Is the United Nations catching up with Ebola at last?

Early inMay, six weeks after the first case of Ebola virus disease had been confirmed in west Africa and rapidly spread into three of the poorest countries in the world, the director general of the World Health Organization, Margaret Chan, declared a public health emergency of international concern. It is “an extraordinary event and a public health risk to other states for which a coordinated response is essential,” she said. The health risk Chan was talking about was not from Ebola but polio—a disease for which only 413 cases were reported in the whole of 2013 (243 so far in 2014) and whose risk of spreading globally is low because of well established vaccination campaigns. What Chan feared was not the spread of polio but missing the target of eradicating polio by 2018, which has been strongly urged on her by organisations such as the Gates Foundation and the US Centers for Disease Control and Prevention. What she missed was a genuine global emergency that, according to WHO’s figures, had already caused at least 160 deaths in three countries and whose spread had been described as “unprecedented” by the charity Médecins Sans Frontières (MSF). It took another three months, until 8 August, for Ebola to be declared a public health emergency: by then there had been 2274 cases in four countries and 961 people had died. The latest figures show that there have been a total of 13 703 cases in the eight countries affected and 4922 deaths. Public health specialists find it hard to understandWHO’s delay. Joanne Liu, international director of MSF, says: “In the spring, WHO were downplaying it. We disagreed. We finally got the message across at the end of July. Margaret Chan told me: ‘I don’t want you to be pessimistic.’ I said: ‘I’m not being pessimistic—I’m just being realistic.’” David Fidler, a law professor at Indiana University and an associate fellow at the Centre of Global Health Security at Chatham House, says: “I cannot make sense of what on earth went wrong. MSF and others were giving information that something very badwas going onwith Ebola. Any time anybody mentions Ebola you get pins and needles. If WHO was getting this kind of information, its failure to act makes no sense. “Their reactions were poor and mismanaged. Mistakes were made. WHO’s credibility is badly damaged and that goes all the way from the operational level to the director general’s office.” TheUnited Nations has scurried tomake up lost time, appointing one of its most experienced public health experts, David Nabarro, as senior coordinator for Ebola virus disease in August and setting up a UN Mission for Ebola Emergency Response (UNMEER), the first emergency health mission in the UN’s history, under deputy Ebola coordinator Anthony Banbury. On 12 October, Nabarro told the BBC that he believed a “reasonable target” would be to get the outbreaks under control within the next three months. By “under control” he explained that it meant that the numbers of new cases each week falling compared with the previous week, to the point where there was no new transmission. “All of us are going to have to perform in an outstanding way over some months,” he said in an interview with the New York Times. Has the beefed up UN response made a difference?