What the new Ebola ourbreak says about the state of Global Public Health

May 23, 2018

23rd of May 2018, and the WHO tweets that 49 people have likely been infected with ebola, 22 of them dead, in the latest outbreak in north-west Democratic Republic of Congo.

If infections reach the nearest city, Mbandaka, it could be a disaster. If the ebola virus follows the flow of people and goods down to the DRC’s capital, Kinshasa, it will be a catastrophe, unlike anything we have experienced.

Yet the World Health Organization – quite contrary to its half-hearted response in West Africa in 2014, has mounted, in partnership with the Ministry of Health, MSF and the private sector, a serious and innovative response. At its heart, is the distribution of an – as of yet – unapproved vaccine, developed by the pharmaceutical manufacturer, Merck. Even two years ago, it would have been unthinkable for the WHO to cut through its red tape and recommend the distribution of an unlicensed medicinal product – even in an emergency.

Equally innovative is the way the vaccine is being distributed. WHO, the Ministry of Health and MSF are implementing a “ring vaccine”, through which the immediate circle of contacts of an infected person are targeted, and then the circle of contacts around those individual contacts. This, combined with community-led behavior-change strategies to restrict physical contact – particularly the shaking of hands. 

It is too early to applaud success, but the speed and creativity of the response, combined with the planning and preparation for another outbreak is pretty breathtaking. And it tells us something about the state of global health.

It is an example of what can be achieved when the biomedical and behavioral sciences work hand in glove. And it is an example of the immediate impact of political will and funding can have when they decide to face down an emergency.

Sadly, it is also an example of the damage being done to global health by the current occupant of the White House - the contribution of a measly one million dollars to the response, which coincides with a request to Congress to cut ebola funding by over 250 million, and the abrupt departure of the White House pandemics adviser.  This is petty politics “trumping” evidence. Any excuse to do exactly the opposite of Obama. It highlights, yet again, the enormous risks the entire world faces as Trump abdicates the US’ global authority and leadership. The brutal truth is that everyone else has to step up to replace US influence – and can achieve results, despite the waning of US power. 

Above all, if WHO’s turgid bureaucracy can be sliced through like this to build a concrete partnership of governments, NGOs and the “evil” private sector, imagine what could be possible. It is a breath of fresh air after the deepening stagnation and crisis of the AIDS response, particularly that of the UN institution headquartered opposite the WHO in Geneva. 

Lives are being saved. Infections averted, and a wholesale public health crisis avoided. I had forgotten what excitement in global public health felt like!