Last week, the World Health Organization called for a meeting of the International Health Regulations Emergency Committee to examine the nearly eight-month long outbreak of the Ebola virus. The group discussed at length the implications of the outbreak and whether there was enough evidence to support taking the next step in a worldwide public health response, the announcement of a Public Health Emergency of International Concern (PHEIC). Over two days, the team went over a number of questions designed to best summarize the situation in the present and into the future. They concluded there was sufficient reason to make the call.
To many, the declaration of a PHEIC is a bad omen. After all, it means there is an extraordinary event creating a significant public health risk to several countries. It also points out an international effort is needed to put an end to the spread. But while the implications may appear to be dire, there are numerous positive aspects although not apparent at first glance.
When the outbreak first started, there was only one region affected, the remote town of Guékédou in the country of Guinea. At the time, the potential for a widespread outbreak was low and as such, Guinea was expected to be able to handle the situation. Yet, due to a number of reasons including logistical, cultural and political, the virus spread, reaching the capital city of Conakry and the neighbouring countries of Liberia and Sierra Leone.
Though many other countries, including Canada, paid attention, little assistance was provided to help stop the outbreak. Instead, groups such as Doctors Without Borders came to provide as much care as they could. But even their heroic efforts could not stop the virus from infecting more people and taking more lives.
By declaring a public emergency, all nations are now asked to turn attention into action in part by offering money to pay for supplies and to keep health care workers gainfully employed. In Canada, this has translated into 3.6 million dollars in funding to help Doctors Without Borders and the World Health Organization. We're not alone. The European Union has committed 8 million Euros and the United States has put in another $12.45 million. The Americans are also devoting much of the staff at the Centers for Disease Control and Prevention to the outbreak and will be sending specialists to help coordinate the efforts.
Apart from financial contributions, countries are also being asked to take care of their own by enacting higher levels of public health security. This could mean travel restrictions -- although they were not recommended in the PHEIC -- as we as a heightened awareness and surveillance of individuals arriving at airports from affecting countries. In more extreme cases, this may also require closing borders completely. At the same time, the public healthcare system is also asked to be more vigilant.
Should an individual with a recent history of travel to an affected country present with symptoms of flu-like illness, isolation and immediate testing should be done. In addition, the names of any contacts -- loved ones, friends, business colleagues -- should be taken for possible notification if the diagnosis is indeed Ebola. Over the last few weeks, this scenario has played out in several countries, including Nigeria, Saudi Arabia, the United States, Benin, and Ghana.
In Canada, these measures are part of daily routine. This was most recently evidenced by the recent case of a Brampton man who was placed in isolation on suspicion his trip to Nigeria may have put him -- however slight the chance -- into contact with Ebola. Thankfully, tests came back negative; Ebola has yet to cause any cases in this country.
There is one last positive aspect to a PHEIC needed to ensure the outbreak can be contained: community interaction to improve health. One of the greatest hurdles has come from anecdotal reports from the field. Workers have said there is distrust in public health, of a lack of belief in the medical arts, and the fear associated with going into a hospital meant certain death. No matter how hard they tried, they could not make a dent in the spread due to this unfortunate circumstance.
Although this last positive may seem to offer minimal gain, in an anthropological context, it is the most valuable, regardless of the environment. For example, in New York City in 1832, an outbreak of cholera killed over 10 per cent of the population. This led to a similar situation in which the medical profession was no longer trusted. Eventually, after the situation appeared to be growing dire, the city introduced the first ever public health board -- the Metropolitan Board of Health -- in 1866. It took years to change people's perspectives but eventually, public health officials began to regain favour by the population and health improved.
The same is expected to happen in today's outbreak. With the PHEIC in place, experts can approach community, indigenous and religious leaders to share the knowledge of hygiene and the best practices to stop the spread of the virus. Together, along with the help of other international experts, the right information can be given and disseminated and the public will begin to appreciate how to put an end to the suffering and deaths.
The declaration of a PHEIC is one of the world's most important actions although people may choose to see it differently; the situation requiring its call may lead to fear and panic. But, the only reaction should be resilience. Humans have gone through a number of outbreaks, epidemics and pandemics and come out scarred but safe. Sadly, as seen with the New York City example, we have paid a dear price. The PHEIC is simply a means bring the world's citizens, regardless of culture, race, religion and socioeconomic status, in unison to defeat an enemy that may threaten our survival and to ensure as few lives as possible are lost.
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