AFRICAN UNION (AU) Topic B: Ebola and Health Issues

Transcription

1 AFRICAN UNION (AU) Topic B: Ebola and Health Issues

2 NUMUN XII 2 Introduction Within the past couple of years, there have been many outbreaks of the deadly human disease Ebola. Most of the outbreaks have occurred in African nations including the Democratic Republic of the Congo, Gabon, South Sudan, Ivory Coast, Uganda, Republic of Congo, Guinea, and Liberia 1. In fact, as of October 29, 2014, Guinea, Liberia, Mali, Nigeria, Senegal and Sierra Leone witnessed a total of 13,562 cases, and 4,950 deaths as a result of the disease. The United States, in contrast, only reported 4 cases of Ebola, two of which originated in Africa. The disease is moderately contagious it is not transmitted through the airborne route, but instead through contact with body fluids from an infected person or contaminated objects from those infected ( Experimental Drug ). Symptoms include: weakness, fever, aches, diarrhea, vomiting, stomach pain, rash, red eyes, chest pain, throat soreness, difficulty breathing or swallowing, and bleeding (including internal). There is currently no treatment for this disease. In fact, CNN.com reports that there is no specific treatment for the disease, which is extremely infectious (a single virus has the ability to trigger a fatal infection) and has a fatality rate of up to 90% ( Experimental Drug ). Given the increase in recent outbreaks and the lack of treatment for the disease, there have been many responses both scientifically and internationally to Ebola. Logically enough, one scientific response has been to expand research on Ebola so as to develop a treatment for the disease. There have been few experimental drugs that have come out of such research; however, the experimental drug that has shown the most promise is called Zmapp. This experimental drug was used successfully on two Ebola patients, according to CNN.com ( Experimental Drug ). Still, Zmapp had never been tested on humans prior to Dr. Kent Brantly

3 NUMUN XII 3 and Nancy Writebol who were two aid workers in Liberia. Brantly seemed to be dying prior to receiving the medication through an IV, and within an hour, his symptoms began to improve. His rash faded and his breathing improved, in a situation where doctors describe his recovery as miraculous. Writebol also improved, although in her situation, it took two doses to result in improvements ( How Guinea ). The use of the new drug on these two individuals has created new political dilemmas by calling into question the ethical implications of using an untested drug on human subjects. The World Health Organization was naturally called upon to assist in this controversy and did so by convening a council of experts in the field that were asked to discuss the ethics of using experimental drugs more widely ( Should Experimental Drugs ). The group eventually determined the following: It is ethical to offer unproven interventions with as yet unknown efficacy and adverse effects, as potential treatment or prevention. Ethical criteria must guide the provision of such interventions. These include transparency about all aspects of care, informed consent, freedom of choice, confidentiality, respect for the person, preservation of dignity and involvement of the community. ( Should Experimental Drugs ). Some countries are still not keen to offer widespread use of experimental drugs and would rather turn to more traditional methods for treatment of Ebola. For example, in Guinea, the first Ebola treatment center adopted an approach that provided patients with IV fluids to keep them otherwise healthy while battling the Ebola disease ( How Guinea ). Dr. Robert Fowler, a clinician in pandemic and epidemic diseases for the World Health Organization, describes his desire to establish a culture of very aggressive supportive care for patients who were coming in dehydrated with electrolyte and metabolic abnormalities and try to correct those very early on, so the

4 NUMUN XII 4 complications of very severe depletion don t compound the effects of Ebola virus infection. Time reports that although there was still a high death rate due to Ebola, the rate was lower than in other West African areas ( Health ). Controversies over responses to the Ebola outbreak extend beyond the question of treatments. Due to the aforementioned high quantity of Ebola patients in Africa compared to other countries, many countries like the United States and Canada have imposed increased flight regulations as a result of the outbreak. Such regulations included greatly increased medical screenings before and after flights in addition to entry restrictions and restricted flight schedules. Sometimes, such restrictions can even result in quarantines of passengers on a flight to or from Africa in which individuals are suspected or claim to be experiencing Ebola-like symptoms ( Travel Restrictions ). African countries are also taking measures to protect against the recent Ebola outbreak. Many countries that are showing a significant amount of outbreaks are implementing curfews so as to limit the possibility of infection between people; one such country is Liberia whose government recently imposed a curfew from 9pm-6am. In addition, Africa is not only facing issues with Ebola. It has a history of other illnesses. HIV/AIDS, sleeping sickness, malaria (which kills one African child every 30 seconds), polio, elephantiasis, leprosy, helminthiasis, and trachoma are all illnesses that are common within Africa. OurAfrica.org reports that the continent has varying standards of healthcare, and also that conflicts hinder disease prevention ( Health ). Such scientific and international responses to the Ebola crisis raise a number of serious ethical dilemmas concerning the crisis. Do economically advanced countries have an ethical duty to offer further aid to affected African countries? Should such aid include experimental drugs or will

5 NUMUN XII 5 the widespread use of experimental drugs simply serve to hurt the international image of the United States should they prove ineffectual and even harmful? Should both affected and unaffected African countries be taking more measures to prevent the spread of Ebola? What is being done to assist in the many other terminal diseases currently mentioned in Africa?

6 NUMUN XII 6 Background In order to fully tackle the issue of the most recent Ebola outbreak in West Africa, and further, to attempt to reform the methods by which the continent as a whole deals with such epidemics, it is essential to understand the history of the African healthcare system and of the disease itself. For the most part, African health systems are very similar those of the colonial era. Thus, they are unevenly weighted toward privileged elites and urban centers (Kaseje). After gaining independence, countries in sub-saharan Africa quickly expanded access to health services to larger portions of their populations, facilitating significant improvements. Public health measures were able to bring major communicable diseases under control, and investments were made in order to strengthen health systems by incorporating all available institutions and resources. Unfortunately, these benefits are now reversed as a result of economic stagnation, rapid population growth, the spread of HIV/AIDS, and insufficient allocation of funds to the health sector (Kaseje). Despite increases in government spending in the 1960s and 1970s, there has not been ample progress to ensure health care equality. Poor citizens in Africa are being negatively affected by national and international policy decisions made in favor of the rich. Furthermore, weak governing systems are not able to effectively obtain or utilize data regarding the performance of health systems, which undermines the capacity for effective decision making that would benefit individuals of all socioeconomic statuses. In 2001, the African Union met in Nigeria to discuss health care spending. Countries agreed to allocate 15% of their budgets to health care, however, only six countries to date have met this commitment. These countries are Botswana, Burkina Faso, Malawi, Niger, Rwanda, and Zambia. As of 2014, health experts believe that even if the 15% goal is reached, it will not be enough to make

7 NUMUN XII 7 substantial improvements in health care, as four of the six countries allocating 15% of their budget only spend about 14 dollars per capita on health care. Thus, foreign aid is a large source of health care funding within the continent. Unfortunately, this often causes decision making to rest in the hands of donor governments and organizations, rather than the specific country s local officials who have the best knowledge of what is needed in the area ( Health ). Furthermore, history and tradition definitely come into play in terms of treatments. For centuries, traditional African healers have been using herbal and ritual remedies to treat illnesses, and in many areas, communities have better and easier access to traditional medicines than to modern ones. It is very common to find herbal remedies sold in markets, and many Africans trust cheaper, traditional treatments more than modern medicines ( Health ). Although there is much controversy regarding treatment, epidemics like Ebola require breakthroughs in modern medicine and up-to-date medical facilities in order to prevent it from spreading and in order to hopefully find a cure. In terms of the history of the virus itself, Ebola first appeared in 1976 in Sudan and Zaire. The first outbreak of the disease infected over 284 people, and a few months later, another strain of the virus emerged, infecting 318 people with an extremely high mortality rate of 88% ( Brief General History of Ebola ). The following map indicates the regions of Africa in which Ebola outbreaks have originated.

8 NUMUN XII 8 Figure 1: Map of Ebola Outbreaks in Africa The 1995 epidemic in Kikwit serves as an excellent case study from which the global community can, and must, learn some lessons from history. During this particular outbreak, medical infrastructure was poor to begin with and was negatively impacted by the disease. Hospitals closed, many physicians and nurses contracted the illness, the city had no regular transportation, no newspaper or radio station, and no source of electric power (Peters). The lesson that can be learned from this is clear: healthcare facilities must be reformed and strengthened. Although this will require money, training, and time, improvements in the African health care system are essential for preventing the spread of infectious diseases like Ebola.

9 NUMUN XII 9 Current Situation The aggressive response to Ebola has recently met some success. The situation once seemed much more bleak than it is currently. In September 2014, the Centers for Disease Control and Prevention estimated that there were approximately 550,000 Ebola cases in Liberia and Sierra Leone or 1.4 million if corrections for underreporting [were] made (CDC - Questions and Answers). This estimate was likely a little alarmist, as it assumed a completely unchanged Ebola response even though positive changes were already being implemented. Still, the difference between this estimate and the actual number of cases is significant. As of January 16, 2015, about 21,373 cases of Ebola existed in the hardest-hit countries of Guinea, Liberia, and Sierra Leone (CDC Case Counts). A decline in new cases caused this difference between the estimate and reality. In September 2014, the number of Ebola cases doubled every days in Liberia (CDC - Questions and Answers). Although Ebola is still a persistent problem, the number of new cases has declined since December 2014, amounting to about 30 new cases a week, well below the doubling rate (3). The following graphic illustrates the declining rate of new cases: Figure 2: Cumulative confirmed Ebola cases, selected countries (CDC Reported Case Graphs)

10 NUMUN XII 10 The fatality of Ebola has also decreased. Not even two years ago, Ebola was a disease with a 90% fatality rate. Contracting the disease was practically synonymous with death. The following graphic shows how medical advances over the course of the current Ebola epidemic have reduced the fatality rate: Figure 3: Cases vs. Deaths from Ebola, Sierra Leone (CDC Reported Case Graphs) Such changes are encouraging. However, they do not undermine the need for vigilance against Ebola. The overall number of cases is still rising. Therefore, it is a time for analyzing the effectiveness of the response to Ebola. This involves countless factors, but can be roughly summarized by three categories of response: treatment methods, government health policy, and community response. If the governments of Africa aim to end the Ebola epidemic and prevent future epidemics of any disease, they must find out what worked and what didn t during the last year. Then, these governments must enact policies that reflect this knowledge so they become more effective at fighting widespread diseases, including Ebola, in the future.

11 NUMUN XII 11 Treatment The medical response to Ebola has been a complicated and multifaceted one. The ultimate boon to the Ebola fight would be the approval of an effective vaccine. Although there are vaccines under safety testing, none have been approved yet (Mayo Clinic). If a vaccine were to be approved, governments would have to act to determine that it is made available efficiently. Current treatments for Ebola include rehydration with intravenous fluids, maintaining blood pressure, replacing lost blood, and preventing other infections (Mayo Clinic). Quick treatment reduces the fatality rate of Ebola. If the sick are treated at a hospital, however, medical personnel must avoid allowing the disease to spread. This often means putting entire buildings under quarantine. People with other ailments must go elsewhere for care, putting a strain on many struggling health systems. This problem has been alleviated somewhat by American Ebola facilities, which isolate Ebola patients from other patients (Bernstein). These facilities were built too late to help most of those affected by Ebola, but should be available to contain future flare-ups (indeed, Ebola may emerge in other places after it seems contained in one area). All in all, isolation of Ebola patients is pivotal, but also highlights overarching problems with healthcare systems in Africa. The medical community has worked admirably to develop increasingly effective treatments and prevention methods, but ineffective government has stymied some of their potential progress. Government The African governments play an essential role in the Ebola response. They have been working with world governments and organizations to allocate funds, coordinate actions, and develop long-term health policies. A great deal of funding has come from the United States, which has spent over $360 million fighting the disease. Additionally, governments such as the United Kingdom, Germany, and China, and organizations such as the World Food Programme, UNICEF,

12 NUMUN XII 12 and the World Health Organization have contributed funds to fight Ebola. This funding has been instrumental in treating Ebola, but also brings up concerns about the overall effectiveness of health systems. With a glut of funding, even the most inefficient of disease response plans can function to an extent, but it cannot thrive. It s abundantly clear that the Ebola response was inefficient, in part because affected countries were (and continue to be) heavily reliant on foreign aid. Figure 4: Donations to Ebola Relief, October 2014 (Sanchez)

13 NUMUN XII 13 African governments have had to coordinate actions to fight the disease. On July 31st, 2014, WHO launched an Ebola response plan that aimed to strengthen national and local coordination. It sought to: mobilize and deploy needed WHO staff, experts, and consultants develop and disseminate information, education, and communication materials for the public and additional training materials for health professionals and strengthen surveillance, case finding, and reporting (Ebola Virus Disease Outbreak Response Plan). These basic goals highlight the need for governments to continue to use their power to coordinate effectively, and strengthen these coordination plans. Even as Ebola declines, it is vital to maintain a coordinated response so that local isolated cases remain isolated, instead of ballooning into a mass of infections. As reported by Swedish physician and adviser to the Liberian government, Hans Rosling, We are now in a different phase that is not so visual, but it s just as dangerous. In September, this city was under attack by an army of virus. We defeated that army. But now we have terrorists in every part of the country (Bernstein). Ebola has exposed larger problems in many African healthcare systems. The systems largely serve the rich due to high out-of-pocket costs, and facilities are not able to guarantee quality service to average people. According to the World Health Organization, By 2008, only 7 countries in the Region [of Africa] had a per capita Health Expenditure higher than US $34, clearly showing the inability of countries to ensure basic healthcare, let alone respond to large-scale crises. When systems were strained by Ebola, they broke: Liberia s non-ebola health system virtually collapsed at the height of the epidemic (Bernstein). It is clear that overall structural adjustments will need to be made to create lasting health policies. These policies must be built on a stronger health infrastructure, including larger ambulance corps, passable roads, and modern machinery. However, the persistent problem of HIV/AIDS has stymied economic growth in Africa, leading to low

14 NUMUN XII 14 investment in health infrastructure. This time of health crisis in Africa is important because, in reducing the effects of the crisis, African governments can also create better health policies that make primary care universally available. Communities In addition to large-scale government action, an energetic community response can make all the difference in bringing an end to a deadly disease. This holds true for Ebola. According to the World Health Organization (WHO), increased public engagement is an important part of the containment plan (Ebola Virus Disease Outbreak Response Plan). Early in the Ebola response, locals were their own worst enemy. Cultural norms were a major setback. Some people did not believe that Ebola existed. Deep-rooted beliefs in ritual medicine and suspicions of modern medicine prevented people from reporting Ebola. The importance of family also set back the response, as people feared ostracization from the community if they gave up their relatives to treatment centers. To many, infection and contagion seemed certain in hospitals. Also, traditional burial customs would be violated by performing safe burials or cremation, and so the continued performance of traditional burials contributed to the spread of Ebola. Community education has helped to improve knowledge about Ebola. Unified communities have reduced the stigma associated with sending relatives to the hospital and burying corpses safely, leading to reductions in underreporting and better containment of infections (Bernstein). The tide is turning, but rash actions against modern medical response are still happening. In November, an Ebola ambulance was forced off the road in the Port Loko district of Sierra Leone after being stoned by irate youths, unhappy that their relatives were being taken away. An angry mob in Freetown ripped down Ebola posters, until police intervened with tear gas (The

15 NUMUN XII 15 Economist). The educational response must become even more effective than it is. Also, the lessons learned from this Ebola crisis about community education could be applied to other health crises, such as HIV/AIDS or FGM. The local response has also been important in mobilizing resources from national governments and the world. Command centers must organize the resources and use them to enforce prevention measures, discourage infection, and distribute treatments. As Sierra Leonean Chief Philip Musa Koroma says, Our great challenge is logistics. We don t have ambulances. It takes a long time for teams to arrive while roads are difficult and distances are long (Gborie). While communities receive supplies, they must often deal with mobility problems and training on their own. The African Union could provide guidelines that, when implemented by national governments, will help communities deal with logistical problems. Truly effective improvements will be useful for future health crises.

16 NUMUN XII 16 Bloc Positions Severely Affected by Ebola Liberia, Sierra Leone and Guinea are the African nations most severely affected by Ebola. These three nations lead the world in deaths caused by Ebola. As of January 21 st, 2015, Ebola caused 3636 deaths in Liberia, 3159 in Sierra Leone, and 1880 in Guinea 1. The disease is highly contagious, and even one case can cause an outbreak. As a result, nations must track everyone who comes into contact with the disease 2. In addition, these three nations have a large patient to doctor ratio, resulting in lack of available medical care. For example, in Sierra Leone, there are approximately two doctors available for every 100,000 people, and there are only 8 surgeons in the entire nation 3. African nations must make an effort towards training surgeons in order to result in sustainable, long-term health improvement. In addition, they need to work to counteract the effects of doctor emigration in sub-saharan Africa, there was a 40% increase in emigration of doctors to the United States 3. Currently, the number of Ebola cases in these majorly affected nations is decreasing. At the peak of the outbreak, there were 509 weekly cases in Liberia, 292 in Guinea, and 748 in Sierra Leone. Now, there are 8 per week in Liberia, 20 in Guinea, and 117 in Sierra Leone 2. Ebola poses a threat not only to the health of its citizens, but also impacts the economies of affected nations. World Bank Group expects that there will be $1.6 billion of lost economic growth this year in these nations. This loss makes up over 12% of these countries GDPs combined 4. Nations must work against the spread of Ebola in order to minimize economic damage. UN.org recommends efforts to prepare to contain the spread of Ebola, public health improvements, and assistance from neighboring countries 4.

17 NUMUN XII 17 Moderately Affected by Ebola These Nigeria, Mali, Senegal, and the Democratic Republic of the Congo are African nations that are moderately affected by Ebola. There have been 20 cases in Nigeria, 1 in Senegal, 8 in Mali. Of those, there have been 8 deaths in Nigeria, 0 in Senegal, and 6 in Mali 5. The World Health Organization has declared that the outbreaks in Nigeria and Senegal are over, since there have been no new cases since September 5 th, In addition, the case of Ebola in the Democratic Republic of the Congo is of a different strain than the one in West Africa. Up to January 18 th, 2015, there have been 66 cases in DR Congo, 49 of which resulted in death 6. These nations should play a role in helping other nations counter. For example, Nigeria has sent 250 healthcare professionals and over $3.5 million in donations to Liberia, Sierra Leone, and Guinea 7. Senegal played a role in the movement of supplies through the region 7. Minimally or Not Affected by Ebola Unlike African nations which are unaffected by Ebola play a role by giving aid to suffering countries. The countries that border affected nations have spent money on border-control surveillance, public awareness campaigns, positioning supplies, and training healthcare workers 7. For example, in January 2015, Ethiopia sent 187 healthcare professionals to Sierra Leone, Guinea, and Liberia. Kenya sent 170 doctors 7. Kenya has also donated $1 million each to these three nations. Cote d Ivoire and Namibia have done the same 7. South Africa has also played a large role in assisting affected nations. It has donated over $300,000 to the affected region, donated medical supplies such as personal protective equipment (PPE) suits and ambulances, built a treatment center, and trained almost 100 health workers. In January 2015, South Africa sent 12 healthcare workers to Sierra Leone. In addition, Ethiopia,

18 NUMUN XII 18 Burundi, Chad, the Central African Republic, Ghana, Kenya, Lesotho, Tanzania and Zimbabwe have programs to provide individuals to help through donations 7. Figure 5: Ebola outbreaks (source 6)

19 NUMUN XII 19 Questions to Consider 1. Should the African Union support the use of experimental Ebola drugs, or wait until a vaccine has been approved before considering its implementation? What is the more ethical choice? 2. If a vaccine is developed, how should African governments manage its distribution? 3. How should foreign aid be tailored to encourage health policy improvements that remain long after the Ebola outbreak ends? 4. What would an effective response to a disease outbreak incorporate? How can governments ensure that this response is implemented quickly and with little waste? 5. The Ebola crisis has highlighted the importance of community response and has shown that culture cannot be ignored when implementing health policies. How can the lessons from the Ebola crisis be broadly applied to other health problems (ex. HIV/AIDS)? 6. How should African governments facilitate the distribution of treatments? 7. What changes, if any, should be made to government responses to Ebola as the threat shifts to a more terroristic mode, as opposed to an army mode? 8. How should governments plan to deal with the aftermath of the Ebola crisis, esp. care for children who lost their parents to Ebola?

20 NUMUN XII 20 Bibliography Introduction 1. Experimental drug likely saved Ebola patients. CNN.com. < 2. How Guinea Found the Best Way to Survive Ebola. Time.com. < 3. Health. Our-Africa.org Should Experimental Drugs be used in the Ebola Outbreak? Nature.org < > 5. Travel Restrictions, flight operations, and screening internationalsos.com < Background 1. "Brief General History of Ebola." Brief Ebola General History. N.p., n.d. Web. 17 Jan < 2. "Health." Our Africa. N.p., n.d. Web. 18 Jan < 3. Kaseje, Dan. "Health Care in Africa: Challenges, Opportunities, and an Emerging Model for Improvement." (n.d.): n. pag. Wilsoncenter.org. 2 Nov Web. < 4. Peters, C.J., and J.W. Peters. "The Journal of Infectious Diseases." An Introduction to Ebola: The Virus and the Disease. Oxford Journals, n.d. Web. 18 Jan < Current Situation 1. "2014 Ebola Outbreak in West Africa - Case Counts." Centers for Disease Control and Prevention. January 23, Accessed January 24, <

21 NUMUN XII "2014 Ebola Outbreak in West Africa - Cumulative Reported Cases Graphs." Centers for Disease Control and Prevention. January 23, Accessed January 24, < 3. "A Glimmer of Hope." The Economist. November 1, Accessed January 20, < 4. Bernstein, Lenny. "When U.S. Military Ebola Treatment Centers Open in Liberia, There Might Be Few Patients to Fill Them." Washington Post. November 3, Accessed January 20, < liberia-health-officials-reassess-response-plans/2014/11/03/88126a4c e4-bb14-4cfea1e742d5_story.html> 5. "Ebola Virus Disease Outbreak Response Plan in West Africa." WHO. July 31, Accessed January 22, < 6. Gborie, Saffea. "Sierra Leone Communities Organize Ebola Response." WHO. December 1, Accessed January 20, < 7. Mayo Clinic Staff. "Ebola Virus and Marburg Virus." Treatments and Drugs. January 1, Accessed January 20, < 8. "Overview - Health Policy and Service Delivery Programme." WHO Regional Office for Africa. Accessed January 23, < 9. "Questions and Answers: Estimating the Future Number of Cases in the Ebola Epidemic Liberia and Sierra Leone, " Centers for Disease Control and Prevention. November 19, Accessed January 20, <

22 NUMUN XII Sanchez, Raf. "What Countries Have Pledged to Fight Ebola... and How Much They've Paid into the Fund." The Telegraph. October 22, Accessed January 20, < 11. Sieff, Kevin. "U.S.-built Ebola Treatment Centers in Liberia Are Nearly Empty as Outbreak Fades." Washington Post. January 18, Accessed January 20, < liberia-are-nearly-empty-as-disease-fades/2015/01/18/9acc3e2c-9b52-11e4-86a3-1b56f64925f6_story.html> Bloc Positions 1. Ebola: Mapping the Outbreak. BBC News. 6 February < > Falling Ebola Cases Show Turning Point. BBC News. 22 January < > 3. Yasmin, Seema and Sathya, Chethan. Ebola Epidemic Takes Toll on Sierra Leone s Surgeons. Scientific American. 22 January < World Bank: worst affected countries crippled by economic impact of Ebola. UN News Centre. 20 January < -.VNjv0MY8r-n -.VNjv0MY8r-n Ebola Outbreak in West Africa Case Counts. Centers for Disease Control and Prevention. 6 February < Ebola in graphics: The toll of a tragedy. The Economist. 5 February <

23 NUMUN XII Lazuta, Jennifer. UN: African Countries Vital In Fight Against Ebola. Voice of America. 20 January < >