West Africa: Independent Ebola Report - Not Listening to Civil Society Caused Thousands of Deaths, Notes AHF

Ebola survivor Beatrice Yardola was one of Liberia's last Ebola patients. There could have been many fewer deaths with better national and global responses.
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Freetown — Time is Now for Reform & Immediate Change of Global Health Leadership - Panel convened by Harvard Global Health Institute and London School of Hygiene & Tropical Medicine issues hard-hitting analysis of the global response to Ebola

An independent group of 19 experts from around the globe, convened by the Harvard Global Health Institute (HGHI) and the London School of Hygiene & Tropical Medicine, has issued a hard-hitting analysis of the global response to the 2014-15 Ebola outbreak in West Africa, published in the prestigious medical journal The Lancet.

The report offers 10 major reform proposals to prevent future such catastrophes, with emphasis on: preventing major disease outbreaks; responding to outbreaks; the production and sharing of research data, knowledge, and technologies; and ways to improve the governance of the global health system, with a focus on the World Health Organization (WHO).

The members of the Harvard Global Health Institute-London School of Hygiene & Tropical Medicine Independent Panel on the Global Response to Ebola concluded that while the 2014-15 Ebola outbreak "engendered acts of outstanding courage and solidarity," it also caused "immense human suffering, fear and chaos, largely unchecked by high level political leadership or reliable and rapid institutional responses." Panel members come from academic institutions, think tanks and civil society, with expertise in Ebola, disease outbreaks, public and global health, international law, development and humanitarian assistance, and national and global governance.

The Panel was chaired by Professor Peter Piot, Director of the London School of Hygiene & Tropical Medicine and co-discoverer of the Ebola virus. Professor Piot said: "We need to strengthen core capacities in all countries to detect, report and respond rapidly to small outbreaks, in order to prevent them from becoming large-scale emergencies. Major reform of national and global systems to respond to epidemics are not only feasible, but also essential so that we do not witness such depths of suffering, death and social and economic havoc in future epidemics. The AIDS pandemic put global health on the world's agenda. The Ebola crisis in West Africa should now be an equal game changer for how the world prevents and responds to future epidemics."

In addition to over 11,000 deaths from Ebola, the epidemic "brought national health systems to a halt, rolled back hard-won social and economic gains in a region recovering from civil wars, sparked worldwide panic, and cost several billion dollars in short-term control efforts and economic losses."

"The most egregious failure was by WHO in the delay in sounding the alarm," said Dr. Ashish K. Jha, Director of the Harvard Global Health Institute, K.T. Li Professor of International Health at the Harvard T.H. Chan School of Public Health (Harvard Chan) and a professor of medicine at Harvard Medical School. "People at WHO were aware that there was an Ebola outbreak that was getting out of control by spring…and yet, it took until August to declare a public health emergency. The cost of the delay was enormous," said Jha.

The report's 10 recommendations provide a roadmap to strengthen the global system for outbreak prevention and response:

  1. Develop a global strategy to invest in, monitor and sustain national core capacities
  2. Strengthen incentives for early reporting of outbreaks and science-based justifications for trade and travel restrictions
  3. Create a unified WHO Center with clear responsibility, adequate capacity, and strong lines of accountability for outbreak response
  4. Broaden responsibility for emergency declarations to a transparent, politically-protected Standing Emergency Committee
  5. Institutionalize accountability through an independent commission for disease outbreak prevention and response
  6. Develop a framework of rules to enable, govern and ensure access to the benefits of research
  7. Establish a global fund to finance, accelerate and prioritize R&D
  8. Sustain high-level political attention through a Global Health Committee of the Security Council
  9. A new deal for a more focused, appropriately-financed WHO
  10. Good governance of WHO through decisive, timebound reform and assertive leadership

The Harvard and London School of Hygiene & Tropical Medicine teams felt strongly that an independent analysis from academic and civil society voices should inform the public debate, in addition to other planned official reviews of the global response. Dr. Jorge Saavedra from AIDS Healthcare Foundation (AHF), a member of the Independent Panel and who visited Sierra Leone by June 2015 and interviewed a dozen of key players on the Ebola response, considers that WHO and Governments, by not listening and giving credibility to civil society voices—specifically to the voice of Medecins Sans Frontieres (MSF), one of the first responders—caused thousands of deaths and delayed the international response.

According to Liberian Panel member Mosoka Fallah, Ph.D., MPH, of Action Contre La Faim International (ACF). "The human misery and deaths from the Ebola epidemic in West Africa demand a team of independent thinkers to serve as a mirror of reflection on how and why the global response to the greatest Ebola calamity in human history was late, feeble and uncoordinated. The threats of infectious disease anywhere is the threat of infectious disease everywhere," Fallah said. "The world has become one big village."

"We gathered world-class experts and asked, how can we bolster the dangerously fragile global system for outbreak response?" said the Panel's Study Director, Dr. Suerie Moon, MPA, PhD of the Harvard T.H. Chan School of Public Health and Harvard Kennedy School. "Now, the billion-dollar question is whether political leaders will demand the difficult but necessary reforms needed before the next pandemic. In other words, will Ebola change the game?"

"There is a high risk that we will fail to learn our lessons," added the Harvard Global Health Institute's Ashish Jha. "We've had big outbreaks before and even careful reviews after, but often the world gets distracted. We owe it to the more than 11,000 people who died in West Africa to see that that doesn't happen this time."

Finally, a non-member of the Panel, Michael Weinstein, President of AIDS Healthcare Foundation (AHF), commented that in August 2014, when Miata Jambawai, AHF's Country Program Manager in Sierra Leone—where AHF has free AIDS treatment clinics—requested technical information from WHO related to personal protective gear (gloves, gowns, masks, booties, etc.) a fact mentioned in the Report, the response from WHO was close to null and Ms. Jambawai and her team in Sierra Leone needed to find out other sources of information, primarily via MSF. Mr. Weinstein considers that the Independent Panel Report on Ebola has highlighted sufficient evidence to openly request not just a profound reform of WHO but also a change of its Director General, Dr. Margaret Chan, in order to ensure that critically needed reforms happen in a rapid manner and without WHO's resistance to the changes.

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