Address by Dr Margaret Chan, Director-General of WHO

16-09-2014

Mr Chairman, excellencies, honourable ministers, distinguished delegates, my good colleague, Zsuzsanna Jakab, ladies and gentlemen,

Prior to 23 March of this year, the world’s public health communities, also here in Europe, were focused on a number of major health threats, big-picture needs, and priorities for the future.

Issues like the rise of noncommunicable diseases, antimicrobial resistance, universal health coverage, climate change, and the post-2015 development agenda were being debated.

Many were looking forward, with great anticipation, to the Second International Conference on Nutrition, being co-hosted by WHO and FAO in Rome in November.

The focus of the public health debate changed, at first very gently, on 23 March, when WHO confirmed the first case of Ebola virus disease in Guinea.

That announcement of a newly confirmed case barely raised a ripple in the international media.

The world, it was felt, would not notice or feel a thing from the outbreak in Guinea.

No one was deeply worried at first: not WHO, not the partners we usually work with during outbreaks, not the key international nongovernmental organizations.

Look where we are today. All of you read the headlines and watch the news. Nearly every single day, on a US/International Google search, Ebola is either number one or number two among the top ten news stories.

Like other parts of the world, countries in this Region are on high alert for any possible importation of the Ebola virus in an air traveller.

Hardly a day goes by without rumours of an imported case at an airport or in an emergency room somewhere in the world.

Governments are right to bring out the hazmat suits and showcase their isolation rooms.

This reassures their citizens and their media crews that the country is well-prepared to stop further transmission should an imported case occur.

This is understandable. The virus is deadly. The disease is dreadful. People are afraid.

Ladies and gentlemen,

This is the largest, most severe, and most complex Ebola outbreak ever seen in the nearly four-decade history of this disease.

This is a fast-moving outbreak, with a number of unprecedented features, that is delivering one surprise after another.

This is an unforgiving virus that shows no mercy for even the slightest mistake. To date, nearly 300 health care workers have been infected and around half of them have died.

Before the outbreak began, the three hardest-hit countries, namely Guinea, Liberia, and Sierra Leone, had only one to two doctors available to treat nearly 100 000 people.

The death of every single doctor or nurse diminishes response capacity significantly.

As we look at what this virus has done to affected parts of West Africa, every country in the world wants to keep the Ebola virus out of its borders.

What we see is this: decimated families and communities, entire villages abandoned as everyone dies or flees, uncollected bodies, well over two thousand recent and fresh graves, orphans that no one will shelter, and hospitals overflowing or shut down entirely.

In Liberia, 14 of the country’s 15 counties have now reported confirmed cases. 
The number of new cases is increasing exponentially, yet there is not one single bed available for an Ebola patient anywhere in the entire country.

In trade, tourism, and travel, all of sub-Saharan Africa is suffering. The perception is out there that this is an “African disease”, that all of the African Region is somehow contaminated.

People don’t bother to look at maps.

Here is what the Chief of the African Development Bank had to say:

“Revenues are down. Foreign exchange levels are down. Markets are not functioning. Airlines and ships are not coming in. Development projects are being cancelled. And business people have pulled out.”

In some areas, no health services whatsoever are functioning. Not for HIV/AIDS, malaria, tuberculosis, Lassa fever, typhoid fever, cholera or dengue.

Not for childhood diarrhoeal disease and pneumonia, or even immunizations and safe childbirth. Not for anything.

As a team of WHO emergency experts observed, “Delivering a baby in Liberia is the most dangerous job on the planet.”

Honourable ministers, can you imagine, just imagine something like that happening to your country, to your people?

I thank the many countries represented in this room, the European Union, and others for the tremendous support you are providing to the governments of affected countries and to WHO.

The whole world is watching this disease as we, all together, fight back in a spirit of global solidarity.

A humane world cannot let the people of West Africa suffer on such an extraordinary scale.

Ladies and gentlemen,

What does this outbreak, that has been making headlines for months, tell us about the state of the world at large?

What does it tell world leaders, and the citizens who elect them, about the state and status of public health?

I see six things.

First, the outbreak spotlights the dangers of the world’s growing social and economic inequalities.
The rich get the best care. The poor are left to die.

Second, rumours and panic are spreading faster than the virus. And this costs money.

Ebola sparks nearly universal fear. Fear vastly amplifies social disruption and economic losses well beyond the outbreak zones.

The World Bank estimates that the vast majority of economic losses during any outbreak arise from the uncoordinated and irrational efforts of the public to avoid infection.

Third, when a deadly and dreaded virus hits the destitute and spirals out of control, the whole world is put at risk.

Our 21st century societies are interconnected, interdependent, and electronically wired together as never before.

We see this now with a very dangerous outbreak in Nigeria’s oil and natural gas hub, the city of Port Harcourt. 

Nigeria is the world’s fourth largest oil producer and second largest supplier of natural gas.

If not rapidly contained, that outbreak could dampen the economic outlook worldwide.

The Nigerian government has launched a massive response effort and made substantial resources available.

WHO has a team headed by one of its best epidemiologists on the ground in Port Harcourt.

But far too many people had very high-risk exposures on numerous occasions.
Fourth, decades of neglect of fundamental health systems and services mean that a shock, like an extreme weather event or a disease run wild, can bring a fragile country to its knees.

You cannot build these systems up during a crisis. Instead, they collapse.

A dysfunctional health system means zero population resilience to the range of shocks that our world is delivering, with ever greater frequency and force.

We know that higher numbers of deaths from other causes are occurring, whether from malaria and other infectious diseases, or zero capacity for safe childbirth.

We do not know precisely the size of this “emergency within the emergency”, as systems for monitoring health statistics, not good to begin with, have now broken down completely.

But you do need to understand this:

These deaths are not “collateral damage”.
They are all part of the central problem.

No fundamental public health infrastructures were in place, and this is what allowed the virus to spiral out of control. 

In the simplest terms, this outbreak shows how one of the deadliest pathogens on earth can exploit any weakness in the health infrastructure, be it inadequate numbers of health care staff or the virtual absence of isolation wards and intensive care facilities throughout much of sub-Saharan Africa.

Here is one of the few things that I am glad to see.

When presidents and prime ministers in non-affected countries make statements about Ebola, they rightly attribute the outbreak’s unprecedented spread and severity to the “failure to put basic public health infrastructures in place.”

Have messages about the importance of health systems, so forcefully articulated by this Region and so well backed up by your evidence, begun to sink in?
The fifth thing I see is this, and I feel very strongly about this point.

Ebola emerged nearly 40 years ago. Why are clinicians still empty-handed, with no vaccines and no cure?

Because Ebola has been, historically, geographically confined to poor African nations.

The R&D incentive is virtually non-existent. A profit-driven industry does not invest in products for markets that cannot pay.

We have been trying to make this issue visible for ages, most recently through the deliberations of the Consultative Expert Working Group on Research and Development: Financing and Coordination.

Now people see the reality of this R&D failure, this market failure, on TV screens and in the headline news: the world’s empty-handed clinicians in their hazmat suits, trying to help Africa’s desperate poor, putting their own lives at risk, and losing them.

Finally, the world is ill prepared to respond to any severe, sustained, and threatening public health emergency.

This statement may sound familiar to some of you, as it was one of the main conclusions of the IHR Review Committee convened to assess the response to the 2009 influenza pandemic.

The Ebola outbreak proves, beyond any shadow of a doubt, that this conclusion was spot on.

I also see two specific lessons for WHO.

One: We must continue to push for the inclusion of health, and health systems, on the post-2015 development agenda.

We now have much more compelling evidence for doing so, and a much more responsive audience. People are now willing to hear arguments that have fallen on deaf ears for years.

Two: The pressures of this outbreak are revealing some weaknesses at WHO, some dysfunctional elements that must be corrected urgently as part of organizational reform, at all three levels.

At the same time, I want you to know that this Organization can move very fast and effectively in some key areas.

Two weeks ago, we brought together the world’s leading experts on the many complex issues surrounding the use of experimental medicines and vaccines during this outbreak.

As a result, this could be the first Ebola outbreak in history that can be tackled with vaccines and medicines.

For vaccines, testing on human volunteers has already begun.

If all continues to go well, two vaccines could be ready
for progressive introduction near the end of this year. Some five to ten drugs are also being developed as quickly and safely as possible.
Ladies and gentlemen,

Let’s get down to business. You have a packed and important agenda.
 
The loud screaming noise about Ebola must not drown out all the other health needs that are crying out for attention.

You will be discussing the first report on the implementation of Health 2020.

The region is at a crucial turning point for immunization. You have a good success story, but it is fragile.

You will be looking at noncommunicable diseases, one of the highest priorities for this Region.

You will consider ways to invest more in the health of children and adolescents, and what this brings for societies.

HIV/AIDS and malaria are on your agenda, but so is viral hepatitis. 
Viral hepatitis has finally emerged from obscurity to receive the attention it deserves. Make that attention even sharper.

You will be looking at what can be done to slow the rise of antimicrobial resistance.

Some of your heads of state and government have been very vocal in profiling what this trend really means for the survival of modern medicine as we know it.

You must not drop the ball on any of these initiatives.

Polio eradication is on your agenda. I want to assure you: our efforts to finish the job are moving ahead full force.

We need top outbreak managers right now for Ebola, but we are not pulling these people away from the polio campaign.

Thank you.