Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

[Gemineye]

Lindis Hurum, the Doctors Without Borders) emergency coordinator in Monrovia has been quoted as saying:

"It is simply unacceptable that, five months after the declaration of this Ebola outbreak, serious discussions are only starting now about international leadership and coordination," said Brice de le Vingne, director of operations at Doctors Without Borders. Referring to other countries that have the potential to help, he says, "They can do more, so why don't they?"

In my opinion, here are some possible reasons. It is not my intent to be critical but to point out why people are reluctant to get involved.

1. It's simply too dangerous to reasonably ask anyone to volunteer for direct patient care. At least 150 health care workers have already died. Healthcare workers are physically threatened and barred from entering certain hot zone areas.

2. Much of the money donated to African countries ends up in the pockets of corrupt politicians, greedy bureaucrats and other unscrupulous people. Western countries have donated tens of billions of dollars on Africa with little to show for it.

3. This Ebola outbreak is the "African humanitarian crisis of the month". Just another in a long line of such disasters. Compassion fatigue is a factor in the lack of response. People reasonably ask the question: "When will African nations stand up on their own two feet?"

4. The affected countries themselves are not doing enough to combat the outbreak. Doctors and nurses run away from treatment centers. Politicians beg for money but do not get directly involved. Healthcare workers are not adequately protected by the military or police.

I'm am hoping to spark a dialogue on this issue and hope people will add their thoughts! Please be nice.

[Vibrant62]

Re: Why Outside Countries are Not Doing More about the Ebola Outbreak

I believe that top policy makers and politicians fail to grasp the seriousness of the situation, and do not see how it would become a global threat in the same way as e.g. a high CFR flu pandemic.

For a long time now top virologists and other experts have preached several characteristics of ebola. This has firmly entrenched a 'not our problem' and a 'not a global threat' mentality. As it is quite a horrible prospect to contemplate a global ebola pandemic, the 'dont worry, not a problem for us' mentality is psychologically more comfortable to take refuge in - i.e believe in the established thinking for ebola.

For example, the established mantra is:-

1. That the CFR of ebola is so high that the virus will burn itself out in outbreak areas, and that as such, does not produce a global threat unless as a result of terrorism.

This has now been thoroughly disproven, but such historical thinking has firmly established a 'not a problem for us' mentality amongst government departments and their scientific advisors.

There is also a firm belief that as things historically stand vis a viz the behaviour of ebola, any imports of the virus can easily be controlled by western healthcare systems. This however may not be true if the virus behaviour changes e.g. if carriers becomes infectious far earlier in the infection cycle, and whilst they only show mild symptoms. In such a situation, an infected person could easily set up multiple transmission chains in the period before they seek help. Also remember that with an incubation period of up to 21 days, someone could enter the country without fever, and bypass all screeing efforts until they became symptomatic.

2. That the virus only transmits when someone is highly symptomatic and cannot travel = no threat to us.

Again, I believe that the evidence of how this outbreak is spreading and transmitting shows that this is not the case, in every case. Many people who are sick and infectious are remaining at work, and it isnt until the terminal stages of the disease that they are too sick to move about.

3. That dead bodies are the greatest threat, and this aspect can be easily managed.

With sufficient resources, still true. One caveat is that MSF and other NGO workers have reported atypical deaths, where it has not been immediately apparent that the person died from ebola. This has only come to light after others have been infected.

4. That the virus is stable, and unlikely to change.

Disproven by the research published yesterday. With multiple passages through human hosts the virus is changing from an animal virus to a human one. With that we can expect refinements in adaptation, of which the main evolutionary pressure would be to increase infectivity and transmissibility.

With so many other humanitarian crises in the world just now, this one is sinking in the mire. Competing contenders for attention include Syria, Iraq, not to mention the situation in Gaza or the political crisis of Ukraine, as well as domestic issues aplenty for every major western government.

Until our leaders start to see this as a threat of national / global security proportions, they wont act.

Truly expert scientists, such as the ones who published the paper yesterday, do understand. Its just that scientists dont like to raise alarm or shout loudly. I hope that they start to do so as they see the lack of response. They are perhaps the only ones that can, and have a chance of being heard.

[Gemineye]

Re: Why Outside Countries are Not Doing More about the Ebola Outbreak

Vibrant62, that was a very thoughtful reply. Thank you. Everyhing you say is true. I'm also worried that this Ebola virus is behaving in different ways from the ones causing previous outbreaks.

[mac68DC]

Re: Why Outside Countries are Not Doing More about the Ebola Outbreak

At least here in the United States, the narrative that the threat is so low that there is no need to panic equates to very little motivation to send resources into harms way. Unfortunately, if anything, there is motivation NOT to send resources.

By the time the narrative changes, simply throwing money at the problem later is doomed to fail. What is most vital are health care providers who are experts at dealing with this - and that is not something that scales well at all. There are only so many of them. All the money in the world can't help if there are not enough boots on the ground. That window is closing fast - imo.

[ming]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

I agree with the first poster - and also think that no country is going to order it's troops or medical personnel into west Africa, this disease is too terrible to do that without a massive public outcry.

[Laidback Al]

Re: Why Outside Countries are Not Doing More about the Ebola Outbreak

. . . simply throwing money at the problem later is doomed to fail. What is most vital are health care providers who are experts at dealing with this - and that is not something that scales well at all. There are only so many of them. All the money in the world can't help if there are not enough boots on the ground. That window is closing fast - imo.

Yes, trained personnel with the right supplies will stem the tide of cases. But we may have already passed the point of no return with local medical staff in these countries. More than 120 health workers have already died and at least that many more have been infected. (WHO link) It will take outside medical specialists to help bring this outbreak under control.

[Vibrant62]

Re: Why Outside Countries are Not Doing More about the Ebola Outbreak

At least here in the United States, the narrative that the threat is so low that there is no need to panic equates to very little motivation to send resources into harms way. Unfortunately, if anything, there is motivation NOT to send resources.

By the time the narrative changes, simply throwing money at the problem later is doomed to fail. What is most vital are health care providers who are experts at dealing with this - and that is not something that scales well at all. There are only so many of them. All the money in the world can't help if there are not enough boots on the ground. That window is closing fast - imo.

I would agree that the window is closing fast.

The thing that governments fear more than anything else is panic. Look at what is going on West Africa: this concern is there for good reason. So official pronouncements are designed to play things down, but it must also be remembered that nothing is certain. In discussions like this all we can talk about are possible futures. They may not come to pass. But highlighting risks allows expedient measures to be taken so that some possible futures do not become reality.

The only problem with this approach is that authorities (and individuals within them) will believe their own propaganda when its repeated often enough.

[mac68DC]

Re: Why Outside Countries are Not Doing More about the Ebola Outbreak

I would agree that the window is closing fast.

The thing that governments fear more than anything else is panic. Look at what is going on West Africa: this concern is there for good reason. So official pronouncements are designed to play things down, but it must also be remembered that nothing is certain. In discussions like this all we can talk about are possible futures. They may not come to pass. But highlighting risks allows expedient measures to be taken so that some possible futures do not become reality.

The only problem with this approach is that authorities (and individuals within them) will believe their own propaganda when its repeated often enough.

Totally agree. Ironically, if narratives are overly sugar coated - trust is broken when the story changes. If it changes dramatically enough - people stop believing and trusting anything the institutions put out there - which ends up being a disaster.

[Gemineye]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

I also agree. A perfect example is Nigeria. The government recently declared the outbreak was contained and the next day they had two new cases in another part of the country. That kind of behaviour really undermines your credibility.

[JJackson]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

While the on the ground ex-patriot works have adequate PPE many of the local HCWs have little or no kit and have suffered badly.

While I understand that governments may not be keen to send their nationals I do not see why they have not shipped all the PPE they can. Had this been done early in the outbreak the current situation would be a lot smaller and more manageable.

[AnnaLisa]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

Is there hoarding of PPE going on in non-affected countries?

[mac68DC]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

Is there hoarding of PPE going on in non-affected countries?

I don't think so, but not sure. Mostly because there is no panic here yet. I remember in the past n95 masks sold out, but not this time around.

Not sure if that is an indication of non-hording?

[JJackson]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

Is there hoarding of PPE going on in non-affected countries?

I suspect there may be now.

At the outset they should have donated the PPE but now, I suspect, they are more cautious. Despite their 'it won't be a big problem in developed health care settings' mantra I would not be surprised if they are now wondering if shipping their PPE stockpiles may become a political disaster if EBOV does get a foot hold within their territory. I can not see the-powers-that-be relishing explaining that they can not safely treat the growing number of case because they gave their stockpile away to a deserving cause.

The need now is massive. It was small and could have been met with relatively modest donations.

[Vibrant62]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

A key question is what the manufacturing capabilities are of PPE. I do not expect any country has large stocks in hand, except for national strategic reserves, and they wont let those go. There is a domestic obligation to maintain such stocks.

It may be that the PPE is simply not available, and that donating countries are having to wait for additional/ new manufacture.

[JJackson]

Re: Discussion topic: Why Outside Countries are Not Doing More about the Ebola Outbreak

PPE is not the only thing they need.
Looking at some of the lists of supplies they were low on Wellington boots, body bags, various disinfectants and many others which are not likely to be due to supply chain bottlenecks. As there is only supportive treatment they badly need IV drips, and salts & sugars for them. Treatment of the US patients shows you also need blood tests to determine the blood chemistry to formulate your drip. Given the nature of the disease taking and analysing blood tests safely must be challenging.