At a time when the entire world is focused on COVID-19, it is important to recall some important lessons which emerged from the response to previous sudden outbreaks  like Ebola infectious disease and other diseases in recent times. Of course no two diseases are the same but lessons can be learnt in terms of  policy responses, the various factors and forces at play and their impact on decisions of  governments and international organizations.

Ebola caused havoc in parts of West Africa in 2014-15. A very important aspect of the situation there was that as the health system got exceedingly centered on Ebola,  mortality from some other diseases which could not receive the same attention as before increased rapidly and this extra mortality caused by these diseases turned out to be more than Ebola-related mortality. Hence this entire effort of making the health system too concentrated on Ebola turned out to be highly questionable.

Summing up the Ebola experience the World Health Organization  said in a recent statement dated March 30 2020, “ Previous outbreaks have demonstrated that when health systems are overwhelmed, mortality from vaccine-preventable and other treatable conditions can also increase dramatically. During the 2014-15 Ebola outbreak, the increased number of deaths caused by measles, malaria, HIV-AIDS and tuberculosis attributable to health system failures exceeded deaths from Ebola.”

The studies which the WHO has cited to support this view include one authored by JW Elston, C. Cartwright, P. Ndumbi and J. Wright. This study ( 2017) titled ‘ The Health Impacts of the 2014-15 Ebola Outbreak’ states, “ The impact of the Ebola outbreak was profound and multifaceted. The health system was severely compromised due to overwhelming demand, healthcare workers’ death, resource diversion and closure of health facilities.”

There was 80 per cent reduction in maternal delivery care in Ebola affected areas. Institutional care for malaria for small children declined by 40 per cent. Reduction in coverage of vaccination was substantial. There was reduction in child protection. Increased morbidity and mortality and reduced life expectancy were reported.

Another cited study was authored by A.S. Parpia, M.L. Ndeffo-Mbah, N.S. Wenzel and A.P.Galvani. This study ( 2016) titled ‘Effects of Response to 2014-15 Ebola Outbreak on Deaths from Malaria, HIV-AIDS and Tuberculosis, W. Africa’ says, “ Response to the 2014-15 Ebola outbreak in W.Africa overwhelmed the healthcare systems of Guinea, Liberia and Sierra Leone, reduced  access to health services for diagnosis and treatment for the major diseases that are endemic to the region: malaria, HIV/AIDS and tuberculosis.”

This study found that a 50 per cent reduction in access to health care services during the Ebola outbreak exacerbated malaria, HIV-AIDS and tuberculosis mortality rates in significant ways in these three countries.

In another study published in Lancet Infectious Diseases , Mathew Waxman and colleagues reported an overall high mortality ( 8 .1 per cent )  in patients without Ebola Virus Disease admitted to three Ebola Treatment Units. Colebunders and colleagues recommended, ( writing in Lancet Infectious Diseases), “ As part of outbreak preparedness, measures are required to ensure that non-Ebola referral hospitals maintain capacity to appropriately manage seriously ill patients , including non-Ebola Virus Disease patients requiring transfer from an Ebola Treatment Unit.”

Thus what these various studies have brought out is that during the Ebola outbreak on  the one hand many people suffering from non-Ebola serious diseases had much higher mortality rates than before because they  did not get access to modern or formal health systems . On the other hand even among non-Ebola patients who had somehow managed to access the modern/formal health system, those who got sent to Ebola Treatment Units also had a high mortality rate due to a number of factors.

Earlier there was wider worldwide panic at the time of the spread of the H1N1 swine flu disease in 2009-10. The prestigious British Medical Journal or BMJ published an expose and several strong citizen groups came forward to demand greater transparency.

The Social Health and Family Affairs Committee of the Parliamentary Assembly,Council of Europe published an important report titled ‘ The Handling of the H1N1 Pandemic—More Transparency Needed’.This report said, “ The Parliament Assembly is alarmed about the way in which the H1N1 influenza pandemic has been handled, not only by the World Health Organization , but also by the competent health authorities at the level of the European Union and at the national level. It is particularly troubled by some of the consequences of decisions taken and advice given , leading to distortion of priorities of public health services across Europe, waste of large sums of public money and also unjustified scares and fears about health risks faced by the European public at large.”

Further this important note on lack of transparency regarding an infectious disease related crisis said, “ The Assembly notes that grave shortcomings have been identified regarding the transparency of decision making processes relating to the pandemic which have generated concerns about the possible influences of the pharmaceutical industry on some of the major decisions relating to the pandemic. The Assembly fears that that this lack of transparency and accountability will result in a plummet in confidence on the advice given by major health institutions. This may prove disastrous in the case of the next disease of pandemic scope which may turn out to be much more serious than the H1N1 Pandemic.”

The text of a resolution passed in this context in the Council of Europe Parliament said, “ In order to promote their patented drugs and vaccines against flu pharmaceutical companies influenced scientists and official agencies responsible for public health standards, to alarm governments worldwide and make them squander tight health resources for inefficient vaccine strategies and needlessly expose millions of healthy people to the risks of an unknown amount of side-effects of inefficiently tested vaccine.”

Michael Fumento , Director of Independent Journalism Project , wrote  that the fatality rate of the swine flu had turned out to be milder than ordinary seasonal flu but a pandemic had been declared with undue haste. He wrote, “ this wasn’t merely over-cautiousness, or simple misjudgment. The pandemic declaration and all the Klaxon-ringing since (then) reflect sheer dishonesty motivated not by medical concerns but political ones.” He also quoted the director of the WHO Collaborating Center for Epidemiology in Munster , Germany as stating that we are witnessing a gigantic misallocation of resources ( $ 18 billion so far ) in terms of public health.

In fact to their credit some of the WHO top officials came at least half-way in acknowledging some of the problems and trying to make amends. On April 12, 2010 Reuters released a report written by Stephanie Nebehay titled ‘ WHO admits shortcomings in handling flu pandemic.’ This report said that the WHO has conceded shortcomings in its handling of the H1N1 swine flu pandemic. This report quoted Keiji Fakuda, described as the WHO’s top influenza expert, as stating that the UN agency’s six phase system for declaring a pandemic had shown confusion about the flu bug which was ultimately not as deadly as the earlier fears.

This top expert of the top health organization said, “ The reality is there is a huge amount of uncertainty ( in a pandemic). I think we did not convey the uncertainty. That was interpreted by many as a non-transparent process.”

BMJ teamed up with an organization of investigative journalists to publish an expose of the conflict of interest of key scientists advising the WHO on planning for an influenza pandemic doing paid work for the pharmaceutical firms that stood to gain from this guidance. Later the BMJ editor wrote that the expose had  led to the WHO making some badly-needed reforms. “ In fact the WHO endorsed the article’s central argument which was that its handling of conflict of interest needs to be improved. Last year ( WHO top boss) Margaret Chen commenced an independent review into the WHO’s handling of the pandemic led by Harvey Fineberg. Its findings were published in May. Far from discrediting the BMJ article ,the report echoes the article’s concerns.”

Bharat Dogra is a  journalist and author. His recent books are Planet in Peril and Protecting Earth for Children.


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