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Does Ebola Reveal WHO Shortfalls?

  • Joe DeCapua

In this undated photo provided by the Centers for Disease Control and Prevention is one form of CRE bacteria, sometimes called “nightmare bacteria.” CRE bacteria is blamed for 600 deaths each year, and can withstand treatment from virtually every type of antibiotic. (AP Photo/Centers for Disease Control and Prevention)

In this undated photo provided by the Centers for Disease Control and Prevention is one form of CRE bacteria, sometimes called “nightmare bacteria.” CRE bacteria is blamed for 600 deaths each year, and can withstand treatment from virtually every type of antibiotic. (AP Photo/Centers for Disease Control and Prevention)

As the Ebola outbreak rages in three West African countries – and raises fears abroad – some are questioning whether the World Health Organization is being stretched too thin. A proposal for a new global agency to deal strictly with infectious diseases is gaining some support.

Dr. Harvey Rubin writes that that “local phenomena can have global consequences.” And he points to the Ebola epidemic as a prime example.

Rubin is director of the Institute for Strategic Threat Analysis and Response at the University of Pennsylvania in Philadelphia. He and ISTAR’s associate director Nicholas Saidel have written in New Scientist Magazine that “global infectious disease control, as it now stands, is a disjointed effort riddled with gaps and inconsistencies.” Rubin said this can be seen in the response to Ebola.

“The world’s response has been late and incomplete. This is a tragedy at many, many levels. And obviously people are dying, commerce is impacted, economic development is impacted, but, overwhelmingly, people are dying and we could have done a better job as a global community. There have been some groups that have been absolutely fantastic like Doctors Without Borders and individual aid groups have been putting their own lives at stake. But the global community has dropped the ball.”

Rubin said many have been worried about such a scenario for a long time.

“A lot of this, maybe not all of it, but a lot of this could have been avoided with a more robust global governance system for infectious disease. This was predictable. We’ve been talking and writing about this for a long time now – for at least several years. Other people have been writing about this,” he said.

TB, malaria, various types of hepatitis, MERS, the flu, avian flu, measles, polio and Ebola – these are some of the infectious diseases the WHO has tracked and monitored over the years. And then there are the many noncommunicable diseases on the rise, such as diabetes, obesity, cardiovascular disease and cancer.

“Believe me,” said Dr. Rubin, “I’m not critical of the World Health Organization or any of the other groups. They are so over stretched with so many things to worry about. Arguably, more people die of infectious diseases than just about anything else. A lot of these are preventable diseases and the World Health Organization has a huge mandate.”

He said there’s a looming health crisis that’s not getting nearly as much attention as Ebola.

“If I had to list the number one problem that we see across the borders and certainly in this country, it’s antibiotic resistant bacteria. We have an epidemic already and an impending doom and disaster – and I don’t want to overstate this – but we have organisms in this country in our hospitals that are resistant to just about every antibiotic that we have. Antibiotic resistant bacteria is an enormous problem,” he said.

He’s calling for a Global Governance Structure for Infectious Disease – a place where any nation can go and raise the alarm about a potential infectious threat. He said it would provide a more focused approach.

“What kinds of resource are available for us? Are there experimental drugs that we could start developing? Are there ways to distribute these drugs? Are there ways to do surveillance that’s meaningful? Are there ways to harmonize and align various regulatory aspects of getting drugs and vaccines to the places that are needed? That’s what we mean by a focused approach on infectious disease. There is no other group like that.”

He said the proposed Global Governance Structure for Infectious Disease should be a public/private stand-alone agency that receives serious input from the United Nations and others.

The New Scientist article lists four interconnected goals: “First, coordinate the collection, sharing and analysis of infectious disease information in real time; second, encourage the private sector to develop and distribute affordable drugs, vaccines and diagnostics; third, establish a network of international centers for fundamental research into microbial threats; and fourth, promote standards for best laboratory, regulatory and ethical practice.”

Rubin said the aim is to not have such an agency bogged down in bureaucracy.

“We want to have it streamlined. We want to have decision-making with adequate input and transparent -- and with the recognition of world leaders that this can only help everybody. There are no borders here. Out of all the diseases that we talk and lecture to the students about, we would always say, oh, Ebola is over there. It’s remote. It burns itself out. Now it’s in New York. It’s in Texas. We have to rethink from the beginning our, sort of, entrenched ideas.”

He said it could begin as a grassroots effort, but adds it may be just the right time for it to happen.

“When I’ve given this talk around the world I have enormous support by members in my own medical community, a lot of the NGOs – even the engineering community and the policy community. So the academics really understand this and we’re used to collaborating across countries and across domains and across disciplines. The buzz words around now are innovation and multi-disciplinary. Well, if anybody wants innovation and multi-disciplinary, this is it.”

The University of Pennsylvania medical professor said it must be a self-sustaining agency with innovative ways of funding. Dr. Rubin added that it won’t work if it has to rely on donors.

The staff of the Institute for Strategic Threat Analysis and Response includes doctors, lawyers, business leaders, engineers and political scientists.

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