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WHO Director-General assesses the Ebola outbreak with four West African presidents
Dr Margaret Chan
Director-General of the World Health Organization
Overview of the Ebola situation delivered to the Presidents of Guinea, Liberia, Sierra Leone, and Cote d?Ivoire
Conakry, Guinea
1 August 2014
Excellencies, honourable ministers, members of the press, ladies and gentlemen,
West Africa is facing its first outbreak of Ebola virus disease. This is an unprecedented outbreak accompanied by unprecedented challenges. And these challenges are extraordinary.
West Africa?s outbreak is caused by the most lethal strain in the family of Ebola viruses.
The outbreak is by far the largest ever in the nearly four-decade history of this disease. It is the largest in terms of numbers of cases and deaths, with 1,323 cases and 729 deaths reported to date in four countries.
It is the largest in terms of geographical areas already affected and others at immediate risk of further spread.
It is taking place in areas with fluid population movements over porous borders, and it has demonstrated its ability to spread via air travel, contrary to what has been seen in past outbreaks. Cases are occurring in rural areas which are difficult to access, but also in densely populated capital cities.
This meeting must mark a turning point in the outbreak response. The presence here of four heads of state is clear evidence of the high-level of political concern and commitment.
Let me give you some frank assessments of what we face. And by ?we?, I mean your countries and your neighbours, WHO and its partners in outbreak response, including civil society organizations, and the international community, including countries on other continents that can give you the support you so clearly need.
First, this outbreak is moving faster than our efforts to control it. If the situation continues to deteriorate, the consequences can be catastrophic in terms of lost lives but also severe socioeconomic disruption and a high risk of spread to other countries. As I said before, this meeting must mark a turning point in the outbreak response.
In addition, the outbreak is affecting a large number of doctors, nurses, and other health care workers, one of the most essential resources for containing an outbreak. To date, more than 60 health care workers have lost their lives in helping others. Some international staff are infected. These tragic infections and deaths significantly erode response capacity.
Second, the situation in West Africa is of international concern and must receive urgent priority for decisive action at national and international levels. Experiences in Africa over nearly four decades tell us clearly that, when well managed, an Ebola outbreak can be stopped.
This is not an airborne virus. Transmission requires close contact with the bodily fluids of an infected person, also after death. Apart from this specific situation, the general public is not at high risk of infection by the Ebola virus.
At the same time, it would be extremely unwise for national authorities and the international community to allow an Ebola virus to circulate widely and over a long period of time in human populations.
Constant mutation and adaptation are the survival mechanisms of viruses and other microbes. We must not give this virus opportunities to deliver more surprises.
Third, this is not just a medical or public health problem. It is a social problem. Deep-seated beliefs and cultural practices are a significant cause of further spread and a significant barrier to rapid and effective containment. This social dimension must also be addressed as an integral part of the overall response.
Fourth, in some areas, chains of transmission have moved underground. They are invisible. They are not being reported. Because of the high fatality rate, many people in affected areas associate isolation wards with a sure death sentence, and prefer to care for loved ones in homes or seek assistance from traditional healers.
Such hiding of cases defeats strategies for rapid containment. Moreover, public attitudes can create a security threat to response teams when fear and misunderstanding turn to anger, hostility, or violence.
Finally, despite the absence of a vaccine or curative therapy, Ebola outbreaks can most certainly be contained. Bedrocks of outbreak containment include early detection and isolation of cases, contact tracing and monitoring of contacts, and rigorous procedures for infection control.
Moreover, we do have some evidence that early detection of cases and early implementation of supportive therapy increases the chances of survival. This is another message that needs to be communicated to the public.
Excellences, ladies and gentlemen,
Let me assure you: you are not alone in facing this unprecedented outbreak with all its unprecedented challenges.
Affected countries have made extraordinary efforts and introduced extraordinary measures. But the demands created by Ebola in West Africa outstrip your capacities to respond.
I have made myself personally responsible for coordinating international response efforts under WHO leadership, and personally responsible for mobilizing the support you need, on the most urgent basis possible.
The needs are vast.
Accurate and detailed mapping of the outbreak is urgently needed. All affected and at-risk countries need a national response plan, and these plans need to be regionally coordinated.
Facilities for isolation and supportive therapy need to be properly equipped and adequately staffed. Some facilities lack such essentials as electricity and a safe supply of running water.
Current numbers of national and international response staff are woefully inadequate. Personal protective equipment is absolutely essential, but it is hot and cumbersome, limiting the time that doctors and nurses can work on an isolation ward.
Work is also emotionally very stressful. For national staff, salaries need to be paid.
Dignified burial makes an essential contribution to public trust and eases family grieving, but this must be done safely. Traditional funeral practices are a well-documented spark that ignites further chains of transmission.
Contact tracing is a formidable challenge, for reasons I have mentioned. Again, more staff are needed.
Public awareness of the facts about this disease needs to increase dramatically. Messages from presidents and community and religious leaders are important, but this outbreak needs professionally designed and implemented campaigns, again with help from external experts.
Depending on the epidemiological situation, your governments may need to impose some restrictions, for example, on population movements and public gatherings.
Governments may need to use their police and civil defence forces to guarantee the safety and security of response teams. Some are already doing so.
Under the provisions of the International Health Regulations, I have convened an Emergency Committee that will meet on 6 August to assess the international implications of West Africa?s outbreak.
I am relying on the experts in this Committee, including those from West African nations, to heighten international awareness of the magnitude of this outbreak and the many challenges that need urgent support from the international community.
I am also here to learn first-hand your specific concerns and needs for support.
As I said, Ebola outbreaks can be contained. Chains of transmission can be broken. Together, we must do so.
Thank you.
Dr Margaret Chan
Director-General of the World Health Organization
Overview of the Ebola situation delivered to the Presidents of Guinea, Liberia, Sierra Leone, and Cote d?Ivoire
Conakry, Guinea
1 August 2014
Excellencies, honourable ministers, members of the press, ladies and gentlemen,
West Africa is facing its first outbreak of Ebola virus disease. This is an unprecedented outbreak accompanied by unprecedented challenges. And these challenges are extraordinary.
West Africa?s outbreak is caused by the most lethal strain in the family of Ebola viruses.
The outbreak is by far the largest ever in the nearly four-decade history of this disease. It is the largest in terms of numbers of cases and deaths, with 1,323 cases and 729 deaths reported to date in four countries.
It is the largest in terms of geographical areas already affected and others at immediate risk of further spread.
It is taking place in areas with fluid population movements over porous borders, and it has demonstrated its ability to spread via air travel, contrary to what has been seen in past outbreaks. Cases are occurring in rural areas which are difficult to access, but also in densely populated capital cities.
This meeting must mark a turning point in the outbreak response. The presence here of four heads of state is clear evidence of the high-level of political concern and commitment.
Let me give you some frank assessments of what we face. And by ?we?, I mean your countries and your neighbours, WHO and its partners in outbreak response, including civil society organizations, and the international community, including countries on other continents that can give you the support you so clearly need.
First, this outbreak is moving faster than our efforts to control it. If the situation continues to deteriorate, the consequences can be catastrophic in terms of lost lives but also severe socioeconomic disruption and a high risk of spread to other countries. As I said before, this meeting must mark a turning point in the outbreak response.
In addition, the outbreak is affecting a large number of doctors, nurses, and other health care workers, one of the most essential resources for containing an outbreak. To date, more than 60 health care workers have lost their lives in helping others. Some international staff are infected. These tragic infections and deaths significantly erode response capacity.
Second, the situation in West Africa is of international concern and must receive urgent priority for decisive action at national and international levels. Experiences in Africa over nearly four decades tell us clearly that, when well managed, an Ebola outbreak can be stopped.
This is not an airborne virus. Transmission requires close contact with the bodily fluids of an infected person, also after death. Apart from this specific situation, the general public is not at high risk of infection by the Ebola virus.
At the same time, it would be extremely unwise for national authorities and the international community to allow an Ebola virus to circulate widely and over a long period of time in human populations.
Constant mutation and adaptation are the survival mechanisms of viruses and other microbes. We must not give this virus opportunities to deliver more surprises.
Third, this is not just a medical or public health problem. It is a social problem. Deep-seated beliefs and cultural practices are a significant cause of further spread and a significant barrier to rapid and effective containment. This social dimension must also be addressed as an integral part of the overall response.
Fourth, in some areas, chains of transmission have moved underground. They are invisible. They are not being reported. Because of the high fatality rate, many people in affected areas associate isolation wards with a sure death sentence, and prefer to care for loved ones in homes or seek assistance from traditional healers.
Such hiding of cases defeats strategies for rapid containment. Moreover, public attitudes can create a security threat to response teams when fear and misunderstanding turn to anger, hostility, or violence.
Finally, despite the absence of a vaccine or curative therapy, Ebola outbreaks can most certainly be contained. Bedrocks of outbreak containment include early detection and isolation of cases, contact tracing and monitoring of contacts, and rigorous procedures for infection control.
Moreover, we do have some evidence that early detection of cases and early implementation of supportive therapy increases the chances of survival. This is another message that needs to be communicated to the public.
Excellences, ladies and gentlemen,
Let me assure you: you are not alone in facing this unprecedented outbreak with all its unprecedented challenges.
Affected countries have made extraordinary efforts and introduced extraordinary measures. But the demands created by Ebola in West Africa outstrip your capacities to respond.
I have made myself personally responsible for coordinating international response efforts under WHO leadership, and personally responsible for mobilizing the support you need, on the most urgent basis possible.
The needs are vast.
Accurate and detailed mapping of the outbreak is urgently needed. All affected and at-risk countries need a national response plan, and these plans need to be regionally coordinated.
Facilities for isolation and supportive therapy need to be properly equipped and adequately staffed. Some facilities lack such essentials as electricity and a safe supply of running water.
Current numbers of national and international response staff are woefully inadequate. Personal protective equipment is absolutely essential, but it is hot and cumbersome, limiting the time that doctors and nurses can work on an isolation ward.
Work is also emotionally very stressful. For national staff, salaries need to be paid.
Dignified burial makes an essential contribution to public trust and eases family grieving, but this must be done safely. Traditional funeral practices are a well-documented spark that ignites further chains of transmission.
Contact tracing is a formidable challenge, for reasons I have mentioned. Again, more staff are needed.
Public awareness of the facts about this disease needs to increase dramatically. Messages from presidents and community and religious leaders are important, but this outbreak needs professionally designed and implemented campaigns, again with help from external experts.
Depending on the epidemiological situation, your governments may need to impose some restrictions, for example, on population movements and public gatherings.
Governments may need to use their police and civil defence forces to guarantee the safety and security of response teams. Some are already doing so.
Under the provisions of the International Health Regulations, I have convened an Emergency Committee that will meet on 6 August to assess the international implications of West Africa?s outbreak.
I am relying on the experts in this Committee, including those from West African nations, to heighten international awareness of the magnitude of this outbreak and the many challenges that need urgent support from the international community.
I am also here to learn first-hand your specific concerns and needs for support.
As I said, Ebola outbreaks can be contained. Chains of transmission can be broken. Together, we must do so.
Thank you.
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