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World Health Organization

Controlling the 2014 West African Ebola Outbreak and Preventing a Pandemic Spread

EuroAsia MUN 2014 Training and Development Conference Page 0

EuroAsia MUN Training and Development Conference

6-8 December, 2013

ANKARA

FOOD AND AGRICULTURE ORGANIZATION

OF THE UNITED NATIONS

STUDY GUIDE




LETTER FROM THE SECRETARY-GENERAL

Esteemed participants

I am Gökberk Ekinci, the Secretary-General of EuroAsia Model United Nations Training

and Development Conference 2014. I feel more than honored to be welcoming you to the 9th

session of this ambitious work. Organized under the framework of Model United Nations

Association of Turkey, in accordance with its vision to familiarize MUN related activities to

young people in the country the EuroAsia MUN 2014 is eager to reach wide range of

attendants from high schools and universities which are deeply interested in diplomacy,

international relations, politics and the United Nations itself while constituting a unique

experience of debating and socializing at the same time. This year, the conference takes it a

step further as it is composed of 10 committees chosen delicately to the very attention of the

mentioned variety of participants holding economic, social, humanitarian and real-time crisis

committees as well as a joint cabinet crisis simulation which is a brand new practice for the

training and development concept. The academic team embraces an understanding of content

which concerns actual and urgent problems that the world faces currently in order to create

awareness of the facts touched upon over the youth to which it addresses.

World Health Organization will be discussing the agenda Controlling the 2014 West African

Ebola Outbreak and Preventing a Pandemic Spread. The academic content and the structure

of the committee have been prepared by the respected Under-Secretary-General Derya Buğra

Yarkın. Carrying out his work outstandingly, Mr. Yarkın has accomplished the preparation

of the academic document regarding the very agenda which holds utmost importance in

international arena due to the risk of a possible pandemic.

I advise the participants of this well-prepared committee to read the provided guide

thoroughly. You may also go over further readings and key documents which you may find

on our website with the study guide. For any further questions, please do not hesitate to

contact me via [email protected].

Best regards

Gökberk Ekinci

Secretary-General of EuroAsia MUN Training and Development Conference 2014

mailto:[email protected]




LETTER FROM THE UNDER-SECRETARY-GENERAL

Most Distinguished Delegates,

It gives me utmost pleasure and pride to welcome all to the EuroAsia Model United Nations

2014 Training and Development Conference.

My name is Derya Buğra Yarkın, the Under-Secretary-General responsible for the World

Health Organization (WHO). I am a junior student at Başkent University Department of

Political Science and International Relations and this marks the end of my fifth consecutive

year in Model United Nations. I have been given the high honour of being a member of the

Secretariat consisting of people all of whom I look up to and respect as highly-skilled

MUNers. As an ex-medical student and a passionate medicine aficionado, I've done my best

in order to make the WHO experience as realistic as I could for both other admirers of

science and political debate enthusiasts.

The Committee will focus on the issue of "Controlling the 2014 West African Ebola

Outbreak and Preventing a Pandemic Spread". The Committee is expected to discuss

thoroughly and assess the situation affecting several countries of several continents in

today's times and work towards a solution to contain the deadly outbreak. I hope that the

agenda will make the delegates realize and understand different points of view on the

problem; and come up with an extensive and exhausting resolution that will both control the

outbreak, and see to it so that such humanitarian crises will never occur again.

This document will hopefully act as a guide to your research and discussions in the

committee. With great pleasure, I wish you all a delightful and satisfying conference. Should

you have any questions, please do not hesitate to contact me via [email protected].

Kind regards,

Derya Buğra YARKIN

Under-Secretary-General responsible for WHO and the United Nations Security Council




Introduction to the World Health

Organization

World Health Organization (WHO) is an

agency under the United Nations

Economic and Social Council (ECOSOC)

which deals with international public

health. In 1945, the United Nations

Conference on International Organization

in San Francisco moved to create an

international health organization under the

newly found United Nations; and a year

later, the International Health Conference

in New York approved the Constitution of

the World Health Organization. Having

obtained enough signatures, the

Constitution came into force on 7 April

1948, a day that is now celebrated as the

World Health Day.i

World Health Organization is governed by

two bodies, The World Health Assembly

and the Executive Board. The World

Health Assembly is the decision-making

body which consists of all 194 Member

States' delegations. The Assembly's key

function is to determine the policies of the

Organization; however it also appoints the

Director-General, supervises the financial

policies and reviews the proposed budget

for the Organization. The Executive board,

on the other hand, is composed of

members technically qualified in the field

of health that are elected by the Assembly

for three-year terms. The Board decides on

the Assembly's agenda, forwards

resolutions to the Assembly to be adopted

and deals with administrative matters.

However the main function of the Board is

to give effect to the decisions of the

Assembly, advise it and facilitate its work.ii

The Board is also authorized to call upon

experts and Non-Governmental

Organizations (NGOs) of a certain field in

order to include a more detailed overview

on the subject at hand.

The Organization has worked on the

containment and prevention of epidemics

and pandemics such as the Severe Acute

Respiratory Syndrome (SARS), H1N1

virus (also known as the swine flu), avian

influenza, plague, smallpox, Ebola,

Crimean-Congo hemorrhagic fever and

Acquired Immune Deficiency Syndrome

(AIDS). With its reputation and

significance, WHO is the first responder to

any global health alerts and the bridge

between the United Nations and the scene

of death.




I. Introduction

"It is the world’s first Ebola epidemic, and

it’s spiraling out of control. It’s bad now,

and it’s going to get worse in the very near

future. There is still a window of

opportunity to tamp it down, but that

window is closing. We really have to act

now."iii

Dr. Tom Frieden, Director of the Centers

for Disease Control and Prevention

Ebola, since it first emerged in 1976, has

been a concern for the African states. In its

38 years of existence known to humankind,

there has been 33 outbreaks of the disease;

resulting in about 1548 deaths.iv The

outbreaks, some more than the other,

affected the states’ social, economic and

cultural conditions. The earlier outbreaks

were concentrated on the Sub-Saharan

region of Africa, and after frequent

occurrences, those states learnt to adapt

and live with it. The West African Ebola

Outbreak is different from the 33 earlier

outbreaks for many reasons. The West

Africa region has never before encountered

an Ebola outbreak in history, so the

preparedness level of the states were

minimal because they were not expecting

the disease in the region. This couples with

the public awareness about the disease.

Many communities believe that Ebola does

not even exist, although hundreds of

people were lost to the disease in their

regions.v

This outbreak is also different than the

others in the aspect of number of the cases

reported. The virus is going through

mutations and is very hard to contain and

control because of it. The most recent

outbreak have only been going on since

January 2014, but already turned into the

first Ebola epidemic, claiming three times

the casualties of all previous Ebola

outbreaks combined. It is the only

epidemic that found its place in the United

Nations Security Council agenda after

HIV/AIDS.vi This shows the importance of

the impact that the disease has caused on

the international community.

In upcoming parts, general background

information about the disease and the

particular outbreak, efforts made to control

and contain the outbreak, and a roadmap

for controlling the outbreak with its

problematic points will be examined.

II. Information about the

Disease

Genus Ebolavirus is 1 of 3 members of the

Filoviridae family (filovirus). Ebola first




appeared in 1976 in 2 simultaneous

outbreaks, in Nzara, Sudan, and in

Yambuku, Democratic Republic of Congo.

The latter was in a village situated near the

Ebola River, from which the disease takes

its name.vii

Figure 1. A microscopic view of the Ebola

virus (Photo courtesy: Cynthia Goldsmith/

Centers for Disease Control and

Prevention)viii

A. Key Facts

Ebola is a fairly new disease for the

humankind. According to the Ebola

Factsheet of the WHO, the key points that

we surely know about the disease are as

follows;

"Ebola virus disease (EVD),

formerly known as Ebola

haemorrhagic fever, is a severe,

often fatal illness in humans.

EVD outbreaks have a case fatality

rate of up to 90%.

EVD outbreaks occur primarily in

remote villages in Central and

West Africa, near tropical

rainforests.

The virus is transmitted to people

from wild animals and spreads in

the human population through

human-to-human transmission.

Fruit bats of

the Pteropodidae family are

considered to be the natural host

of the Ebola virus.

Severely ill patients require

intensive supportive care. No

licensed specific treatment or

vaccine is available for use in

people or animals."ix

B. Transmission

Ebola is introduced to the humans when in

close contact with blood, secretions, organs

or bodily fluids of the infected animals.

Even the Reston ebolavirus, a type of EVD

which the humans are clinically

asymptomatic to, is known to cause

infection among workers in contact with

the infected animals. Human-to-human

transmission is through contact with the

blood, secretion, organs or bodily fluids of

the infected people; and indirect contact

with environments contaminated with such




fluids. Men who have recovered from the

disease are still able to transmit the virus

through seminal fluids for up to 7 weeks

after the recovery.x

C. Signs and Symptoms

EVD is a severe acute viral illness often

characterized by the sudden onset of fever

greater than 38.6°C, intense fatigue,

myalgia (muscle pain), headache and sore

throat. This is followed by vomiting,

diarrhea, rash, impaired renal and hepatic

function, and in some cases, both internal

and external hemorrhage. The incubation

period, the time interval from the infection

with the virus to the onset of the

symptoms, ranges from 2 to 21 days.xi

D. Diagnosis

Diseases that should be ruled out before a

diagnosis of EVD can be made are:

malaria, typhoid fever, shigellosis, cholera,

leptospirosis, plague, rickettsiosis,

relapsing fever, meningitis, hepatitis and

other viral hemorrhagic fevers. Ebola virus

infections can only be diagnosed

definitively in a laboratory, through several

types of tests. Samples from patients are an

extreme biohazard risk; testing should only

be conducted under maximum biological

containment conditions.xii

E. Vaccine and Treatment

No licensed vaccine for EVD is available.

Several vaccines are being tested, but none

are available for clinical use because of

either the lack of human trials, or

unsatisfactory results of the vaccine

tests.xiii

Severely ill patients require intensive

supportive care. Patients tend to be

frequently dehydrated and requiring oral

rehydration with solutions containing

electrolytes or intravenous fluids. Other

than the abovementioned caretaking, no

specific treatment is available. Failure to

give such caretaking speeds up the

terminal phase of the disease and increases

the number of fatalities. With no treatment

available, and caretaking is done just for

the sake of relieving the patient’s agony;

most of the infected are assumed as a

fatality. New drug therapies are being

evaluated.xiv

F. Prevention and Control

Since an effective treatment and a human

vaccine is nonexistant in the case of Ebola,

raising awareness of the risk factors for

Ebola infection and the protective

measures individuals can take is the only




way to reduce human infection and death

toll. Educational public health messages

for risk reduction should focus on several

significant factors,according to the WHO,

such as:

"Reducing the risk of wildlife-to-

human transmission from contact

with infected fruit bats or

monkeys/apes and the

consumption of their raw meat.

Animals should be handled with

gloves and other appropriate

protective clothing. Animal

products (blood and meat) should

be thoroughly cooked before

consumption.

Reducing the risk of human-to-

human transmission in the

community arising from direct or

close contact with infected

patients, particularly with their

bodily fluids. Close physical

contact with Ebola patients

should be avoided. Gloves and

appropriate personal protective

equipment should be worn when

taking care of ill patients at home.

Regular hand washing is required

after visiting patients in hospital,

as well as after taking care of

patients at home.

Communities affected by Ebola

should inform the population

about the nature of the disease

and about outbreak containment

measures, including burial of the

dead. People who have died from

Ebola should be promptly and

safely buried."xv

Human-to-human transmission of the

Ebola virus is mainly due to being in direct

or indirect contact with blood and body

fluids. Transmission to health-care workers

has been documented in cases where

appropriate infection control measures

have not been taken, since it is not always

possible to identify patients with EVD

early; because initial symptoms may be

non-specific. For this reason, it is

important that health-care workers exercise

the same precautions consistently for all

the patients regardless of their diagnosis at

all times. These include basic hand

hygiene, respiratory hygiene, the use of

personal protective equipment, safe

injection practices and safe burial

practices.xvi

Health-care workers caring for patients

with suspected or confirmed Ebola virus

should apply, in addition to standard

precautions, other infection control




measures to avoid any exposure to the

patient’s blood and body fluids and direct

unprotected contact with the possibly

contaminated environment. When in close

contact (within 1 meter) with patients with

EVD, health-care workers should wear

face protection, a clean, non-sterile long-

sleeved gown, and gloves.xvii

III. The 2014 West African Ebola

Outbreak

EVD was never considered to be a disease

with a potential to turn into an epidemic,

since Ebola is a disease that is not

transmitted easily, and those who are

infected are known to have a lifespan so

short to have the opportunity to infect a

new host. However; the 2014 outbreak

proved otherwise.xviii

Reports show that

more people have died from the outbreak

than the total number of fatalities caused

by the virus since 1976.xix

The 2014

Outbreak is also the first Ebola epidemic;

which is a result of the spread from Guinea

to Liberia, then Sierra Leone, Nigeria,

Senegal and other countries to where

individual cases with ties to these countries

have been reported.xx

The virus is also discovered to be mutating

in a very short time, and the findings

showing that the virus mutated for some

300 times between May and Junexxi

simply

makes the outbreak difficult to battle,

control and prevent. The lack of health

workers specialized in EVD in the region

and their need to travel to other parts of the

continent made the virus to be easily

transmitted to other villages, and other

countries. Also, the cultural practices of

the West African region such as washing

and kissing the dead before the burial has

played a significant role in the disease

spread.xxii

The incubation period (that is 2-

21 days before the symptoms appear) made

it possible for the disease to emerge at

several locations simultaneously and in

great number of patients. Abovementioned

reasons made the localized outbreak into a

full-force epidemic just in a matter of

months.xxiii

A. Start of the Outbreak

According to the Centers for Disease

Control and Prevention (CDC), the month

of origin of the outbreak is January 2014,

when the virus infected its first non-human

host and incubated in Guinea.xxiv

Later

studies have shown that the patient-zero

(the first patient that the disease spread

from) is a 2 year-old child in Guinea. The

disease is believed to be spread to the

child's parents and then to the health

worker coming to treat the child; and then




spread through the health worker to the

other parts of the country.xxv

When an

outbreak alert was issued by the Guinean

government on 22 March, the outbreak had

already claimed 29 lives out of the 49

reported cases in Guinea and believed to

have spread to Sierra Leone through a man

who had attended the funeral of an infected

person.xxvi

By the time an epidemic alert was raised

by the WHO on March 24, the virus had

spread to another country, Liberia, and the

death toll had risen to 59 deaths out of 86

cases reported.xxvii

On March 27, the virus

spread to the Guinean capital Conakry,

after the government officials claimed that

the infection was contained;xxviii

and on

April 7, the negligence started to show

after the virus had Guinea, Liberia, Sierra

Leone and now Mali in its grasp and the

transmission is sure to have caused by

travelling to the zones of contagion; and

the death toll had risen to 95 out of 151

cases in Guinea and 10 out of 21 cases in

Liberia.xxix

An update on June 6 reports the death toll

as 215 deaths out of 334 cases in Guinea, 6

deaths out of 81 cases in Sierra Leone, and

13 deaths out of 27 cases in Liberia.xxx

Most of the international firms have

withdrawn their staff from the effected

countries. Although this is may be a sign

that the chances of infection will be lower;

the states' economies that rely heavily on

the mining industry, start to suffer. The

operations director for Doctors without

Borders (MSF), Bart Janssens, declares the

second wave of the epidemic has begun

and states that the epidemic "...is

completely out of control".xxxi

The second

wave of a disease pertains to the event that

disease's initial spread rate seems to get

lower, and then a different part of the

population starts to show signs of

infection.

Despite the efforts of MSF, WHO and the

international community; the disease

continues to spread and claim lives.

Experts volunteering in containment of the

outbreak, and educating the public, stress

that neither the governments nor the people

comprehend the magnitude of the issue.xxxii

Some complain about the government

inaction,xxxiii

some about the lack of public

awareness,xxxiv

and there are cases that the

people are hostile against the health

workers,xxxvxxxvi

thinking that they brought

the disease as the death toll is 270 deaths

out of 390 cases in Guinea, 34 deaths out

of 158 cases in Sierra Leone, and 34 deaths

out of 51 cases in Liberia; by the end of

June.xxxvii




On July 3, 11 health ministers from

African Nations issued a statement after a

2-day emergency meeting calling all world

leaders, multinational corporations, non-

governmental organizations, stakeholders

and community members to help stop the

outbreak. The ministers voiced concerns

about the social and economic disruptions

the outbreak has caused and urged the

Economic Community of West African

States (ECOWAS) to address the outbreak

at once.xxxviii

On July 25, the Liberian man

who collapsed at the Lagos airport died

and has been confirmed as Nigeria's first

Ebola case.xxxix

With this, the most

populous city in Africa has been touched

by Ebola. Yet, African people do not seem

to completely fathom the severity of the

situation as in Sierra Leone police had to

fire tear gas at hundreds of people

attacking an Ebola clinic after rumors

spread that Ebola was "merely a ruse

aimed at carrying out cannibalistic

rituals."xl

On August 8, with 1711 confirmed cases

and 932 deaths WHO declared the

outbreak a global health emergency.

However no African state has put

restrictions on general trade or travel, the

main reasons of this cross-border

epidemic.xli

With the situation taking a turn

for the worse every day, desperate

measures have to be resorted to; such as

the WHO panel reached consensus that it is

ethical to use experimental drugs,xlii

and

Liberia's president declares curfew and

quarantines a whole slum of 75000

residents.xliii

The disease continued to

spread cross borders as Democratic

Republic of Congo confirmed its first two

Ebola cases;xliv

and Senegal, a hub for

transportation and business, reported its

first Ebola patient.xlv

Debates on whether

the third wave of the virus has started

began when the virological analysis

showed that the outbreak in Democratic

Republic of Congo and the West African

Outbreak were not linked.xlvi

WHO

Director-General warned for an increase in

number of infections.xlvii

Although the DR

Congo outbreak is virologically unrelated

to the West African Outbreak;xlviii

due to

its circumstances, urgency and

geographical proximity, it will also be

mentioned as a different problem which

needs a similar solution. With at least 1200

killed by Ebola in Liberia, Liberian

Defense Minister told the UN Security

Council that Ebola "...threatens Liberia's

existence."xlix

On September 30, the Director of the

Centers for Disease Control and Prevention




declared that there was a confirmed case of

Ebola in the United States of America.l

This is the first case with a potential of

intercontinental spread. Only 13 days later,

the nurse treating the patient in the USA

has been confirmed to have Ebola.li

B. Current Situation of the Outbreak

Ebola Outbreak has been declared as

"unquestionably the most severe acute

public health emergency in modern

times"lii

and a crisis for international peace

by the Director-General of the WHO, Dr.

Margaret Chan.liii

Rightly so, the disease,

by October 15, has 8300 reported cases

and about 4100 deaths throughout the

world including Spain and the USA.liv

Figure 2. A map of the Western African region

showing number of fatalities due to Ebola.

(Numbers are accurate for 6 October)lv

As shown on Figure 2, Western African

region is where the heart of the epidemic

is. Although heavy precautions were taken

throughout the world such as installing

heat scanners at airports and keeping Rapid

Response Teams (RRT) ready for a




possible quarantine situation; due to the

fact that the virus is asymptomatic for a

period of time after the infection, the

diseased could reach other countries, be it

neighboring or in other continents. Such

precautions, however, makes the disease

harder to be transmitted as was seen in the

isolated cases in the United States, or the

containment of the disease and the

discontinuation of cases in states such as

Senegal and Nigeria.lvi

Another point is that due to this outbreak

being the first in the Western African

region, although the international

organizations and states have been sending

out experts and supplies; the region was

not capable of handling an epidemic, both

in infrastructural sense and in expertise.lvii

Liberia having only 51 physicians to treat

4.6 million people is an example to the

infrastructural insufficiency.lviii

The lack of

education and Ebola related experience can

also be regarded as the reason for criticism

of the authorities, ignorance about the

disease which led to violent acts towards

the medical workers in some regions, as

stated before. Such acts cause a security

threats for the health workers, especially

from a Western origin, and make the

treatment efforts harder than it already is.lix

Security threats, as they were handled in

Liberia, when the government quarantined

a whole slum in order to prevent further

infection, backfired with the rise of cases

in the quarantined zone and the hardships it

caused the health workers when going in to

the zone or trying to help the individuals.lx

Due to this lack of resources and medical

experts in the affected region, officials

predict that the case occurrences will be as

much as ten times as they are now,

increasing to a solid 10.000 cases a week.lxi

The main causatives of the wide spread of

the disease can be summarized as follows;

Punctuality and target of the public

health campaigns

In Uganda, a country that had faced Ebola

4 times in the past and thrived, public

health officials launch campaigns and

overwhelm the media about how to stay

safe from the disease. In accordance,

people stay in their houses fearing the risk

of infection and call to report suspected

infections. This was, however, not the case

in the Western Africa as public health

officials responded too slowly to make the

community know about the disease.lxii

It

was not before most of the population in

said regions was infected when officials

started an information campaign. In the

initial periods of the outbreak,




campaigning was done on the mainstream

media; which did not return satisfactory

results as most of the infections were in

communities in which people were living

with no access to television, radio or the

internet.lxiii

Health campaigning and raising

awareness about diseases is not easy in

places where people cannot read. The most

affected countries are the ones with some

of the world’s lowest literacy rates.lxiv

Disinformation

Low rates of literacy and delayed public

health campaigns only fueled the Ebola

rumors. Although there is no treatment for

Ebola available, myths suggesting that

onions, hot water and salt, homeopathy and

hot chocolate can cure the disease only

delayed the sick from getting medical

treatment.lxv

Poor countries with insufficient

health systems

Sierra Leone, Liberia and Guinea are some

of the poorest countries in Africa with very

little to spend on healthcare. Most of the

Western African states have only invested

less than USD 100$ per person per year for

healthcare.lxvi

Daniel Bausch, associate

professor at the Tulane University School

of Public Health and Tropical Medicine,

who works with WHO and MSF on the

outbreak says: "If you're in a hospital in

Sierra Leone or Guinea, it might not be

unusual to say, 'I need gloves to examine

this patient,' and have someone tell you,

'We don't have gloves in the hospital

today,' or 'We're out of clean needles,' - all

the sorts of things you need to protect

against Ebola."lxvii

Surveillance systems

With very little healthcare spending, these

countries are not able to set up an efficient

surveillance system to monitor the health

of the public, report suspected cases or

even building a healthcare network. In

contrast with the abovementioned Uganda

system, suspected cases cannot be

recognized, tested and quarantined quickly;

which eases the transmission process.lxviii

Slow response from the

International Community

Despite Ebola being a fairly preventable

disease, the international community’s

slow response is what turned the outbreak

into an epidemic. WHO itself was slow to

declare it a public health emergency, which

did not happen until August; 5 months

after the breakout. The Organization’s

response is partly due to the budget cuts

which lead it to be understaffed and under-

resourced.lxix

Developed countries failed to




assess the severity of the issue until the

infection was seen in continental Europe

and North America. Africa was once again

left alone to deal with its problems having

only little concrete aid from the world

against the history’s biggest Ebola

outbreak.lxx

With the main responder to

previous Ebola outbreaks, WHO, failing to

contain the crisis successfully because of

the abovementioned reasons; other

international organizations’ preparedness

did not allow a rapid response, hence

taking the necessary steps against the

outbreak was delayed.lxxi

Interconnected world

The borders, especially the ones between

the West African states, are very porous in

today’s times. At the event of an outbreak,

this leads to the somewhat free circulation

of the most worrisome factor, the

traveler.lxxii

Almost all of the international

spreads were caused by relatives of the

diseased, health workers or tourists that

have been infected and were able to travel

with little or no medical checks being done

at airports, docks or borders.lxxiii

The

patient zero in the United States of

America was subjected to no medical

check in the airport and may have never

been identified if the patient did not go to a

hospital with a fever complaint.lxxiv

And if

the Nigeria’s patient zero did not collapse

at the airport; the disease could have easily

spread in the highest populated city of

Africa, Lagos.lxxv

The disease shows no

symptoms in the first 2-21 days after

infection; however identifying possible

cases could be done with designating

people with suspected origin of travel, and

blood tests.lxxvi

IV. Controlling the Outbreak

Possible solutions towards controlling and

containing the outbreak, and reversing the

trend; and the problems the international

community and the Organization faces on

the path to it, will be investigated in this

section of the guide.

A. Solution Targets

1. Reversing the Trend of

Transmission

In order the reverse the trend of

the high transmission, many

practices should be

implemented, altered, or

abolished. First of all, case

management for the patients

should be done by Ebola

treatment centers with full

infection prevention and control

(IPC) abilities, and referral




centers to primary health care

centers should be

established.lxxvii

Furthermore,

case diagnosis should be made

by WHO recognized

laboratories in order to specify

and confirm the legitimacy and

accuracy of the diagnoses.

Surveillance systems should be

established to ease up contact

tracing and monitoring to

determine individuals that the

disease may have been

transmitted to. Burials should

also be supervised and done by

expert burial teams in order to

avoid the burial related

transmission, which is a big

concern in Western African

countries.lxxviii

Social

mobilization should also be

provided towards a full

community engagement in risk

mitigation and contact tracing.

Short term extraordinary

measures to limit the national

spread, such as but not limited

to implementing specific

programs to ensure continuity

of essential and supportive

services (i.e. food,

psychological support, primary

healthcare services), ensuring

that essential movement of

response teams and services

continue unhindered in cases

where curfews or quarantines

are established, and deferring

mass gatherings until rate of

transmission is reduced.lxxix

In

order to prevent further

international spread, travel of

all Ebola cases and contacts

should be prohibited and

screening systems should be

implemented at international

airports, seaports and major

land crossings, except for

emergency medical evacuation.

Essential services should be

ensured, foundation should be

laid for health sector recovery

and national core capacities for

outbreak response should be

strengthened in order to avoid

humanitarian crises in critical

gaps.lxxx

2. Stopping All Transmission

In order to ensure emergency

and immediate Ebola response

in countries with an initial case;

emergency health procedures

should be initiated, Ebola




response protocols and facilities

should be activated, and

international health regulations

and WHO regulations should be

implemented. lxxxi

When an index case (the case

which is the origin of a new

spread) occurs, the medical

center and the officials should

immediately communicate the

case and relevant information to

the WHO Regional Office. An

emergency operations center

should be established, and

national disaster mechanisms

should be activated. Financial,

security and other risk factors

should be taken into

consideration in crisis

assessment and

management.lxxxii

All suspect and confirmed cases

should be immediately isolated

and taken to fully equipped

Ebola management/treatment

facilities which have diagnostic

access. As previously

mentioned; contact tracing and

monitoring should be

implemented, safe burials

should be provided, and, like

the Uganda example, a public

communications network

should be implemented to

facilitate risk education, contact

tracing and case identification.

Except for emergency medical

evacuation, all suspected and

confirmed Ebola cases should

be prohibited to travel.lxxxiii

3. Ebola Preparedness

For all unaffected countries, be

it a country sharing a land

border with an affected country

or any country with an

international transportation hub,

Ebola preparedness should be

created and strengthened to

prevent spread.lxxxiv

To reach a

level of preparedness in which

the potential of spread is null;

travelers should be provided

advice and information about

Ebola and affected areas, an

isolation unit should be

established for any and all

suspected Ebola cases to be

properly investigated and

managed, a WHO recognized

laboratory with diagnostic

abilities should be verified

access to, a strategy and a




contingency plan should be

established for identifying and

monitoring suspect cases that

include vital infrastructure like

schools, hospitals, state

institutions and places of mass

gathering.lxxxv

B. Problems Encountered In

Practice

Although all the precautions stated

above are reasonable in theory, in

reality not all of them can be viable

in Western Africa’s fight against

Ebola.lxxxvi

There are several

reasons to how in practice Ebola

cannot be dealt with smoothly

because of the problems

concerning; human resources for

strategy implementation, security,

access to a WHO recognized

laboratory, protective equipment

and other essential supplies, social

mobilization and community

engagement, infrastructure and

transport, information management,

research, technical and normative

guidance, financing, and

coordination.lxxxvii

Mobilization and sustaining

sufficient human resources to

implement Ebola response and

intervention needs a detailed

approach to be taken considering

remuneration, training, equipment,

physical security and access to

medical healthcare.lxxxviii

Although

many of the medical NGOs and

humanitarian organizations work

pro-bono, considering the risk

factors, both economically and

physically, betterment pertaining to

salaries, hazard-pay, and insurance

should be established by a

comprehensive economic package.

The proper and standardized

equipment and training should be

granted to the health workers to

prevent strikes in times of desperate

need.lxxxix

Health workers occupy a

considerable part of the people

infected by the disease, so

insurance and right to healthcare

should not be denied to them.

Lastly, the acute lack of health staff

brought the need for community

health workers to be more active;

especially in demolishing stigmas

about the health workers, helping

reduce the role of rumors in such

crises and provide clear and true

information about the disease with

its risk factors.




Security plays an important role in

controlling the outbreak, however

so far it is clearly seen that the

national/local governments are not

taking the necessary safety

precautions as Ebola clinics, health

workers, and isolation centers were

subject to attacks from the local

communities; which wasted time in

the race against an epidemic.xc

Same can be said about the access

to WHO-recognized laboratories as

governments have not shown any

efforts towards samples to be

rapidly sent to these laboratories;

while some of them did not even

have these kinds of resources.xci

Demands on protective gear and

other essential supplies were not

met on the field, which is another

reason to why health workers are

highly prone to be infected. Lack of

sterile needles and gloves, setting

aside the protective gear, led to

them being reused in times of need;

just grew the rate of

transmission.xcii

The Organization

and the local governments have

mobilized their funds to avoid this;

however, the Organization has very

limited funds and the infected

regions are host to the poorest

countries of the continent.xciii

Rapid

international collaboration is

needed towards a financially stable

fight against Ebola.

Social mobilization and community

engagement is another issue for the

region. Local leaders, religious

leaders, locals with prestige have

given little to no effort towards

informing the public about the

disease, the importance of

communal unity in the fight against

Ebola, and the governments have

been hesitant to establish a dialogue

with the community.xciv

Rapid

repurposing and equipping

infrastructure and means of

transport have also been lacking in

the crisis situations by the local

authorities.xcv

Additional transport

capacity to establish safe

transportation of specimens, cases,

contact tracers and burial teams

needs a certain part of the budget to

be reallocated; which is nearly

impossible in some cases.xcvi

The

same budget allocation is needed

for the information management

and data analysis for the Ebola

roadmap to be a success.




Research and product development

is an important cornerstone against

the fight against Ebola, as it may be

the step to win the fight alone.

However, the coordination and

facilitation is seen to be inadequate

for the abovementioned financial

reasons. The well-funded private

pharmaceutical companies have

come close to coming up with a

vaccine, nevertheless the ethical

dilemma of the human trials greatly

reduces the speed of a possible

breakthrough.xcvii

Expert teams should convene on

the topic of providing ethical and

technical guidelines such as the

safe burial guidelines, or

surveillance and reconnaissance for

suspected Ebola cases, etc.

Countries facing an Ebola threat

should be given comprehensive and

legitimate guidelines so that there is

no room for experimentation.xcviii

As stated above, the problem

underlying all the possible

solutions is financial. WHO and the

World Bank have been working

towards an international funding

mechanism to mobilize and

coordinate resource mobilization;

yet these two organizations’ efforts

are nowhere enough to address the

financial deficit pertaining to the

problem.xcix

Other related UN

bodies and all the media in the

international communities should

be addressing the financial

problem.c

Finally, coordination of the crisis

management is problematic in the

response to the outbreak.

International organizations such as

the UN or the WHO has been

working hard towards the

coordination; however issues of

shortage of human resources and

finances keeps these organizations

working at maximum efficiency in

national and subnational levels.ci

V. Conclusion

The West African Outbreak is fairly

different than the 33 outbreaks it followed.

The first reason of the difference is that the

region which the disease has in its grasp is

a financially underdeveloped one. This

relates too many of the causatives of the

outbreak turning into a full force epidemic.

The limited budget allocation for education

and healthcare, and other basic needs

created critical gaps which the disease




benefited from. Low literacy rates in the

region fueled the spread of rumors about

the disease to an extent that health workers

are subjected to violence and highly

infectious patients are kept secret by their

communities only to be treated with

superstitious methods.

Another reason for this is the late response

by both the international community and

the states' unpreparedness. No major actor

seemed to have noticed the severity of the

outbreak until late August due to the

coordination mechanisms being virtually

null, but that was too late by then. The

infected were freely moving through

borders that lacked resources for

monitoring, which made the disease spread

from a village in Guinea to the whole West

African region.

Human factor's being on the disease's side

brought the epidemic into epic proportions

to a point that health officials were

claiming the disease was out of control, the

disease spread to two other continents and

Liberian Minister of Defense was

testifying before the UNSC that his state

was facing total destruction. Lack of

proper equipment, training and funds; lead

to all the volunteering physicians working

with international organizations potential

hosts to the disease. In the end, those

doctors had to be evacuated back to their

country of origin; which was a potential

threat all by itself.cii

As the days pass, the moral side of the

outbreak starts to overweigh the medical

side of it. Unaffected states continue to

debate on the fear of spread to their

countries and tend to choose not send any

help because of it; meanwhile that is the

very reason that why Ebola is a threat to

them.ciii

Outbreak has outpaced the efforts

to stop it; however, the humankind can

overcome the disease with dedication and

proper planning.civ

VI. Points that a Resolution

Should Cover

Measures to prevent further spread

of the disease

Increasing states' preparedness

levels for potential spreads and

outbreaks

Measures to control the outbreak

Improving the crisis management

during outbreaks

Establishing an international

emergency fund to prevent critical

gaps in times of crises

Improvements for the states with

fragile healthcare systems




Designating an institution to help

raise awareness and provide

guidance to local authorities

Improving the communication

between international communities

and local authorities before and

during times of crises

Establishing a network between

governments, international

organizations and local leaders

Improving the human resources,

especially during crises against

manpower and expertise shortages




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study guide - muntrmuntr.org/study-guides/who-study-guide.pdfebola, since it first emerged in 1976,...

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