Committee Information

The World Health Organization (WHO) is the international agency of the United Nations dedicated to focusing on issues of global health and is a constituting body of the United Nations Development Group. WHO defines its primary objectives as being “responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends”.

WHO was founded in 1948 and is based in Geneva, Switzerland. It currently consists of 194 member states, with all of them also being members of the United Nations. WHO also makes room for a number of states and non-governmental organizations to attend as observers.

The activities and scope of WHO in order to reach the objectives laid out are as follows:

• “Providing leadership on matters critical to health and engaging in partnerships where joint action is needed;

• Shaping the research agenda and stimulating the generation, translation and dissemination of valuable knowledge;

• Setting norms and standards and promoting and monitoring their implementation;

• Articulating ethical and evidence-based policy options;

• Providing technical support, catalyzing change, and building sustainable institutional

capacity; and

• Monitoring the health situation and assessing health trends”.

Introductions

The current health crisis that is becoming one of the highest concern of World Health Organization is an outbreak of the Ebola virus that first occurred in March 2014 and is currently ongoing. Due to the highly contagious nature of the disease, it calls for a high degree of outbreak control and incessant monitoring. WHO has focused a majority of their efforts and resources in the past months on this goal.

Unfortunately, despite all of the effort being put into the issue, the Ebola virus is still rampant and spreading across countries and continents. News of patients that have been discovered to be infected on aircraft or in various other confined spaces have caused widespread panic in a variety of nations.

Alongside the panic of Ebola widespread and the danger that spread and infected the healthworker comes the controversy of how citizens of countries that have not been exposed to Ebola should be treated, with arguments concerning whether they should be allowed to be brought back to their home countries for treatment and whether this would risk the safety and unexposed nature of these countries, versus the right of the patient to receive their due care.

However the problem regarding Ebola is a complex one that didn’d only causes huge crisis in medical emergency, but also in economic. The widespread of Ebola have causes those who are infected cannot work and also making others afraid and worried to go out to work. Transportation and travel is disrupted. An impact assessment by the World Bank, released on October 8th, estimated the short-term impact of the outbreak on the economies of Guinea, Liberia and Sierra Leone in terms of forgone GDP at $359m. Depending on whether the outbreak is contained quickly or slowly, the damage will continue into next year; under the Bank’s gloomier “High Ebola” scenario, the economic loss to Liberia in 2015 would be the equivalent of 12% of GDP.

Issues and controversies such as these, as well as the worsening nature of the problem despite all of the efforts so far, have caused for WHO to go in search of new alternatives and solutions. The Ebola crisis is a problem that has so far failed to wane and requires the immediate attention of all states exposed or not, in order to prevent further outbreak.

Historical Events of Ebola

The most recent, currently ongoing, and most widespread Ebola outbreak in history to date began in Guinea in December 2013 and quickly spread to affect a number of countries, most severely Liberia and Sierra Leone. Despite the recent outbreak, Ebola Virus Disease has

occurred shown since 1976. The following table outlines a history of Ebola outbreaks

prior to the outbreak of 2014 and their fatality and scope starting with the discovery of the Ebola virus in 1976:

There are a number of reasons why this particular outbreak caused such quick and uncontrollable spread of the disease. The first one is the development of many regions in

Africa, particularly in terms of transportation and access to areas that were previously much more remote and secluded. The most recent outbreak occurred at a specific point on the border of Guinea, Liberia, and Sierra Leone that is often travelled and has a good transportation network to all three countries, making it particularly easy for it to be spread.

Another issue that affects the speed and effectiveness of the initial response to an outbreak is the education and awareness of the disease in the region. This outbreak was the first time Ebola had ever been seen in West Africa, and particularly in Guinea, resulting in a lack of preparation on the part of the health professionals involved in investigating the cases and reports of infected people for the first couple of dozen cases. “Health workers did not recognize it and had neither the training nor the equipment to avoid infecting themselves or other patients. Hospitals in the region often lack running water and gloves, and can be fertile ground for epidemics. Public health experts acknowledge that the initial response, both locally and internationally, was also inadequate.

Current Condition

Situation Report Update on 25 October 2014

A total of 10 141 confirmed, probable, and suspected cases of Ebola virus disease (EVD) have been reported in six affected countries (Guinea, Liberia, Mali, Sierra Leone, Spain, and the United States of America) and two previously affected countries (Nigeria, Senegal) up to the end of 23 October. There have been 4922 reported deaths.

Following the WHO Ebola Response Roadmap, country reports fall into two categories: 1) those with widespread and intense transmission (Guinea, Liberia, and Sierra Leone); and 2) those with or that have had an initial case or cases, or with localized transmission (Mali, Nigeria, Senegal, Spain, and the United States of America). An overview of the situation in the Democratic Republic of the Congo, where a separate, unrelated outbreak of EVD is occurring, is also provided.

1. Countries with Widespread and Intense Transmission

A total of 10 114 confirmed, probable, and suspected cases of EVD and 4912 deaths have been reported up to the end of 18 October 2014 by the Ministry of Health of Liberia, 21 October by the Ministry of Health of Guinea, and 22 October by the Ministry of Health of Sierra Leone (table 1). All but one district in Liberia and all districts in Sierra Leone have now reported at least one case of EVD since the start of the outbreak (figure 1). Of the eight Guinean and Liberian districts that share a border with C te d voire, only two are yet to report a confirmed or probable case of EVD.

A total of 450 health-care workers (HCWs) are known to have been infected with EVD up to the end of 23 October: 80 in Guinea; 228 in Liberia; 11 in Nigeria; 127 in Sierra Leone; one in Spain; and three in the United States of America. A total of 244 HCWs have died.

2. Countries with An Initial Case or Cases, or with Localized Transmission

Five countries (Mali, Nigeria, Senegal, Spain, and the United States of America) have now reported a case or cases imported from a country with widespread and intense transmission. In Nigeria, there were 20 cases and eight deaths. In Senegal, there was one case and no deaths. However, following a successful response in both countries, the outbreaks of EVD in Senegal and Nigeria were declared over on 17 October and 19 October 2014, respectively.

On 23 October, Mali reported its first confirmed case of EVD (table 2). The patient was a 2-year old girl who travelled from the Guinean district of Kissidougou with her grandmother to the city of Kayes in western Mali, which is approximately 600 km from the Malian capital Bamako and lies close to the border with Senegal. The patient was symptomatic for much of the journey. On 22 October the patient was taken to Fousseyni Daou hospital in Kayes, where she died on on 24 October. At present, 43 contacts, of whom 10 are HCWs, are being monitored; efforts to trace further contacts are ongoing. A WHO team was already in Mali to

assess the country s state of readiness for an initial case. A rapid-response team will also arrive in the coming days.

In Spain, the single case tested negative for EVD on 19 October. A second negative test was obtained on 21 October. Spain will therefore be declared free of EVD 42 days after the date of the second negative test if no new cases are reported. A total of 83 contacts are being monitored.

2014 Outbreak

The 2014 Ebola outbreak has continued to draw many attentions, both on national and international levels. It is one of the most extraordinary global public health crisis in history. The first case was first identified in Guinea, West Africa on March 2014 and continued to become the deadliest occurrence since its first emergence back at 1976. Researchers from the New England Journal of Medicine traced the outbreak to a two-year-old boy who died on 6 December 2013 in Meliandou, a small village in south-eastern Guinea. In March, Guinea’s Ministry of Health reported “mysterious” cases in Nzerekore, Gueckedou, Kissidougou and Macenta (south-eastern regions of Guinea). The symptoms were vomiting, diarrhea, fever, bleeding and severe weight loss which transformed into a high death rate—of the first 89 cases, 59 people died. The disease was then confirmed as Ebola and claimed to be “the biggest health challenge after HIV/AIDS”.

Disease spread

Geuckedou is a leading and strategic trading centre in Guinea and was confirmed as the origin of the outbreak. By the end of March, the disease has crossed the border to Liberia and several cases were identified in Sierra Leone on May. The first case to happen in Nigeria was on July. Senegal reported its first case of Ebola on August and USA on October with further death case reported in Mali and the United States. In August, WHO confirmed a separate outbreak of Ebola in Congo that was localized in Jeera county. The outbreak in Congo was of different strain of virus and unrelated to the epidemics happened in the West Africa, which

now overtops all the previous outbreaks. As of October 31st 2014, 13540 total cases and 4951 total deaths were confirmed in Guinea, Sierra Leone and Liberia.

However, recently it has been declared that the outbreaks in Senegal and Nigeria to be officially over since no further cases reported per September 5th. Nevertheless, the condition

remains the same for Guinea, Liberia, and Sierra Leone, making these countries the most-affected countries in this 2014 Ebola epidemics. Another great impact is these countries are also profoundly destabilized. People are dying in a massive amount from other disease that are normally treatable, for example malaria, dengue hemorrhagic fever (DHF), or mother dying from giving birth to her child because hospitals are so full with patients with Ebola that other patients are often abandoned. This is one major destabilizing factor because Ebola does not only affect those who are infected, but also their surroundings—families and friends—who are also reaching out for healthcare treatments.

Attempts to distribute more health workers and open more Ebola treatment centres in most-affected areas have been made. International communities is providing supports comprising logistics, food, experts and equipment to the field. However, the spread was too “out of control”. Transmission is continuing in Sierra Leone, even in the urban areas. The conditions in Liberia are also deteriorating. The number of patients is moving way faster than the capacity to handle them. There was a significant lack of hospitalizing facilities, remote areas are worst affected. Aside from the technical issues and importance of handling the existent Ebola cases, preventing transmission and occurrence of new cases is also of major challenge.

Containment Methods

Contact Tracing

One of the most effective methods of preventing the further spread of a disease like Ebola is contact tracing. Contact tracing involves tracking every single person that comes into contact with an Ebola patient for 21 days, during which they are inspected for symptoms and signs of them contracting the illness themselves. If such a situation occurs, they are taken into quarantine and tested and, in turn, the people they have come into contact with are also followed and monitored for 21 days until all of the contacts are exhausted. The reason for the limit of 21 days is that Ebola symptoms can show themselves up to 21 days after the disease itself has been contracted, after which point it can be concluded that the person does not have the disease.

The problem with this method that has been incorporated and seen to be effective in the preceding outbreaks is that there aren’t enough health workers to keep up with the contact tracing process as the number of infected and exposed increases exponentially. “In Liberia, Sierra Leone, and Guinea, which each have thousands of infected people, contact tracing

becomes impossible. Consider this: the WHO estimates that every person in this region has at least ten contacts. Liberia already has over 3,000 cases of Ebola. That would be 30,000 potential contacts to follow-up. Imagine, if by the year's end, we see nearly 300,000 cases. So the best method to curtail this untreatable disease is useless at the scale of the outbreak before us.”

Quarantine

Quarantining in response to the Ebola outbreak occurs regularly on an individual basis as part of the contact tracing system. However, as a more drastic measure, it has also occurred and been considered on national and regional levels in more dire situations through the application of systems similar to house arrests or the closing of borders by region or country in the form of a lockdown.

Most notably and controversially, the government of Sierra Leone took the decision to quarantine a number of regions with a total population of over a million, resulting in a lockdown of more than a third of the country. The main goal of the quarantine that was scheduled to last for a total of 72 hours was not to prevent the further contamination and spread of the disease, but rather to expose those that were hiding people who may be contaminated or infected: “everybody is expected to stay indoors as 7,000 teams of health and community workers go door to door to root out hidden Ebola patients.” The government of Sierra Leone has made an official announcement on the matter by stating that “It’s clear that we have pockets of resistance, in terms of denial. (...) People are still harboring loved ones at home. Sometimes neighbors are calling us with information about Ebola. patients. (...) That gave us the clear indication that people are still harboring patients.”

UNICEF in Sierra Leone expressed their support for the system by declaring that “for three days we’ll go house to house to reach every household. (...) The reality is that the fight against Ebola will not be won in the Ebola clinic. By the house-to-house campaign, you try to stop transmission at the family level.”

However, international health organizations including WHO have made statements regarding their lack of support for quarantines as a method of prevention by stating that it reduces the amount of trust in the community, and increases the difficulty of life for the people affected. Especially with the specific case of Sierra Leone, in which the police and local authorities imposed the quarantine, it was criticized for being excessively harsh and too similar in method to a punishment. Doctors Without Borders expressed their concern for and criticism of the system by stating that “it has been our experience that lockdowns and quarantines do not help

control Ebola, as they end up driving people underground and jeopardizing the trust between people and health providers.

Travel Restrictions

The risk of the transmission of diseases such as Ebola has increased greatly with easier and faster travel. One controversial practice in order to prevent uninfected countries from being exposed is to ban or restrict travel and trade to and from the countries with known cases of the Ebola virus. These bans can be instigated either by the entire nation or by specific airlines associated with those nations.

While the idea of travel restrictions serves the purpose of protecting the uninfected nations, it does further harm to the nation that is suffering from the epidemic. In response to travel restrictions imposed throughout August and September, WHO made several announcements advising against them: “If you try to shut down air travel and sea travel, you risk affecting to a huge extent the economy, people’s livelihoods and their ability to get around without stopping the virus from traveling. (...) You can’t ship goods in. Sometimes these goods are basic staples people need to survive — food and fuel.”

Similar to WHO, the United Nations Security Council also met on the matter and issued a statement regarding travel bans. This is a significant event in terms of the epidemic, as it was the second meeting in the history of the UNSC concerning a public health issue, indicating that the problem is dire enough for them to get involved.

The statement by the UNSC “urged governments, airlines and shipping companies to lift any travel restrictions based on the Ebola outbreak, saying such measures ‘contribute to the further isolation of the affected countries and undermine their efforts to respond to the Ebola outbreak.’”

An announcement by WHO at the end of September echoes the sentiments of the UNSC and continues to strongly advise against the implementation of travel restrictions by stating that “"Flight cancellations and other travel restrictions continue to isolate affected countries, resulting in detrimental economic consequences, and hinder relief and response efforts risking further international spread. (...) The Committee strongly reiterated that there should be no general ban on international travel or trade.”

Infection Control

The idea of infection control is based off of the principles of hygiene and decontamination, and it is regarded as an important factor of prevention that requires significant funding, diligence,

and effort on the part of healthcare workers. This is particularly critical when the issue at hand involves a disease with no known cure, leaving the only method of improvement to be prevention.

An account by Doctors Without Borders demonstrating the current state of infection control and care for the infected outlines the problems and shortcomings of the current system: “Ebola treatment centers are reduced to places where people go to die alone, where little more than palliative care is offered. It is impossible to keep up with the sheer number of infected people pouring into facilities. In Sierra Leone, infectious bodies are rotting in the streets.”

A major issue that arises concerning infection control is the lack of healthcare workers required to ensure it. There is currently both an issue of a lack of training for existing professionals, preventing them from being able to start working in Ebola centers and on the field. Alongside this, however, there is also a fundamental lack of people willing to work with and around the disease due to fear for their own lives.

A large number of healthcare workers have become infected and lost their lives as a result of being exposed to the Ebola virus as part of their work. These issues and limitations have made infection control procedures very difficult to execute throughout the crisis.

Future Projections

The 2014 Ebola outbreak is the largest of its kind since the discovery of the disease, and it is so large that the deaths from this single outbreak has surpassed the sum of all of the deaths from the other outbreaks to date added together. The factor making this situation all the more dire is that the infection rate is consistently growing and is not showing signs of waning, despite the best efforts of WHO and other international organizations.

At this point, projections concerning the disease do not indicate that it is going to die down or recede in the near future. “Between 550,000 and 1.4 million people in West Africa would fall ill with Ebola by late January if the infection rate stays the same as it was in August, according to a projection model released by the U.S. Centers for Disease Control and Prevention (CDC).”

The projections also clarify the most likely solution to the problem, resulting in a criterion of what must be done before they can be prevented and the consequences otherwise: “isolating patients will turn the tide of the epidemic. The outbreak will begin to decrease when about 70 percent of patients are isolated and in treatment, it estimates. Every month that the 70 percent threshold isn't reached will lead to an approximate tripling in the number of daily cases, the model projects.”

The speed at which the disease is growing, and the worst-case projections of some of the health organizations, suggest that the disease and epidemic may become endemic and be ever-present in the lives of the people living in Africa, and possibly the world.

UN and WHO Response

As a result of the severity of the crisis, WHO and other bodies of the UN have met concerning the next steps in order to minimize the further damage taking place as a result of Ebola. A largescale effort to invest more resources into aid and solutions for the disease were announced by the UN in mid-September: “’The gravity and scale of the situation now require a level of international action unprecedented for a health emergency,’ Secretary-General Ban Ki-moon said, announcing the formation UN-led response effort involving a ‘rapid and massive mobilization’ of people, material and financial resources.

‘This international mission ... will have five priorities: stopping the outbreak, treating the infected, ensuring essential services, preserving stability and preventing further outbreaks," Ban told the emergency session. He said that the current financial contributions fell far short of what was required, saying the international target should stand at a minimum of $1 billion (775 million euros).’”

Bloc Position

Guinea

Guinea's President Alpha Conde declared a national health emergency due to the Ebola outbreak. He stated efforts to control the spread of the Ebola virus would include forbidding Ebola patients from leaving their homes, border control, travel restrictions, and hospitalization for individuals suspected to be infected until cleared by laboratory results. He also banned the transporting the dead between towns

Liberia

Liberian Government has tried to provide curative measures in response to the outbreak that happen in Liberia. The government has issued an order to cremate all corpses that died from Ebola as safety measures, closes school and apllying for a curfew. TAs the state that has been hit hardest by Ebola, Liberia is also trying to increase it’s medical facilities. However, due to the nature of the disease that exponentially growing make the effort done by Liberia is still lacking to completely contain the disease. In response to that, President of Liberia are asking more aid to fight the Ebola. Liberia also has known to ban journalist to go near Ebola containment centre and insist to just report the statement that came from government officials.

Sierra Leone

Sierra Leone has also declared state emergency and apllying several measures in response to Ebola. The government has announced it’s closure of schools, nightlife places, and cinemas and deployed troops to quarantine hot spots. Sierra Leone has also impose three-day lockdown to help spreading informations on its citizens. The problems in Sierra Leone is worsened by political tension that delay the help of other countries and Ebola related riot that happened due to youth leader refused health authorites to take his relative for Ebola test. Recent report shows that Ebola has spread to all the district in Sierra Leone

USA

President Obama has announced it’s assistance on fighting the widespread of Ebola and has tried to playing a leading role in rallying support and action from other countries. US Government also helped by placing medical staff in Guinea, Sierra Leone, Liberia and Nigeria to assist medical effort in response to the widespread. Department of Defense also has dispatch its military personnel to assist the logistic and transportation of the medical equipment.

The President also highlighted United States' efforts to help, including establishing a military command in Liberia to support civilian efforts. But he urged international

organizations and businesses to move faster to mobilize partners on the ground, and nations to contribute everything from air transport to health care workers to equipment.

UK

UK is working with the United Nations, the World Health Organisation and the wider international community to combat Ebola at the sozurce in the African countries affected. Britain is playing a leading role, particularly in Sierra Leone where it can best help to fight the crisis. The UK has committed a £205 million package of direct support to help contain, control, treat and ultimately defeat Ebola. Regular cargo flights - part funded by the EU - are carrying UK aid to Sierra Leone. UK also deploy scientist to understand more about the disease and are building treatment centre in Sierra Leone.

Other Countries

Most of other countries have expressed support to the global effort that to fight the widespread of Ebola Virus Disease. Some countries also gave medical and financial support to help to contain, control and defeat the disease. However, a number of government also has put various measures on responding toward Ebola and also protecting the citizens. Some countries give advisory notices to warn travellers of the potential risk of travel to countries affected by the epidemic. Some countries choose to withholding visitor visas from nationals of the affected countries, closing borders and cancelling flights. Some countries also provide precautions such as isolation facilities, training of staff, biocontainment exercises, and health screening for incoming travellers

Countries That Focuses on Research and Development of The Ebola Virus Itself and Fund Donor Countries

As the world reels from its deadliest Ebola outbreak, health experts are fast-tracking tests for various vaccines, and hope to have millions of experimental doses by next year.There is currently no cure or vaccine for Ebola, which continues to spread in Liberia, Sierra Leone and Guinea.

Mapp Biopharmaceutical Inc. is in the early stages of developing its drug, ZMapp. It was given to the Americans taken from Africa to Emory University in Atlanta for treatment in August. A total of seven patients got the drug, and it seems to have had success. In animal studies, the therapy seemed to help. Four monkeys infected with Ebola survived after getting ZMapp within 24 hours after infection. Two others survived after getting the treatment 48 hours

after infection. Since the drug is so new, there are no doses of it left.The Department of Health and Human Services contracted with Mapp to make more for early-stage clinical safety studies.

Meanwhile Food and Drug Administration approved the use of the experimental TKM-Ebola drug to test on suspected cases of the infection. The drug is made by Tekmira Pharmaceuticals, a Canadian company. Tekmira was also given the authority to use it under the investigational new drug application rule, so patients could be treated outside a clinical trial.

The National Institutes of Health also has started human testing of a vaccine to prevent Ebola in early September. The U.S. Department of Defense is working with a company to develop a vaccine as well.

After an expedited review by the FDA, researchers were allowed to start a human safety trial. Because there is such an urgent need for a vaccine, the FDA waived some of the preclinical studies that are normally required.

The vaccine was created by GlaxoSmithKline and the National Institute of Allergy and Infectious Diseases. It's being tested in the United States and will be tested in healthy volunteers in the United Kingdom, Mali and Gambia. The National Institutes of Health is also in talks with health leaders in Nigeria, which has seen 20 cases, to test the vaccine on people there.

An international consortium that formed to fight the epidemic gave money to the company to make up to 10,000 additional doses of the vaccine while the trials are ongoing. Another vaccine developed by the Public Health Agency of Canada, licensed to Iowa-based NewLink Genetics, is also about to start trials. It will be tested at the Clinical Trials Center at the Walter Reed Army Institute of Research. That trial should start in mid-October. The process is being accelerated, and the FDA will be monitoring the results to see whether it can move into the next phase.

The Canadian government shipped 800 to 1,000 doses of the vaccine to Liberia at the government's request. An earlier version of that vaccine had been given to a German lab worker in 2009 after he thought he pricked himself with a needle that had the Ebola virus on it. He did not get sick.

A doctor in Liberia is trying an HIV drug called lamivudine. Dr. Gorbee Logan has given the drug to 15 patients; all but two survived. Compared with the 70% mortality rate in West Africa, those are good odds. The drug can cause liver problems and has other side effects, but the doctor said it has been worth it in light of the disease's deadliness.

Scientists in Thailand believe they've found a new type of antibody that is effective against the virus. The team of doctors at Siriraj Hospital are confident that it will work and the side effects will be low, but it has not been tested in animals or humans and is at least a year away at least from being developed.

QARMAs:

• What nations should be doing on a governmental and individual basis in order to protect the wellbeing of their citizens and those of the neighboring countries,

• What should be done in the long-run, including containing the disease in the affected regions.

• How can WHO make sure the ebola care services delivered efficiently and effectively to every country.

• What kind of advancement of technology WHO should work on regarding the ebola care services

Further Readings:

http://edition.cnn.com/2014/10/25/health/ebola-vaccines/index.html

http://edition.cnn.com/2014/10/06/health/ebola-drugs-in-the-works/index.html

https://www.gov.uk/government/news/uk-secures-1-billion-european-ebola-commitment

http://www.un.org/apps/news/story.asp?NewsID=49223#.VFclZ8myq9d

http://apps.who.int/iris/bitstream/10665/137185/1/roadmapupdate25Oct14_eng.pdf?ua=1

http://www.businessweek.com/news/2014-10-25/mali-red-cross-says-ebola-tracking-complicated-by-health-system

http://news.yahoo.com/liberia-bans-journalists-ebola-centres-005429176.html

http://edition.cnn.com/2014/10/24/world/africa/mali-ebola/index.html