Ebola virus disease outbreak in West Africa

Report of the WHO Director-General to the Special Session of the Executive Council on Ebola

Mr. President, distinguished members of the Executive Board, Excellencies, Dear UN colleagues, ladies and gentlemen,

The outbreak of Ebola virus disease that hit several parts of West Africa is the largest, longest, the most serious and most complex ever observed in nearly 40 years of history of this disease. It was the first time that West Africa was faced with this virus that has overtaken the country and caused horrible shock. The entire world, including the WHO, has been slow to see what was happening.

The Ebola outbreak is a rich teachings tragedy for the whole world, including the WHO on how to prevent such events in the future. Various cultural, historical and geographical and inadequate road and health infrastructure have helped create a "toxic combination" of opportunities that the virus was quickly exploited.

Exceptionally mobile populations moving through exceptionally porous borders have infected new areas and have re-infected other, escaping the vigilance of contacts research teams. Health systems already weakened after years of civil war and unrest have crumbled under the weight of this disease.

Before this outbreak, Guinea, Liberia and Sierra Leone counted only one to two doctors for almost 100 000 inhabitants. Ebola has still fallen significantly this figure. The number of doctors, nurses and other health workers infected, nearly 850, including 500 deaths, was unprecedented for Ebola, as was the fact that these infections continue to occur in December, a year after the onset of the outbreak.

The spread of Ebola in two new countries through infected passenger aircraft was also unprecedented.

This disease that we did not expect, was unknown to everyone from doctors and laboratory personnel to governments and citizens. Ebola took this fear of the unknown. It also benefited from a deeply rooted cultural tradition dictates providing compassionate care to the sick and to surround the body of a ritual if they die.

Ladies and gentlemen,

This outbreak has generated extraordinary aid flows to many countries and partners such as the United States, the United Kingdom, France, Cuba and China, the European Union, the African Union, economic Community of West African states (ECOWAS) and many others too numerous to mention support. I must also acknowledge the leadership and extraordinary effort unprecedented commitment by the governments of affected countries. All this occurred in a spirit of global solidarity with the people of Guinea, Liberia and Sierra Leone and their governments. Countless bodies, non-governmental organizations such as Doctors Without Borders and Save the Children, doctors, nurses and volunteers bravely risked their lives to help these patients survive.

Development partners, including many in Africa, have provided funds, equipment, mobile laboratories and training. Foreign military personnel provided logistical support and built new treatment centers.

With its partners, WHO helped create 27 laboratories, supervised the construction and operation of many of Ebola treatment centers and coordinated deployment of nearly 60 foreign medical teams made available by 40 organizations.

Skills, compassion and courage of these teams, a total of nearly 2,000 health workers, allowed to operate 66 Ebola treatment centers.

Researchers, the pharmaceutical industry and regulatory authorities have joined forces to accelerate the development of vaccines, treatments and diagnostic tests used intervention points.

Last September, the Secretary General of the UN, in collaboration with WHO, has established the United Nations Mission for the emergency action against Ebola. Many UN agencies, gathered in this mission have provided logistical and technical support much-needed three affected countries.

Over 100 countries in the six WHO regions have invested heavily in preparedness measures, often with the support of other countries and with many WHO experts.

The WHO staff contributed significantly to the response, in the preparation of countries and research efforts and development, often taking jobs that were not previously executed by WHO. I thank them for their commitment and dedication.

WHO is currently represented on the ground in all 34 prefectures of Guinea, in all 15 counties of Liberia and the 14 districts of Sierra Leone. Nearly 700 caregivers made by WHO are currently present in these three countries.

I appealed to the staff of all relevant departments at Headquarters and Regions. These people are emotionally and physically exhausted. Many of them are on the ground for months and they really deserve our gratitude.

Of course, the big question everyone is asking is this: all the efforts of the affected countries and the international community have they helped to overcome the crisis? Do we have enough to reverse the trend as conventional control measures now make it possible to reduce the number of cases to zero?

The numbers tell us that the case curve declines and we have avoided the worst. We now need to focus on public health measures proven to finish.

The number of cases clearly decreases in all three countries, but we must maintain momentum, keep us from complacency and deal with donor fatigue. Our common goal is to achieve zero cases in the last three countries. It is doable, but it will not be easy.

As we have seen from time to time in the past, a surge of new cases may be triggered by a single burial done in bad conditions or a single violent act of community resistance. These two types of high-risk situations still occur.

Although the collection, reporting and data sharing has improved, we know that all cases, especially all deaths are not always detected or reported. Communication problems and poor road networks increase the risk of missing out on a number of cases and deaths, especially in remote rural areas.

Ladies and gentlemen,

The Ebola outbreak showed the need to make urgent changes in three key areas: preparedness and response to national and international emergencies, how new medical products are placed on the market and how WHO works in emergency situations.

In 2010, a review committee convened by the World Health Assembly under the International Health Regulations to assess the response to the 2009 influenza pandemic had warned stressing that the world was ill-prepared to respond to a severe flu epidemic or other similar emergency threatening public health and globally.

The Committee noted that WHO responded well to outbreaks geographically circumscribed and short-lived, but did not have the necessary means and capabilities to deal with a health emergency both severe and prolonged.

Among the recommendations of the Committee to strengthen preparedness for crisis situations, it advocated the creation of a larger pool of public health personnel that could be mobilized to deal with a prolonged emergency, creating a reserve fund for the rapid ramp-building and the establishment of a comprehensive research and evaluation program.

On the need for new medical products, the world must never be helpless when there is a severe disease with high epidemic potential, let alone a disease that is known for almost 40 years. This was said governments, scientists, leaders of the pharmaceutical industry and public health experts at a meeting on vaccines against Ebola organized by WHO.

Ladies and gentlemen,

The Ebola outbreak revealed some significant weaknesses in the administrative infrastructure, management and technical of this Organization. I propose a series of reforms, but I want to highlight a few.

Proposals submitted to you again insist on the need to create an ad hoc reserve fund to support rapid response to disease outbreaks and emergencies.

Our normal recruitment procedures are too slow to be used in emergency situations. We need to do this streamlined and expedited procedures.

We need to apply in this respect the "one WHO" approach in which all three levels of the Organization will use the same standard operating procedures, the same tools and the same frameworks for risk assessment, monitoring and accountability in emergencies.

The severity of this outbreak shows the need to look for people with experience in the field of emergency when recruiting WHO country office managers.

The regional structure of WHO has its advantages: for example, it allows to adapt the implementation of global strategies and guidelines to crops and local conditions (and we have learned in the course of this epidemic of Ebola how culture is important), organize the response of neighboring countries to common threats such as polio and malaria, and help countries develop and validate key capabilities required by the International Health Regulations to be better prepared to the next emergency.

As shown by the events since the beginning of this century, outbreaks rarely have consequences circumscribed only to local and regional levels in our independent and interconnected world.

Should be given more authority to the International Health Regulations, which is the main line of collective defense against the threat of emerging diseases and epidemic potential. The world never will access a real safety as more countries will not have been equipped with the core capacities.

We need a much more rigorous methodology than a self-assessment using a questionnaire to evaluate these capabilities and the implementation of the said building should be considered an emergency.

We must stop thinking that these abilities are something that must be grafted on the health system of a country as a kind of extra arm. I Do Not.

The capacity to achieve meaningful surveillance, providing laboratory support, manage the collection and reporting of data and organize a response should be an integral part of the health system.

Health systems also have a sufficient number of trained health workers and these people need to be paid appropriately.

This is one of the key lessons the world has learned from last year. Health systems that work well are not a luxury. These are walls that prevent sudden shocks reverberate throughout the fabric that holds our societies and make shatter. As we have seen, the success of the struggle depends on leadership and community involvement at every stage.

In West Africa, which began as a health crisis has rapidly turned into a humanitarian crisis, social, economic and security, resulting in the closure of schools, markets, companies, air and sea links and borders. Tourism has been destroyed, further exacerbating the blow to the faltering economies. Countries have had to resort to military and defense forces to control and monitor the containment measures.

We also need to think about the advice given by the Review Committee on the establishment of a larger pool of public health personnel. To me, this one should have three components.

First, countries should have their own staff to respond to emergency situations, trained and trained to work with military precision. These personnel should be paid.

In Guinea, WHO has trained some young doctors from countries with the basic principles of epidemiology and the fight against outbreaks. In Mali, the government appealed to medical students with training in epidemiology to quickly build effective research teams of contacts. These people know the country and its culture and will be there long after the foreign medical teams will be parties.

Second, WHO should strengthen its own workforce. For detection and response to disease outbreaks, experience and knowledge of experienced field epidemiologists are very valuable. We need more staff like this.

Third, crisis preparedness require to have a greater ability to ramp up outside the WHO, in particular in response to severe and prolonged events.

WHO is working with the World Food Programme to establish a common operating platform, especially for the provision of logistical support.

We must build on existing networks, especially our network of collaborating laboratories with nearly 100 laboratories certified by WHO providing surveillance for measles, polio, yellow fever and other epidemic-prone diseases . We also need to discuss the introduction of additional resources with our institutional partners in the Global Alert and Response Network Action Outbreak (GOARN). The two networks are uniquely equipped to WHO. We work with them for many years and I salute the countries who have given their support to these networks.

GOARN is a huge resource. For their part, institutions particularly appreciate the experience that staff acquires during his deployment on the network.

Ladies and gentlemen,

I conclude by urging all of us to see in the 2014 Ebola crisis an opportunity to build a more robust system to protect global public health security.

The rich countries must support others in the development of stronger health systems that integrate core capacities under IHR.

The instability of the microbial world will always continue to surprise us.

But never again will we allow ourselves to be taken unawares.

Thank you.