The World Health Organization was criticised for responding slowly to Ebola. Now, many fear the same with Zika. What’s gone wrong?
Another global health emergency has been announced by the World Health Organization (WHO). The Zika virus has spread throughout much of Latin America and an infected individual has even been detected in Spain. The WHO has warned that as many as four million people could be infected this year, compared to the 11,000 deaths caused by Ebola, the previous global health emergency. But apart from governments issuing chilling warnings to not get pregnant, what is the WHO doing? Is it enough? And have lessons been learnt from Ebola?
The Ebola virus was fatal, with an average case fatality rate of 50 per cent, with ranges of 25-90 per cent. Fast transmission via contact with body fluids and the gruesome internal bleeding it caused, meant that there was widespread horror as it spread mercilessly throughout West Africa in 2013. But the WHO only declared it a public health emergency as late as August 2014. It was slow, taking months to mobilise boots on the ground to tackle the epidemic.
Neither did it ask for the necessary funds from member states. It was not until September 2014, more than a year after there were first signs of the disease, that Barack Obama sent 3,000 troops to set up treatment centres with 1,700 beds and to train local health workers. By that time, thousands had been infected, and it was clear in the aftermath that had the WHO gained the necessary funds quicker, the worst effects of the epidemic may have been prevented. In the end, the cost of reining in the Ebola virus rose to over $1 billion. Two potential candidates to be used as Ebola vaccines were also brought to the forefront, with rapid testing taking place; the drive to produce a vaccine was clear, and one, developed by Merck, was described by WHO as a “game-changer”.
As the WHO itself said, tackling a disease like Ebola requires community support, especially in administering treatments and implementing quarantines in cultures where these may not have occurred before. Yet another failing identified was the inability of WHO to mobilise ground teams, requiring Obama to step in.
Dr Margaret Chan, Director-General of the WHO, announced thereafter a new programme, costing $100 million, which will have protocol-guided benchmarks showing what a response should be within 24, 48 and 72 hours, rather than on the previous timescale of months. This would ensure a more rapid response to another crisis. The fund would transform the WHO from just an advisory board to one with the capability to immediately respond with a team of pre-trained doctors, nurses and epidemiologists (scientists who study patterns in disease transmission). What must also be added, is the importance of working with other organisations. Until Ebola was properly responded to, the burden of providing care for West African nations largely fell on charities such as Médecins Sans Frontières (MSF), which had 2000 staff in the affected countries. Working alongside these organisations, and utilising their resources and staff to maximise delivery of care, would have been more effective. This was indeed another failing of the WHO, but have these lessons been learnt when it comes to Zika?
Zika is not as scary; at least, it does not cause the horrible, haemorrhagic symptoms of Ebola. But after the realisation that it is linked to microcephaly (head shrinkage) in newborns, and the potentially-life threatening Guillain-Barré syndrome where the immune system attacks the nervous system, causing progressive muscle weakness, the landscape has changed. It has spread far and many unborn children are now at risk, with four million expected to be infected this year.
Sadly, we observe again a lack of initiative from the WHO agency responsible for the region, the Pan-American Health Organisation (PAHO). We need to see that lessons have been learnt when it comes to Zika. Countries have been actively fumigating urban areas to take the mosquito out of the equation, but PAHO has not engaged with local charities and organisations working to fight Zika. By “fight” I mean spreading awareness of how to prevent disease transmission, destroying mosquito breeding sites or fumigating areas. This not only requires government initiative, but support from WHO member states to support these nations before Zika spreads to the subtropical regions.
Many have also criticised the WHO for not as actively funding research into vaccines for Zika compared to when it came to Ebola. Although the Ebola response was slow, a vaccine was developed and distributed. Zika may not be as terrifying, but the effect it has on the new-born next generation and the ease of transmission through a mosquito that regularly feeds on human blood, compared to the slightly more difficult route of transmission preferred by Ebola, means that the WHO should be responding as urgently as it did to Ebola. In the short-term this means working alongside local organisations to tackle Zika by eliminating breeding grounds for the Aedes aegypti mosquito, and in the long-term by increasing funding on research into a vaccine.
The Zika virus has spread throughout half the world and gone from tragedy to tragedy before the WHO could even respond. In a globalised world where one could be in Hong Kong for breakfast and be in time for dinner in Brazil, agencies such as the WHO must, and can do better to tackle global health crises such as Zika, with the full backing of member states in whose interests it is to do so.