Premature optimism on Ebola cases

Upsurge confirms WHO reforms long overdue


Following a steady decline in new cases in recent weeks, the United Nations (UN) predicted the Ebola epidemic in West Africa could be over by June. Its optimism, however, may have been premature, as evidenced by an uptick in weekly incidence in all of the three main infected countries in the latest published figures. Since it first commenced over a year ago, the haemorrhagic virus has infected more than 22,500 people and caused over 9,000 deaths. Some 500 of more than 800 health workers infected have died. It has devastated economies and health systems in Guinea, Liberia and Sierra Leone.

The World Health Organisation (WHO) must now shift its containment strategy. A locally driven, public health approach focusing on case identification and contact tracing is required, especially in light of reports of a recent increase in unsafe burials in border regions of Guinea. Confirmed cases of Ebola rising from these traditional practices could trigger outbreaks in neighbouring Cote d’Ivoire and Mali. And with the wet season approaching, such remote areas will become harder to access.

The WHO’s Twelfth General Programme of Work sets the reduction of “mortality, morbidity and societal disruption resulting from epidemics...through prevention, preparedness, response and recovery activities” as one its five strategic imperatives. Regrettably, the organisation failed to prevent the latest Ebola epidemic and is open to criticism for failing in its secondary prevention efforts also. It was only after the NGO Doctors Without Borders, repeatedly warned that the epidemic was out of control that WHO director general Dr Margaret Chan declared the Ebola outbreak a public health emergency of international concern.

The organisation’s 194 member states must set aside narrow political self-interest and enforce long-overdue institutional reform at the WHO. Notwithstanding ongoing funding difficulties it is an unwieldy bureaucracy with a limited capability to respond rapidly to lethal global threats from infectious agents. This must change.