We Blew It With Ebola. Scientists Don’t Want That to Happen Again

Liberian workers dismantle shelters in an Ebola treatment center closed by the charity Medecins Sans Frontiers in the Paynes Ville neighborhood of Monrovia, on March 25, 2015.

Liberian workers dismantle shelters in an Ebola treatment center closed by the charity Medecins Sans Frontiers in the Paynes Ville neighborhood of Monrovia, on March 25, 2015.

SARAH ZHANG  |  11.22.15

IN THE EARLY days of the Ebola outbreak, the World Health Organization’s response was so lackadaisical it screwed up even the chlorine. The disinfectant doctors got was expired. The outbreak has since killed over 11,000 people, and three new cases flared up in Liberia this week—after officials had declared the country Ebola free. Twice.

To make sure that kind of thing never happens again, WHO is going to need major changes—including a new center dedicated to emergency outbreak response, and an independent commission that will hold the agency accountable for its actions. At least, those are the findings of a new report from international public health researchers, who say that the Ebola outbreak shouldn’t have gotten as bad as it did—and it was at least in part the aid agency’s fault.

“Ebola was really a wake up call,” says Suerie Moon, a public health researcher at Harvard and an author of the report. “If we don’t get together to make reforms after something as devastating as Ebola, you really have to wonder when we will.”

Researchers at Harvard and the London School of Hygiene & Tropical Medicine first convened the panel last year, at the height of the Ebola outbreak. “The WHO is too important to fail,” says Moon. But in this case, the organization was slow to recognize the problem of Ebola and slow to declare it a public health emergency. That meant that, early on, doctors on the ground lacked resources for equipment as basic as body bags.

The WHO has since gathered an independent panel of experts to investigate its response to Ebola. (The organization did not respond to requests for comment.)

The panel’s most ambitious recommendation is that the WHO needs independent oversight, like an Accountability Commission that reports to the United Nations Security Council.

Other recommendations include retooling WHO so it can be more nimble in emergency situations. The report recommends creating a dedicated center for outbreak response with a “protected budget” and a “politically protected” Standing Emergency Committee to declare emergencies. That language is deliberate—for emergency centers to respond quickly, they can’t be totally marginalized in between emergencies.

The authors also want the WHO to use its political sway to get individual countries in line, calling out countries who delay reporting outbreaks and commending ones that are transparent. Other international organizations can play a role, too. The World Bank, the report’s authors write, can offer emergency funds to countries with outbreaks to soften the economic blow.

Another section of the report deals with sharing scientific information about Ebola. By comparing the sequences of Ebola viruses from patients in different cities, geneticists can track its spread in near real time. Yet at the height of the Ebola epidemic, no one made virus sequences information publicly available for three months. Because gathering virus sequences during outbreaks is still somewhat new, there is confusion over who owns the data and, of course, the “ever present fear of getting scooped,” says Nathan Yozwiak, a geneticist at the Broad Institute who has worked on Ebola.

The report isn’t just about Ebola, the authors stress. “It’s about the next pandemic. It’s how we get ready for the virus we haven’t discovered yet,” says Ashisha Jha, director of Harvard Global Health Institute and another panelist. The outbreak revealed weak spots in the global health system, and now is the time to fix them. when we will.”

Puzzling Ebola Death Shows How Little We Know About The Virus

Some health workers in Liberia had stopped using the protective gear that was part of the Ebola routine. The photo above is from 2014, when the epidemic was at its peak.

Some health workers in Liberia had stopped using the protective gear that was part of the Ebola routine. The photo above is from 2014, when the epidemic was at its peak.

David P. Gilkey/NPR

"The reality is this outbreak's not over," says Dr. William Fischer, speaking about Ebola. "It's just changed."

Fischer, a professor at the University of North Carolina who's been studying Ebola survivors, was speaking about the new cases in Liberia. On Monday, a 15-year-old died of the disease. The teenager's father and brother have also tested positive for Ebola. Health authorities have not yet determined how the family was infected.

Liberian health officials say the 15-year-old boy visited several clinics in Monrovia last week before finally being directed to an Ebola treatment unit. The more than two dozen health care workers who came into contact with him are among the nearly 160 people now being monitored for signs of Ebola.

The World Health Organization had declared in May and then again in September that transmission of Ebola in Liberia had come to a halt. Both announcements turned out to be premature. In June, a 17-year-old boy died of the disease; the source of his infection was unknown.

And now there are the three new cases.

WHO officials say the latest cases hadn't been in contact with any known Ebola survivors or done anything else that would have put them at obvious risk of getting the disease.

"I think it is a surprise for us all but it also just demonstrates how much we don't know about the virus," says Carissa Guild, a nurse who is in charge of Doctors Without Borders operations in Liberia.

"I think in Liberia now, especially the third time that it's come back, even if we were thinking that maybe it's over and that everything is over, it just shows us once again that Ebola can still come back and we don't really necessarily know where or how," Guild says. " We still have to keep up our vigilance and we still have to be protecting ourselves as health care workers."

This year, researchers have found that the Ebola virus can survive in semen for 9 months or more. This was far longer than what had been the standard message to male Ebola survivors earlier in the epidemic. The original advice for men was to abstain from sex or use condoms for 3 months after they'd recovered. Then in March a Liberian woman got Ebola and died in what's become the first documented case of sexual transmission of the virus. Her sex partner had been discharged from a treatment unit and been declared Ebola free 6 months prior to infecting her.

Last month a Scottish nurse who'd recovered from Ebola in January had the virus come roaring back in her blood.

Clinics across Monrovia have stepped up infection control measures. Several doctors concede that health care workers let their guard down after Liberia was declared Ebola-free. They weren't wearing protective gowns; some even went back to examining patients with their bare hands.

Rick Sacra is a doctor and an Ebola survivor. In Monrovia, the capital of Liberia, he's worked at ELWA Hospital, which is run by the Christian aid group SIM. Sacra says that as a result of these new cases his clinic has ramped up infection control protocols and even scrambled to get more protective clothing.

But he also has noticed ordinary Liberians are taking the new cases in stride:

"I'm not seeing the public panicking and staying away from the hospital like last year, so I'm encouraged by that."

The news from Liberia makes the work of doctors like William Fischer even more critical.

There are thousands of Ebola survivors in West Africa right now. Many of them are facing various health problems. And they may also be the reservoir that sparks the next major outbreak. Rather than handwringing over what went wrong in the international response to this outbreak, Fischer says, we need to understand how the disease continues to affect the survivors.

"We have to pivot. We can't stop and say, 'Oh what should we have done differently in the beginning of the epidemic,' " Fischer says. "We have to say, 'What do we need to do right now.' "

One of the obvious things is to get a clear understanding of how survivors can or can't pass the virus to others.

Ebola will always return unless we develop the tools to end it

On 7 November, the World Health Organisation declared that Sierra Leone is officially Ebola-free for the first time in over a year. We are inclined to celebrate this by urging people not to celebrate too much.

The biggest lesson we have learned with Ebola is that it will return, and we have to be prepared for – and prevent – the next epidemic. That’s why we have just launched an important new Ebola vaccine trial in Sierra Leone, and it’s why we strongly support the many other vaccine trials that are under way in west Africa.

Since history’s worst Ebola epidemic began in rural Guinea in December 2013, it has killed more than 11,300 people worldwide, devastating communities and families, and leaving behind a generation of Ebola orphans. Health systems in the affected countries have been severely damaged, resulting in even more deaths from preventable diseases such as measles and malaria. Ebola has also set back economies across west Africa, and cost the countries and the world billions of dollars in humanitarian aid.

And, despite the rapid decline in case numbers in recent months, and the good news from Sierra Leone, the outbreak isn’t over yet – we continue to see a steady trickle of new cases in Guinea. We have seen the price of waiting, of losing focus, of downplaying the seriousness of emerging epidemics. We both worked on HIV and Aids in the early 1980s, and 39 million deaths later, we wish desperately that the world had moved faster. We dread having to say the same thing about Ebola 30 years from now.

 

The Ebola virus has broken out at least 24 times since 1976. Liberia was declared Ebola-free in March, but then the disease came back. The country was declared free of the disease again in July. Last week, three new cases of Ebola were confirmed in Liberia, the country’s health ministry and the World Health Organisation said.

The reason Ebola keeps returning is that the world doesn’t yet have the tools to stop it. As yet, there is no approved vaccine and more research is needed to develop a vaccine to protect healthcare workers and populations. There is no rapid point of care test widely available to diagnose it. There is no approved drug to cure it.

We are now closer than ever to filling these gaps, because governments, global health institutions and biomedical researchers have spent the past year in emergency mode. Pharmaceutical companies, in collaboration with health authorities, have been running phase I, phase II and phase III vaccine trials (progressively testing safety) and manufacturing vaccines simultaneously, instead of treating them as separate steps in a drawn-out process. They have worked closely with governments in affected countries to get trials up and running in fewer than six months, a speed that is unheard of.

The London School of Hygiene & Tropical Medicine is working with partners to coordinate a number of these studies, including a new trial in Sierra Leone testing a candidate Ebola vaccine regimen in development at Janssen Pharmaceutical Companies, part of Johnson & Johnson. This prime-boost vaccine is designed with the goal of potentially strengthening and optimising the duration of immunity – it involves giving two shots, the first to prime the immune system and the second to boost it. It is just one of a number of promising vaccine candidates now being investigated in numerous clinical trials around the world.

A nurse administers an injection as part of Ebola vaccine trials at Redemption hospital, in Monrovia, Liberia, in February 2015. Photograph: John Moore/Getty Images

A nurse administers an injection as part of Ebola vaccine trials at Redemption hospital, in Monrovia, Liberia, in February 2015. Photograph: John Moore/Getty Images

An unprecedented array of global stakeholders is working in partnership on these and other studies, including leading funders of research such as the US National Institutes of Health and the European Innovative Medicines Initiative, pharmaceutical companies including Merck and GlaxoSmithKline, and the governments of Sierra Leone, Guinea and Liberia, among other African countries.

In short, after an initial and very costly delay in recognising the significance of the outbreak, the global health community has been undertaking more research, faster, and with greater innovation, than ever before.

Every potential vaccine candidate and prevention tool needs to be tested, but we also need to guarantee a market for new life-saving technologies. There are many diseases, like Ebola, for which no vaccine has yet been developed and this is largely because there is very little incentive for companies or public institutions to undertake research and development. To overcome this challenge, the world needs to create a fund to help pay for the development and distribution of vaccines for this and many other emerging epidemics and infectious diseases.

We do have cause to celebrate. The people of Sierra Leone are safer from Ebola than they’ve been in well over a year. But the best way to celebrate is to ensure that the world doesn’t make the same mistake it has made so many times before in moving on to the next problem before this one is solved.

The priorities now are to strengthen local capacities to detect and promptly contain epidemics, and to intensify research and development for vaccines, therapeutics and diagnostics. The global community can stop the next Ebola epidemic. Whether or not we do so is a choice we have to make today.

  • Peter Piot co-discovered the Ebola virus in 1976 in Zaire (now the Democratic Republic of the Congo). Paul Stoffels is chief scientific officer and worldwide chairman of the Pharmaceuticals group, Johnson & Johnson

Researchers successfully test new method for rapid diagnosis of Ebola in Guinea

An international team of researchers, including Ahmed Abd El Wahed, scientist at the University of Göttingen and the German Primate Center, has tested a new method for rapid diagnosis of Ebola in a field trial in Guinea. The test procedure was carried out using a portable suitcase laboratory. The mobile suitcase lab is operated with solar power and enables simple on-site diagnostics in remote areas without the need of an equipped laboratory. The new detection method, a recombinase polymerase amplification technique, shortly RPA, is based on the rapid identification of viral RNA in oral swabs of infected persons at 42 degrees. The comparison with two other currently available diagnostic methods revealed that the RPA is a very sensitive and rapid technique. An Ebola infection case was detected after 30 minutes. The results of the field study have been published in the current issue of the journal Eurosurveillance.

In the field study, which took place in Guinea from March to May 2015, oral swabs samples from persons suspected of dying of Ebola virus were analyzed. The scientists compared the new RPA with two variants of a currently available detection method, the so-called real-time polymerase chain reaction (PCR). "In the analysis we were able to determine two things", says Ahmed Abd El Wahed, currently in the Department of Microbiology and Animal Hygiene at the University of Göttingen and a guest scientist at the German Primate Center. "First, RPA works very well with oral swab samples, which greatly simplifies sampling in the future, because it is faster and less complicated than sampling blood. Second, we have demonstrated that RPA is as sensitive and specific as the gold standard, but technically much more simpler than the real-time PCR methods."

Nine hundred twenty eight oral swab samples were tested with RPA, one hundred twenty samples were positive and eight hundred eight negative. The reference real-time PCR method gave exactly the same results. "That is a 100 per cent accuracy", says Abd El Wahed. "In addition, we observed during the test that RPA even works better than a currently commonly used WHO approved real-time PCR for the detection of Ebola."

Both the PCR and RPA-tests are based on the identification of viral RNA in the serum or oral swabs of infected persons. In contrast to the real-time PCR, the RPA reagent can be shipped, stored and used at ambient temperature of Africa (up to 38 degrees), which makes them cold chain independent. After 30 minutes, the detection of Ebola with RPA is possible. In contrast, the real-time PCR usually takes several hours. This complicates the use of the method in remote areas. "In order to better control an Ebola epidemic, we must be able to prove infections on-site as early as possible", says Abd El Wahed.

In a previous project, Abd El Wahed, Manfred Weidmann and Frank Hufert of the former Department of Virology of the University Medical Center Göttingen (UMG) developed the laboratory suitcase. It now also contains all the necessary reagents and equipment needed for the Ebola virus detection by RPA and works up to 16 hours with solar power. A mobile glove box provides additional protection against infection with contaminated sample material.

"The mobile diagnostic kit facilitates detection of Ebola and other infectious diseases directly in the crisis areas", says Ahmed Abd El Wahed. "With the field study, we could now also demonstrate the effectiveness of the new tool. Speed, accuracy and ease of use are three important criteria that we were able to achieve with the new method. Thus, the procedure could contribute decisively to the management of future Ebola crises."

In future, the diagnostic kit is also to be used for the detection of other viral infections. For example, Dengue virus, Chikungunya virus and Rift Valley fever virus.

Source:

http://www.dpz.eu/

http://www.news-medical.net/news/20151106/Researchers-successfully-test-new-method-for-rapid-diagnosis-of-Ebola-in-Guinea.aspx

The last days of this Ebola outbreak are as much about access to information as access to healthcare

liberia-ebola.jpg

Nurse Mariatu Fofana says she should have known better than to touch and hug her father as he lay dying at his home near the capital of Sierra Leone, but she has paid an unbearable price for her error.

Ebola had been raging for months by the time he fell ill in February with symptoms of the disease. Health organizations and aid had flooded the country, reinforcing the government’s drive to educate the public on how to stop the spread of the virus.

As a nurse, Fofana knew the rules: isolate the patient, wash hands, avoid contact with victims of the disease. But her father had been diagnosed—wrongly, with a hernia and her love for her father allowed her to drop her guard in his final days of life.

“Initially I didn’t want to touch him,” she said of the time when he fell sick. After he died, she said: “I held him in my arms, shook him.”

Disregarding precautions led to the deaths of seven members of Fofana’s family. 

Disregarding those precautions led to the deaths of seven members of Fofana’s family in the weeks that followed, including her husband and child. She too contracted the virus, but survived.

Fofana’s story illustrates how difficult it is to stamp out the last vestiges of Ebola from Sierra Leone, Guinea and Liberia, where it has killed more than 11,300 people since March 2014: However hard authorities try, it is tough to persuade everyone to follow public health precautions needed to eradicate the disease. Even nurses are at risk.

Accounts by other survivors underscore the fragility of sub saharan Africa’s rural, uneducated or semi-illiterate women, who are vulnerable to emergency and conflict situations and bear the brunt of national disasters. In Sierra Leone an estimated 4,000 people have survived out of over 8,704 confirmed infected with the virus, according to figures from the National Ebola Response.

The three countries went two weeks without a new case, but on Oct. 16 two more people were diagnosed in Guinea.

In addition, a new threat has emerged as a British nurse who had recovered from Ebola has apparently suffered a relapse and is critically ill. Health professionals say that this raises the possibility that the long term health impacts of the virus may be much more dangerous than had previously been thought.

Information war

It also means that information campaigns to educate the public in Guinea, Liberia and Sierra Leone are far from over.

Women are particularly vulnerable because they care for the family and are often marginalized in terms of education and access to resources. In addition, women who lost their husbands to Ebola often lose the family’s primary breadwinner.

Like with other affected countries, the women of Sierra Leone are most vulnerable to the aftermath of Ebola.(AP Photo/Sunday Alamba)

At the height of the epidemic in Sierra Leone, Media Matters for Women, a journalist-led non-profit organization deployed Bluetooth technology to provide critical information to women and girls.

Today, its focus is to provide information to survivors through health centres and maternal clinics: how to reintegrate into society and overcome to the social stigma that often follows former patients and how to cope with challenges of health and access to employment.

“It’s an information war we are fighting,” said Victoria Nicol, who heads the Sierra Leonean NGO, which hired journalists to send pre-recorded messages to the towns of Makeni and Bombali in western Sierra Leone that were particularly hard hit during the Ebola epidemic.

Even though new cases of Ebola have dwindled almost to zero many women say they are still fighting an uphill battle against the basic social deficiencies that allowed the virus to spread with ease.

These include ignorance and traditional practices but inadequate access to basic health care also played a huge part.

For example, Fofana says her family was exposed to Ebola in part due to her not heeding her own concerns and ignoring protocols, but the misdiagnosis of her father also played a crucial role and that is evidence of a weak healthcare system.

“Ebola was a wake-up call,” said Bernadette French of the Sierra Leone Market Women’s Association. “We had no emergency plan. It exposed the state of our health services.”

For a cash-strapped country like Sierra Leone, the long term answer could lie in community ownership of health care through organizations such as German Kooperation Sierra Leone (GECKO), said Baba Car Conteh, a psycho-social worker who works with Ebola survivors in the southwestern Sierra Leone town of Port Loko.

The group provided support and intervention in places overlooked by government outreach and was a lifeline at a time when healthcare workers were deeply afraid.

“Our response came at a time when traditional beliefs, cultural practices ignorance were at a record level,” said Conteh.

These days most of the international organizations that poured in at the height of the crisis have packed up and gone home, taking their expertise and resources with them. But groups like GECKO are still on the ground.

Psychosocial care is going to be critical in the months ahead for bereaved families and survivors.

“There’s more to be done,” Conteh said.

http://qz.com/532662/the-last-days-of-this-ebola-outbreak-are-as-much-about-access-to-information-as-access-to-healthcare/

Mobile Technology: The future of healthcare

Mobile technology continues to transform the face of health care delivery across the globe. The internet, smartphones and other associated phenomena have permeated lives across the world, particularly Africa.

Mobile technology is the future of health care in Africa, and Nigeria’s eradication of the Ebola virus in 2014 is a clear indication that Mobile technology is capable of changing the landscape of health care delivery across the globe.

In the world today, nearly everything from your smartphone to patients’ hospital records creates data. Medical treatments can now be personalised, allowing for rapid identification and control of infectious disease outbreaks.

Nigeria’s former minister of Information Communication and Technology, Omobola Johnson, at the International Telecommunications Union ITU 2014 Plenipotentiary Conference (PP-14) held in Busan, Republic of Korea, said technology played crucial roles in the successful containment of Ebola virus disease (EDV) in Nigeria.

According to the former minister, the combination of the internet and mobile cellular phones has opened up tremendous opportunities for countries in Africa, particularly Nigeria.

“The steep increase in mobile use is driven by a number of factors, particularly, the additional ways in which mobile phones are being used in Nigeria,” Johnson said.

Reports by PwC last year had predicted that the Internet will be a key driver for the Nigerian economy, where the number of mobile Internet subscribers is forecast to surge from 7.7 million in 2013 to 50.4 million in 2018.

An existing health surveillance system for Polio for contact tracing was put into use, enabling health workers to trace and isolate Sawyer’s primary and secondary contacts quickly. Mobile technology meant live updates could be made to the contact list.

E-Health Technologies actually fills up the gaps in Nigeria’s deteriorating health care system and could be the future of health care in the country.

While a meteoric growth of apps is expected transpire quickly, this shouldn’t come as too much of a surprise. After all, apps are the fuel that is driving mobile’s growth and where most of the Smartphone’s utility comes from in developed economies.

E-Health-focused Nigerian tech start-up Mobile Software Solutions emerged winner of the Best Mobile Software Solution in Africa 2014 at the World Summit Award (WSA).

The start-up was selected out of over 400 other solutions from across the continent, having initially won the Best Mobile App (Game) of the year award at Mobile West Africa Conference held in Lagos Nigeria.

The fuel driving mobile’s huge growth is primarily app usage. An android app designed to facilitate the spread of information during the EVD outbreak in Nigeria is said to have reduced reporting times for new Ebola cases by half initially, and then by 75 percent before becoming almost real-time.

In addition, test results were scanned to tablets and uploaded to emergency databases and field teams got text message alerts on their phones informing them of the results.

On metrics of human health, Nigeria falls far short of the United Nations’ Millennium Developmentand lags behind other developing economies that spend a similar proportion of GDP in these areas.

For example, public spending on health care amounts to $29 per capita in purchasing power parity terms, yet 127 of every 1,000 children die before their fifth birthday.

Senegal and Sudan spend similar amounts per capita on health care, yet the child mortality rate is 60 per 1,000 in Senegal and 73 per 1,000 in Sudan.

For Nigeria to achieve the upside potential for growth in the health sector, the government will need to play a central role.

There is much scope for advancement in Nigeria’s healthcare sector. Innovations in mobile and information and communication technology can address many of the challenges faced today.

http://businessdayonline.com/2015/11/mobile-technology-the-future-of-healthcare-2/

Ebola Is Coming Back—But It Never Really Went Away

CHELSEA LEU  |  SCIENCE  |  10.16.15.

ONCE A MAJOR outbreak dies down, getting rid of a disease entirely is a game of whack-a-mole—and in Ebola’s case, the mole is a deadly, gruesome virus scientists are just beginning to understand. Last Friday, London’s Royal Free Hospital announcedthat it was treating Pauline Cafferkey, a Scottish nurse who had served in Sierra Leone during this year’s West African outbreak, for what they termed “an unusual late complication” of Ebola. Somehow, the Ebola virus was once again raging through her system, nine months after her initial infection and recovery.

The case is dismaying, but it’s no freak occurrence. Even though the worst of the Ebola outbreak is over, the virus keeps reappearing—in survivors, new patients, and the press. In the past 24 hours, Ebola has struck two people in Guinea, and a paper out this week in the New England Journal of Medicine announced that Ebola patients still housed traces of the virus’s RNA up to nine months after they first showed symptoms. And even if they’re not wracked by the disease anymore, Ebola survivors suffer a whole range of maladies that come from the lingering virus: back pain, hearing loss, meningitis, seizures. (Though, thankfully, the survivors probably aren’t infectious.)

The WHO counts 42 days without new cases as the cut-off for a region to be Ebola-free (Guinea was weeks away), but they may need to rethink that length of time, or the very idea that a regioncan be Ebola-free, says Dan Kelly, an Ebola researcher at UC San Francisco.  To stretch the mole analogy, the squiggly virus collects in certain hidey-holes the immune system doesn’t patrol as well—eyes, brains, testes, and even semen—where it can then lurk for months before replicating and causing problems for its host. (In another study this week in NEJM, scientists found that Ebola can be transmitted through sex, which presents a whole ‘nother set of risks.) Scientists still don’t know how long Ebola stays infectious in the body.

So, even if you fight off the infection once, Ebola can still live and grow inside of you. That’s scary, Kelly says. “The immune system didn’t do a great job of curing itself—how do we know giving Pauline Cafferkey supportive care will cure her of Ebola? We don’t.” (Supportive care, as opposed to, say, therapeutics or steroids to give the body a boost.) Of course, this relapse has a dark silver lining: When people used to get Ebola, they’d die. Now, with high-profile survivors like Cafferkey and other health workers, scientists have a better view of the disease’s long tail—which, in the end, might lead to cures.

http://www.wired.com/2015/10/ebola-is-coming-backbut-it-never-really-went-away/

Ebola countries record first week with no new cases

The three West African countries at the heart of the Ebola epidemic recorded their first week with no new cases since the outbreak began in March 2014.

The outbreak has so far killed more than 11,000 people in Guinea, Liberia and Sierra Leone, according to the World Health Organization (WHO).

New cases have fallen sharply in 2015, but the WHO has warned that the disease could break out again.

The epidemic is the worst known occurrence of Ebola in history.

More than 500 people believed to have had dangerous contact with an Ebola patient remain under follow-up in Guinea, the WHO said in a report.

It also said several "high-risk" people linked to recent patients in Guinea and Sierra Leone had been lost track of.

Liberia has already been declared free of Ebola transmission after 42 days without a new case. It is the second time the country received the declaration, following a flare-up in June.

Sierra Leone released its last known Ebola patients on 28 September and must now wait to be declared free of Ebola transmission.

Guinea's most recent cases were recorded on 27 September.

BBC News http://www.bbc.com/news/world-africa-34471234

With the Ebola epidemic nearly over, Paul Farmer has ideas about how to prevent the next one

PaulFarmer.jpg

Updated by Julia Belluz on October 7, 2015 @juliaoftoronto julia.belluz@voxmedia.com

Paul Farmer, the co-founder of Partners in Health, last summer in New York City.Dimitrios Kambouris/Getty Images

Exactly a year ago, America was gripped by a panic it had never known: "Fearbola." As the deadly Ebola virus snaked through West Africa, reaching epidemic proportions for the first time and killing thousands, Americans were infected with a violent worry about an outbreak on our shores — even though an Ebola flare-up was highly unlikely in the developed health systems of the US.

The greatest problem with Fearbola was that it diverted the discussion away from something that would actually control the spread of deadly diseases in West Africa and beyond: strengthening health systems.

Paul Farmer, one of the world's most influential thinkers on global health (who was immortalized in the fantastic book Mountains Beyond Mountains), has been preaching that message for decades. At the height of the outbreak, and long before it, the physician and Partners in Health co-founder argued that the best way to control viruses like Ebola would be to train local health workers in Africa, ensure hospitals are well-equipped with resources, and check that systems for disease surveillance are functioning.

Last month, Farmer helped put his ideas into action with the launch of the University of Global Health Equity in Rwanda. The new health sciences institution, owned and operated by Partners in Health, was established to train the next generation of African medical professionals and global health-care leaders. From Rwanda, Farmer spoke to us about this Ebola epidemic and how to prevent the next one. This conversation has been edited for length and clarity.

Julia Belluz

What did you learn from this Ebola epidemic?

Paul Farmer

I learned this is another setting in which we’ll fail to make the link between an emergency intervention and building the health systems that are required to prevent and take care of people once primary prevention fails. We still haven't learned how to deal with urgent crises and long-smoldering crises.

There's not a caring deficit, though. We had a thousand people sign up to volunteer [with Partners in Health] within a month of the outbreak, and many more with Doctors Without Borders. Ebola is a disease of people who care. It’s a caregivers' disease. So one thing I take out of this [epidemic] is that plenty of people care.

Julia Belluz

What did you think of the US's government and military response to the outbreak?

Paul Farmer

We deployed a lot of resources, talent, and passion. I'm proud of what was done. I'm proud of the official response. The caliber of people who were engaged from the government side was very high.

But it’s what we haven't done yet that is the problem. I don't think we can point and say that some of these resources are going to be used for building up the health-care system.

Julia Belluz

So what should the US government do to strengthen the health infrastructure in Africa?

Paul Farmer

One of the things we will be doing here in Rwanda is a human resources for health project to address the staff part of the formula. Patients come in, they have a lot of cancer, but there's no cancer doctor able to procure the chemotherapy agents or pathology. You don't have the staff, and you need to work on training people, making a long-term investment in medical education — doctors, nurses, managers, all the community health workers — and that takes many years.

It’s not attractive to many development funders to spend money on long-term postsecondary education. That’s why we’re launching the university here.

Julia Belluz

How will your university address some of these health systems problems?

Paul Farmer

The idea is that this is a regional resource, very focused on global health equity. The way it’ll be different is that we start focusing on health-care delivery from the beginning. The students spend two years in this particular degree program that launched in September — the master of science in global health delivery — and they spend part of their time at work. They may work at UNICEF or the Ministry of Health or at an NGO. But they are making a firm commitment to this coursework.

When we open up the medical school and nursing school at the university, students will also take a global health delivery degree. So if you train as a doctor, you study medicine but also health delivery — the pragmatics of delivery.

Julia Belluz

So you'll help build the health workforce in Africa, as well as the number of people who understand health systems and delivery. But once more local health professionals are trained, isn't the trickier part of the problem paying and retaining them?

Paul Farmer

If you asked me that question 30 years ago, I would have thought 100 percent of the answer lay with salary compensation. I don't think that’s true right now.

I think there are lots of forms of compensation, and a decent wage is a key one. But also the fact that when nurses don't have the fellow staff or safe systems to work with, no matter how much they're paid, it’s an unpleasant experience.

Then there’s the issue of continuing education. It’s incredible to me that it’s so controversial to argue, even at this low point in the medical history of West Africa, that we need to invest in advanced training.

Why should that be controversial? We all went to advanced training, graduate and postgrad. In the US, if you're a teacher of nursing or medicine, rest assured you have gone through your MD, PhD, internship, residency, and fellowship. So to think African doctors and nurses don't have the same aspirations is just not prudent.

The brain drain is a lot more complex. It's very highly tied to compensation — but it's also the quality of the work environment, the presence of educational opportunities. Finally, if you are well paid, with good educational opportunities, in a gleaming hospital with plenty of staff and systems in place, but people can't access that system, a lot of health professionals are unhappy about that, too.

Julia Belluz

Rwanda is an interesting contrast for its health miracle — it's an outlier in Africa with some of the biggest gains premature mortality and vaccine-preventable illnesses anywhere. What went right?

Paul Farmer

I came here to work here 11 years ago with Partners in Health. The difference between 2004 and now is pretty stunning. And that’s certainty true of the whole country, not just where we work.

When we came here, of the 30 districts, there were four without functioning district hospitals. We helped put in place district hospitals to train community health workers. We got to work on policy issues with [the Ministry of Health]. I don't think it's an exaggeration to say that these interventions across the country are why there’s been the steepest declines in mortality ever documented anywhere in the world at any time.

Rwanda had to play catch-up — it started behind everybody else because of the genocide and more. If you look at what scant data was available back then, they were starting from a much worse baseline, and then they plowed ahead. If Rwanda has done this, it's important for other nations to know how — if they want — to emulate that and to improve health-care delivery.

So Rwanda makes me optimistic. If you can do it in Rwanda — come back from where they were at end of genocide — you can do it in [the three countries most affected by Ebola] Liberia, Sierra Leone, and Guinea. But you have to invest — not just donor investment, but public investment. A large fraction of the public budget goes into health care and education in Rwanda, and it's very high compared with other countries.

In the chaotic fight against Ebola last August, 10 critical mistakes made by WHO and others

FILE - In this Wednesday, Sept. 24, 2014, file photo, a health worker sprays a colleague with disinfectant after working inside a morgue with people suspected of dying from the Ebola virus, in Kenema, eastern Sierra Leone. An Associated Press investigation has found that the World Health Organization and other responders faced key obstacles in their efforts to stop the spiraling Ebola outbreak in the summer of 2014 in Kenema, a pivotal seeding point for the virus and a microcosm of the messy response across West Africa. (AP Photo/Tanya Bindra, File) 

FILE - In this Wednesday, Sept. 24, 2014, file photo, a health worker sprays a colleague with disinfectant after working inside a morgue with people suspected of dying from the Ebola virus, in Kenema, eastern Sierra Leone. An Associated Press investigation has found that the World Health Organization and other responders faced key obstacles in their efforts to stop the spiraling Ebola outbreak in the summer of 2014 in Kenema, a pivotal seeding point for the virus and a microcosm of the messy response across West Africa. (AP Photo/Tanya Bindra, File) 

By The Associated Press

KENEMA, Sierra Leone (AP) — An Associated Press investigation has found that the World Health Organization and other responders faced avoidable obstacles in their efforts to stop the spiraling Ebola outbreak last summer in Kenema, a pivotal seeding point for the virus and a microcosm of the messy response across West Africa. Their work was hampered by poor management, lack of basic protective gear and bureaucratic infighting, according to internal WHO emails, documents and AP interviews. Here are 10 critical mistakes:

1. Questionable chlorine: Unlike other aid agencies, WHO obtained the disinfectant locally in Sierra Leone. On several occasions, officials at Kenema Government Hospital discovered the chlorine had expired or that the containers had their tags ripped off and expiration dates were missing. In an email, WHO's Sierra Leone representative called for a criminal investigation into the defective disinfectant, which is key to limiting exposure to the virus.

2. Health care workers at risk: More than 40 health staffers died; 20 were infected during the delayed construction of an Ebola clinic meant to relieve pressure on Kenema's hospital. Many weren't properly trained on how to use protective equipment and worked in an Ebola ward so dangerous that aid agency Doctors Without Borders called for its closure.

3. Delayed construction: The Red Cross offered to build an Ebola clinic in Kenema, but no one in Sierra Leone's government or WHO could tell them where to build it. By the time it opened, the outbreak in Kenema already had peaked.

4. No body bags: At the beginning of August 2014, an internal WHO report noted "supplies of body bags have completely run out," vital information since the bags limit exposure to the corpses of Ebola victims, which are highly contagious. Later that month, an aid official attempting to arrange delivery of about 100 body bags to Kenema was stymied for hours by government bureaucracy. After finally being released, the bags were delayed yet again — this time overnight — when the driver couldn't reach a sleeping police superintendent for clearance through a checkpoint.

5. Tight-fistedness: WHO responders were so constrained by bureaucracy that Director-General Dr. Margaret Chan intervened, writing in an email that logistics experts in West Africa were getting only a couple hundred dollars a week to cover thousands of dollars in expenses for basics like protective rubber boots and disinfectant.

6. Shaky power supply: A generator being used by WHO at the hospital's laboratory was so unstable one expert feared it might damage the equipment and alerted his colleagues to the potential problem in an Aug. 4 email. The problem was not dealt with and, four days later, the laboratory was hit by a blackout.

7. Weak leadership: WHO officials on the ground in Kenema repeatedly called on their superiors to intervene, warning that the agency's failure to seize control meant it was being sidelined.

8. Doctored data: A WHO outbreak expert noted in an email that the U.N. agency's official count of Ebola cases was being altered by a Sierra Leonean official to match his government's statistics, a practice that spread confusion back in Kenema.

9. No transportation: Despite a fleet of more than 50 new Land Cruisers parked at U.N. headquarters in Freetown, WHO responders didn't have enough vehicles to track the spread of the virus. One WHO official suggested Sierra Leonean responders requesting motorbikes for travel to villages buy bicycles instead.

10. Infighting: Philippe Barboza, WHO's Ebola coordinator in Kenema, described the tension between his agency and the U.S. epidemic monitoring company Metabiota as verging on "open conflict" and deteriorating so much he recommended WHO's outbreak team be pulled from the city.

Copyright 2015 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Fighting Ebola With a Palm-Sized DNA Sequencer

Raymond Koundouno using a MinION.Sophie Duraffour

Raymond Koundouno using a MinION.Sophie Duraffour

The MinION, a pocket-sized, USB-powered sequencing machine, lets scientists track the spread of deadly diseases in real-time. 

ED YONG   |   SEP 16, 2015

When Lauren Cowley arrived in Guinea in June 2015, the country was still trying to contain the record-breaking Ebola epidemic that had begun in early 2014. With several new cases cropping up every week, epidemiologists had to work frantically to track the skeins of the virus as they threaded from one person to another.

Cowley was there to help. By sequencing Ebola genomes from newly diagnosed patients, she could help her colleagues chart the source of new infections. Ebola mutates at a fairly constant rate, so if two people have identical strains, it's likely that one infected the other, or at least that they are nearby links on the same transmission chain. By tying fresh cases to existing clusters, Cowley could help local health workers to nail down the routes through which the virus was spreading—and develop effective strategies for stopping it.

Speed was essential and, until recently, out of the question. Even last year, the only way to carry out such work was to send samples of Ebola's genetic material to specialist labs with expensive sequencing machines, which took weeks or months to spit out the results. But by the time Cowley arrived, she could do that work herself in an ersatz desktop laboratory within 48 hours, thanks to a revolutionary sequencer called the MinION.

Unlike rival sequencers, which are as big as microwaves or fridges, the MinION is the size of a chocolate bar. Cowley had three, and she could clutch them all in a single fist. These devices quite literally bring the power of modern genomics to the palm of your hand. And at a cost of just $1,000, they herald a new era where sequencing moves away from well-equipped institutions and into places where it is most needed, from hospitals to epidemic-afflicted hot zones. Rather than sending samples from outbreak sites to special labs, scientists like Cowley will be able to take the labs to the outbreaks.

A MinION sequencer (Joshua Quick)

A MinION sequencer (Joshua Quick)

The MinION uses a technique called nanopore sequencing, which involves a donut-shaped protein whose hole is just a billionth of a meter wide—a nanopore. When the pore is unblocked, ions can flow freely through it, creating a measurable electric current. But if something gets in the way—say, a strand of DNA—that current collapses. The four bases of DNA—A, C, G, and T—each change the current through the nanopore in different ways. So, as a DNA strand threads its way through the pore, the rising and falling current reveals its sequence.

This concept was mooted in the 1990s. Amid serious skepticism about its feasibility, nanopore sequencing was quickly developed, refined, and commercialized, culminating in the recent launch of the MinION by UK-based company Oxford Nanopore Technologies. In spring of 2014, researchers couldget their hands on the pocket sequencer by paying a $1,000 deposit to take part in an early-access program.

Nick Loman, a genomicist from the University of Birmingham who works on infectious diseases, was one of the hundreds who signed up. Last June, his team used the MinION to study a suspected Salmonella outbreak, which had spread through the local Heartlands Hospital. Within two hours of receiving samplesfrom the hospital, the team had completely sequenced the bacterium, confirmed that it was indeed Salmonella, determined its strain, and showed that the various cases were all part of the same cluster. Loman was so impressed that he began looking for a bigger challenge.

By then, West Africa's Ebola outbreak had become a serious emergency. Deaths were mounting and the virus had spread from Guineato neighboring Sierra Leone and Liberia. Observing from the UK, Loman was shocked to learn that despite thousands of cases and months of intensive control efforts, researchers had only sequenced a hundred or so Ebola genomes. “I thought: Why aren't we generating more genome data?” he says. “That should almost be a basic part of surveillance now.”

“I saw, first-hand, epidemiologists being able to accurately track transmission routes in real time.”

So, in April 2015, Loman's student Joshua Quick travelled to Guinea with three MinIONs that the team called Ribz, Chicken, and Brisket, for reasons best known only to them. Quick also packed three laptops, some chemical reagents, a miniature centrifuge, and a small machine for amplifying genetic material. He fitted this fully-functioning sequencing lab into just two suitcases, which he unpacked onto two small desks in a pop-up diagnostic laboratory, run by the European Mobile Laboratory Project. Over the next 12 days, he sequenced Ebola genomes from 14 patients. When Quick flew home, he left the porta-lab behind. His colleagues, including Sophie Duraffour, Lauren Cowley, and Raymond Koundouno (pictured above), continued the work. Together, the team have so far sequenced around 130 Ebola genomes.

“Ebola sequencing in the field is an amazing feat,” says Mark Akeson from the University of California, Santa Cruz, who is one of the pioneers of nanopore sequencing. “None of us thought the technology could have advanced this rapidly.” Loman's team have also confirmed that the MinIONs are now 90 percent accurate—a significant improvement over their performance at launch. Loman adds that this statistic underestimates the machines. Each nanopore sequences one strand of DNA at a time, so while each readout may have a 10 percent error rate, these mistakes average out once you combine the results from thousands of reads.  

In fact, the team found that the sequencing was the easiest part of the work. The difficult bit was... well, everything else, according to Cowley, who spoke about the experience at the Genome Science 2015 conference. When she took collections of new samples, which had often travelled for hours over road-less terrain, she had to run them through several chemical reactions to prepare them for sequencing. Simple enough, except that insects would repeatedly land on her face and, worse, in her reagents.

The electricity supply to the lab would also shut off erratically so Cowley frequently had to work by the gleam of a head torch; the MinIONs were fine since they can run off a laptop via a USB connection. The heat was stifling. The humidity loosened the tiny magnets on one of her test-tube racks, which would launch themselves across the room at anything metal. “I thought I was more likely to die from flying magnets than from Ebola,” she recalls. And perhaps the biggest challenge was finding an internet connection fast and stable enough to send sequences to the UK for Loman to analyze. (He also uploaded the data to a public site called Nextflu so that other scientists could view Ebola’s evolution in real-time.)

These sequences helped the team and their colleagues to work out how each patient became sick, and how best to react. For example, if they treated a man who fell ill after burying his mother, and found that both carry genetically identical viruses, they could reasonably deduce that he became infected through contact with her—case closed. If they learned about a woman who became sick even though all her friends and family were healthy, they could look for other places in Guinea that had genetically similar viruses; perhaps that might pinpoint a source like, say a particular food vendor. And when those sources were found, health workers could set up quarantine centers, or monitor people for symptoms.

“I saw, first-hand, epidemiologists being able to accurately track transmission routes in real time and then intercept the chain to prevent further transmission of the virus,” says Cowley.

At the peak of the outbreak, there were too many transmission chains to keep track of, but that number has fallen. As of this month, only one chain remains in Guinea—a single persistent dynasty of Ebola that keeps rearing its head. “I think it’ll be not too long before we go down to zero,” says Cowley, who plans to carry on her sequencing work until the outbreak is completely stopped. “We need zero cases in [Guinea, Sierra Leone, and Liberia] for 42 days, before we can breathe easy.”

To Loman, the success of the portable MinION lab is a taste of things to come. “When it's a doddle to have sequencing anywhere you are, whether it's an a sewage works, or a doctor's surgery, or a hospital ... and when you can detect links between patients, or between patients and the environment ... and when you can get other information about pathogens like antibiotic resistance ... if you can do all that in one cheap, available assay, that's clearly going to be the future,” he says.

“The MinION has proven that you can squeeze genome sequencing down to this incredibly tiny size,” he adds. “If we can continue to miniaturize, you can have genuinely handheld diagnostic devices, or even sensors like in a water plant—a biological Internet of things.”

Ebola: 700 in quarantine as Sierra Leone battles fresh outbreak

By Jigmey Bhutia

September 16, 2015 12:33 BST

A health worker wearing protective equipment assists a patient at the Kenama Ebola treatment centre in Sierra LeoneAFP

The northern province of Sierra Leone which for the past six months had not reported a single Ebola case has now been hit by the deadly virus. Health authorities have quarantined nearly 700 people after a 16-year-old girl from the rural suburb of the city of Makeni succumbed to the disease.

A medical examination of the deceased tested positive for Ebola but the source of the infection is still unknown. The news of the Ebola outbreak is a setback for the country as it had been desperately trying to end the transmission of the lethal virus, which till date has killed nearly 4,000 in Sierra Leone.

The West African Ebola outbreak has killed more than 11,000 out of 28,000 people infected since the outbreak first emerged in December 2013 in Guinea.

Over 680 people in the village of Robureh are now under a 21-day quarantine. They include the deceased girl's parents, close relatives, classmates and the entire village where the girl succumbed to the disease. Health ministry spokesman Seray Turay said those who are under quarantine are considered as high risk although they have not shown any signs or symptoms of the lethal virus.

In August, a patient thought to be the last known Ebola victim, was released after recovering from a Makeni hospital which had prompted Sierra Leone to initiate a countdown which would last for 42 days according to World Health Organization norms so as to be declared Ebola-free. But, nearly two weeks ago a 67-year-old food trader died of Ebola in the northern Kambia district. This has led to the quarantine of 1,524 people across the two districts of Robureh and Kambia.

Four Ebola patients undergoing treatment are relatives of the woman who died in Kambia district, officials said, adding that a niece who is also at risk could not be traced. The total number of people killed from the virus in Kambia stands at 159.

http://www.ibtimes.co.uk/ebola-700-quarantine-sierra-leone-battles-fresh-outbreak-1519972

Ebola Isn’t Over Yet

James Giahyue/Reuters

James Giahyue/Reuters

By CRAIG A. SPENCER   |   AUG. 17, 2015

Recent news from West Africa that the number of new Ebola cases continues to fall and that an Ebola vaccine appears to provide protection against infection is heartening. But focusing only on these positive developments overlooks the huge challenges that remain.

The West African epidemic, which has caused at least 11,298 deaths since it was first reported in Guinea in March 2014, is incredibly stubborn and has proved hard to control. With a grave shortage of health professionals in the region, the international community needs to remain committed to rebuilding health care systems in the wake of Ebola’s destruction.

So much of what I hear about Ebola in West Africa is wrong. The most common misperceptions — that the epidemic is almost over; that enough trained personnel are available to combat the crisis and the aftermath; that plans are in place for post-Ebola recovery — will only encourage inaction and harm the response on the ground.

It’s true that the epidemic reached its peak in late 2014, and has declined significantly since then. Even so, the number of new cases since late March alone — more than 500 — would otherwise represent the largest Ebola outbreak in history. We’ve had spells when the number of new cases in both Guinea and Sierra Leone went down steadily — only to be reversed by clusters in new areas, arising from unsafe burials and unknown chains of transmission.

Even the remarkable improvement in Liberia, which went from hundreds of new infections a week in September 2014 to being declared Ebola-free in May, was short-lived — further outbreaks have occurred. Right now, there are no known cases in Liberia, but there is widespread apprehension about whether more will occur.

Liberia is proof that the goal of “Getting to Zero” — the slogan of an anti-Ebola effort led by the Centers for Disease Control and Prevention — will not be enough. Staying at zero will require an enormous input of financial and human resources for many months after the last case is diagnosed. Instead, the international effort has become dangerously fatigued.

The waning effect is felt most by those on the ground. For perspective, before the epidemic, there were more physicians on staff at Bellevue Hospital in New York City, where I was treated for Ebola, than were practicing in the three most affected West African countries combined. The dearth of health care professionals means that for many responders, there has been little respite. And since the start of the epidemic, nearly 7 percent of health care workers in Sierra Leone and more than 8 percent in Liberiahave died from Ebola.

I know very well the dangers of being a health care worker in West Africa, as I contracted the virus while caring for Ebola patients in Guinea. I was able to avoid the tragic fate of so many of my West African colleagues because, in New York City, dozens of providers with unlimited resources were involved in my care — whereas, in Guinea, I had been the only caregiver for dozens of patients.

It will be years before these West African countries are able to train nurses, develop and implement a sustainable medical education model, and supply an adequate number of homegrown health care workers. Without sustained assistance from the international community, the nations of West Africa face a losing war of attrition with the epidemic.

Sagging global attention is putting at risk the rebuilding of a post-outbreak West Africa. All three countries are ranked among the lowest in the world in basic preventive and primary health care; the absence of disease surveillance systems allowed Ebola to go unrecognized despite being present in the region for years.

Ebola has virtually shut down clinics and public health infrastructure in many areas. Without a doubt, more people have died from the epidemic’s crippling effect on these hobbled health systems than from the virus itself. Visits for routine health services dropped precipitously. In Guinea alone, health facilities treated an estimated 74,000 fewer malaria cases (compared with previous years) during this outbreak. That will have meant not only more deaths from this treatable disease, but also more patients with symptoms similar to Ebola in the community, placing further stress on treatment centers.

If the epidemic’s immediate impact on the West African health system sounds dire, the probable consequences are even more unsettling. Immunization levels have dropped across all three countries, so that, for instance, a regional measles outbreak could cause hundreds of thousands of cases — and potentially more deaths than Ebola. A recent World Bank report estimated that maternal mortality could skyrocket, setting the entire region back with rates not seen in almost two decades: In Liberia, for example, the previous mortality rate for women in childbirth (of 640 per 100,000 births) could more than double.

We cannot allow Ebola to continue destroying communities even after it’s gone. Instead, we must seize the opportunity to restore and improve the capacity of the region’s health systems.

Strong global commitment, political leadership and access to adequate resources all contributed to the remarkable success of the 1970s campaign to eradicate smallpox, arguably one of mankind’s greatest public health achievements. Will future generations judge us so favorably unless we now make wise commitments and investments in West Africa’s frail health systems that allowed this outbreak to flourish?

Craig A. Spencer is a humanitarian aid worker with Doctors Without Borders and the director of global health in emergency medicine at New York-Presbyterian/Columbia University Medical Center.

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Sierra Leone Has First Week of No New Ebola Cases

Zoom Dosso—AFP/Getty Images  Sierra Leonean health officials checking for the ebola virus on passengers transiting at the border crossing with Liberia in Jendema on March 28, 2015 .

Zoom Dosso—AFP/Getty Images  Sierra Leonean health officials checking for the ebola virus on passengers transiting at the border crossing with Liberia in Jendema on March 28, 2015 .

Alexandra Sifferlin  |  @acsifferlin

Aug. 17, 2015

An entire village was put under quarantine

Sierra Leone has gone one full week without any new Ebola cases, a first since the start of the outbreak over a year ago.

On Monday, the World Health Organization (WHO) announced that the Ebola response has moved into “phase 3,” which means responders are working to ensure that the last known cases of Ebola in the country have not spread.

The WHO traced the final cases to a man who worked in Freetown, the capital, and then returned to his home village of Massessehbeh in a northern region in the country, called Tonkolili. The man died in a hospital while receiving malaria treatment, and a postmortem test confirmed he had Ebola. Responders put the entire village in quarantine for 21 days, bringing in water and food and providing information and support, while checking everyone daily for signs of Ebola.

Two family members of the man who died got Ebola and were treated. On Aug. 14, nearly 600 people in the village came out of quarantine and there was a celebration, the WHO said. The President of Sierra Leone, Ernest Bai Koroma, cut the quarantine tape.

Since the outbreak started, about 13,470 people in Sierra Leone have been infected with Ebola, and nearly 4,000 have died from the virus. The latest numbers available indicate that among the most affected countries of Sierra Leone, Liberia and Guinea, over 27,920 cases of Ebola have been reported and over 11,280 people have died from the disease since the start of the outbreak.

Liberia: Ebola Disrupts Birth Records, Poses Trafficking Threat - UN

ebola-virus.jpg

By Kieran Guilbert

London — West Africa's Ebola epidemic has disrupted birth registrations in Liberia, leaving hundreds of thousands of children without citizenship and in danger of being trafficked or illegally adopted, the U.N. children's agency UNICEF said on Friday.

The closure of health facilities and limited health services due to the Ebola outbreak has halted Liberia's progress in registering births in recent years, according to UNICEF.

Before the Ebola outbreak in December 2013, birth registration rates in Liberia increased to 25 percent in 2013 from four percent in 2007, then the world's second lowest rate, according to the country's demographic and health surveys.

But the number of birth registrations fell to 48,000 in 2014 from 79,000 in 2013, before the onset of the virus, and only 700 children had their births registered between January and May this year, UNICEF said.

"Children who have not been registered at birth officially don't exist," said UNICEF's Liberia representative, Sheldon Yett.

"Without citizenship, children... risk marginalisation because they may be unable to access basic health and social services, obtain identity documents, and will be in danger of being trafficked or illegally adopted," he said in a statement.

The worst-known Ebola epidemic in history has killed more than 11,200 people, mostly in Guinea, Liberia and Sierra Leone since the outbreak began in December 2013.

Liberia, worst hit by the outbreak last year, was declared Ebola free on May 9 even as new cases emerged in neighbouring Sierra Leone and Guinea.

But it reported one new case nearly two months later, on June 30, and five more cases since. Two patients died but the four others recovered, meaning there are no more confirmed carriers of the deadly virus in Liberia.

At least 100 people who came into contact with the six cases and are at risk of developing symptoms will remain under surveillance into August.

Health experts do not know why Ebola resurfaced in Liberia, but officials think sexual transmission is the most likely explanation, since the virus can persist in soft tissues of the body such as semen for up to 90 days.

UNICEF said it was working to revamp birth registration systems in Liberia ahead of a planned nationwide campaign later this year to reach all children not registered since 2014.

Some 250,000 children were registered during a recent five-day birth registration and polio vaccination campaign in Sierra Leone, where the Ebola epidemic also disrupted health services, according to the children's agency.

(Reporting By Kieran Guilbert, Editing by Tim Pearce. Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, women's rights, trafficking, corruption and climate change. Visit www.trust.org)

http://allafrica.com/stories/201507311239.html

Ebola's Not Done with West Africa

 NICK STOCKTON  |  SCIENCE  |  07.23.15  |  7:00 AM

OFFICIALLY, IT’S CALLED the Ebola Outbreak of 2014. But it’s 2015 now, and the disease is still infecting people. For the past two months, that rate was about 15 people a week. But in the past two weeks, the rate has doubled.

This is bad. Not last summer-bad—when weekly infection rates were in the hundreds—but bad enough that relief agencies have begun to worry about a resurgence. And even a trickle of infections is a wear on the aid workers, government authorities, and most of all, communities living in months of fear. “I was here in 2014. If you would have told me in 2014 I would see 30 cases of Ebola every week I would not have believed it,” says Marc Forget, Doctors Without Borders’ relief coordinator for Guinea.

What’s behind the continued spread? Depends on where you go. In Guinea and Sierra Leone, Ebola never died, and the new cases are a continuation of the same strain that first emerged in December of 2013. In Liberia—which declared itself ebola-free on May 12—experts believe the new outbreak was transmitted through sexual intercourse, from latent viral bodies that were alive in a man’s sperm.

In some ways, it’s tougher to stamp out a flicker of disease than it was to handle an apocalypse-sized outbreak. “If you have a big disease center, you have the ability to isolate as many patients as you can,” says Forget. It might not be apparent who is giving the disease to whom, but you can be pretty sure that everyone is in the same place.

On the final sprint, aid workers have to track down every single case, and make sure every person that the infected case came into contact with have been identified. “We track each case and try to get ahold of all the people they contacted while sick, and then follow each of them for 21 days,” says Forget. Despite all the resources in place, about a third of all new cases are coming from people without known prior contacts. “So these are contacts that we either weren’t able to identify, or who ran away and were hiding,” he says.

As an example, Forget brings up a case that came in just a few days ago. “A young medical student was working in a private clinic on the side,” he says. While there, the student encountered a few infected kids and caught Ebola. Then he went home to his big room inside a big communal cluster of homes. “There you have 33 people who were in contact.” The man, who was diabetic, started to feel sick, and thinking he was experiencing symptoms of his prior condition went to a clinic. The workers there gave him diabetes-specific tests.

Still feeling sick the next day, he went to a much larger university hospital—through triage, examination, and the endocrinology ward. Eventually his symptoms were identified as Ebola, but not before he came in close-enough-to-transmit contact with 65 people. And counting. “Even if he was in contact with 80 people, and we got 75, there are still five people we didn’t identify,” says Forget.

Even though the disease was so prevalent, people are still hesitant to out themselves as having been potentially exposed. “If they have symptoms and people know they will be restricted,” says Forget. Not just for the 21 days, but socially the stigmatization can last for much longer.

More than that, people in the affected region are tired of the disease—much more tired than you are of seeing it reappear in the headlines. Not just because of the uncertainty and fear, but also for the way it has affected the economy, education, and other basic structures of society. “I would just like people not to forget about Ebola because it’s not done,” says Forget. “If you are here you can’t stop paying attention.”

So, by the numbers: 19 months, 27,741 infections, 11,284 dead. And counting.

Getting Closer to an Ebola Vaccine

Yann Libessart/MSF A volunteer Ebola frontline worker receives the experimental Ebola vaccine at Donka Hospital in Conakry, Guinea.

Yann Libessart/MSF

A volunteer Ebola frontline worker receives the experimental Ebola vaccine at Donka Hospital in Conakry, Guinea.

July 31, 2015

An interim review published today in the medical journal The Lancet indicates very promising results for one of the Ebola vaccine candidates. The interim review states that the efficacy of the vaccine is 100 percent. The trial of the so-called rVSV-EBOV vaccine has been led by the World Health Organization (WHO), Doctors Without Borders/Médecins Sans Frontières (MSF), the Norwegian Institute of Public Health, and the Guinean health authorities. It started in March 2015 in Guinea and focused on “rings” of people around the infected patients as well as on frontline workers at risk of contracting the disease.  

MSF is heavily involved in the trial by administering the vaccine to 1,200 frontline workers in Guinea, including doctors, nurses, paramedics, laboratory staff, cleaning staff, and burial teams. Dr. Bertrand Draguez, who has been spearheading the MSF platform on experimental tools for Ebola, tells us what that means for the fight against the disease.

What does the preliminary data tell us?

The current data basically tells us that the vaccine works to protect people against Ebola. Even if the sample size is quite small and more research and analysis is needed, the enormity of the public health emergency should lead us to continue using this vaccine right now to protect those who might get exposed to the disease: contacts of infected patients and frontline workers.

How exciting are these preliminary results?

For the first time ever, we received evidence of efficacy of a vaccine that will help fighting Ebola. Too many people have been dying from this extremely deadly disease, and it has been very frustrating for health care workers to feel so powerless against it. More data is needed to tell us how efficacious this preventive tool actually is, but this is a unique breakthrough.

For example, it is not clear how soon protection kicks in and how long it lasts. All this needs to be determined by more research and analysis.

What does this mean in fight against Ebola?

The current pattern of the epidemic—which is sporadic, with relatively small chains of transmissions popping up here and there—means that all the components of the fight against the disease need to be continued. This includes Ebola case management, isolation, community outreach, safe burials, health promotion, psycho-social support, and contact tracing.

But, of course, adding a preventive tool in the mix will accelerate the break-up of transmission chains by targeting people who have been in contact with infected patients, as well frontline workers.

How can this new tool be best used?

Now that we know that the vaccine works, people who need it most should get it as soon as possible to break the existing chains of transmission. Replication of a targeted approach focusing on those most at risk of infection should therefore happen immediately and we urge governments in affected countries to start using this vaccine as soon as they can within the framework of the existing trial.

Should a mass vaccination campaign happen in all countries affected?

At the moment, the epidemic is quite localized in a few hotspots across the affected region. This kind of pattern means that it would make much more sense to focus our energy and resources in vaccinating people around infected patients and among frontline workers. They are the people most at risk of contracting the disease and should therefore be targeted as a matter of urgency.

How was MSF involved in the trial?

It is rare that MSF gets involved in clinical trial, but faced with the enormity of the crisis and our unique position on the frontline of the fight against Ebola, we took the decision to take part. In Guinea we have already vaccinated 1,200 frontline workers in this first phase of the trial. Now that the preliminary efficacy results are known, MSF is determined to expand on this and encourage and contribute to similar trials in Sierra Leone and Liberia.

Is this going to change MSF’s response in the affected countries?

These results are promising and we should definitely make this vaccine available to at-risk groups as soon as possible. But it is also of crucial importance to keep working on all the pillars of an Ebola response including contact tracing, health promotion, and isolation of infected patients.

http://www.doctorswithoutborders.org/article/getting-closer-ebola-vaccine

Liberia Confirms Third Case in New Ebola Outbreak

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BY JESSICA FIRGER 7/2/15 AT 1:40 PM

The home of 17-year-old Abraham Memaigar in Nedowein, Liberia on July 1, 2015. Liberian authorities were monitoring more than 100 people to contain a new outbreak after the body of Memaigar tested positive for the virus on Sunday in Margibi County, a rural area about 30 miles from the capital. REUTERS/JAMES GIAHYUE

Health officials in Liberia on Thursday confirmed a third case of Ebola. These newly diagnosed cases come two months after the country was declared Ebola-free, and Liberia’s government, the World Health Organization (WHO) and other relief organizations are bracing for another outbreak.

According to the WHO, officials confirmed a case of Ebola on June 29 in Margibi County during “routine surveillance.” The 17-year-old male, Abraham Memaigar, began experiencing symptoms of the virus on June 21, at which point he visited a nearby health facility. He received treatment for malaria, not Ebola, and was discharged soon after and died on June 28. His body was buried the same day and a post-mortem oral swab—done twice—tested positive for the Ebola virus.

Two additional cases have been confirmed since then, and officials are now monitoring more than 100 people in the county who may have come into contact with patients. They expect that number to increase as investigations into the cases continue.

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Officials believe new cases of the outbreak are emerging because some people in the country are choosing to hide family members at home who have Ebola symptoms rather than seek out medical attention. Even after a full recovery, most Ebola patients in the country face tremendous stigma and often are shunned by their families and communities.

According to The Washington Post, residents of a village in the county, located approximately 30 miles from Liberia’s capital, Monrovia, told officials that some people began experiencing symptoms of the virus after eating a dog.

The WHO also reports that two health workers from Boke, Guinea, were diagnosed with Ebola. There have been a total of 874 confirmed infections and 509 reported deaths of health care workers in West Africa since the outbreak first began in early 2014.

As of June 28, there have been 27,550 suspected, confirmed and probable cases of Ebola and 11,235 deaths, nearly all in Liberia, Sierra Leone and Guinea. In Liberia alone, more than 4,800 people have died.

An American woman's fight to stop Ebola with technology

By PARVATI SHALLOW | CBS NEWS May 8, 2015, 4:41 PM

ACT founder Camilla Hermann with a group of contact tracers in Liberia.  

Last Updated May 9, 2015 9:53 AM EDT

As Liberia reaches a milestone in its struggle against Ebola, with the World Health Organization on Saturday declaring the nation Ebola-free, new contact tracing technology may help health workers remain vigilant in preventing another outbreak.

As of Saturday, May 9, it's been 42 days since the last known case in Liberia, double the incubation period and long enough for officials to consider the outbreak there officially over. But with neighboring Sierra Leone and Guinea still reporting cases of the disease, the Liberian government is setting systems in place to monitor the borders and other high-risk parts of the country.

Assisted Contact Tracing (ACT) technology, a new mobile application developed by American social entrepreneur Camilla Hermann, will form part of the public health surveillance at Liberia's borders, and it will also provide a way to continue monitoring affected communities within Liberia.

Touched by the enormity of the Ebola crisis in West Africa, 25-year-old Hermann felt called to help. She developed the ACT system to provide a link for people living in rural, hard-to-reach areas of Liberia and to also protect the lives of health workers who were trying desperately to contain the outbreak.

"Because I had done work in West Africa prior to the Ebola epidemic, I had an understanding of what the initial barriers would be and what was required for a tech platform to be successful there. Telecommunications form the backbone of infrastructure in the region. For a public health crisis like Ebola, wheretransmission occurs through physical contact, rapid response marks the difference between outbreak and epidemic," Hermann told CBS News.

ACT allows people to self-report symptoms of Ebola via an app on their cellular phones. After a confirmed Ebola case is isolated in a treatment facility, the app allows health workers to monitor anyone who has had close physical contact with the patient for 21 days -- without having to travel to the affected area. People who are being monitored will receive a phone call twice a day asking them in their native dialect if they are experiencing any symptoms. This information is quickly reviewed by health workers who can respond according to each person's level of risk. The quick feedback allows for someone to be isolated immediately if symptoms emerge, thus containing the risk of spreading the virus to others.

After collaborating with health officials in the U.S. to get ACT up and running last fall, Hermann traveled to Liberia and began working with the National Ebola Response Incident Management System. In the last few weeks, she completed her first successful trial measuring the effectiveness of ACT. Findings showed a 74 percent call completion rate in which people self-reported symptoms and enabled information gathering by health workers.

Hermann hopes that the initial success of ACT in Liberia will open the door to more opportunity to assist other developing countries in public health surveillance and beyond.

"ACT is a low-cost, highly scalable tool for cross-border public health surveillance and contact tracing. Because the system is highly adaptable, diverse applications outside of public health provide potential revenue generating opportunities to ensure long-term sustainability of the tools for public good," says Hermann.

Though the Ebola crisis has finally waned in Liberia, the outbreak took a terrible toll, killing more than 4,700 people in that country and 11,000 across West Africa. Implementing public health surveillance tools for developing countries in the event of another outbreak is still vital.

"There is no systematic disease-surveillance process in place today in most poor countries, which is where a naturally occurring epidemic seems most likely to break out," Bill Gates wrote in the New England Journal of Medicine. "Even once the Ebola crisis was recognized last year, there weren't resources to effectively map where cases were occurring and in what quantity."

Hermann and her team will continue to address this issue by working with Dr. Mosoka Fallah's Community Based Initiative team in Liberia to map out how to sync ACT with existing human capacity on the ground. Moving forward, Hermann says this team will be one the main implementation partners in ongoing public health surveillance in Liberia.

© 2015 CBS Interactive Inc. All Rights Reserved.

The Ebola Review, Part II

The G-7 Summit in Germany convening June 7 to June 8 will focus on the epidemic threat agenda, framed both as biosecurity and health system strengthening. Detailed G-7 draft documents are not yet available, so the precise outlines of Germany’s plan aren’t visible. But German Chancellor Angela Merkel left clues in the speech she delivered at the World Health Assembly (WHA68) in Geneva in May. She said: “We need some kind of global disaster response plan. And the World Health Organization must play a key part in this. But first of all we have to ask ourselves what we expect from the World Health Organization, what we think it should achieve and what its member states have to provide.”

Merkel’s appearance at the opening ceremony of the WHA68 was unprecedented — never previously had a political leader, rather than the WHO’s director-general, presented the gathering’s opening remarks. Dressed in her characteristic button-down pant suit the German chancellor voiced support for WHO’s continued existence, noting:

“In my opinion, the WHO is the only international organization that enjoys universal political legitimacy on global health matters. The aim now must therefore be to make its structures more efficient. It is, I am sure, an advantage for the World Health Organization to have 150 country offices and six regional offices in addition to its headquarters — a decentralized structure with strong local links is important. But let’s be honest. Decentralized structures can also impede decision-making and hinder good functioning.”

Merkel continued, describing her vision of a tightly structured three-tiered organization, from countries, to region, to headquarters, each level respecting the hierarchy. 

The overall WHO structure, Merkel insisted, should be robust, reactive, accountable, transparent, and capable of working well with the rest of the United Nations system.

The overall WHO structure, Merkel insisted, should be robust, reactive, accountable, transparent, and capable of working well with the rest of the United Nations system. “Notwithstanding its central health policy legitimacy, the WHO cannot be the only organization involved in drawing up a global disaster response plan. We need to ensure that the WHO can work well together with the U.N. system as a whole and with the World Bank,” Merkel concluded.

 

Among the issues the G-7 is likely to address, according to member experts, are beefing up the nearly moribund Global Outbreak Alert and Response Network (GOARN) within WHO, and clarifying what are now two very separate response streams inside the agency: infectious diseases control and humanitarian crises with health consequences. Leading into the summit the sentiments of G-7 members support the notion that the logical plug-in point for their disease surveillance and epidemiology teams is GOARN. But the network has lost 130 staff in recent rounds of layoffs (ordered by the 2013 World Health Assembly), and was characterized to me by G-7 health experts as “anemic,” “undernourished,” and “emasculated.”

Knowledgeable sources directly engaged in Berlin Summit preparations tell me that the G-7 will call for creation of an emergency workforce that is virtual, rather than a standing army. (Though Merkel refers to them as “the white helmets” other G-7 members recoil at the military-like metaphor.) And though concepts were still gelling at this writing, it appears the G-7 will expect a substantially strengthened GOARN to train and certify health workers — a “virtual response team — that may be called up when needed. Whether they are called White Helmets or something with a less military ring, the will be located in their regular jobs and habitats until called up for service. Some of these doctors, nurses, and other emergency workforce individuals may be located within nongovernmental organizations and humanitarian groups, others may be mobilized by their respective governments. One G-7 member representative described the evolving concept as a partnership with a range of health actors. The experience of the 165 Cuban physicians that worked under the WHO aegis in Sierra Leone, Liberia, and Guinea was cited as the beginning, conceptually, of the health workforce model. The Disaster Assistance Response Team (DART) mechanism used successfully by the U.S. coordinating its diverse array of civilian and military Ebola responders, including the 101st Airborne of the U.S. Army and several NGOs, was also offered as a model.

The G-7 is likely to demand improvements in the language of the International Health Regulations (IHR), which was passed by the World Health Assembly in 2005. As originally passed, the IHR compelled all of the nations of the world to have in place systems of disease surveillance and rapid response for both animal and human disease outbreaks by 2012. But by the deadline fewer than 35 nations, all rich countries, had complied. With substantial financial and expertise assistance from the Obama administration more countries have managed to meet the IHR requirements. But Miatta Gbanya of Liberia’s ministry of health told the WHA68 that, “Only 64 states have met the core requirements, 81 want an extension and about 48, we have no idea.” The Scandinavian states want enforcement in place, even sanctions against nations that fail to meet the core terms of the IHR. But nations large and small plead poverty, inexperience, and lack of technical capacity, begging forgiveness for their failures. And the WHA68 complied with those pleading poverty, voting to extend what was originally a 2012 deadline for compliance to June 2019.

According to G-7 insiders, the Berlin summit will commit resources toward bringing nations into IHR compliance. And the rich nations will put “millions of dollars” into GOARN, creating a muscular, robust disease surveillance and response institution that nests inside the WHO, but outside of its current hierarchy, answering only to the director-general. The GOARN will have a series of trigger points to operate from, both in response to outbreaks and major humanitarian disasters with health repercussions. The triggers, which the G-7 reportedly wants written into an updated IHR, will give GOARN flexibility to take a range of actions, rather than WHO’s current all-or-nothing limitations that WHO Director-General Margaret Chan has blamed for her failure to declare a Public Health Emergency of International Concern for Ebola until Aug. 8, 2014, despite widespread viral carnage that by then had been spreading for months.

In January, the WHO executive board issued a blistering report that labeled all tiers of Ebola response in 2014, from local country efforts all of the way up to Geneva “complete failure[s],” and called for radical change. Noting that Ebola had never previously crossed national borders during outbreaks, the executive board called upon countries to strengthen eight key facets of their disease surveillance and response capabilities.

And the executive board spared nothing in its criticisms of operations at WHO-AFRO, the regional office for Africa based in Brazzaville, or Geneva headquarters. The board also called for a complete shake-up in all aspects of the African regional operations, and gave Chan a tough list of nine directives for improvement.

The G-7 is not expected to explicitly endorse each of the January executive board recommendations, but seems poised — according to multiple inside sources — to embrace the overall intentions and criticisms. 

It will not, however, be satisfied with merely a fine-tuned WHO.

It will not, however, be satisfied with merely a fine-tuned WHO. It will demand that a semi-independent GOARN operates with its own budget authority, and exercises direct power over outbreak and humanitarian health responses.

 

Of course the GOARN was “emasculated,” its budget slashed, and staff laid off just prior to the Ebola outbreak by the 194 member states of the World Health Assembly. The countries voted to shift the WHO’s resources away from infectious, toward noncommunicable disease issues, leaving the agency bereft of expertise to handle Ebola. It’s tempting to agree with the G-7 assumption that a beefed-up GOARN would be the key to proper handling of future outbreaks. But Chan and the WHO had powerful tools at their disposal last year, despite the weakened GOARN — tools they chose not to use until the outbreak had reached catastrophic proportions. Chief among them was the IHR, which Chan delayed implementing until Aug. 8, 2014, after hundreds of deaths had occurred in four countries. Beefing up GOARN won’t be enough to protect the world from epidemics if the leadership of WHO fails to exercise its options in a timely, smart manner.

After months of delay in WHO action, U.N. Secretary-General Ban Ki-Moon lost confidence in the agency and created a novel superstructure for Ebola control that answered directly to him. There was a tendency in media coverage and perhaps the United Nations to view the United Nations Mission for Ebola Emergency Response (UNMEER) structure as something of a savior. Despite U.N. oversight of funds used in the Ebola fight, a tremendous amount of money remains unaccounted for. In addition to the estimated $19 million was spend and $3.3 went missing that , the enormous UNMEER mobilization appears to have been spectacularly expensive, accounting for far more expenditure than WHO’s interventions. The primary criticism of UNMEER is that it was carried out as a humanitarian famine mobilization, transporting vast quantities of food, rather than medical supplies, and pushing logistics operations of little value to a medical crisis. In short, it acted in the Ebola outbreak as it would in an earthquake, refugee disaster, or famine.

Individual countries also merit criticism, experts say. Gbanya, the Liberian delegation member, pointedly noted at the WHA68 that there were “failures” of country responses early in the epidemic. “The epidemic started in Guinea in December — which did not report it to WHO until March 21. That was a defective response [by Guinea].”

Sierra Leone has depended on mass quarantines, placing entire towns and even regions of the country under lockdown for protracted periods. The strategy has been criticized by neighbor states as ineffective and in violation of human rights. Nevertheless, the mass quarantine approach has garnered both political and financial backing from the U.K.’s foreign assistance agency.

Responders in Guinea during the March and April outbreak in that country incorrectly assumed a single line of transmission, stemming directly from the December Meliandou index case, represented the totality of the outbreak. After contact tracing that chain of transmission, the government of Guinea, the U.S. Centers for Disease Control and Prevention (CDC), and WHO declared the epidemic was under control and withdrew most foreign responders and scientists from the country. But they were wrong, both about having successively identified the full chain of the primary transmission, and in missing a second line of transmission entirely.

Ebola had by then reached Conakry, establishing the first urbanized epidemic of the disease in history. It is extremely difficult to understand how and why the U.S. CDC and the WHO reached the conclusion that the prospect of urban Ebola in a large city with an international airport posed no larger risk. Moreover, Guinea health authorities were aware that a second line of transmission existed, and the index case had crossed into Sierra Leone. Guinea failed to inform Sierra Leone, allowing the epidemic to cross into the neighboring nation. Recently released e-mail communications between WHO-AFRO, WHO headquarters, and its teams in the field reveal a dramatic failure to implement the IHR. Though no language in the IHR stipulates that economic considerations should carry equal weight with health and medical ones, Geneva clearly chose to respect the Guinean government’s economic worries.

Finally, the performance of WHO-AFRO was nothing short of abysmal. On Feb. 1, Matshidiso Moeti took over the WHO’s Africa Regional Office. Born in South Africa, the physician grew up in Botswana and cut her teeth on public health working with AIDS patients and the national HIV response. In a wide-ranging private conversation, Moeti assured me that she plans major shake-ups that will affect all of the 2,500 country-based employees and 200 staff in the headquarters of WHO-AFRO.

“Our challenge: There is big skepticism about WHO-AFRO, and many demands, expectations — all with the same resources. We have to make changes, and earn back the trust,” Moeti said. “We have to prove ourselves. We can’t float on nice speeches.” The staff throughout WHO-AFRO displays enormous ignorance, she said, includes genuine thieves, and “a large element just bumbling along, being inefficient.”

Perhaps the most complicated problem Moeti faces involves the African Union’s announced scheme to create its own centers for disease control, based in Addis Ababa. The African member states have no faith in WHO-AFRO, and plan to shift most infectious disease surveillance and response to the planned center. “We need to think it through,” Moeti concluded.

Thinking things through carefully is obviously the key to transforming the WHO into an institution that is fit for the purpose of epidemic control — or, perhaps, to concluding that the Geneva agency cannot carry out the task, forcing creation of a novel institution. Given how full the G-7 plate is, and the leaders’ brief two-day summit, it’s hard to believe considerations can be sufficiently weighed to provide an optimistic beginning to true WHO reform. But I’ve been wrong before. In 2000 the then G-8 met in Okinawa, and Prime Minister Yoshiro Mori pushed for creation of an international response to infectious disease threats, particularly HIV/AIDS, tuberculosis and malaria. I thought the summit’s was overly vague, and nothing but hot air would come of it. But I couldn’t have been more off base, as the outcome was creation of the multibillion-dollar Global Fund to Fight AIDS, Tuberculosis and Malaria in 2002. As of December 2014, the programs supported by the fund “have 7.3 million people on antiretroviral therapy for AIDS, have tested and treated 12.3 million people for TB, and have distributed 450 million insecticide-treated nets to protect families against .”

Please, G-7: Prove my skeptical soul wrong, and make biosecurity a reality for all people, living in rich and poor nations, alike.

Read “The Ebola Review, Part I: The G-7 is gathering to tackle the world’s biggest problems. It’s starting with Ebola — and what the World Health Organization did wrong.”

FABRICE COFFRINI/AFP/Getty Images