As the UN celebrates the official launch of the post-2015 agenda with the Sustainable Development Goals and world leaders start laying out their views in the UN General Debate, much of this week in New York is about looking forward. But on the sidelines of the main events focused on the SDGs, peacekeeping, violent extremism and the Syrian crisis, many are using this week as an opportunity to look back at the past year. Namely, a year after the West African Ebola outbreak reached its peak, many are discussing what went wrong and how to better prepare for the next epidemic.
With more than 28,000 estimated cases and over 11,000 deaths, there is no doubt that the West African Ebola outbreak is the largest in history. Although the outbreak mainly impacted the three West African states of Guinea, Liberia and Sierra Leone, cases were ultimately reported in nine other countries including Nigeria, Senegal, Mali, the US and most of Western Europe. The outbreak, which the World Health Organization and international public health community were slow to recognize as Ebola, severely strained the resources of the local and international health system and highlighted how dangerous epidemics can be if they are not managed properly.
In July, a report by an independent panel of experts found that the WHO was not only slow to respond to the outbreak, but lacked the institutional culture to respond adequately once it was clear how devastating the outbreak would be. In some ways the report only confirmed what many public health experts and commentators suspected as the Ebola outbreak raged on. But rather than placing blame, the report and the discussions around it also give the WHO and its member states the opportunity to reform, hopefully ensuring that everyone involved will be better prepared the next time a complex international epidemic occurs.
As Dr. David Nabarro, the UN Secreary-General’s Special Envoy on Ebola, pointed out to UN Dispatch earlier this week, epidemics always seem to come as a surprise, no matter what the warning signs are. Specific aspects of West Africa such as cultural practices around death, the close proximity of rural forested areas to heavily populated urban cities and the fragile nature of the national health systems in Guinea, Liberia and Sierra Leone may have made the outbreak worse, but the inability of the international community to prepare and respond rapidly also contributed to the devastation. Changing this culture of reaction, rather than prevention, is a key part of being ready for the next epidemic, no matter where it comes.
But this change will require more than just reports and high level recommendations. Much of the discussion around the SDGs this past week has been about how the 17 goals adopted are formulated in such a way to require all actors and stakeholders involved to “break out of their silos” and work together across multiple disciplinary fields. Emergency health response and epidemiology are no different, where far more cooperation is needed not just local, national and international levels of government, but among aid workers, health care workers, scientists and community leaders.
In retrospect, it is easy to see how the lack of communication compounded the Ebola outbreak in West Africa. It took nearly three months before the mysterious disease popping up across Guinea was identified as Ebola, mainly because local and international health care workers didn’t think that Ebola could occur in West Africa as previous outbreaks were limited to Uganda and the DRC. Yet in the years leading up to the outbreak, scientists found Ebola antibodies in bats throughout the Upper Guinean forests that extend from Guinea to Ghana. The antibodies are an indication that the bats – believed to act as reservoirs and carriers of Ebola – had come into contact with the virus. Since 2005 when antibody testing became common, the presence of the antibodies have been associated with outbreaks among humans as the more carriers of the virus are around, the more likely a person will come into contact with them and be infected. But because this information largely stayed in academic literature, those responsible for identifying and responding to the disease had no idea that Ebola was a strong possibility.
But there are lessons that can be learned from this. Breaking down walls between different disciplines can help everyone be ready for the next epidemic, increasing response time and improving containment. Many of the meetings happening this week aim to create this new culture of cooperation and interaction, making sure that the next epidemic that comes around, we will all be ready.