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So far, we have lucked out. After 2 months, the latest Ebola virus outbreak in the Democratic Republic of Congo, or DRC, still awful, had not been in place. It has not spread to neighboring Uganda, or to Kenya, then to Europe or the United States, triggering panic and a global public health and economic crisis. Yet.
But the biggest issue is we have not heard of Ebola outbreaks.
Lesson 1: Preparation at the local level
Whether it is Ebola, Pandemic influenza or a novel virus, the leadership of local health departments, the ministries of health, the elected officials, the nongovernmental organizations like Doctors without Borders, and WHO.
The preparation must start at the local level. Our qualitative research study is about the involvement of community leaders, the health care providers, the traditional healers and the patients is important to building trust. This is especially true in places with low literacy. Contact tracing, follow-up and vaccination are resource-intensive in areas of poverty, conflict and insecurity.
Lesson 2: Country leadership
The DRC is responsible for investing in local health care facilities. It is important to understand that we can not prevent human-animal interaction and, therefore, can not necessarily prevent introductions of Ebola or novel viruses. But we can prevent outbreaks. Each introduction has a history of an infection. Once Ebola spreads in a health care facility, it becomes a community problem. But the key intervention that could easily be made to be safe. That should be both an ethical and a security obligation of governments. It is not cheap, but it is essential.
The DRC is impersonated, and is often viewed by Westerners as dependent, but the misaligned or misappropriated. We also need to study the history of DRC to understand the current situation. We need to start thinking about how to be more effective.
Lesson 3: Global leadership
At the global level, Ted's Adhanom Ghebreyesus, PhD, MSc. This year may be the first time that a director general-general visited an outbreak zone early in the response. The broader question is when the world will not invest in people and supplies, but logistics. Getting into and out of rural areas to deliver essential supplies and medications should be simplified. Global health agencies should have the same logistics infrastructure as militaries do. The advent of drones and advanced communication technology should help with supply chain.
Lesson 4: Coordination, communications and relationships
The resources expended by the CDC and the United States should be better coordinated. Decisions for who is deployed to the DRC, to the WHO headquarters and to the neighboring countries, Uganda and Rwanda are challenging and require long-standing relationships and excellent communication.
The CDC's Field Epidemiology Training Program and the newly established Africa CDC also need to be funded and staffed appropriately. Experts are needed to work on cross-border health, communication, security, laboratory strengthening and cultural awareness. Training and cultural awareness are very important.
Lesson 5: Global health security
More broadly, cuts are expected in the US Global Health Security Agenda, a plan to prevent and fight infectious threats. We need to build capacity for a country-level response. Cuts limit CDC and the U.S. government's ability to do that. The funding needs to be increased.
The U.S. also should re-establish a body for global health security in the biosecurity arm of the National Security Council (NSC). Since its inception under President Harry S. Truman, the NSC's function has been to assist the president on national security and foreign policies. Pandemic preparedness is an essential component of national security.
The NSC should coordinate with CDC's Epidemic Intelligence Service, the U.S. Army Medical Research Institute of Infectious Diseases and Navy Medicine, as well as academic medical centers and public health departments.
Lesson 6: Advocacy
Organizations such as the Infectious Diseases Society of America need to lobby more vociferously for funding and coordination. And infectious disease clinicians, an integral part of the first-line response to Ebola, need to act. Knowledge is important, but advocacy is crucial. We need to speak out, before it is too late. Real collaboration is what it takes for global health to succeed.
- Reference:
- Schwitters A, et al. Glob Health Sci Pract. 2015; doi: 10.9745 / GHSP-D-14-00145.
- For more information:
- Philip A. Lederer, MD, is an assistant professor of medicine at the Boston University School of Medicine and an infectious disease physician at Boston Medical Center. He can be reached at [email protected].
Disclosure: Lederer reports no relevant financial disclosures.
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