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Conflict and insecurity driving spread of diseases like Ebola, WHO chief warns

Deadly outbreak is global wake-up call, Dr Tedros Adhanom Ghebreyesus tells Guardian

The head of the World Health Organization has called the worlds second worst Ebola outbreak a global wake-up call to the escalating risk of disease outbreaks spreading from conflict areas neglected by the international community.

Only when there was fear and panic in the headlines did the international community put money into responding, said Dr Tedros Adhanom Ghebreyesus. The real issue was a lack of day-to-day funding for preparedness to combat serious epidemics before they become regional or international threats, he said.

Speaking ahead of a new call for funding for the response to the Ebola outbreak, he added: The problem is that [donors] refrain from paying until there is fear and panic. That has to change. We should not be funding by huge amounts when we panic, but should be funding to avoid panic.

Invoking the spectre of Spanish influenza, which killed tens of millions in the aftermath of World War I, he added that international health systems in an increasingly globalised world were only as strong as the weakest link.

In an exclusive interview with the Guardian in Geneva, Tedros added that while he believed the outbreak in the Democratic Republic of the Congo could be controlled in the short term given the right security conditions the virus would inevitably return while political instability continued in North Kivu and Iruri, the provinces at the heart of the outbreak.

Quick guide

Ebola in the Democratic Republic of the Congo

How bad is the current outbreak?

More than 2,100 people have been infected with Ebola in theDemocratic Republic of the Congo since August last year, making the outbreak the second largest in history. More than 1,412 people have died.

The disease has been spreading at an unprecedented rate. While it took eight months to reach 1,000 reported cases, it took just 71 days to double that figure.

What exactly is Ebola and how does it spread?

Ebola causes fever, aches and diarrhoea and attacks the immune system, causing blood clotting cells to malfunction so that victims bleed extensively and die if their immune system cannot fight off the viral infection. It is spread from person to person through body fluids.

Can it be treated?

Infected patients are isolated and treated by medical teams wearing full protective body suits who try to boost their immune response.

A vaccine, still experimental, has proven to be highly effective in preventing the disease, according to the World Health Organization.

Why is it spreading even though there’s a vaccine?

The history of conflict in the DRC has lead to a suspicion of outsiders: rumours that health workers are making money from the crisis – or that Ebola doesn’t even exist continue to circulate. Aid agencies have been accused of failing to address community mistrust.

A government decision in December to suspend voting in the presidential election in Ebola-affected areas fuelled the idea that the disease is being used as a political tool.

There have been repeated attacks on health workers and facilities, slowing down vaccination programmes. Health workers have resorted to using police escorts, which has in turn exacerbated a feeling of intimidation among local people.

Tedros also reiterated his resistance to declaring the current outbreak a public health emergency of international concern (PHEIC). This is despite calls from the British international development secretary, Rory Stewart, during a visit to the city of Butembo, the current epicentre of the outbreak.

I know we can finish this Ebola outbreak, said Tedros, former foreign minister of Ethiopia, who became director general of the UN global health organisation in 2017. But at the same time it can come back because all the [political and security] conditions remain the same.

There are some people who say we need to declare the outbreak as an [emergency] to mobilise resources. Thats really wrong. Resources should be available to prevent needing to declare a PHEIC. Preparedness is the solution, not firefighting.

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The director-general of the WHO, Dr Tedros Adhanom Ghebreyesus. Photograph: Denis Balibouse/Reuters

WHO officials also questioned Stewarts assertion in the Guardian that more cash was needed to pay for ring vaccination. They said that at present there was a sufficient supply for the current models of the epidemic, although in the longer term, this would depend on the evolution of the outbreak.

The outbreak is designated a category three emergency, the WHOs highest level before a declaration of PHEIC. Three cases crossed the border briefly into Uganda last month.

Tedros warned, however, that far from helping with the response to the outbreak, designating it as a PHEIC could actually complicate the response of health teams on the ground. It could see borders closed and increase economic hardship for an already highly marginalised and angry population that relies on cross-border trade and has already attacked health teams.

Briefing a meeting of science journalists on Friday, ahead of Stewarts intervention, Tedros reiterated his objections.

PHEIC only shows there is a very high risk of international spread, which is not the case based on the criteria. But if you take whether Ebola is an emergency in DRC or not, it is its actually the highest level of emergency.

Although outbreaks of the disease in the neighbouring town of Beni and surrounding areas were largely brought under control last year, the outbreak in Butembo has proved hugely complicated, with violent attacks on health officials and treatment centres.

The WHO has attracted criticism for its response to the DRC outbreak, not least over the issue of whether to declare it a global health emergency, a move critics say could prompt more donor countries to offer funds and other resources.

Im not saying we cannot learn lessons and there was no shortfall, Tedros told the Guardian, adding that the organisation would conduct a proper assessment of the current response.

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A health worker in the Katwa Ebola treatment centre exits one of the high risk infection areas. Photograph: Peter Beaumont/The Guardian

But we have never had conditions like this in other places where we have had Ebola.

As an example of the political issues facing the response to the Ebola crisis, Tedros cited the DRC governments decision to cancel voting in national elections in the Ebola-affected areas, as the outbreak moved to the city of Butembo last autumn.

When we heard about the decision to cancel the elections we said: Dont do that. Its dangerous, he said, adding that he had personally appealed to ministers in the DRC as well as the African Union to reverse the decision.

That was a game-changer, to be honest, he added. An opportunity was missed and the community was angered and started attacking the responders.

Like other senior health officials involved in the response on the ground, Tedros blamed highly complex political and security issues for resurgences in the outbreak.

The political problems [in DRC] have broken the whole system social, economic and so on. And to be honest when I talk to the community it is embarrassing for me, because they say, You are only interested in Ebola because you do not want it in your own countries and you are trying to protect yourselves while mothers and children are dying here.

The root cause of the problem is lack of peace, the lack of a political solution. The incidence of Ebola, malaria and cholera is the symptom.

Its not about Ebola only. What concerns me is the lacking of understanding about how to make our world safe, he said, citing the risk of an airborne pandemic.

Were not investing in preparedness to detect outbreaks quickly. We are investing after the problem comes and knocks on our door when its too late. So how can we move on from that mindset? We have to be as strong as the weakest link and we need to invest in strengthening the systems of the weakest link.

We think that we are very far from the problem but in a globalised world even if it is only happening in one country it can be exported so there is a risk, even as we speak, of spread. We should support the Congolese but also help ourselves.

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A patient is treated at the Katwa Ebola treatment centre, on the outskirts of Butembo. Photograph: Peter Beaumont/The Guardian

Read more: https://www.theguardian.com/global-development/2019/jul/09/ebola-outbreak-global-wake-up-call-says-who-head-tedros-adhanom-ghebreyesus-congo

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