada, over Portugal, England, Switzerland and Croatia to Hong Kong and Japan and many more. Globally, they started a campaign on social media with crowdfunding to raise awareness about the lack of health workers and the need to respond to the Ebola outbreak, organizing international, online and university based fundraising events collecting more than 5000 $ for local projects in Sierra Leone.

Currently international team of medical students and young doctors is preparing a mobile phone learning platform for healthcare students in Sierra Leone and worldwide about Ebola, focusing on prevention, transmission, surveillance and management of the disease being aware of cultural and religious background of the areas affected. The medical students in Sierra Leone will also be delving into other areas of the outbreak such as research, infection control and orphan care.

Thanks to the international support, further impact of medical students from Sierra Leone is being empowered and supported by their colleagues from all over the world, showing the empathy and professionalism of future doctors.

Ljiljana Lukic, Asad Naveed and Tola Awonuga

At the forefront of the Ebola Outbreak - Sierra Leone Medical Students’ Association

Michael dashes to the white board and back to his seat. Phones rang in endless fashion; he made to answer the call in a precise manner. In between answering the calls, his eyes remained glued to his computer screen as if his entire life depended on it. Flurry of activities could be seen going on from desk to desk. I sat close to Michael for 30 minutes and my presence wasn’t even noticed until whatever issue he had going on was solved. Michael is one of the numerous Sierra Leone Medical Students’ Association (SLeMSA) members who are engaged in the fight against the dreaded Ebola virus in Sierra Leone. It was indeed an engaging workspace which gave room for no idleness. 

 

The Ebola virus has taken its toll on our daily life affecting the economy, breaking up families, closing down schools and killing top Sierra Leonean doctors in its wake. It was the reality of the danger that stares us in the face that has prompted all capable hands to be on deck in the fight against this deadly scourge. The Sierra Leone Medical Students have been in the forefront in this regard working as Case Managers, Surveillance Officers, Contact Tracers and Screening team. They have provided the government a workforce which not only has the ability to work in emergency situations but that understands the public health challenge that this disease poses. On the other hand, this activity has also afforded members the opportunity to have a clearer practical understanding of what has often been read in books and journals. 

Taking a cursory look at the Western Area Emergency Response Centre (WAERC) as an example, SLeMSA is ably represented by medical students who are working as Case Managers. The regular working schedule of the managers spans 8am through 7pm every day! The Case Managers’ work roles involve liaising with all isolation and treatment centres, to determine daily bed availability to make patient referrals from the communities into these centres. It also involves maintaining an up to date database of all patient movements and outcomes and checking Ebola lab results everyday.

The above represent a great work load which must be done daily and the case managers have been very efficient in maintaining the prompt transfer of both suspected cases and confirmed cases.

The airport which is an important port of entry for people moving out and coming into the country is also manned adequately by SleMSA members working as screening officials. Our members, up to 20 in number can be seen at the departure and arrival areas of the airport armed with their electronic thermometers screening and assessing travellers; it is to our record that no case has been recorded of any Sierra Leonean citizen escaping their watch to cause infection in other countries.

The Surveillance team is also an important arm of the WAERC with above 100 medical students. The team assesses patients to ascertain if they meet the case definition for Ebola to be taken to the holding centre.

Together, SLEMSA has been active in this fight and has proved to be an invaluable asset to the Government and her partners in stopping the spread of the disease. 

Tola Awonugah

Italian Society of Hygiene, Preventive Medicine and Public Health

According to World Health Organization (WHO), major role and responsibilities, assigned to national agencies or national and academic institutions, included (i) assistance to governments through expert task teams and/or working groups to address priority gaps in normative and technical guidance and (ii) providing technical expertise, training and capacity building for essential targeted functions including surveillance systems, data generation, information management, and implementation of Ebola response interventions [World Health Organization Ebola response roadmap. August 2014].

 

Since the very beginning of the Ebola outbreak, the Italian Society of Hygiene, Preventive Medicine and Public Health (SItI) has been engaged in these tasks. Several members of SItI provided technical expertise to draw up national recommendations about surveillance strategy at international transportation hubs and  management of travelers who arrive at international airports with unexplained febrile illness with potential exposure to Ebola and guidance for the management of suspected and confirmed cases of Ebola and their contacts throughout the Country. In particular the guidance, released on October 1st 2014 by the Italian Ministry of Health, established the national reference centers for the management of these cases and provided recommendations about epidemiological criteria to define the risk of exposure, initial assessment and management of suspected cases of Ebola virus disease, transportation of these patients to the national reference centers and precautions to be adopted for the protection of healthcare workers. Members of SItI  were also involved in the draft of regional or local guidance for the management of suspected cases. Our Society has been also engaged in the education of healthcare workers and in social communication about Ebola.

Indeed SItI dedicated a plenary session of its 47° National Congress, held from 1 to 4 October 2014 in Riccione, to Ebola outbreak: over one thousands specialists in hygiene and preventive medicine attended this session. Furthermore, in the last few months, the regional sections of the Society organized several regional and local courses on this global health threat in order to educate healthcare workers (HCWs) about the epidemic, the transmission of the virus and the precautions to be adopted for their protection. According to WHO roadmap, specific accelerated training programmes have been developed, at local and hospital level, to train HCWs on infection prevention and control measures and proper use of personal protective equipment.

Moreover the Italian Society of Hygiene, and its regional sections, contributed to social and media communication about the outbreak through television, newspapers and websites. In particular, the Society communications activities aimed at  enhancing  community understanding of the Ebola epidemic, the real risk of disease in Italy and the risk mitigation measures.

Giancarlo Icardi

Spanish Association of Public Health and Health Administration

Coping with Ebola in Spain: the role of SESPAS

The Ebola crisis, which represents such an enormous challenge in Western Africa, has also posed public health communications questions in many other parts of the world. Spain had the first case of infection outside Africa and consequently became a focus of international media and public attention. The Spanish Government had resolved to repatriate two religious volunteers engaged in the fight against the disease in Africa. While taking care of one of these patients, an auxiliary nurse became infected. In spite of the quality of public health services in Spain, the failure to implement proper procedures in the follow-up of the health care workers in charge of the patients led to a potential spread of the disease. In fact the nurse continued with her daily life and contacts despite presenting fever. It appears that the arrangements made by the national and regional health authorities were insufficient. The situation created a high level of public alarm compounded by a low level response by the Ministry of Health.

 

In this context the Spanish Association of Public Health and Health Administration (SESPAS) had to face a huge demand from the media for information updates and to respond to public anxiety. Most interventions are available at SESPAS website. Our approach to communication was based on the following aims. First of all, to reassure the public of the quality and competence of the public health system in dealing with the problem; creating trust is crucial in crisis management. Second, to ensure that the public had access to accurate information on risks. Third, to remind both Ministers and public through the media that public health is fundamental for good governance. We think that the response to any crisis should include a strategy to raise the profile of public health on the political agenda. SESPAS also contributed to the management of the problem by facilitating expertise in committee work and protocols. We took part in task groups and provided advice to health authorities.

 

In the aftermath of the crisis we are still in a process of constructive criticism of the health authorities and highlighting some of the failings. Public health should never be neglected. Plans of preparedness and response to health crises should always be available. Plans must be flexible and easy to adapt, in other words we need generic plans of high quality that can be adjusted to any challenge. 

The issue is clearly not only a question of confronting acute crises. In the midst of the present impetus to squeeze the size of states with the pretext of the economic crisis, reducing public health infrastructure is a temptation to some politicians. In Spain, the Madrid Region has relegated public health on the government organization agenda and the central government is infringing the Public Health Law. This neglect of public health could explain some of the observed failures in managing the Ebola crisis in spite of the high quality professionals available. The situation shows again how disregarding public health has harmful consequences. The Ebola case has produced negative effects in public trust, but Spain also faces other serious health problems without proper response capacity. SESPAS is now working to expose the links between overall disregard of public health and societal dysfunction. In particular we are preparing a statement on some social determinants and health outcomes such as the connection between infant poverty and health.

Ildefonso Hernández-Aguado

 

 

  ---  
 

6. World Health Organization

Health-system resilience: reflections on the Ebola crisis in western Africa

Bull World Health Organ 2014;92:850 | doi: http://dx.doi.org/10.2471/BLT.14.149278 

Marie-Paule Kieny, David B Evans, Gerard Schmetsa & Sowmya Kadandalea - WHO

 

Disease outbreaks and catastrophes can affect countries at any time, causing substantial human suffering and deaths and economic losses. If health systems are ill-equipped to deal with such situations, the affected populations can be very vulnerable.1 The current Ebola virus disease outbreak in western Africa highlights how an epidemic can proliferate rapidly and pose huge problems in the absence of a strong health system capable of a rapid and integrated response. The outbreak began in Guinea in December 2013 but soon spread into neighbouring Liberia and Sierra Leone.2 In early August 2014, Ebola was declared an international public health emergency.2 At the time the outbreak began, the capacity of the health systems in Guinea, Liberia and Sierra Leone was limited. Several health system functions that are generally considered essential were not performing well and this hampered the development of a suitable and timely response to the outbreak. There were inadequate numbers of qualified health workers.3 Infrastructure, logistics, health information, surveillance, governance and drug supply systems were weak. The organization and management of health services was sub-optimal. Government health expenditure was low whereas private expenditure – mostly in the form of direct out-of-pocket payments for health services – was relatively high.4 The last decade has seen increased external health-related aid to Guinea, Liberia and Sierra Leone. However, in the context of Millennium Development Goals 4, 5 and 6, most of this aid has been allocated to combat human immunodeficiency virus infection, malaria and tuberculosis, with much of the residual going to maternal and child health services. Therefore, relatively little external aid was left to support overall development of health systems.5 This lack of balanced investment in the health systems contributes to the challenges of controlling the current Ebola outbreak. Weak health systems cannot be resilient.6–8 A strong health system decreases a country’s vulnerability to health risks and ensures a high level of preparedness to mitigate the impact of any crises. Frequently, the response by governments and external partners to a health crisis posed by a communicable disease, such as Ebola, is to focus solely on reducing transmission and the effect of the disease. However, such a response is insufficient. Febrile individuals need to be screened for Ebola – even if most of them have fevers caused by other infections – and those found to be negative for Ebola still need to be treated rather than simply turned away. Even in the worst-affected areas, women still need antenatal services, safe delivery and postnatal care. Many people will travel to seek care for unrelated conditions in areas that they perceive to be Ebola-free, putting enormous strain on the health system in so-called “non-Ebola” areas. Routine services need to be assured while dealing with the direct effects of an epidemic. Otherwise, more people may die – of unrelated causes – from a general breakdown of health services than as a direct result of the epidemic. If this Ebola outbreak does not trigger substantial investments in health systems and adequate reforms in the worst-affected countries, pre-existing deficiencies in health systems will be exacerbated. The national governments, assisted by external partners, need to develop and implement strategies to make their health systems stronger and more resilient. Only then can they meet the essential health needs of their populations and develop strong disaster preparedness to address future emergencies. In the short-term, nongovernmental organizations, civil society and international organizations will have to bolster the national health systems, both to mitigate the direct consequences of the outbreak and to ensure that all essential health services are being delivered. However, this assistance should be carefully coordinated under the leadership of the national governments and follow development effectiveness principles. We expect health systems in the worst- affected areas to be left in a very weak state once the outbreak has ended. Hopefully, after the epidemic has ended, economic growth and government health spending will eventually rebound, with increased domestic investments in health systems. For the foreseeable future however, the negative economic impact on the affected countries9 means that substantial external financing will be needed to build stronger national and subnational health systems. 

 

1. Strengthening health-system emergency preparedness: toolkit for assessing health- system capacity for crisis management. Copenhagen: World Health Organization; 2012. Available from: http://www.euro.who. int/__data/assets/pdf_file/0008/157886/ e96187.pdf [cited 2014 Nov 3].
2. Statement on the 1st meeting of the IHR Emergency Committee on the 2014 Ebola outbreak in West Africa [Internet]. Geneva: World Health Organization; 2014. Available from: http://www.who.int/mediacentre/news/ statements/2014/ebola-20140808/en/ [cited 2014 Nov 3].
3. Global Health Observatory [Internet]. Geneva: World Health Organization; 2014. Available from: http://www.who.int/gho/en/ [cited 2014 Nov 3].
4. Global health expenditure database [Internet]. Geneva: World Health Organization; 2014. Available from: http://apps.who.int/nha/ database [cited 2014 Nov 3].
5. From whom to whom? Official development assistance for health, 2nd edition, 2000–2002. Geneva: World Health Organization; 2012. Available from: http://apps.who.int/iris/ bitstream/10665/77930/1/WHO_HSS_ HDS_2012.1_eng.pdf [cited 2014 Nov 3].
6. Bayntun C, Rockenschaub G, Murray V. Developing a health system approach to disaster management: a qualitative analysis of the core literature to complement the WHO toolkit for assessing health-system capacity for crisis management. PLoS Curr. 2012;4:b6037259a. PMID: 23066520
7. Health systems in urban disasters. Kobe: World Health Organization; 2013. Available from: http://www.who.int/kobe_centre/ emergencies/Health-systems-in-urban- disasters_2013.pdf?ua=1 [cited 2014 Nov 3]. 8. Pavignani E, Colombo S. Analysing disrupted health sectors: a modular manual. Geneva: World Health Organization; 2009. Available from: http://www.who.int/hac/techguidance/ tools/disrupted_sectors/adhsm_en.pdf?ua=1 [cited 2014 Nov 3].
9. The economic impact of the 2014 Ebola epidemic: short and medium term estimates for West Africa. Washington: World Bank; 2014. 
 
Other WHO articles and communications are available at point 15.
 
  ---  
 

7. African Union

The African Union Commission (AUC) has contributed through the African Union support to Ebola Outbreak in West Africa (ASEOWA) to on-going efforts at addressing the Ebola Virus Disease outbreak in West Africa.

Detailed descriptions of the activities and latest updates are available here.

Decision of the Executive Council - 16th Extraordinary Session on the EDV Outbreak

Addis Ababa, Ethiopia, 8 September 2014

To read the decision, click here.

Ethiopia Contributes to African Union Ebola Response Efforts

The Federal Democratic Republic of Ethiopia has answered to the appeal made by the African Union Commission Chairperson, H.E. Dr. Nkosazana Dlamini Zuma to Member States to urgently contribute human resources to the fight against Ebola in West Africa.

For more information, click here.

 

Source: African Union Website

---

 

8. International Federation of Red Cross and Red Crescent Societies

"An effective global response to the Ebola virus disease outbreak in West Africa requires unhindered movement to and from the region for humanitarian workers. The International Red Cross and Red Crescent Movement is urging all governments to support and facilitate this, and ensure health workers returning from Ebola-affected countries are treated with respect and without discrimination. These workers are on the frontline of all our efforts to contain and combat the disease.” Elhadj As Sy, IFRC Secretary General

 

IFRC is engaged against the epidemic since April 82014in Guinea. IFRC volunteers have contributed effectively to the control of the epidemic and to the alleviation of the suffering of the people.
IFRC c
ommitment focuses mainly in Guinea and Côte d'Ivoire:

In Côte d'Ivoire, the Ministry of health has commissioned the French Red Cross to implement a contingency plan ready to be deployed as soon as the first confirmed cases of Ebola. This plan, to be financed by the European Union, have a clinical component and a component of prevention.

In Guinea, IFRC continued our actions alongside the volunteers of the Guinean Red Cross, in partnership with the french government in its decision to set up a centre of additional processing, to complement the two existing centres run by doctors without borders Belgium.

To have an insight on IFRC response to Ebola Outbreak and strategies adopted click here or visit IFRC website (IFRC Switzerland - available in French and German).

 

Source: IFRC website

---

9. Medecins sans Frontiers

Medecins sans Frontiers (MSF)’s West Africa Ebola response started in March 2014 and counts activities in Guinea, Liberia, Mali and Sierra Leone. MSF currently employs 263 international and around 3,077 locally hired staff in the region. The organisation operates six Ebola case management centres (CMCs), providing approximately 600 beds in isolation, and two transit centres. Since the beginning of the outbreak, MSF has sent more than 700 international staff to the region and admitted more than 5,600 patients, among whom around 3,500 were confirmed as having Ebola. More than 1,400 patients have survived.More than 1,107 tonnes of supplies have been shipped to the affected countries since March. The provisional 2014 budget for MSF’s Ebola response in West Africa is €51 million. MSF will continue its operational response in 2015, and is currently estimating operational budgets beyond 2014. So far, MSF has approved institutional funding for a value of €20M and have raised about €28M in private funds.

For more information, visit MSF website.

 

Source: MSF website - Ebola crisis update - 7th November 2014

---

10. International Pharmaceutical Federation

Ebola: What can pharmacists do about it?

Pharmacies are often the first point of contact with the health system for patients and people with health-related concerns. Given the current outbreak of the Ebola virus disease (EVD) in some West African countries and the possibility of it spreading to other parts of the world, it is important that the whole pharmacy workforce is well informed. 

The International Pharmaceutical Federation (FIP) believes that pharmacists can provide a crucial public health service by preventing the spread of EVD through:

  • Informing, advising and educating the community

  • Promoting disease prevention and infection control

  • Screening any suspected cases and referring them in a timely and safe manner to appropriate healthcare facilities and health authorities

For more information and to read FIP resources for the pharmacy workforce, click here.

 

Source: FIP website

---

11. International Association of National Public Health Institutes

As the 2014 West Africa Ebola outbreak continues to unfold, National Public Health Institutes around the world are putting their outbreak preparedness measures into practice to prevent the spread of the deadly virus:

GUINEAIANPHI Supports Infection Control Trainings in Guinea

NIGERIACurrent Ebola situation in Nigeria

TANZANIATanzania Ebola trainings

CANADANPHIs, others develop resources to combat outbreak

CAMEROONIANPHI invests in Cameroon Ebola prevention

ETHIOPIAEthiopia's EPHI showcases Ebola prevention measures

US CDCCDC outbreak report from Nigeria

UGANDAUVRI, MoH key players in Uganda Ebola prevention

WEST AFRICA COLLABORATIONNPHIs work together in Ebola response


Moreover, the International Association of National Public Health Institutes (IANPHI) Secretariat is in the process of compiling Risk Communication tools from member National Public Health Institutes.

These will be posted by December 2014.
For more information, click here.

 

Source: IANPHI website

---

12. Comparative from other outbreaks - why is this one so much bigger? 

The first recorded outbreak took place in 1976.  In that year separate outbreaks were experienced in Sudan (South Sudan) and Zaire (DRC), killing 151, and 280 people respectively.  Sporadic outbreaks occurred for the next 20 years, but it was not until 1995 that another major outbreak was recorded, in Kikwit, DRC, killing 250 people.  In Gulu, Uganda, 224 people died from an outbreak in 2000, and there have been regular outbreaks of the virus throughout the last decade in Gabon (2001), Sudan (2004), DRC (2001, 2002, 2003, 2007, 2011, 2012, 2014), and Uganda (2007, 2011, 2012 - Source: CDC).

 

Conclusive research has yet to be carried out on detailing why exactly the current outbreak is so unprecedented in terms of scale.  However a number of observations can be made.  

The current outbreak is the first time that the virus has been recorded in West Africa, and health systems in the region have been criticised for not initially diagnosing the virus.  Equally many previous outbreaks have been recorded in isolated rural areas, in places with poor transport infrastructure.  What has happened in West Africa is that the virus was able to make it’s way into larger populated areas before the severity of the threat was realised and the outbreak diagnosed.

 

A number of other observations could be made, that further research in would prove useful.  Weak public health care systems have also clearly been unable to respond to the virus, and problems in paying local healthcare has lead to strikes in Sierra Leone.  Liberia had just 60 doctors at the point of the outbreak.  The impact of the virus in killing many healthcare and medial workers has also serious hampered the relief effort.  There are many reports of people shunning health care facilities because they were overrun, and leaving quarantines because of lack of food (4th Nov 2014, Christian Aid).

 

Equally, in an area that has suffered recent conflict, trust in governments and services is low.  This has created problems related to communication about the virus, in that many people have not believed government information.  Quarantines have been met with suspicion and in some cases open aggression that has culminated in the deaths of government officials and relief workers (8 people killed Nzerekore by the local community, 19th Sep 2014), and the shooting dead of a teenage protestor by the Liberian military (21st August 2014) have occurred.

Chris Jenkins

---

13. The need for an Anthropological viewpoint?

The current response has been overwhelmingly characterized by the traditional methods and actors in outbreak control, namely, by medical professionals and a medical analysis, public health specialists, community outreach and education teams, and the military.

This actors, of course, all have, and should be playing major roles.  Should other groups and areas of expertise, however, additionally be involved?  There are anthropologists being utilized in the relief effort as part of both WHO and MSF teams, but is it worth questioning how their role could be increased and to what effect?

 

Barry Hewlett was the first anthropologist to be invited to assist in an Ebola relief operation, in 2000/2001 in Uganda.  In his book Ebola, Culture and Politics: The Anthropology of an Emerging Disease he states, “It is essential to consider how biology and culture interact if we are to obtain a holistic and realistic understanding of human responses to Ebola outbreaks”.

The challenges of communication, of building trust, of tackling perceptions and addressing denial are common themes for public health work.  There is a need for approaches for dealing with the outbreak that are culturally sensitive and appropriate.  This is where anthropologists can contribute.

There is clearly a need for a more culturally nuanced response.  In the current outbreak there has been rioting in response to quarantine centres being opened in West Point, Liberia.  Removal of bodies from clinics has been common.  8 members of a relief team were killed by the local community in Nzérékore, Guinea.  Understanding why these events happen will be critically important to the success of any response. 

 

Community resistance isn’t unique to the current outbreak.  Hewlett, describing Gabon in 2001 states, “Villagers and politicians were verbally abusive and angry at the team’s presence.  Small groups took up spears and machetes to block the team’s entrance into villages, and village residents refused to take sick family members to the hospital.  The international team had to be evacuated twice from the area”.  Past experience should be better utilized in response to some of these challenges characterized in the current response.

 

The distrust of international health workers has to be tackled.  And cultural understanding needs to be strengthened.  The Ebola Response Anthropology Platform is one group advocating for a better informed and culturally sensitive approach.  They describe themselves as “Anthropologists from around the world providing advice on how to engage with crucial socio-cultural and political dimensions of the Ebola outbreak and build locally-appropriate interventions.”  Their areas of work include identifying and diagnosing cases, burial of the dead, and working on culturally appropriate and more nuanced ways of caring for the sick.  All these areas are considered to help to ease negative relations between communities and international relief teams, and contribute to a more effective response and containment of the virus.

Chris Jenkins

---

14. Conclusion & Reflection

Public health knows no borders.  Swine flu, bird flu and now the Ebola crisis in West Africa ensure this message has never been clearer. The devastating impact of Ebola with its extraordinary mortality and horrible symptoms should have ensured a rapid and targeted world response.  Instead, wealthy countries focussed on their own protection with governments ensuring readiness of isolation facilities, protection at the borders and even excluding entry of people from West Africa.

Such countries were quick to look after their own and slow to provide the sort of help that was called for by the World Health Organization (WHO).  There was little understanding that the root cause of the spread of Ebola was poverty.  At least a number of humanitarian organisations such as the Médecins Sans Frontières , Save the Children and Red Cross/Crescent were on the ground attempting to cope while governments of developed countries slowly, very slowly, decided to respond to the crisis where it was occurring.

 

Under pressure first from World Federation of Public Health Associations (WFPHA) members in some countries, and then backed up by partner organisations such members of the World Medical Association, governments did begin responding.  The Chair of the United Nations Security Council urged all nations to make a much stronger response to Ebola.  It was ironic that the Chair at the time was Australia’s Foreign Minister, Julie Bishop and Australia, while injecting around US$40million refused Public Health Association of Australia’s calls to deploy its rapid response teams which are capable of setting up a treatment centre within days and begin to assist the people who are in greatest need. 

 

Some major lessons must be learnt from this Ebola outbreak.  First, public health issues cross borders and all governments should be prepared to respond positively to calls from the WHO.  Secondly, the earlier the public health intervention the more likely it is to have better health outcomes and greater economic advantage.   Third, disease spreads most quickly where poverty is widespread and other social determinants increase the potential.  A long term contribution to improved health outcomes internationally requires a sustained effort to move towards universal health care, improving health and medical infrastructure starting with the countries in most need and concentration on improving health workforce in these countries.

 

The 2014 Ebola outbreak in West Africa should be a call to action for all governments world-wide.  It should provide a spring board for much greater support by members of the United Nations for the work of the WHO in ensuring appropriate preparedness and interconnectedness in preparation for further outbreaks in countries with poor infrastructure, being mindful that any disease may have international ramifications. The Ebola “stress-test” to the respective health systems illustrated that serious weaknesses exist. The outbreak is as much a call to buttress systems in vulnerable countries with weak health care systems as it is to express concern about the problems posed by disease-specific project based funding on such frail systems (see Paris declaration 2005 on Aid Effectiveness and Akkra Agenda for Action 2008 ).  Simply supporting project based help without follow up may even weaken the health care systems in the long term.

 

The WFPHA has an important role through its relationship with the WHO and through members’ relationships with the governments of their nations to understand the role of the social determinants of health in the spread of disease and to encourage greater responsiveness, international preparedness and increased generosity in supporting the work of the WHO.  It is not a time for complacency now that intensity of the first attention fades out. On the contrary, the lesson learned is that we have to act as global public health citizens throughout and not only during an emergency.

Bettina Borisch and Michael Moore

---

15. Selected publications & websites & courses

BBC (2014) 'Ebola outbreak: What Uganda can teach West Africa' 12th Aug 2014. 

 
 
 
Hewlett, Barry S. & Hewlett, Bonnie L. (2008) Ebola, Culture and Politics: The Anthropology of an Emerging Disease. Thomas Wadsworth Publishing, Belmont. CA.
 
Legrand, J. Grais, R. F. Boelle, P. Y. Valleron, A. J. and Flahault, A. (2007) 'Understanding the Dynamics of Ebola Epidemics' in Epidemiology and Infection, Vol. 135, No. 4. pp. 610-621
 

Martin_Moreno JM , W. Ricciardi, V. Bjegovic-Milkanovic, P. Maguire, M. McKee, on behalf of 44 signatories (2014) Ebola: an open letter to European governments.

 

MSF (2014) 'Ebola Response. Where are we now?' MSF Briefing Paper. 
 
Sambala Evanson Z- Chairperson of the Malawi Public Health Forum
 
in Security Sector Reform, Resource Centre. 
 
 
 
New England Journal for Medicine.  Article published on September 23, 2014, at NEJM.org. 
 

Ebola in context: new free online course launched

The London School of Hygiene & Tropical Medicine is launching its first free online course with the help of its partners FutureLearn. This two-week free interdisciplinary course looks at the science behind the Ebola outbreak, to understand why it has occurred on this scale and how it can be controlled.

For more information, click here

---

The WFPHA wishes you a happy new year,

full of love, health, wealth and joy!

---

 
  Follow us | facebook twitter  rss