Can the Ebola Outbreak Strengthen Global Health Security?

Marcia Frellick

May 08, 2015

Ten essays published online May 7 in the Lancet explore whether the recent Ebola crisis can strengthen commitment to global health security.

The Lancet invited global health practitioners to reflect on lessons learned and to offer suggestions for next steps.

Each of the articles provides insight on factors that affect security, including demoralized health workers, falsified and substandard medicines, armed conflict, natural disasters, and patterns of immigration.

"Absence of Resilience" in Health Systems

In an accompanying viewpoint, Margaret Kruk, MD, MPH, from the Department of Global Health and Population, Harvard T. H. Chan School of Public Health in Boston, Massachusetts, and colleagues said the outbreak spotlighted what happens when a crisis hits and health systems are not prepared.

She describes a global "absence of resilience" in health systems that starts with lack of recognition that a crisis in one region is a crisis for all.

Also missing, she told Medscape Medical News, were lack of investment in and implementation of the International Health Regulations, a series of guidelines that clearly spells out what it takes to detect and respond to outbreaks effectively.

"What's ironic is that most of the countries of the world have signed onto these," but many, especially poor countries, did not implement them, she says.

Lack of resilience was also seen in the workforce in West Africa, where workers were too afraid or too demoralized to come into work.

"One of the things that came to the fore was that health workers were completely demotivated," Dr Kruk says. "Often their paychecks were delayed by months. That's even before Ebola hit. So you have a lackluster group of folks suffering from bad morale and then a disease hits for which they have no cure and no equipment or supplies to deal with it effectively."

What is needed is a real investment in training the right numbers and categories of workers, she says. Governments need to plan for enough workers in the outlying areas where Ebola will first show up and make sure they are respected and supported and paid adequately and on time.

With resilient systems, people would have gained trust in the health system faster and understood the importance of such measures as safe burials, which could have minimized the death toll, Dr Kruk says. In addition, health systems need to be able to handle nonemergency care such as vaccinations and prenatal and delivery care. That lack led to deaths beyond the Ebola-related deaths.

Still, Dr Kruk is hopeful this outbreak will be a wake-up call different from previous outbreaks.

"I think the energy and creative ideas and the level of soul-searching and forward-looking discussion we're seeing for this outbreak is in a way much greater than we've seen in the past for H1N1 or SARS."

Collective vs Individual Health Security

David L. Heymann, MD, from the Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine in London, United Kingdom, makes a distinction between collective health security and individual health security.

For instance, infected workers in West Africa who were from developed countries were brought back to their home countries, where they could get safe and effective treatments. However, infected West Africans have had to accept that their healthcare is not always safe or effective even if they have access, Dr Heymann writes.

Lancet editors Pam Das and Richard Horton, MD, say in a comment accompanying the review that the essays show that working toward global health security requires cooperation among nations, although many fight multilateralism.

"In Washington, DC, the most influential city affecting global health, the political atmosphere is deeply hostile to multilateral solutions to global health challenges," they write. "It is, sadly, also deeply hostile to [the World Health Organization] which, one senior US State Department official told us recently, has been 'overwhelmed' by Ebola."

The central message of the essays is that health security is not universally defined, but that should not halt progress toward achieving it.

"The complexity of global health security should not induce paralysis. But it should make us pause before we argue for quick solutions," they write.

Dr Kruk and Dr Heymann have disclosed no relevant financial relationships.

Lancet. Published online May 7, 2015.

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