Skip to 0 minutes and 13 seconds DAVID HEYMANN: After the SARS outbreak in 2003, there was a revision of what’s called the International Health Regulations. The International Health Regulations are a treaty which were developed by the member countries of WHO, and this treaty requires now, in the revision, that countries develop eight core capacities in public health, ranging from good public health laboratory services, good epidemiology services, all the way through to risk communication services. These were to have been developed, these capacities, in each country, by the end of this year 2014. And they were assessed by countries that reported each year to WHO whether or not they had attained their goals. It’s clear that no matter what countries were reporting, they didn’t attain those goals in West Africa.
Skip to 1 minute and 3 seconds And now we see countries with very weak public health systems and weak infrastructure for health care trying to deal with an epidemic of Ebola and also probably not able to deal with common infections, such as malaria, diarrheal diseases, and other infections in children because the health systems are not able to accommodate them or because patients are afraid to go to them because of fear of infection from Ebola. At the time when the International Health Regulations were revised after the SARS outbreak, it was thought that the core capacities were what was necessary to help countries detect and respond to diseases where they occur. Clearly, this hasn’t happened.
Skip to 1 minute and 45 seconds And the question is were the core capacities right or were the countries negligent in developing their capacities. It seems that the latter is probably true. These core capacities cover a wide range of public health resilience activities that could have prevented this outbreak from spreading. The whole problem with the International Health Regulation revision is that the bilateral donors and developed country governments didn’t invest in strengthening capacities in developing countries. The framework existed. There were attempts to get development agencies, such as DFID and USAID, to buy into this to strengthen these capacities, and there was a very weak response from these development agencies because their priorities were in different areas.
Skip to 2 minutes and 31 seconds It’s unfortunate, and hopefully after this outbreak, development agencies and industrialised country governments will see the need and the advantage of helping countries develop their core capacities. The problem with the end of an outbreak is that all attention then disappears from that outbreak and it’s again business as usual. What has to happen now is that the international community has to keep this terrible outbreak in mind despite the fact that other infectious diseases kill many, many more people each week than has the Ebola outbreak to date. But it’s still important to remember this as a sign of what can happen and what could happen. The step that’s needed is rapid detection and rapid response by countries.
Skip to 3 minutes and 13 seconds So countries need to strengthen their capacities to detect and respond when and where outbreaks occur. It needs public health laboratories which have the capacity to diagnose the hemorrhagic fevers as well as endemic infectious diseases, which can also cause outbreaks of diseases, such as cholera or malaria. A lot of financial resources have been invested in this outbreak. Unfortunately, much of it is for structures which will not exist after the outbreak ends. They’ve been for temporary hospitals, temporary treatment units. Other laboratory facilities will disappear.
Skip to 3 minutes and 52 seconds And the challenge will be after this to make sure that resources that are being given or that have been given can be in some way also channelled towards increasing infrastructure to take care of patients and to prevent infections in countries. So that means that we need to develop resilient health care systems and resilient public health care systems to deal with future outbreaks and to help people have access to lifesaving medicines and vaccines they need every day. The training that’s going on to train people in epidemiology and contact tracing and outbreak investigation will be very important for countries in the future. Polio eradication invested in strengthening epidemiology skills and laboratory skills in countries and those skills have remained in countries.
Skip to 4 minutes and 42 seconds And in fact, they did contribute in Nigeria to better addressing the outbreak of Ebola when it occurred in Nigeria. So hopefully, as time goes on, the investments that have been made into human resources, into strengthening capacities, in people to do outbreak investigation and containment will be able to be applied in other areas as well. After the outbreak is finally contained, which hopefully will be sooner rather than later, countries must then sit down and decide within their own governments how they’re going to proceed. They must call on help from the World Health Organisation and others so that they can develop a plan which will help them develop more resilient health systems and better and stronger public health.
How can we prevent this happening again?
International health regulations set out what countries should be doing to detect and respond to outbreaks, but they have not been well implemented. In this video, Professor David Heymann describes what needs to happen.
The international health regulations set out the core capacities that countries need for good public health. They are comprehensive but were not fully implemented. They were not seen as a priority for investment by donors.
It is essential that when the outbreak is over the lessons are not forgotten. Countries need to strengthen their capacities to detect and respond. This will need considerable investment in health systems, which should have benefits for the prevention and control of many diseases, not just Ebola.
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