Global

Response to

Ebola Virus

Disease

By:

Dr. Chitra Pai K

House surgeon

KIMS Hubli

Guide:

Dr. Laxmikant L

Associate Professor

Department of Commmunity Medicine

KIMS Hubli

17th September 2014:

intention set forth to establish the United Nations Mission For

Emergency Ebola Response

18th September 2014:

Outbreak is a threat to international peace and security

19th September 2014:

United Nations member states called upon to provide

full support to UNMEER

23rd September 2014:

Special Envoy for Ebola and Special Representative and Head of

UNMEER Appointed

United Nations Response Timeline

Mission critical actions undertaken by UNMEER

1.Identification and tracing of people with Ebola virus

disease

2.Care for the infected and infection control;

3.Safe and dignified burial;

4.Medical care for responders

5.Food security and nutrition

6.Access to basic health services;

7.Cash incentives for health workers;

8.Economic protection and recovery

9.Supplies of material and equipment;

10.Transportation and fuel;

11.Social mobilization;

12.Messaging

Guiding Principles of the United Nations Mission for Emergency Ebola Response:

*1. Reinforce government leadership;

*2. Deliver rapid impact on the ground;

*3. Closely coordinate and collaborate with actors outside the United Nations

*4. Tailor responses to particular needs in the different countries;

*5. Reaffirm WHO lead on all health issues;

*6. Identify benchmarks for transition post emergency and ensure that actions strengthen systems.

Treat the infected Ensure essential servicesStop the outbreak

Preserve stabilityPrevent further

outbreaks

Five aims of the Global Response

Global Response

PARTNERS

United Nations

World Health Organization

United Nations

Children's Fund

United Nations

World Food Programme

United Nations Office for the

Coordination of Humanitarian

Affairs

Food and Agriculture Organization

of the United Nations

United Nations

Development Programme

United Nations Population Fund

World Bank Group

Médecins Sans Frontières

International Federation

of Red Cross and Red

Crescent Societies

United States Centers for

Disease Control & Prevention

"I appeal to the international community to

provide the $1 billion launch that will enable

us to get ahead of the curve and meet our

target of reducing the rate of transmission by

December 1st."

— UN Secretary-General Ban Ki-moon in an

address to reporters at UN Headquarters in New

York, 16 October

The UN Office for the Coordination of Humanitarian Affairs (OCHA) released the Overview of Needs and Requirements on 16 September 2014. It outlines the resources considered critical to effectively address the crisis across a range of objectives over the next six months by national governments, the World Health Organization, the UN agencies, funds and programmes , and some non-governmental organizations.

Priority requests

a list of priority in-kind requirements for the Ebola response has been compiled which will augment and multiply the impact of the resources identified by OCHA. This is now being shared with all Member States. These include:

*air lift, particularly helicopters, and maritime transport capabilities, fuel, vehicles

*mobile laboratory facilities capable of movement throughout affected countries;

*static non-Ebola medical clinics;

*emergency medical evacuation capability for movement of international aid workers potentially exposed to Ebola to locations for appropriate medical care;

*3.3 million items of high quality personal protective equipment; training

*provision of Ebola Treatment Centres.

EBOLA RESPONSE ROADMAP

28th August 2014

GOAL

To stop Ebola transmission in affected countries within

6-9 months and prevent international spread.

1. To achieve full geographic coverage with complementary Ebola

response activities in countries with widespread and intense transmission

2. To ensure emergency and immediate application of comprehensive

Ebola response interventions in countries with an initial case(s) or with

localized transmission

3. To strengthen preparedness of all countries to rapidly detect and

respond to an Ebola exposure, especially those sharing land borders with

an intense transmission area and those with international transportation

hubs

OBJECTIVES

Factors that contributed to Senegal’s success

According to Health Minister Dr Coll-Seck, the most important actions that

contributed to the rapid containment of the disease in Senegal– with no

onward transmission whatsoever – are the following:

• Strong political leadership at the highest level.

• Early detection and response, aided by a detailed plan and a quickly-

activated National Crisis Committee.

• Stepped up surveillance, especially at the country’s many entry points

by road.

• Rapid mobilization of resources from both domestic and international

sources; solid preparedness plans are thought to have earned the

confidence of donors.

• Support from operational partners, including WHO

• Nationwide public awareness campaigns that made good

use of media experts, embedded in the Ministry of Health

and Welfare and allowed to closely observe its emergency

actions, and local radio networks.

• Deliberate and heavy emphasis on multisectoral

collaboration among all relevant government ministries,

backed by community engagement every step along the way.

• Direct support to patient contacts as a strong incentive

for cooperation and compliance, through the provision of

social support in the form of money, food, and psychological

counselling.

• Support for reintegration of the recovered patient into a

society that could understand why he posed no risk of

contagion to others.

WHO declares end of Ebola outbreak in Nigeria

• WHO commends the Nigerian Government's strong leadership

and effective coordination of the response that included the

rapid establishment of an Emergency Operations Centre.

• WHO, United States Centers for Disease Control and

Prevention (CDC), Médecins Sans Frontières (MSF), UNICEF

and other partners supported the Nigerian Government with

expertise for outbreak investigation, risk assessment, contact

tracing and clinical care.

• Strong public awareness campaigns, teamed with early

engagement of traditional, religious and community

leaders, also played a key role in successful containment of

this outbreak.

Global Outbreak Alert & Response Network

The Global Outbreak Alert and Response Network (GOARN) is a technical

collaboration of existing institutions and networks who pool human and

technical resources for the rapid identification, confirmation and response

to outbreaks of international importance. The Network provides an

operational framework to link this expertise and skill to keep the

international community constantly alert to the threat of outbreaks and

ready to respond.

Objectives

The Global Outbreak Alert and Response Network

contributes towards global health security by:

• Combating the international spread of

outbreaks

• Ensuring that appropriate technical assistance

reaches affected states rapidly

• Contributing to long-term epidemic

preparedness and capacity building.

• Avoid contact with bats and nonhuman primates or blood, fluids,

and raw meat prepared from these animals.

• Avoid hospitals in West Africa where Ebola patients are being

treated. The U.S. embassy or consulate is often able to provide

advice on facilities.

• After you return, monitor your health for 21 days and seek medical

care immediately if you develop symptoms of Ebola.

Impact on Social determinants of health

1. Trading, industry, agriculture, tourism

1. Worsening poverty

1. Hunger

1. Orphans

1. Stigma

1. School closures

1. Other diseases not being treated

Response–World Health Organization Roadmap

•Actual number 2-4 times higher

• Case count could exceed 20,000

Objectives targeted at countries:

• With widespread or intense transmission

• With an initial case(s) or with localized transmission

• Sharing land borders with an intense transmission area and

those with international transportation hubs

•Elements of the response:

Treatment centres, referral centres,

laboratory access, surveillance and

contact tracing, safe burial, social

mobilization

Estimated cost $ 490 million

Responses to the Ebola virus epidemic in

West Africa

Organizations from around the world have responded to help stop the

2014 Ebola virus epidemic in West Africa. In July, the World Health

Organization convened an emergency meeting with health ministers

from eleven countries and announced collaboration on a strategy to co-

ordinate technical support to combat the epidemic. In August, they

declared the outbreak an international public health emergency and

published a roadmap to guide and coordinate the international response

to the outbreak, aiming to stop ongoing Ebola transmission worldwide

within 6–9 months. In September, the United Nations Security Council

declared the Ebola virus outbreak in West Africa a "threat to

international peace and security" and unanimously adopted a resolution

urging UN member states to provide more resources to fight the

outbreak; the WHO stated that the cost for combating the epidemic will

be a minimum of $1 billion.

United Nations

UN Mission for Ebola Emergency Response

• UNMEER has been tasked to coordinate all relevant United Nations actors in

order to ensure a rapid, effective, efficient and coherent response to the

Ebola crisis. UNMEER's objective is to work with others to stop the Ebola

outbreak. UNMEER will work closely with governments, regional and

international actors, such as the African Union (AU) and the Economic

Community of West African States (ECOWAS), and with UN Member States,

the private sector and civil society.

World Health Organization

Report that they "are on the ground establishing Ebola treatment centres

and strengthening capacity for laboratory testing, contact tracing, social

mobilization, safe burials, and non-Ebola health care" and "continue to

monitor for reports of rumoured or suspected cases from countries

around the world."

WHO Roadmap

A. Immediate actions to support the three EVD affected

countries

1. Urgently strengthen the field response

Output 1: local response team in place in each “hot

spot”

Output 2: Provision of field logistical support

Output 3: Provision of care to patients

Output 4: Chains of transmission broken through active

surveillance, case investigation, contact tracing and

follow-up

Output 5: Public relations and reputation management,

social mobilization, and risk communications strengthened

2. Coordinate the outbreak response

2.1. Manage the WHO Sub-regional Ebola Operations Coordination Centre

Output 1: Field coordination, collaboration and operational management

of the outbreak response strengthened

Output 2: Cross-border coordination strengthened

2.2. WHO's leadership and coordination of EVD outbreak response

strengthened at all levels

Output 1: Logistics management systems strengthened

Output 2: Disease-related and other content-based expert support and

expert networks mobilized

Output 3: Global communication and information provided

Output 4: External relations strengthened

Output 5: Clinical support strengthened

Output 6: Development of new medical treatments and interventions

against EVD advanced

B. Preparedness in countries at-risk

• Output 1: Preparedness plans activated and tested

• Output 2: Active surveillance strengthened

• Output 3: Laboratory diagnostic capacity strengthened

• Output 4: Public information and social mobilization

enhanced

• Output 5: Case management and infection prevention and

control capacities strengthened

World Food Programme

On 18 August, plans to mobilize food assistance for an

estimated 1 million people living in restricted access

areas. In an 18 September WHO Ebola Response Roadmap

Situation Report it was reported that as of that date the

WFP have delivered an estimated 3,000 metric tonnes of

food to the worst affected areas, enough to feed 147,500

people. They have also assisted in the transportation of

400 cubic meters of medical cargo.[25]

International organizations

Médecins Sans Frontières

According to a WHO report released on 18 September, the humanitarian

aid organisation Médecins Sans Frontières (Doctors Without Borders) is

the leading organization responding to the crisis. Currently it has five

treatment centers in the area with two in Guinea, two in Liberia and one

in Sierra Leone. The centers are staffed by 210 international workers in

collaboration with 1,650 staff from the affected regions

European Union

The European Union has committed €150 million funding to fight the

outbreak, including the provision of 3 mobile laboratories, funding to

strengthen healthcare capacity, support to help cushion the

macroeconomic impact, and support to the deployment of an African Union

medical mission.

Economic Community of West African States

In March, the Economic Community of West African States (ECOWAS)

disbursed US$250,000 to deal with the outbreak. In response to the ECOWAS

Special Fund for the Fight Against Ebola, in July the Nigerian government

donated 3.5 million dollars to Liberia, Guinea, Sierra Leone, the West

African Health Organization, and the ECOWAS Pool Fund, to aid in the fight

against the epidemic.

World Bank Group

The World Bank Group has pledged US $230 million in emergency

funding to help Guinea, Liberia, and Sierra Leone contain the spread

of Ebola infections, help their communities cope with the economic

impact of the crisis, and improve public health systems throughout

West Africa. On 25 September The World Bank made additional

funding of $170 million available to help curtail the spread of the

Ebola virus. The funds will be used to finance medical supplies and

increase the number of healthcare workers.

National responses

A number of governments across the world have put measures in

place to protect their populations from Ebola. These include:

• Advisory notices to warn travellers of the potential risk of

travel to countries affected by the epidemic. (Germany, Spain,

UK, USA, Colombia, Philippines, Saudi Arabia. )

• Withholding visitor visas from nationals of the affected

countries, closing borders and cancelling flights. (Equatorial

Guinea, Kenya, Sri Lanka, Nigeria, South Africa, Chad, Seychelles,

Mauritania)

• Precautions such as isolation facilities, training of staff,

biocontainment exercises, and health screening for incoming

travellers. (Malta, Colombia, India, South Africa, Morocco, Mali,

Germany, Philippines, Mauritania, United States, Canada, UK)

Charitable organizations, foundations and

individuals

• International Charter on Space and Major Disasters

• International Committee of the Red Cross

• GOAL

• International Medical Corps

• Bill & Melinda Gates Foundation

• Paul G. Allen Family Foundation

• Samaritan's Purse

*Inadequacy of International Community’s initial response to this unusually fast spreading outbreak.

*WHO’s weakened capacity in face of budget and staff , Lack of emergency response fund at the outset of outbreak.

*Lack of centralised global command and control structure to enable swift deployment of resources and trained personnel

Drawbacks

• The National governments responses of some of the african countries towards the outbreaks has been badly Misjudged.

• Lack of Trust of people on their Government , International agencies , Other organizations .

• It was only on Aug 8, after a meeting of the International Health Regulations Emergency Committee, that WHO declared the outbreak a “public health emergency of international concern”. Such delays have probably enabled the outbreak to spread rapidly

The key to epidemic control is rapid diagnosis, isolation, and treatment of infected individuals.

This strategic approach was not taken in time during the present Ebola outbreak in west Africa.

There are Fewer than 24 established/planned laborataries equipped to use PCR in all the three countries.

Adequate number of Testing sites and Mobile testing sites are lacking.

Delay in the deployment of drugs --- Zmapp , TKM Ebola. Safety and tolerability studies yet to be conducted.

Limited Production of drugs from the company. Need to Cope up with adequate supply to combat epidemic.

Vaccines proved Effective in primates , yet to clear in Clinical Trials going on in US, Africa, UK.

How can India Contribute to this war against

Ebola ?• India can contribute to global efforts to fight against Ebola crisis.

• It has a large cadre of epidemiologists, laboratory scientists, doctors and nurses who are experienced in epidemic control.

• They can help support diagnosis, the training of health workers, or clinical services in Ebola treatment units

• India also has a large number of social mobilisers who have proved their abilities in health campaigns such as the polio eradication campaign. They could contribute their experiences in community empowerment (one of the cornerstones of the Ebola response), address rumours and fears and help communities regain trust in the humanitarian response

STATE

Union Government has issued advisories to state disease surveillance units to ensure protection from Ebola.

SDS Units are alert for early detection and management of travel related cases reported from community.

Laboratory capacity is strengthened at Neurovirology lab at NIMHANS Bangalore to diagnose Viral disease and disburse report on timely basis apart from National Institute of Virology Pune.

Karnataka Health and family welfare department is on a preparedness mode

It has already identified the nodal officers and designated hospitals like Rajiv Gandhi Institute of Chest diseases with isolation wards to respond to any possible cases.

Bangalore International Airport Authority has commenced screening of passengers coming in /Transiting from West Africa via State.

Loopholes at country level

No sustained Health awareness messages / sessions regarding the disease over mass media.

Inadequate Health Education sessions , Health awareness campaigns among community regarding the Ebola disease , its transmission and preventive measures to be taken.

Insufficient training to how to use PPE and adherence to Usage of Personal Protective measures by health care professionals ( ex:- gloves etc).

India has only two facilities capable of testing for the virus.

The prevalence of Malaria, Dengue and other fever inducing illness in India could make it especially difficult to isolate who might show an early onset of Ebola.

Lack of availability of the candidate promising drugs and vaccines.

WHO Response : Global Alert Response www.who.int/csr/don/2014_04_ebola/en/

www.un.org/ebolaresponse/

en.wikipedia.org/wiki/

Ebola_virus_epidemic_in_West_Africa

REFERENCES

Thank you