WHO Director-General briefs Geneva UN missions on the Ebola outbreak

Dr Margaret Chan

Director-General of the World Health Organization

Distinguished Member States of the United Nations, ambassadors, diplomats, ladies and gentlemen,

Thank you. I want to share WHO’s assessment of the Ebola outbreak and brief you on the response.

We are facing a public health emergency of international concern.

The outbreak of Ebola virus disease in west Africa is a crisis. It is a crisis for the affected countries and their neighbours, for the African continent, and for the international community.

The outbreak is unprecedented in its size, severity, and complexity. Cases are occurring in remote rural areas that are difficult to access, but also in capital cities.

Confirmation of the first case in Lagos, Nigeria, was a wake-up call. Ebola virus disease can be spread by international travel, placing every city with an international airport at risk of an imported case.

To date, nearly 2000 people have been infected and more than 1000 have died. No one is talking about an early end to the outbreak.

This is a severe health crisis, and it can rapidly become a humanitarian crisis if we do not do more to stop transmission.

Decisions to seal off the hot zone of disease transmission, that is, the area where the borders of Guinea, Liberia, and Sierra Leone intersect, are critical for stopping the reinfection of areas via the cross-border movement of people.

More than one million people are affected, and these people need daily material support, including food. The isolation of this zone has made it even more difficult for agencies, like MSF, to bring in staff and supplies.

I have discussed this situation with the presidents of the three countries. The international community must come together to give them the resources they need.

The number of health-care workers who have been infected is unprecedented. In past outbreaks, transmission of the virus in health-care settings ended after the Ebola virus was identified and measures for infection control were put in place.

Not in the current outbreak. To date, nearly 170 health-care workers have been infected, and more than 80 have died.

The infections and deaths of health-care workers have three major consequences. First, they diminish one of the most important assets for the response to any outbreak.

Second, they can lead to the closure of hospitals and isolation wards, especially when staff refuse to come to work. Third, they drive fear, already very high, to new extremes. The general public is asking this question: if well-trained and equipped doctors and nurses are getting infected, what hope is there for us?

This is what I heard yesterday, in a meeting with ambassadors from a core group of African countries. Many feel helpless and hopeless given the demands of this outbreak, which far outstrip their capacity to respond. Others on the panel will be sharing their assessments.

As just one example, a facility treating 70 Ebola patients needs at least 250 health-care workers. In this region, staff are scarce and hospitals with isolation facilities are virtually non-existent.

Many facilities lack reliable supplies of electricity and running water. Other severe infectious diseases, like malaria, typhoid fever, and Lassa fever, and many chronic diseases are being neglected, as people are too frightened to seek hospital care.

Guinea, Liberia, and Sierra Leone have only recently returned to political stability following years of civil war and conflict, which left health systems largely destroyed or severely disabled.

The outbreak, which is already having serious economic consequences, threatens to push these countries backwards. Airlines are cancelling flights. Companies are moving their staff out.

Let me be clear. Travel bans will not stop this outbreak. But preventive efforts will.

Standard measures, like early detection and isolation of cases, contact tracing and monitoring, and rigorous procedures for infection control, have stopped previous Ebola outbreaks and can do so again. We have learned much during past outbreaks, including in Uganda, Democratic Republic of the Congo, and Gabon.

But like the outbreak, the challenges to containment are unprecedented. The recent surge in the number of cases has stretched all capacities to the breaking point.

Supplies of personal protective equipment and disinfectants are inadequate. Rumours and myths abound. The outbreak continues to outstrip diagnostic capacity, delaying the confirmation or exclusion of cases and impeding contact tracing.

Some treatment facilities are overflowing. All beds are occupied and patients are being turned away.

Other facilities are empty. The fact that Ebola has no cure reinforces the desire of families to care for loved ones in their homes or seek help from traditional healers. Both practices fuel further transmission.

Deep-seated traditional burial practices, which involve close contact with highly infectious corpses, are another major impediment to control. In Guinea, for example, around 60% of cases have been associated with burial practices.

Data from the field show that risks of transmission are greatly diminished when burials are performed, with dignity, by properly trained teams with pay, mobile phones, and designated vehicles.

Six months into the outbreak, fear is proving to be the most difficult barrier to overcome. Fear causes contacts of cases to escape from the surveillance system, families to hide symptomatic loved ones, and patients to flee treatment centres. Fear, and the hostility it can provoke, have threatened the security of national and international response teams.

Ladies and gentlemen,

This is a fast-moving outbreak. It has come in three waves, with the current wave by far the most severe. WHO and its partners are rapidly catching up.

I have personally made myself responsible for coordinating the response under WHO leadership, and for mobilizing support from the international community.

Affected countries are being equipped with IT systems and programmes that allow real-time reporting of cases. The outbreak is being mapped so that all transmission zones are identified and priorities can be assigned.

More international aid is flowing in. WHO logisticians are coordinating this aid to ensure that it goes where most needed and assists countries instead of overburdening them.

The UN Secretary-General has asked Dr David Nabarro to coordinate the response throughout the UN system. He has agreed to do so and has been with us here in Geneva since the start of the week.

I speak frequently with Jim Kim, the President of the World Bank Group. We both want to ensure that financial support goes some way towards strengthening health systems. But the most important immediate priority is to stop the virus from spreading, both within affected countries and to others. This is critical to the outbreak response.

The level of vigilance and alert is high worldwide, as seen by the number of false alarms at airports and in emergency wards. High vigilance helps ensure that imported cases are identified and isolated before they have chance to spread infection to others. This was well-done in Nigeria.

I am optimistic that, with strong support from our partners, working together with the UN agencies and other partners here on this panel, we can get this outbreak under control. The US Centers for Disease Control and Prevention is not here today but has been providing robust support within countries.

But as I said, there is no early end in sight. This is an extraordinary outbreak that requires extraordinary measures for containment. Together we can do it. Everyone has a role to play.

Thank you.