Deep within the newspaper today, a spark of good news: new Ebola treatment centres in Liberia are sitting 80% empty. Because Ebola is declining. Hurray. Health officials caution there are still hotspots and there may be another rise, but the trend is in the right direction.
With the official death toll around 5000 but the real toll probably more like 10,000, this was the next epidemic everyone feared. But “fear” is the operative word here, because the hyperbolic reaction outstripped the reality. I read columns in which opinion leaders blamed the World Health Organization, blamed doctors, blamed Obama (for goodness’ sake). If you believed any of this nonsense, you would think that no one did anything they should have.
But the reality is precisely the opposite.
Before 2006, there was no real global public health system. The World Health Organization (WHO) tracked only a few developing-world diseases. But that all changed, and the thing that changed it was SARS. When SARS broke out in China, the Chinese public health system did not have the tools in place to cope with it. It then took the Chinese government much too long to admit that the country had an outbreak. By that time, SARS had reached Canada, and the WHO said people should stop travelling here. Conferences were cancelled and Toronto streets were empty, which was ridiculous given that very few people were exposed, and most of them were doctors and nurses treating the sick. Canada’s economy suffered a loss of billions of dollars unnecessarily.
In the wake of SARS, a lot of people around the world got together to put in place a functioning world early-warning and intervention system. The result was the International Health Regulations, which came into effect in 2006. All UN members agreed to abide by the regulations, which give the WHO new powers to monitor outbreaks and knock on government doors, asking, “What’s going on?” The regulations also require countries to have a public health system. If a serious situation arises, an emergency committee is formed of experts from around the world. They can declare an international emergency, which has important ramifications. It means that the host country has to get on top of the epidemic, or the UN will walk in. But — and this is key — it does not mean trade and travel stop. On the contrary, the WHO tries to keep supply lines open.
The regulations got their first work-out during the H1N1 epidemic, which was the first declared international emergency. My Mexican colleagues explain that Mexico welcomed the involvement of the WHO, which worked side-by-side with the Mexican government to get the outbreak under control there. The WHO has also worked closely with China during its avian influenza outbreak and with Saudi Arabia during its outbreak of a new SARS-like virus, MERS. Neither was declared an emergency, but the close monitoring by the WHO nudged and supported the Chinese and Saudi Arabian governments to handle the outbreaks properly. The next emergency declared was an outbreak of polio in war-torn Syria… who knows what is going on there.
After putting out these fires, WHO was hit with the conflagration: Ebola. This was the nightmare the regulations had been set up to face: an outbreak growing at a geometric rate in countries with poor public health infrastructure and few resources. The WHO was quickly overwhelmed, and the UN set up a special body to cope with the outbreak.
I get the WHO’s daily progress reports, and amid the skyrocketing death toll there was a lot of good news. Many countries committed money and health-care workers to fighting Ebola right on the ground. Several African countries contained small outbreaks and conducted careful contact tracing to find all those infected. They quickly eliminated the virus. Local education and safe burial practices were instituted and started working to contain new infections. Travel and trade were kept open, and countries like Canada that imposed ridiculous entry conditions had their wrists slapped. (If it had been Canada with an outbreak like SARS, we would have been singing a different tune.)
In fact, as some commentators have noted, this was the first real test of the International Health Regulations, and the WHO passed. Ebola has been turned around. It did not become a pandemic, and most of the world is safe. Sure, there will be some lessons learned, but the fundamental approach is sound.
We have a lot to thank the WHO for. And it behooves us to cooperate with the WHO and abide by the regulations against the day that an emergency is declared here and we need to keep things going while battling to save lives.