The international response to Ebola is still “too slow and patchy,” Doctors Without Borders warned Tuesday, as officials said the disease is crippling the economies of the three West African countries hardest hit.
The medical aid group, also known by its French name Médecins Sans Frontières (MSF), launched a scathing attack on the global community for its “inadequate” response to the effort to stamp out the Ebola outbreak.
The agency says the poor international response risks creating “a double failure” because ill-equipped locals in Sierra Leone, Liberia, and Guinea have been left to run hospitals and treatment centers, likely contributing to the spread of the virus.
Three months after MSF called for global intervention, its international president, Dr. Joanne Liu, said it was “extremely disappointing that states with biological-disaster response capacities have chosen not to deploy them.” She said people “are still dying horrible deaths in an outbreak that has already killed thousands” and urged the world not to be complacent.
“We can’t let our guard down and allow this to become a ‘double failure’: a response that is slow to begin with, and then is ill-adapted in the end,” added Dr. Liu.
‘A transnational threat’
MSF compiled its briefing to review the status of the response in the time since they issued a plea for the global community to get involved in the Ebola response. Dr. Liu criticized the concentration of international efforts on the construction of Ebola treatment centers without also providing necessary staff and training, transport and laboratories.
Instead, the task of staffing treatment centers has been left up to national authorities, local healthcare staff and NGOs, which do not have the expertise required to do so, said Dr. Liu. “Training NGOs and local healthcare workers to safely operate case management facilities takes weeks. Though MSF and other organizations have been offering training, this bottleneck has created huge delays,” she said.
In rural areas of Liberia, where hopes had been raised that the Ebola infection rate had plateaued, there were still “active chains of transmission” and no transport facilities to test the patients, the briefing said. In Sierra Leone, the national Ebola response team was struggling, with callers to the emergency 117 helpline being told to isolate themselves at home.
“How is it that the international community has left the response to Ebola – now a transnational threat – up to local doctors, nurses and charity workers?” asked Dr. Liu.
MSF’s briefing paper on the three countries hardest hit by the disease comes a day after the World Health Organization (WHO) missed its first major target for containing the outbreak, which called for 70 percent of Ebola patients to be isolated and 70 percent of Ebola-related deaths safely buried as of Dec. 1.
Although that target was reached and even exceeded in parts of Guinea, the agency fell short of the 70 percent mark in Liberia, where only 23 percent of infected patients were in isolation as of Nov. 26, and Sierra Leone, where just 40 percent of cases were isolated.
Liberia
MSF described the situation as “far from under control” in Sierra Leone and “alarming” in Guinea and, despite signs of progress in Liberia, the group says there is no room for complacency. “The outbreak is far from over, as a single case can start a localized epidemic,” it said, reporting infection chains starting in remote rural areas with no access to treatment centers or testing facilities.
The briefing paper said case numbers had dropped in the Liberian capital, Monrovia, where there was now surplus bed capacity, but added that many international agencies “seem unable to adapt to the rapidly changing situation” with outbreaks in Bong, Margibi, Gbarpolu, Grand Cape Mount and River Cess counties. In some areas, such as River Cess, patients must travel for up to 12 hours by road to reach a functioning laboratory and a community care center, it said.
Guinea
Guinea, where the outbreak started, has been “long overlooked by international efforts”, according to MSF, which said the response was “painfully slow”. The briefing said Guinea’s taskforce for dealing with Ebola was improving but that the caseload in November was up 25 percent. Furthermore, “there is insufficient capacity for isolating and providing supportive medical care to patients in Guinea,” it said.
“New areas are reporting infections and 17 of Guinea’s 33 prefectures have reported cases in the past three weeks,” MSF said. “Like in Sierra Leone and Liberia, the absence of implementing partners willing and able to manage case management centers and a lack of trained staff have been a bottleneck and the source of large delays.”
Sierra Leone
Infection is increasing “alarmingly” in Sierra Leone, said the report, and local healthcare workers are carrying the burden. According to the latest figures, the total numbers of cases in Sierra Leone (6,599) will soon eclipse the number reported from Liberia (7,168).
Foreign governments — manly the UK and China — have sent teams to build Ebola treatment centers in locations including Port Loko, Freetown and Makeni, the worst-affected of the country’s 14 districts. However, MSF noted that the UK’s promise to build and provide resources for an additional 700 beds had yet to be fulfilled, two months after its aid program was announced.
“As of 27 November, only 11 of these beds were operational, and only 28 patients had been treated. While the remaining centers are under construction and scheduled to open soon, they will not be running at full capacity until well into the new year,” it said.
Since the UK government’s announced plans for six hospitals, only one has opened, in Kerrytown, an hour’s drive from Freetown. About 50 percent of the available beds were government-run or run by the armed forces, with another 40 percent run by MSF, the briefing said.
“In the absence of adequate facilities to isolate, diagnose and manage Ebola cases, Sierra Leonean healthcare workers are struggling,” MSF added. “[We are] deeply concerned about contamination of uninfected patients and healthcare workers where staff are not necessarily trained to manage Ebola patients and where infection control measures cannot be assured.”
Long-term outlook
Lack of education about Ebola in all three countries is still a major issue and will prevent the containment of the virus. “MSF teams are still finding that misconceptions about Ebola are widespread and stigma is intense, leading some to avoid seeking treatment or report cases,” it said of Liberia. In a recent example it found that people who had been in contact with the sick were fleeing into the bush so as not to be traced, fearful of what would happen if they were.
Ebola has infected nearly 17,000 people, of which at least 5,987 have died, according to the latest figures from the World Health Organization. Of these cases, the vast majority have taken place in the three hardest-hit countries, although isolated clusters have spread to Senegal, Nigeria, Spain, the U.S., and most recently Mali.
On Tuesday, President Barack Obama urged U.S. lawmakers not to lose sight of the ongoing crisis in West Africa despite a marked drop in Ebola-related news coverage. While he acknowledged that progress had been made in the fight against Ebola, the President pushed Congress to approve $6.2 billion in emergency funding to help sustain that progress and prepare U.S. hospitals to handle future cases.
Also on Tuesday, the World Bank once again lowered its growth projections for the hardest-hit countries. It had already cut them in October. In addition to killing to thousands, the Ebola outbreak, which was first identified in March, has shut hospitals, schools and markets, hampered cross-border trade and resulted in the suspension of many of the airline flights.
Guinea’s economy will grow just 0.5 percent this year, down from an expected 4.5 percent before the crisis began, the bank said in its latest assessment of Ebola’s impact. Sierra Leone is expected to register 4 percent economic growth, down from a pre-crisis expectation of 11.3 percent, while Liberia will see just 2.2 percent growth, down from 5.9 percent. The economic effects are expected to worsen in Guinea and Sierra Leone next year, when both economies will shrink, according to the latest estimate.