From Bad to Worse With Ebola

The New York Times, Editorial Board – The widening epidemic of Ebola in West Africa looks worse with each passing day. The outbreaks in the hardest-hit countries — Guinea, Liberia and Sierra Leone — have outstripped the ability of humanitarian groups and fragile government health systems to treat the sick and slow the spread.

A panicky effort to quarantine a large slum in Monrovia, Liberia, using troops to keep people penned in, proved a disastrous failure that probably made things worse. A shortage of protective clothing for health care workers treating sick patients in Sierra Leone led nurses to strike last week in a desperate effort to get more help. The virus has begun to spread to other countries where there is always a danger that it could ignite a new round of outbreaks.

In separate statements last week, officials of the World Health Organization, the Centers for Disease Control and Prevention, and the medical charity Doctors Without Borders warned that the outbreak is spreading out of control. W.H.O. leaders have said the outbreak in West Africa could be stopped in six to nine months, but only if a “massive” global response, which is nowhere in sight, is carried out.

The most shocking news of the week was how ill-prepared the W.H.O. was to organize an effective response. As Sheri Fink reported in The Times on Thursday, the agency had been weakened by harsh budget cuts in recent years and did not have the staff or ability to flood the Ebola zone. Its emergency response units have been slashed, veterans who led previous fights against Ebola have left, and scores of positions have been eliminated.

The agency argues rather unconvincingly that it is simply a technical organization that provides advice, and that governments have the primary responsibility to take care of their people.

The problem is that the afflicted countries had very weak health care systems to begin with, and they have disintegrated under the pressure of finding and caring for Ebola victims. The United Nations should direct the W.H.O. to take charge where governments are weak.

In another worrisome development, the virus popped up in Nigeria, when a patient who had been infected in Liberia flew to Lagos, where he became ill and died. Health workers responded properly and began an intensive effort to track down every person he had contact with before he died. Unfortunately they missed one, who then carried the virus to another populous area nearly 400 miles away, where it killed a doctor and has put 200 people at risk. A case has also been confirmed in Senegal, brought in by a Guinean who traveled by land through the porous borders.

Hope that a vaccine or drug could come to the rescue looked dim after an emergency meeting of more than 150 experts convened by the W.H.O. last week. A consensus was reached to test two promising experimental vaccines and several drugs or therapies for patients who are already infected, but there is scant hope any will be available in large quantities any time soon. Some of those treatments require intravenous administration, continuous cold storage and facilities able to deliver care safely, all of which will be hard to achieve in the stricken countries.

For now, the afflicted countries will have to rely on methods that have worked in curbing much smaller outbreaks in the past — like finding and isolating sick people quickly, providing supportive care like hydration to keep them alive while their bodies mount a defense, and tracing and isolating their contacts. But these nations will have to apply these tactics on an enormous scale that will require a large amount of help from global organizations and donors.

Given the W.H.O.’s weaknesses, the White House ought to consider whether the United States should take the lead.

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