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THE NEED TO KEEP EBOLA ON THE FRONT PAGES

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I had already started to pen this weeks article when a few headlines/comments/articles caught my eye, forcing me to push it onto the back burner, as I feel this issue is more pertinent and pressing.

A tweet from Laurie Garrett had me concerned. She tweeted; Google News no longer ranks #Ebola in top 20 search items, and even within the health category, only in the Italian and USA news-feeds. This was then followed by a press release from the UN (United Nations’ Ebola Emergency Response Mission – UNMEER) stating that they will miss their December the 1st containment target, due to escalating numbers of cases in Sierra Leone.

The kicker, that then really got me switching my thought train was a press release from the the nonprofit ONE.org (http://www.one.org/us/ebola-tracker/). The Ebola Response Tracker follows the money and shows us the money; i.e.: how much that has been pledged, has made it onto the ground in West Africa to fight the good fight. While the Office for the Coordination of Humanitarian Affairs (OCHA), the UN, and the World Bank have data on the dollar figures associated with each pledge, no one had taken the time to figure out how much of those resources have actually made it to the ground in West Africa.

Erin Hohlfelder, global health policy director at ONE and the brains behind the tracker, says the tracker shows the importance in transparency (and the follow through on ones commitment). “It’s one thing to make a great pledge and commit to doing that, but in the meantime, every day that goes by without these resources is a missed opportunity.”

While progress has been made in the months since these pledges, there is still much work to be done. The USA leads the pack with the highest pledge and disbursement; $572 million of which 72% has made it to the ground in West Africa. Here is a sampling of a few other countries, foundations and institutions: (in no particular order)

Google/Larry Page Family Foundation pledged $25 million – none disbursed yet

Bill & Melinda Gates Foundation $50 million – 27% disbursed

African Development Bank $220 million – 20% disbursed

Paul G. Allen Family Foundation – $100 million 3% disbursed

Silicon Valley Community Foundation $25 million – none disbursed yet

EU $468 million – 17.5% disbursed

China $123 million – 8% disbursed

Australia $36 million – 38% disbursed

Visit their website to check out other countries and follow them on twitter and facebook.

At a press conference last week, Liberian President Ellen Johnson Sirleaf said that the progress her country has made may be damaging. “Our government remains concerned that progress in this battle will lead to complacency on the part of the international community. We must not interpret gains as an outright victory—nothing could be more dangerous.” Complacency must not be allowed to seep in, we need to keep the issues on the front pages. Margaret Chan, director of the World Health Organization, agrees on the complacency front; “We must not forget—Ebola virus is a formidable enemy. Yes, we are seeing some early signals of hope. Cases are stabilizing, we are also seeing some new areas where they are reporting new cases. We must maintain our vigilance. Complacency would be our enemy. And in order to get it to zero, we have been successful in bending the curve a bit, but we need to continue to do more to get to zero.”

The fight is still in the early stages, we must aggressively push to keep Ebola in the news and for more action on the ground. The international response is being outpaced by this epidemic, If more help doesn’t arrive soon, the worst may not be over. Ebola hasn’t simply overwhelmed these health-care systems, it has decimated them. Women in need of support for childbirth have been turned away, leading to an increase in infant morality rates in a region with the some of the highest numbers in the world. Children suffering from malaria or extreme diarrhea are now too often left without medical care, leading to an increase in deaths from dehydration. Life-saving vaccines for those illnesses and others are lying unused in clinics and warehouses, as there are not enough (or any) medical workers to disburse them. Crops are not being planted, food is not making it to the market places!

UNMEER was set up to provide coordination, policy and logistics rather than to treat patients. It needs more resources to halt Ebola as quickly as possible, at present the emphasis is on allocating existing resources in the smartest way, possibly because they are still waiting for more resources/pledges/manpower to make it to the ground in West Africa.

According to October estimates from the World Bank, the epidemic could cost the West African countries affected upward of $32 billion in the next 24 months. What are we waiting for! Every day spent without pledges being delivered on, manpower to hit the ground and the process of rebuilding shattered healthcare services and networks; more people die. Containing Ebola is a constant battle and already we are seeing it cropping up in Mali, where to next?

I will let Anthony Banbury from UNMEER end this weeks blog:

Containing the epidemic still calls for a tremendous increase in resources on the ground. We are far, far away from ending this crisis, there is a long battle ahead of us.

Politics and Medicine

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Politics and Medicine

“Medicine is a social science, and politics is nothing else but medicine on a large scale”—Rudolf Virchow

Politics is defined as “organised human behaviour”, thus we can postulate that Medicine is micro managed organised human behaviour, at times right down to the molecular level. If we examine the Ebola outbreak/s (globally) and how it is being managed on a macro (politics) and micro scale (medicine) we can begin to see the cracks in the system, and hopefully then move to addressing these cracks, before they begin yawning chasms that are not repairable.

The region (Liberia, Sierra Leone and Guinea) has had success (we could add Nigeria and Senegal to the successes) and failures in both areas. Neither is Spain and the USA exempt from this analysis as can be noted from the various press releases (government and medical) over the past few months.

Since the first outbreaks in 1976 (Sudan and The DRC) till the current one in West Africa; care has generally been palliative and symptomatic, questions have often been asked during this period; What of a vaccine and/or other means of treating the infected patients? There was a report in the British Sunday Times (12/10/14), cited a Cambridge University zoologist as saying that “it is quite possible to design a vaccine against this disease” but reported that applications to conduct further research on Ebola were rebuffed because “nobody has been willing to spend the twenty million pounds or so needed to get vaccines through trial and production”. Globally this has been one of the failures of the pharmaceutical companies, and most probably even the WHO, for not pushing harder over the years to get this in motion.

In her 1994 book The Coming Plague: Newly Emerging Diseases in a World Out of Balance Laurie Garrett: warned that there are more than 21 million people on earth “living under conditions ideal for microbial emergence.” Garrett when on to win the Pulitzer Prize in 1996 for reporting on Ebola. In 1995 Joshua Lederberg, the American molecular biologist said: “The world is just one village. Our tolerance of disease in any place is at our own peril. Are we better off today than we were a century ago? In most respects, we’re worse off. We have been neglectful of the microbes, and that is a recurring theme that is coming back to haunt us.”

Jump forward to the 23rd of September 2014, US President Obama issued an unprecedented ‘Presidential Memorandum on civil society  recognising that:

Through civil society, citizens come together to hold their leaders accountable and address challenges that governments cannot tackle alone. Civil society organisations…often drive innovations and develop new ideas and approaches to solve social, economic, and political problems that governments can apply on a larger scale.

If we look at the current crises in West Africa civic leaders are what is missing, hence the inability to track and trace potential infected persons, motivate communities to change risky behaviours (handing of the deceased), agitate with government to create better health care systems, this all adds fuel to the fire of the current epidemic.

Have we listened and learnt as governments, NGO’s and Multinational Pharmacare companies since then?

Despite Medical Advances, Millions Are Dying, this is a banner from 1996, not 2014! from the WHO, which was “declaring a global crisis and warning that no country is safe from infectious diseases, the World Health Organization says in a new report that diseases such as AIDS, Ebola, Hanta, Mad Cow, tuberculosis, etc., killed more than 17 MILLION people worldwide last year”.

As Laurie Garrett wrote in her the closing section of her book, The Coming Plague, “In the end, it seems that American journalist I.F. Stone was right when he said, ‘Either we learn to live together or we die together.’ While the human race battles itself, fighting over ever more crowded turf and scarcer resources, the advantage moves to the microbes’ court. They are our predators, and they will be victorious if we, Homo sapiens, do not learn how to live in a rational global village that affords the microbes few opportunities. It’s either that or we brace ourselves for the coming plague.”

Time is short.

The Ebola outbreak in West Africa is “unquestionably the most severe acute public health emergency in modern times,” Dr. Margaret Chan, the director general of the World Health Organization, said Monday 20/10/2014). We do seem to be going in circles… circa 1995.. have we learnt nothing from history.

Sooner or later we learn to throw the past away History will teach us nothing Sting – Musician, singer-songwriter

Where have all the people gone, long time passing?

Where have all the people gone, long time ago?

Where have all the people gone?

Gone to graveyards, everyone.
 Oh, when will they ever learn?

Oh, when will they ever learn?

Pete Seeger – American folk singer and activist