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Expert panel discusses challenges of controlling Ebola in West Africa

The rapidly growing Ebola outbreak in West Africa is not only overwhelming the health systems of the countries involved, but the World Bank recently warned that it could trash the economies of Liberia, Guinea, and Sierra Leone - the countries that have seen the most cases. Since the first confirmed case in December 2013 in Guinea, almost 5,000 people have become infected with the virus in five countries and about half of them have died. On September 16, President Obama committed 3,000 military personnel to help fight the outbreak, along with other resources.

This morning, KQED's Forum hosted a panel of Ebola experts, including Michele Barry, MD, director of Stanford’s Center for Innovation in Global Health. The panel discussed some of the challenges this outbreak poses. One issue is the enormous need for resources to control an outbreak of this momentum and magnitude. The WHO estimates it will take about a billion dollars to contain and by some estimates, it will require 1,000 international health care workers to train national, local clinicians.

Barry discussed the prospects for Zmapp, an experimental drug to treat Ebola -“a cocktail of monoclonal antibodies” according to Barry - for helping to curb the disease. She said that besides the lack of human clinical data on the effectiveness of this drug, the difficulty producing the drug also slows down plans to use the medication in the field. She went on to say:

I do have optimism for containing the virus. What I don’t have optimism for is the long-term trajectory of the Liberian healthcare workforce. It’s been actually decimated. I think there are wonderful people there working on it on the ground, but actually, there’s only a only a couple hundred doctors and a serious percentage of them have died—as well as nurses, in this battle against Ebola.

She elaborated on her concerns for the long-term problems for controlling epidemics in general:

I think there are short-term problems, but then I would urge people to start - and I know many people are - to think about long term issues. The long term issues of when you have a WHO that’s had its budget decimated, and its pandemic and epidemic division disbanded. That needs to be strengthened. When you have a workforce in Africa of only - I mean they have 25 percent of the disease burden but only four percent of the workforce. That needs to be strengthened. So there are long term issues of control for future epidemics.

She also suggested that a global health worker reserve corps could be assembled, a fund to strengthen health systems could be established, much like The Global Fund to fight AIDS, Tuberculosis and Malaria, and the UN could take a more active role in large infectious disease epidemics.

Another guest, Dan Kelly, MD, of the University of California at San Francisco, described some of the social barriers to controlling the outbreak, including the fear and stigma associated with Ebola in the communities affected. He described four patients he had seen on his most recent visit to the region:

All of them, when they heard they found out they were Ebola suspects (cases), they ran - within an hour or two - and they went back to their communities, they went into hiding. And what I did was, I followed them a few days later in the communities to understand why they ran, why they went into hiding. And it’s because the word Ebola in the communities means destruction and because being given that label means a death sentence and they’re extremely scared not only of dying—which is a natural reaction and one that leads to traditional healing - but also, they’re afraid of the stigma associated with that. One of the mothers of a child who was an ebola suspect, she reported that when she went back to her home, her own family distanced themselves from her because they were afraid of her.

Despite the daunting challenges of controlling the Ebola virus in this outbreak, most of the panel believed that with the right resources, the outbreak could be brought under control, though it will take time and commitment from the global community.

Previously: Should we worry? Stanford’s global health chief weighs in on EbolaBiosecurity experts discuss Ebola and related public health concerns and policy implications and Stanford global health chief launches campaign to help contain Ebola outbreak in Liberia

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