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Emails: UN health agency resisted declaring Ebola emergency

ASSOCIATED PRESS   by   Maria Cheng and Raphael Satter                                        March 20, 2015

GENEVA  — In a delay that some say may have cost lives, the World Health Organization resisted calling the Ebola outbreak in West Africa a public health emergency until last summer, two months after staff raised the possibility and long after a senior manager called for a drastic change in strategy, The Associated Press has learned.

Among the reasons the United Nations agency cited in internal deliberations: worries that declaring such an emergency — akin to an international SOS — could anger the African countries involved, hurt their economies or interfere with the Muslim pilgrimage to Mecca.

Those arguments struck critics, experts and several former WHO staff as wrong-headed.

"That's like saying you don't want to call the fire department because you're afraid the fire trucks will create a disturbance in the neighborhood," said Michael Osterholm, a prominent infectious diseases expert at the University of Minnesota.

In public comments, WHO Director-General Dr. Margaret Chan has repeatedly said the epidemic caught the world by surprise.

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3 ways mobile helped stop the spread of Ebola in Nigeria

BROOKINGS TECH TANK   by Joshua Bleiberg and Darrell M. West                                       March 19, 2015

...There were a variety of factors that contributed to Nigeria’s success at combating the (Ebola)  disease. One important factorwas the use of mobile electronic health records programs.

1. Training Healthcare Workers

Training health care providers was a priority at the beginning of the Ebola outbreak. A survey found that 85 percent of health care workers in the country believed you could avoid Ebola by abstaining from handshakes or touching. Correcting these myths about the disease was a critical part of the response effort, especially for health care workers.

2. Rapid Deployment

One of the virtues of mHealth is its speed and flexibility. Mobile allows officials to quickly disseminate the latest information to front line health care workers. Increasing the speed of communication is a general boon to any large public health response.

3. Virtual Records

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How to Prevent the Next Ebola

THE ATLANTIC  by                 Mar 18 2015 

(Scroll down for additional links

Brian D'Cruz, a Virginia emergency-room doctor, spent the winter volunteering in a Doctors Without Borders Ebola treatment center in Conakry, Guinea. One of the myriad obstacles he encountered was that the yellow hazmat suits Ebola doctors wear take 45 minutes to don, yet are so stifling that a doctor can only spend an hour in one before risking dehydration. Having to frequently drop everything to pull off the suits made it even more difficult to stretch their already meager staff, D'Cruz told me in an interview at the Washington Health Forum this morning.

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Violence against women rises in Ebola-hit nations: ministers

REUTERS  By Maria Caspani                                       March 18, 2015

 UNITED NATIONS - The Ebola epidemic in West Africa exacerbated violence against women and rolled back access to reproductive healthcare in the region, ministers from Guinea and Liberia said on Wednesday.

In Guinea, data indicates a 4.5 percent increase in cases of gender-based violence since before the epidemic including twice as many rapes, Sanaba Kaba, the country's minister of social action, women and children, said on a panel at the United Nations 59th Commission on the Status of Women.

Liberia also saw more cases of gender-based violence as a result of the outbreak, said Julia Duncan Cassell, minister of gender and development in that country.

She said some men were not respecting the recovery protocol that Ebola survivors should observe and were infecting their spouses and female partners through unprotected sex.

Sierra Leone also has seen an increase in violence against women, said panel moderator Awa Ndiaye Seck, Liberian country representative for UN Women, the agency responsible for gender equality and women's empowerment.

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The case for EOCs post-Ebola

DEVEX    by  By Jenny Lei Ravelo                        March 19, 2015
Emergency operation centers have been critical in stemming potential Ebola outbreaks in several West African countries like Nigeria and Mali, but there remain doubts about whether countries would keep them post-Ebola. Ismail Ould Cheikh Ahmed, special representative of the secretary-general and head of the U.N. Mission for Ebola Emergency Response, meets with UNMEER staff at the Ebola Operation Center in Bamako, Mali. Should EOCs be retained post-Ebola? Photo by: Pierre Peron / UNMEER / CC BY-ND

This is largely because of its potential to cause “institutional turf wars” within the government structure, according to Madji Sock, partner at global development advisory firm Dalberg.

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Guinea's Ebola cases rise sharply, as cases ebb elsewhere

CENTER FOR INFECTIOUS DISEASE RESEARCH AND POLICY by Lisa Schnirring                                March 18, 2015
(Scroll down for link to full WHO Situation Report.)

Though Ebola patterns look promising in Sierra Leone and Liberia, the number of new confirmed cases spiked in Guinea last week, underscoring tough challenges that remain there, such as gaps in contact tracing and unsafe burials, the World Health Organization (WHO) said today.

For the third week in a row, Liberia reported no confirmed Ebola cases, and cases declined slightly in Sierra Leone, the WHO said in its weekly epidemiologic analysis of the outbreak.

Overall, 150 new confirmed Ebola cases were reported in the outbreak region last week, up from 116 the week before. The number of confirmed, probable, and suspected cases in the three countries has risen to 24,666, with death total increasing to 10,179.

...The WHO warned that although Ebola's footprint is now limited to a narrow area, the population is mobile, posing the risk or reseeding the disease to other districts and countries.

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FDA panel to discuss Ebola vaccine development in May

REUTERS                                                    March 18, 2015

WASHINGTON ==The U.S. Food and Drug Administration said an advisory panel will discuss the development of Ebola vaccines, days after an American health worker was flown back after being tested positive for Ebola in Sierra Leone.

The federal health regulator would discuss the development of vaccines on May 12, it announced on its website on Wednesday.

The resurgence of the virus last year prompted drugmakers from across the world to develop new treatments that are in different stages of studies....

The World Health Organization said it will decide on mass vaccination against the virus in August.

See full story.

http://www.reuters.com/article/2015/03/18/us-health-ebola-fda-idUSKBN0ME1D520150318
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See Federal Register notice of meeting.

https://www.federalregister.gov/articles/2015/03/17/2015-06116/vaccines-and-related-biological-products-advisory-committee-notice-of-meeting

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Ebola Epidemic: Why a Few Cases Could Threaten Progress

LIVE SCIENCE by Rachel Rattner                                                                                 March 18, 2015

Health officials have made tremendous progress in fighting the Ebola epidemic in West Africa in recent months, but continued efforts are still needed, experts say. That's because the cases that are happening now could be enough to restart the whole epidemic....

Although health officials are trying to trace all of the people who had contact with each Ebola patient, this "contact tracing" is far from perfect in Guinea and Sierra Leone. As a result, cases pop up among people who officials didn't know were at risk. For example, so far this month, just 14 percent of cases in Guinea occurred among people who were known to have had contact with someone who was sick with Ebola, WHO says.

This "shadow epidemic," which is occurring under the radar, is very worrisome, said Dr. Amesh Adalja, a senior associate and infectious disease physician at the Center for Health Security at the University of Pittsburgh.

If this shadow transmission continues, "it will threaten to cause this whole outbreak to reignite again," Adalja said. "You have to make sure you're finding every case, and stopping transmission in every case."

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How to Fight the Next Epidemic

The Ebola Crisis Was Terrible. But Next Time Could Be Much Worse.

 

NEW YORK TIMES OPINION PAGE by Bill Gates                                                           March 18, 2015

(Scroll down for fuller Bill Gates article in the New England Journal of Medicine)

SEATTLE — The Ebola epidemic in West Africa has killed more than 10,000 people. If anything good can come from this continuing tragedy, it is that Ebola can awaken the world to a sobering fact: We are simply not prepared to deal with a global epidemic.

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Care Differs for American and African With Ebola

NEW YORK TIMES  by Sheri Fink, MD                                                           March 17, 2015
    
The latest American aid worker to contract Ebola overseas, last week in Sierra Leone, was swiftly evacuated to a specialized treatment center for infected health workers run by the British Defense Ministry in the country’s capital, Freetown, then on to the National Institutes of Health clinical center in Bethesda, Md. Doctors at the center said Monday that his condition had worsened from serious to critical since his arrival on Friday.

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