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Building bridges

Ebola continues to refuse to lie down and go away. Liberia was ‘free’ for a few weeks but then a new and as yet unexplained little cluster of cases emerged a few miles north of Monrovia. Meanwhile in both Guinea and Sierra Leone case incidence continues to spike despite all efforts.

Those involved in trying to end the epidemic continue to report significant difficulties in gaining the confidence of communities who are still not convinced that the problem is borne of a rogue virus. People remain confused and upset by being told that they have to forego their usual burial ceremonies etc. Whilst undoubtedly there were mistakes made in the initial efforts to contain the epidemic, (all seem to agree that not enough attention was placed on the importance of engaging the community and its leaders) it is interesting that a long way into this epidemic, with the lessons learned, it is still proving difficult to overcome the suspicion from the community.

As I write the World Health Organization (WHO) has just responded to the Report of the Ebola Interim Assessment Panel which was set up by the agency with a panel of independent external experts to report on the alleged shortcomings by the organization in its response to the Ebola crisis. Its criticism was firm but constructive. What is very clear is that while changes are going to be made, (just look at the WHO website which is now far more informative than it was at the outset of this epidemic) WHO is going to have to change to enable it to take on a more positive role. It needs more funds, better systems and as the report calls - it needs the support of member states to enable better response. In short, the long- standing enmity between WHO Afro in Brazzaville and WHO HQ in Geneva has got to be bridged. It also means, it needs stronger funding.

The report also highlights how the International Health Regulations are not being taken seriously by many countries. Currently it is ‘voluntarily binding’ as in every country has a duty to report certain disease incidence, (notifiable diseases) but no one has really been policing whether they do. Intriguingly the Panel goes so far as to suggest ‘incentives for countries to encourage countries to notify public health risks to WHO’, and goes
on to suggest an insurance system which can mitigate against economic effects.

Clearly there is still a long way to go to prevent a similar outbreak happening again, but measures are underway. In this issue we’ve included a fascinating report on how the final cluster of cases in Liberia was tracked and transmission stopped. It is well worth a read. Alas, six weeks later another small cluster of cases has emerged so Liberia still has work to do. But as a lesson for those who may be faced with such a challenge in the future, it is instructive.


Bryan Pearson

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