Bruce Aylward is used to mobilize armies of health workers A Deputy Director General at the World Health Organization (. WHO) in charge of poliomyelitis and emergency situations, leading the massive global effort to eradicate polio. But Aylward said he never met a challenge as big as the Ebola epidemic in Africa West, which has infected more than 4,000 people and killed over 00. Margaret Chan, who leads wHO Aylward asked to help with the response in August and since he was running operations and helped develop Ebola response WHO Roadmap, published August 28 He spoke with Science September 4. (This interview has been edited for clarity and brevity.)
Q: Margaret Chan said that all organizations involved in the outbreak, including WHO, underestimated the complexity and scale. How did this happen
A: I did not live through it, but as I went back and asked what was going on, clearly these guys [in the response effort] were flat on it for 6 months. And they put 450 people on the ground. These are incredible numbers to respond to Ebola. But the virus got past them.
Could the answer have been scaled faster? Maybe they were out of 2 weeks to a point here or there. As Margaret said, you are still a few weeks behind the virus, and there are so many reasons. It is a dangerous pathogen. Foreign medical teams and NGOs [nongovernmental organizations] are used to treat trauma and primary health care; they are not trained to deal with pathogens
Q :. I have heard that there are tensions between WHO and Médecins Sans Frontières (MSF), the organization has treated more patients than any other. They criticized the WHO for being too slow and do too little
A :. Probably at the local level, there is some tension in some places, but certainly not here in Geneva to senior levels. There is great respect for the organization. MSF is great at two things: They are fantastic in their field operations and to tell the rest of us how we are to them. Of course, people will go out and say, "Oh, that's unfair," You need a thick skin you're in the World Health Organization; you deal with a major international threat, and our job is to.. . be responsible if MSF considers that this is a public responsibility, it is their right
. Q: Why stop this epidemic so hard compared to control polio
a: the polio program is really difficult because of the level of programmatic perfection you need you must reach every single child with the vaccine over a vast geography and environments. very difficult. But even if you do not, you still have a level of control over the virus. Now, when I look Ebola, you need a whole new level of perfection.
you have make perfect contact tracing because contact can blow open a new chain of transmission. You must get your perfectly safe burials. You must get your right to laboratory tests. There is not much capacity in the world about it. You must get your right social messages. You must be perfectly safe and protect the health of workers. And you have to do it all at incredibly low environments in three countries that are near the bottom of the development index, and also deal with the embers landing in Nigeria or Senegal. Wow, that is really hard
Q:.? Do you think it is still possible to contain the epidemic with standard procedures, patient isolation, contact tracing, bury the dead safely
A: Absolutely. But with one important difference. What happened is that you have a workload that far exceeds the capacity of standard Ebola strategies to manage them, so you need to innovate on these strategies. Each infected person is having a lot of contacts because they are essentially left to their communities for long periods of time. What you have to do is first shot spread outward from each patient, which means you have to get many new Ebola treatment centers up. And you have to adapt your strategies in a way that communities can play a much larger role and help them increase their own Ebola Community Care units. This is absolutely essential and must be done in September.
Will it be done? Well, that will depend on whether the international community will put money on the table, help people in, and understand the conditions they need to operate
Q :. WHO Ebola road map calls for the epidemic to finish in 6-9 months. Is it not too optimistic
A: I do not know, because no one has ever had to do something of this magnitude. What I know is that if the roadmap is not implemented, you're not going to stop in 6 to 9 months. In a month, you need at least 10 new operational facilities with an additional capacity of bed and teams on the ground, and money for people who do such things are paid, and a means evacuate stakeholders who get medical trouble. You must begin to implement the roadmap today.
But the usual relief organizations are not rushing to do so. These are not bad people and they are not cowards. These are people who go to wars operating environments and the most dangerous natural disasters. But they do not normally deal with dangerous pathogens
Q:.? So you need more people and you need more money, but it's just not coming
A: Not yet, but I'm optimistic. I think it is time the world struggling with this. It is so new, and he plays the deepest fears of the people and their greatest uncertainties. People will learn MSF will remain on the ground there. And then one or two NGOs will go and run an installation, and they will do very well. And then it will degenerate. The world does not want to be beaten by a pathogen. But the question is: will they do it fast enough
Q :? So who are the players you hope come to build and manage treatment centers
A: many foreign medical teams are linked to governments, and some affected countries have deep relations with the United States Liberia; the U.K. with Sierra Leone; France with Guinea. Now these countries are keen to look at what they can do and how to do, but they are struggling to mobilize. They might be able to set up a field hospital, but can they provide? Because a field hospital that does not have just a building, it is not an Ebola treatment center
Q :. Two vaccine candidates will soon be tested in Phase I studies and can be deployed later this year. How important do you think they will and drug candidates to end the epidemic
A: You want to have as many tools as possible to help lower the number of breeding where you can manage with traditional strategies. Want to do both in parallel and go flat-out. Vaccines and treatments would be extremely helpful-they help get the stakeholders and keep the players that are there healthy. This can give us an advantage to close this thing faster. But if we say that we have these drugs and vaccines, then you are yourself the establishment of defeat because you can not get them. And then you also have the risk of people saying, "There will be a vaccine or med, we'll wait," and a lot of people will die. I will not sit twiddling my thumbs waiting to find, and neither is my organization
* Ebola files :. Given the current epidemic of Ebola, unprecedented in terms of the number of people killed and the rapid geographic spread, science and Science Translational Medicine have a collection of articles research and news on the viral disease available for researchers and the general public.
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