Ebola: When will we learn?

We are facing a global pandemic that will impact millions, with a devastatingly high mortality rate, no known cure, and a slow and embarrassingly inadequate international response.

Sound familiar? Not so long ago these very terms were used to describe the HIV/AIDS pandemic. And now, only a few days ago Thomas Frieden, director of the Centre for Disease Control in the United States, warned that we must act now to prevent Ebola from becoming the next HIV. Hyperbole or a warning to be heeded?

According to Prof. Michael Merson, founder of the Duke School for Global Health, the current Ebola Viral Disease (EVD) crisis has many of the key hallmarks of the early days of the HIV crisis:

  • EVD is presumed deadly;
  • There is no effective treatment;
  • We have little knowledge about causative agent, clinical illness, and immune response;
  • Patients and care givers face stigmatization, discrimination, and fear;
  • There is an inadequate global response.[1]

In a 2013 column for the Huffington Post, shortly after he took the reigns at the Global Fund to Fight AIDS, Tuberculosis and Malaria, Mark Dybul wrote:

Timing is critical. If we do not start to act this year, we may miss that opportunity. As we have learned with other infectious diseases, when you have a window of time to control the spread of a disease, you must take action or else face the risk that the disease finds new forms that are far more complex and expensive to defeat. When that happens, all the investment made so far is effectively lost.

In 2013, an estimated 35 million people were living with HIV. There were 2.1 million new infections, and 1.5 million people died of HIV.

As the Ebola outbreak continues to spin out of control the dangers are becoming more and more apparent. The latest WHO predictions see the possibility of new infections rising from the current rate of 1,000 to 5,000-10,000 per week by November if the response does not improve.

The Center for Disease Control has modeled a worst case scenario that would see 1.4 million people infected with EVD by January 2015. With a mortality rate of 70% that translates into almost 1 million deaths.

What can be done to avert disaster? Perhaps the most frustrating aspect of the Ebola response is that it suffers from a lack of “will”, not of “way”. In the words of the World Bank ‘s Head of Health in Africa Initiative, Dr. Khama Rogo: “We know what we need to do. But we’re still not doing it.” The WHO has mapped out a response to end of global transmission within six to nine months.

Jim Kim, President of the World Bank and an infectious diseases and public health expert, said the international community was “way, way behind the curve” in tackling the outbreak adding, “we have to quickly speed up, and scale up the global response.”

In a recent appeal to members of the UN Security Council, President Koroma of Sierra Leone, said that his country needed 5,000 additional medical workers, including 720 doctors and 3,000 nurses, along with 1,500 more beds to treat infected patients.

But it is becoming increasingly clear that despite a recent surge in donations hopes of a quick containment of the outbreak are slipping away.  The UN has estimated that a billion dollars are needed to mount an effective response to the Ebola crisis. To date 36% of that has been donated.

Over the last 20 years billions have been spent on HIV. In 2013 alone, an estimated $19.1 billion in funding was made available for HIV programs in low and middle-income countries. Exactly how much misery and money a more robust initial global response to HIV could have saved is impossible to tell.  However, it certainly puts the current Ebola response price tag of $1 billion in perspective.  A billion now for Ebola could save us billions of dollars in future costs. And, more importantly, it would save millions of lives.

[1] Taken from Prof. M. Merson, presentation to Joep Lange & Jacqueline van Tongeren Memorial Scientific Symposium on Global Health in Amsterdam, 14 October 2014.

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