GENEVA, 24 August 2015 (WHO): The review of ebola takes place at a time of nearly universal agreement that the international response to the outbreak was inadequate, Dr Chan noted.
When the number of cases in Guinea, Liberia, and Sierra Leone began to increase exponentially, all responders, including WHO, were overwhelmed, she said, adding:
Managing the global regime for controlling the international spread of disease is a central and historical responsibility of the World Health Organization.
Since Ebola first emerged in 1976, WHO and its partners have responded to 22 previous outbreaks of this disease. Even the largest were contained within four to six months.
But in West Africa, WHO, and many others, were late in recognizing the potential of the latest outbreak to grow so explosively. Some warning signals were missed. Why?
We need to pinpoint the reasons why the response fell short. We need to learn the lessons. We need to put in place corrective strategies just as quickly as possible, she stated.
11.000 døde – men det kan blive værre
Dr. Chan made her remarks at a two-day meeting of the Review Committee on the Role of International Health Regulations in the Ebola Outbreak and Response, consisting of experts with a broad mix of scientific expertise and practical experience in public health, security, law and trade.
Also stating that Ebola in West Africa, where the epidemic has killed more than 11,000 people, was the largest, longest, and most deadly event in the nearly four-decade history of this disease, the top UN health officials said “it was not a worst-case scenario.”
“Preparedness for the future means preparedness for a very severe disease that spreads via the airborne route or can be transmitted during the incubation period, before an infected person shows tell-tale signs of illness,” she said.
Every day, nearly 100,000 flights carry 8.6 million passengers and 17.5 billion US dollar of goods to their destinations.
Internationale sundhedsregler skydes til side
Dr. Margaret Chan went on:
The Internatioal Health Regulations (IHR) is a principal instrument. These regulations are the only internationally-agreed set of rules governing the timely and effective response to outbreaks of infectious diseases and other public health emergencies.
If its legally-binding obligations on States Parties are not being met, change is urgently needed. If WHO is not exercising its full authority under the regulations, change is urgently needed.
The dynamics of virus spread in West Africa had many exceptional features.
But it would be a mistake to forget that many other countries also have extremely weak health systems and infrastructures, a history of conflict and civil unrest, highly mobile populations, and entrenched (indgroede) high-risk cultural practices.
Tre store svagheder blotlagt
Expert groups have identified three main weaknesses in the performance of the IHR (International Health Regulations).
FIRST, compliance with the obligation to build core capacities for event detection and response has been dismal.
Eight years after the IHR entered into force, fewer than a third of WHO Member States meet the minimum requirements for core capacities to implement the IHR.
Why? Is this because health security is not a priority for governments and the international community?
Is this because SARS (akut luftvejssyndrom eller Severe Acute Respiratory Syndrome på engelsk) was contained within less than four months, and the long-dreaded influenza pandemic turned out to be so mild? Did everyone relax?
Or is it a matter of not having sufficient financial and human resources?
Are the minimum requirements set out in the IHR too demanding? Should we lower the bar? Surely not.
But perhaps we should change our whole approach to the way progress is supported and monitored.
I have heard broad agreement that the practice of relying on self-assessments needs to be replaced with a more rigorous and objective mechanism.
Bureaukrati og ineffektivitet
Many factors have been cited as contributing to this poor compliance with core capacities.
In a number of countries, implementation of the IHR is regarded as the sole responsibility of ministries of health, with very little engagement from other relevant ministries, such as those responsible for finance, trade, tourism, agriculture, and animal health.
National focal points often have limited authority and very little access to a country’s true power base. Misunderstanding of the IHR as a rigid, legal process further constrains compliance.
Ebola in Guinea, Liberia, and Sierra Leone was an extreme stress test that saw the virtual collapse of health services.
The national responses in Nigeria, Senegal, and Mali show the good results possible when health officials are on high alert and the health system is well-prepared.
Global sikkerhed for et sundt liv ligger laangt væk
Overall, nevertheless, national and international responses show how far the world is from achieving global health security.
Overall, these experiences provide a stunning example of all that was missing, all that can go wrong, Dr. Chan stressed
The IHR call for national capacity “to detect events involving disease or death above expected levels for the particular time and place in all areas within the territory”.
But how can countries that routinely experience deaths from diseases like malaria, Lassa fever, yellow fever, typhoid fever, dengue, and cholera recognize an unusual event in the midst of all this background noise from difficult and demanding diseases?
Maybe this is another truly fundamental problem that keeps the IHR from working as intended.
Under radarskærmen i tre lange måneder
The Ebola virus circulated in Guinea for three months, undetected, off every radar screen, with no alarms sounding, misdiagnosed as cholera, then thought to be Lassa fever.
Even in Sierra Leone, where health officials were on high alert, the virus spread undetected for at least a month, sparking numerous chains of transmission that rapidly multiplied.
The earliest cases to reach the health system were managed as gastroenteritis (mavekatar), again with a diagnosis of cholera presumed.
Within six weeks, three hotspots of intense virus transmission were firmly established.
Isolerede sig i skræk og rædsel
As a SECOND weakness, many countries imposed measures, such as restrictions on travel or trade, that went well beyond the temporary recommendations issued by the Emergency Committee last August.
These measures isolated the three countries and vastly increased economic hardship for some of the world’s poorest people. All three ran short of food and fuel.
Just as important, travel restrictions, including the many airlines that suspended flights to West Africa, impeded the arrival of desperately needed response teams and equipment.
If countries are punished in this way, where is the incentive for rapid and transparent reporting?
At present, WHO does not have a mechanism for enforcing compliance with its recommended measures.
This has to change.
Hvem ringer med alarmklokken næste gang?
A THIRD weakness is the absence of a formal alert level of health risk other than the declaration of a public health emergency of international concern, or PHEIC.
Establishing a formal intermediate level of alert of health risk would require an amendment to the IHR.
Another option is illustrated by the Emergency Committee convened to assess the MERS situation.
Although many meetings under this Committee were held, none declared a PHEIC, yet their reports consistently set out advice aimed at reducing the number of cases and preventing further international spread.
In the best possible case, any amendments to the IHR proposed now would take several years to come into force. Is this what you want?
Systematic studies conducted over decades have shown that the emergence of new diseases follows a non-random (ikke tilfældigt) global pattern.
Farerne fra det vilde dyreliv
From these studies, we also know that nearly 72 per cent of all new human pathogens (sygdomsfremkaldere) originate in wildlife, and most frequently at lower latitudes.
Can mapping of geography, climate, and cultural behaviours pinpoint hotspots for the emergence of new diseases?
Can we give the international community a list of priority countries ranked as likely to experience outbreaks? Some countries may see this as stigmatizing (blive hængt ud).
In other words, not lower the bar for core capacities, but narrow the list of countries in urgent need of support.
De døende efterlod et uudsletteligt indtryk
The image of people dying on the grounds of overflowing hospitals should have left an indelible (uudsletteligt) mark on the world’s collective conscience.
This is also a window of political opportunity, Dr. Chan concluded.
At the 68th World Health Assembly in May 2015, member States set a mandate for a Review Committee on response to the Ebola outbreak.
The Committee will recommend steps to improve the functioning, transparency, effectiveness and efficiency of the Regulations, and to strengthen preparedness and response for future emergencies with health consequences.
Læs Dr Chans bemærkelsesværdigt åbenhjertige tale til komiteen i sin helhed på
http://www.who.int/dg/speeches/2015/review-committee-ihr-ebola/en
