EBOLA/EVD [to 28 November 2015]

EBOLA/EVD [to 28 November 2015]
Public Health Emergency of International Concern (PHEIC); “Threat to international peace and security” (UN Security Council)

The Lancet
22 November 2015
Health Policy
Will Ebola change the game? Ten essential reforms before the next pandemic. The report of the Harvard-LSHTM Independent Panel on the Global Response to Ebola
Suerie Moon, Devi Sridhar, Muhammad A Pate, Ashish K Jha, Chelsea Clinton, Sophie Delaunay, Valnora Edwin, Mosoka Fallah, David P Fidler, Laurie Garrett, Eric Goosby, Lawrence O Gostin, David L Heymann, Kelley Lee, Gabriel M Leung, J Stephen Morrison, Jorge Saavedra, Marcel Tanner, Jennifer A Leigh, Benjamin Hawkins, Liana R Woskie, Peter Piot
Full text (may require registration): http://lancet.com/journals/lancet/article/PIIS0140-6736%2815%2900946-0/fulltext

The west African Ebola epidemic that began in 2013 exposed deep inadequacies in the national and international institutions responsible for protecting the public from the far-reaching human, social, economic, and political consequences of infectious disease outbreaks. The Ebola epidemic raised a crucial question: what reforms are needed to mend the fragile global system for outbreak prevention and response, rebuild confidence, and prevent future disasters? To address this question, the Harvard Global Health Institute and the London School of Hygiene & Tropical Medicine jointly launched the Independent Panel on the Global Response to Ebola.

Recommendations Summary [full text includes discussion on each recommendation]
Recommendation 1: Develop a global strategy to invest in, monitor, and sustain national core capacities

Recommendation 2: Strengthen incentives for early reporting of outbreaks and science-based justifications for trade and travel restrictions

Recommendation 3: Create a unified WHO Centre for Emergency Preparedness and Response with clear responsibility, adequate capacity, and strong lines of accountability

Recommendation 4: Broaden responsibility for emergency declarations to a transparent, politically protected Standing Emergency Committee

Recommendation 5: Institutionalise accountability by creating an independent Accountability Commission for Disease Outbreak Prevention and Response (Accountability Commission)

Recommendation 6: Develop a framework of rules to enable, govern and ensure access to the benefits of research

Recommendation 7: Establish a global facility to finance, accelerate, and prioritise research and development

Recommendation 8: Sustain high-level political attention through a Global Health Committee of the Security Council

Recommendation 9: A new deal for a more focused, appropriately financed WHO

Recommendation 10: Good governance of WHO through decisive, timebound reform, and assertive leadership

Taken together, the Panel’s ten recommendations provide a vision for a more robust, resilient global system able to manage infectious disease outbreaks. Preventing small outbreaks from becoming large-scale emergencies demands investment in minimum capacities in all countries and encouragement of early international reporting of outbreaks by adhering to agreed international rules. Responding effectively to outbreaks demands much stronger operational capacity within WHO and within the broader aid system if outbreaks escalate into humanitarian emergencies, a politically protected process for WHO’s emergency declarations, and strong mechanisms for the accountability of all involved actors, from national governments to non-governmental organisations and from UN agencies to the private sector. Mobilisation of the knowledge needed to combat outbreaks will require an international framework of rules to enable, govern, and ensure access to the benefits of research, and financing to develop technology when commercial incentives are inappropriate. Finally, effective governance of this complex global system demands high-level political leadership and a WHO that is more focused and appropriately financed and whose credibility is restored through the implementation of good governance reforms and assertive leadership.

Ebola Situation Report – 25 November 2015
A cluster of three confirmed cases of Ebola virus disease (EVD) were reported from Liberia in the week to 22 November. The first-reported case was a 15-year-old boy who tested positive for EVD after admission to a health facility in the Greater Monrovia area on 19 November. He was then transferred to an Ebola treatment centre along with the 5 other members of his family. Two other members of the family – the boy’s 8-year old brother and his 40-year-old father – subsequently tested positive whilst in isolation. In addition to the family, 149 contacts have been identified so far, including 10 health workers who had close contact with the 15-year-old prior to isolation. Investigations to establish the origin of infection are at an early stage. Liberia was previously declared free of Ebola transmission on 3 September 2015.

On 7 November WHO declared that Sierra Leone had achieved objective 1 of the phase 3 framework, and the country has now entered a 90-day period of enhanced surveillance scheduled to conclude on 5 February 2016. As of 22 November it had been 6 days since the last EVD patient in Guinea received a second consecutive EVD-negative blood test. The last case in Guinea was reported on 29 October 2015.

The recent cases in Liberia underscore the importance of robust surveillance measures to ensure the rapid detection of any reintroduction or re-emergence of EVD in currently unaffected areas. In order to achieve objective 2 of the phase 3 response framework – to manage and respond to the consequences of residual Ebola risks – Guinea, Liberia, and Sierra Leone have each put surveillance systems in place to enable health workers and members of the public to report any case of illness or death that they suspect may be related to EVD to the relevant authorities. In the week to 22 November, 29 176 such alerts were reported in Guinea, with alerts reported from all of the country’s 34 prefectures. Equivalent data are not currently available for Liberia. In Sierra Leone, 1420 alerts were reported from 14 of 14 districts in the week ending 15 November (the most recent week for which data are available)…

WHO – Press Conference: Update on Ebola situation (Geneva, 20 November 2015)
20 Nov 2015 – Subject: Update on Ebola situation in West Africa
Speaker: Dr Bruce Aylward, Executive Director a.i., Outbreaks and Health Emergencies
Video: 46:58
At approx 15:50 Dr. Aylward notes:
“…Still the vaccine is not licensed and able to be used only under a trial, but we are working very hard with the producers and regulators to put in for an expanded access protocol to allow people to use the vaccine as part of a response in the interim as we work towards licensure of the vaccine…”

Global Humanitarian Assistance (GHA) [to 28 November 2015]
Ebola virus disease in Liberia
Report Synopsis
Date: 2015/11/23
On 20 November 2015 we responded to a funding alert for a new case of the Ebola virus disease in Liberia. The day before, less than three months after Liberia was last declared free of Ebola, it was confirmed that a 10-year-old boy had tested positive for the virus.

According to the UN Office for the Coordination of Humanitarian Affairs (OCHA)’s Financial Tracking Service (FTS), donors have committed/contributed US$236.9 million of humanitarian assistance to Liberia since the start of 2015. At least US$227.7 million of this is for the Ebola response. However, there are currently no financial contributions or pledges in response to this new outbreak of the disease.
Read our full analysis of the current funding situation.