Ebola crisis: Is the world up to the challenge?ايبولا اكبر تحدي يواجه العالم

September has been a month of US action on Ebola. President Barack Obama announced he was sending 3,000 troops to Liberia, where they would set up a regional command, build treatment facilities and help train medical workers. The Department of Health Human Services awarded a $25 million contract to fast-track the development of a promising experimental treatment, ZMapp. And the US called an emergency meeting of the UN Security Council – the first ever to be held on a public health crisis.

UN firsts

There was also a first from the United Nations itself in the form of the UN Mission for Ebola Emergency Response. Never before had the world organization launched an emergency health mission. Countries around the world scrambled to announce their own new measures.

All this came as experts gave their grimmest warnings yet of the severity of the crisis. The US Center for Disease Control said that without appropriate action, the number of infections in Liberia and Sierra Leone alone could leap from about 20,000 to 1.4 million by late January 2015. With cases doubling every three weeks, it was a projection of ruthless, relentless mathematics.

Too late?

Amid the promises of action, there is frustration that the mathematics has been allowed to get even this far. Especially vocal is aid group Doctors Without Borders (MSF) – which has more than 3,000 staff battling the crisis. Speaking at a special meeting during the UN General Assembly, MSF President Joanne Liu said, ‘Generous pledges of aid and unprecedented UN resolutions are very welcome. But they will mean little, unless they are translated into immediate action. Today, Ebola is winning.’

Going slow

Increasingly, attention is focusing on the shortfalls of the response so far – not just in the immediate crisis, but stretching back years. Bloomberg Businessweek reported that the drug ZMapp, now attracting funds and fanfare over its use to treat two US volunteers in Liberia, has been stuttering through the development pipeline since at least 2005 – and is based on simple technology that has been around for decades.

Global health expert Yanzhong Huang of the Council on Foreign Relations in New York told DW he was ‘puzzled’ by the slow progress – especially in the light of concern at the Pentagon and the Department of Homeland Security about the potential use of viruses like Ebola in bioterrorist attacks. ‘I’m sure that if they had a strong interest – given all the money and research expertise that this country has – I’m sure that they would have had something by now.’

New models of innovation?

Part of the issue: the dizzying array of US agencies with an interest in infectious diseases – in both the defense and health-care arms of government. But the fundamental problem is that fighting Ebola doesn’t make money. As Huang puts it, ‘biopharmaceutical firms really do not have an interest in developing a drug because it doesn’t make a profit.’

MSF says ‘new models of innovation’ are urgently needed – especially in the search for a vaccine. Spokesman Tim Shenk told DW, ‘Incentives such as ‘push’ funding – up-front grants, for example – and initiatives such as a large cash prize or an advance purchase commitment could be used to incentivize researchers and companies to work on developing and marketing an Ebola vaccine. RD should be as open-source as possible, with data and information transparent and widely available in the public domain.’

‘Securitizing’ Ebola

Any progress on a vaccine will come too late for those facing the current outbreak. What about the immediate measures announced by Barack Obama? Yanzhong Huang has one concern – over Obama’s casting of the crisis as a security issue.

‘Once you ‘securitize’ the threat of the virus, especially when you speak about involving troops – the enemy naturally changes from the virus to the people,’ Huang told DW. ‘That is going to exacerbate, I believe, the trust problem between the people and the public health authorities.’

Public mistrust is a widely recognized problem in this year’s outbreak. But MSF says military expertise is now needed – on strict conditions. Spokesman Tim Shenk told DW, ‘military assets and personnel deployed to the region should not be used for quarantine, containment, or crowd control measures. They should be intended purely for a medical and public health response – because of their training, logistical strengths and technical proficiency.’

Who’s WHO

While the military takes on a greater role, the effectiveness of the World Health Organization – the UN’s public health body – is being questioned. Here MSF has been outspoken too, with executive director Sophie Delauney telling the US news site Politico, ‘It took us many months to convince the WHO that this was a crisis.’

Yanzhong Huang says problems at the WHO run deep: ‘The WHO has for decades been underfunded. It’s been overstretched… it is very difficult for the WHO to play the kind of leadership role we expect of it.’ The underfunding intensified after the financial crisis, and the body now gets by on just $2 billion per year. But Huang says the issues are not just budgetary: The ‘fundamental nature’ of the institution needs to change in order for it to exercise leadership.

Huang is backing calls for a rapid response capacity within the WHO to ensure it can act fast over future crises – what former WHO Assistant Director-General Jack Chow has dubbed a ‘medical NATO.’ But Huang is not optimistic that their calls will be heard: It ‘depends on whether the WHO has the will… to do so. And when I talk about the will, I mean not just the WHO leaders and secretariat, I mean also the member states – whether they’re willing to invest in building such an institution.’

The surge

For now, the urgent task is slowing the outbreak – and eventually ending what Joanne Liu of MSF calls its ‘deadly trajectory.’ A ‘medical NATO’ or ZMapp won’t play a role – the response is tried and tested, a methodical process of isolating the sick, providing them with supportive care, and tracing the people they have been in contact with.

It’s a process that has brought every previous outbreak under control. But those outbreaks were in isolated rural areas – the raw power of exponential growth hadn’t brought them to congested urban communities. Might this fail under these radically different conditions? Joanne Liu admitted to DW: ‘It’s still part of the possibility.