Responding to Ebola

The international response to Ebola is gathering force, supported by WHO with particular contributions from the UK, France and the United States. Not only has the UK offered money and material, but over 1000 NHS staff and 185 staff from Public Health England have volunteered to provide assistance.[1] The altruism of these staff must be applauded and admired, particularly given harsh conditions, such as the need to work in intense heat while wearing suffocating protective clothing.[2]

Recriminations are already pouring in to say that WHO responded far too late and MSF were certainly pushing at a closed door from a very early stage in the epidemic. Dr Margaret Chan (WHO Director General) responds that this is all very well with hindsight, but at the outset Ebola in West Africa was just one of many signals from around the world.[3] In addition, telephone companies are accused of failing to release vital anonymised data that could help epidemiologists track local pockets of disease and the likely direction of spread – a technique that has proved itself with other infectious diseases in other settings.[4]

Meanwhile the UK team are in place and responding using a framework very similar to those deployed by CLAHRCs in delivering improved services:

  1. Acquiring up-to-date knowledge, in this case concerning the nature and spread of the virus and of previous methods to contain outbreaks.
  2. Working with local stake-holders to identify local facilitators and barriers. Some of these will be logistic, but cultural practices have loomed large in the case of Ebola.[5]
  3. Developing prototype solutions based on a synthesis of knowledge about viral epidemiology, general anthropological principles, and local factors.
  4. Trying out solutions iteratively and evaluating them in a formative way using such qualitative and quantitative data as may be gleaned.

When all the dust has settled and the virus has been driven into retreat, there will be time for a mopping-up exercise, so as to learn lessons for next time. There will be managerial (service delivery) and policy (political) lessons.

At the service level we should be able to reconstruct the process, say from the point where the UK contingent arrived, by synthesising results of formative evaluations over various iterations of roll-out. This will depend on disciplined data collection over the intervention period. An unreasonable requirement, do I hear you say? Wrong ­­– medics do it in the heat of military campaigns because they know that allocating time and resources to data collection in the short-term will save lives in the long-term.

At the policy level, WHO and other organisations will have to open their books too. In return the enquiry should be conducted in the spirit of learning, not blame. Dr Margaret Chan should keep her job – even if the response was slow – since it is not mistakes, but failure to learn from them, that is inexcusable.

— Richard Lilford, CLAHRC WM Director

References:

  1. Ellison J. Ebola: Written question – 212924. [Online]. 2014
  2. Black B. The First 24 Hour Shift. [Online]. 2014
  3. Hawkes N, Arie S. Is the United Nations catching up with Ebola at last? BMJ. 2014; 349: g6576.
  4. The Economist. Ebola and big data: Waiting on hold. The Economist. 2014.
  5. Landry Faye S. How anthropologists help medics fight Ebola in Guinea. Sci Dev Net. 2014.
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