Albert Camus, The Plague

Transcription

1 Everybody knows that pestilences have a way of recurring in the world; yet somehow we find it hard to believe in ones that crash down on our heads from a blue sky. There have been as many plagues as wars in history; yet always plagues and wars take people equally by surprise. Albert Camus, The Plague

2 Ebola in Sierra Leone: Challenges & Barriers in Getting to Zero Institute of Medicine 25 March, 2015 Joseph Fair, Ph.D., MSPH Advisor, Fondation Mérieux Chair-Global Engagement, American Society for Microbiology

3 Sierra Leone

4 The Mano River Union

5 Regional Ethnic Distributions in the MRU

6 Lassa: The everyday VHF

7 Origins & Early EpiCenters There is a near 50/50 political divide in Sierra Leone and the epidemic started in the Republican stronghold.

8 Patients antibody reactions to arthropodborne and hemorrhagic fever virus antigens, Lassa Diagnostic Laboratory, Kenema, Sierra Leone, October 2006 October 2008* Virus No. positive /total (%) No. IgM only positive/total (%) Dengue 11/253 (4.3) 6/250 (2.4) West Nile 7/253 (2.8) 3/250 (1.2) Yellow fever 5/201 (2.5) 5/201 (2.5) Rift Valley fever 5/253 (2.0) 5/253 (2.0) Chikungunya 10/253 (4.0) 5/253 (2.0) Ebola 19/220 (8.6) 18/219 (8.2) Marburg 8/220 (3.6) 7/219 (3.2) CCHF 0/220 Not tested Total 65/253 (25.7) 49/253 (19.4)

9 What is different between then and now?

10 What is different between then and now? Transport from Freetown to Kenema is now 3.5 hours vs. 8. Checkpoints are minimal. Forests are extremely connected to major urban centers. Major land use change Cassava.

11 Why was the epidemic different from other Ebola outbreaks? Only colonial borders separate a large tribal region that crosses boundaries between Sierra Leone, Liberia, Guinea, and the Ivory Coast; The tri-state region where the outbreak first occurred is a nexus of commerce and transport, locally; More than a decade of civil conflict has led to a lack of trust for government authority; The public health infrastructure of the MRU is much less developed than other parts of Africa; Denial and scattering early in the epidemic, resulted in much higher numbers than previously observed.

12 Pre-Sierra Leone Statistics 0.02 physicians/1,000 population (2010) Human development index of in 2014; By comparison, Yemen has an index of 0.482; 3 laboratories with virology capability existed in country prior to outbreak; Country was sensitized to Lassa fever; One doctor for Lassa fever.

13 Ebola 2014 Lessons Learned Globally, the World is ill-prepared for a pandemic; our arrogance was quickly dismissed by Dallas and similar circumstances. Contingency plans for epidemic and pandemic responses must be placed in regional and global contexts. Governments and international bodies are not the only players in global health emergencies and future policy must include stakeholders from the philanthropic, NGO, and with case-by-case consideration, for-profit Industry.

14 Challenges to getting to Zero The fight against complacency Re-establishment of baseline diagnostics Continue extensive community engagment Rebuild trust in the community Maintaining active surveillance once the emergency is over Develop protocols during down time. Train in a controlled environment using model disease systems.

15 Prepare for the unknown by studying how others in the past have coped with the unforeseeable and the unpredictable. George S. Patton

16 Multi-Sectorial Collaboration Response to Epidemics INDUSTRY PHILANTHROPIC/NGO ACADEME GLOBAL HEATLH SECURITY GOVERNMENT

17 DERIVATIVE OUTPUTS Hard/Software Basic Research/$ Long/Short-term education Twinning ACADEME Lifelong Networks PHILANTHROPIC/NGO Innovative Products & Programs Harness the Power of Private Wealth Operations without flags = sustainable ideas Therapeutics Diagnostics INDUSTRY Vaccines GLOBAL HEATLH SECURITY GOVERNMENT Essential Public Health Countermeasures Increased Global/National Security Global, lasting friendships or Allies.

18 Re-defining Engagement Engagement, cooperation, and collaboration (friendships) are not defined in terms of fiscal years; Relationships cannot be one sided; for example, because your program is interested in Ebola usually means that you cannot fund locally essential, yet clinically relevant diagnostics for Malaria, Typhoid, Shigella, and the other usual suspects; Money is important, but being there when you are needed is priceless. As we saw with Ebola 2014, divided we fall.

19 Investments in Regional Health Security Community Education Infrastructure Maintenance Human Capital Quality Control

20 Stimulating Innovation in Public Health Grand challenges stimulate innovative thinking from multiple sectors, invigorates our economies, and gets the products to where they need to be for an effective cost. Germ Games as proposed by Bill Gates, leading to prize money for research or further product development. Let s make use of the billions spent thus far in biodefense research dollars, and let s go back to the quality of science produced by field programs pioneered in the mid 20h century.

21 Return on Investment Feedback to product developers and progression in clearance cycle Humans Product Test & Evaluation Infrastructure/Systems Product Development

22 Reinforcing Access and Quality of Biological Diagnosis in West Africa This inter-country West African laboratory network was launched in 2009 by Fondation Mérieux. RESAOLAB focuses on six key areas: Improving laboratory services through implementation of a standardized quality system, Strengthening both initial and continuing training of laboratory staff, Establishing an information management system in the network s main laboratories, Strengthening the national laboratory procurement, maintenance and management systems through a regional approach, Obtaining additional funding for the laboratory systems, Strengthening regional and national governance of the laboratory systems. *RESAOLAB: Réseau d Afrique de l Ouest des Laboratoires d Analyses Biologiques (West African network of biomedical analysis laboratories)

23 Expansion of the RESAOLAB Network

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25 Continued Professional Growth & Development Keeping the Lines Open

26 Hi-Fidelity Sequencing Conducted by CIRMF Gabon Made possible with investments by the DTRA Cooperative Biological Engagement Program and DoD Critical Reagent Program (CRP)

27 CIRMF MiSeq

28 A New Era in Asymmetrical Threats Human & Animal Populations have reached unprecedented levels and continue to increase exponentially, thus competition for food and resources will continue to increase. Human population density and the supporting livestock density, as well as the proximity of humans to their livestock, in addition to wildlife = a world at high risk for a lethal pandemic.

29 Gone, but not forgotten

30 In Recognition of Excellence

31 It is not often that nations learn from the past, even rarer that they draw the correct conclusions from it. Henry Kissenger Will this time be different?