ebola

1. Global
Response to
Ebola Virus
Disease
By:
Dr. Chitra Pai K
House surgeon
KIMS Hubli
Guide:
Dr. Laxmikant L
Associate Professor
Department of Commmunity Medicine
KIMS Hubli

2. United Nations Response Timeline
17th September 2014:
intention set forth to establish the United Nations Mission For
Emergency Ebola Response
18th September 2014:
Outbreak is a threat to international peace and security
19th September 2014:
United Nations member states called upon to provide
full support to UNMEER
23rd September 2014:
Special Envoy for Ebola and Special Representative and Head of
UNMEER Appointed

3. Mission critical actions undertaken by UNMEER
1.Identification and tracing of people with Ebola virus
disease
2.Care for the infected and infection control;
3.Safe and dignified burial;
4.Medical care for responders
5.Food security and nutrition
6.Access to basic health services;
7.Cash incentives for health workers;
8.Economic protection and recovery
9.Supplies of material and equipment;
10.Transportation and fuel;
11.Social mobilization;
12.Messaging

4. Guiding Principles of the United Nations
Mission for Emergency Ebola Response:
*1. Reinforce government leadership;
*2. Deliver rapid impact on the ground;
*3. Closely coordinate and collaborate with actors
outside the United Nations
*4. Tailor responses to particular needs in the
different countries;
*5. Reaffirm WHO lead on all health issues;
*6. Identify benchmarks for transition post
emergency and ensure that actions strengthen
systems.

5. Five aims of the Global Response
Treat the infected Ensure essential services
Stop the outbreak
Preserve stability
Prevent further
outbreaks

6. Global Response
PARTNERS
United Nations
World Health Organization
United Nations
Children's Fund
United Nations
World Food Programme
United Nations Office for the
Coordination of Humanitarian
Affairs
Food and Agriculture Organization
of the United Nations
United Nations
Development Programme
United Nations Population Fund
World Bank Group
Médecins Sans Frontières
International Federation
of Red Cross and Red
Crescent Societies
United States Centers for
Disease Control & Prevention

7. "I appeal to the international community to
provide the $1 billion launch that will enable
us to get ahead of the curve and meet our
target of reducing the rate of transmission by
December 1st."
— UN Secretary-General Ban Ki-moon in an
address to reporters at UN Headquarters in New
York, 16 October

8. The UN Office for the Coordination of Humanitarian Affairs (OCHA)
released the Overview of Needs and Requirements on 16 September 2014.
It outlines the resources considered critical to effectively address the crisis
across a range of objectives over the next six months by national
governments, the World Health Organization, the UN agencies, funds and
programmes , and some non-governmental organizations.
Priority requests
a list of priority in-kind requirements for the Ebola response has been
compiled which will augment and multiply the impact of the resources
identified by OCHA. This is now being shared with all Member States. These
include:
*air lift, particularly helicopters, and maritime transport capabilities,
fuel, vehicles
*mobile laboratory facilities capable of movement throughout affected
countries;
*static non-Ebola medical clinics;
*emergency medical evacuation capability for movement of international
aid workers potentially exposed to Ebola to locations for appropriate
medical care;
*3.3 million items of high quality personal protective equipment; training
*provision of Ebola Treatment Centres.

9. EBOLA RESPONSE ROADMAP
28th August 2014
GOAL
To stop Ebola transmission in affected countries within
6-9 months and prevent international spread.
OBJECTIVES
1. To achieve full geographic coverage with complementary Ebola
response activities in countries with widespread and intense transmission
2. To ensure emergency and immediate application of comprehensive
Ebola response interventions in countries with an initial case(s) or with
localized transmission
3. To strengthen preparedness of all countries to rapidly detect and
respond to an Ebola exposure, especially those sharing land borders with
an intense transmission area and those with international transportation
hubs

10. Factors that contributed to Senegal’s success
According to Health Minister Dr Coll-Seck, the most important actions that
contributed to the rapid containment of the disease in Senegal– with no
onward transmission whatsoever – are the following:
• Strong political leadership at the highest level.
• Early detection and response, aided by a detailed plan and a quickly-activated
National Crisis Committee.
• Stepped up surveillance, especially at the country’s many entry points
by road.
• Rapid mobilization of resources from both domestic and international
sources; solid preparedness plans are thought to have earned the
confidence of donors.
• Support from operational partners, including WHO

11. • Nationwide public awareness campaigns that made good
use of media experts, embedded in the Ministry of Health
and Welfare and allowed to closely observe its emergency
actions, and local radio networks.
• Deliberate and heavy emphasis on multisectoral
collaboration among all relevant government ministries,
backed by community engagement every step along the way.
• Direct support to patient contacts as a strong incentive
for cooperation and compliance, through the provision of
social support in the form of money, food, and psychological
counselling.
• Support for reintegration of the recovered patient into a
society that could understand why he posed no risk of
contagion to others.

12. WHO declares end of Ebola outbreak in Nigeria
• WHO commends the Nigerian Government's strong leadership
and effective coordination of the response that included the
rapid establishment of an Emergency Operations Centre.
• WHO, United States Centers for Disease Control and
Prevention (CDC), Médecins Sans Frontières (MSF), UNICEF
and other partners supported the Nigerian Government with
expertise for outbreak investigation, risk assessment, contact
tracing and clinical care.
• Strong public awareness campaigns, teamed with early
engagement of traditional, religious and community
leaders, also played a key role in successful containment of
this outbreak.

13. Global Outbreak Alert & Response Network
The Global Outbreak Alert and Response Network (GOARN) is a technical
collaboration of existing institutions and networks who pool human and
technical resources for the rapid identification, confirmation and response
to outbreaks of international importance. The Network provides an
operational framework to link this expertise and skill to keep the
international community constantly alert to the threat of outbreaks and
ready to respond.
Objectives
The Global Outbreak Alert and Response Network
contributes towards global health security by:
• Combating the international spread of
outbreaks
• Ensuring that appropriate technical assistance
reaches affected states rapidly
• Contributing to long-term epidemic
preparedness and capacity building.

14. • Avoid contact with bats and nonhuman primates or blood, fluids,
and raw meat prepared from these animals.
• Avoid hospitals in West Africa where Ebola patients are being
treated. The U.S. embassy or consulate is often able to provide
advice on facilities.
• After you return, monitor your health for 21 days and seek medical
care immediately if you develop symptoms of Ebola.

15. Impact on Social determinants of health
1. Trading, industry, agriculture, tourism
1. Worsening poverty
1. Hunger
1. Orphans
1. Stigma
1. School closures
1. Other diseases not being treated

16. Response–World Health Organization Roadmap
•Actual number 2-4 times higher
• Case count could exceed 20,000
Objectives targeted at countries:
• With widespread or intense transmission
• With an initial case(s) or with localized transmission
• Sharing land borders with an intense transmission area and
those with international transportation hubs

17. •Elements of the response:
 Treatment centres, referral centres,
laboratory access, surveillance and
contact tracing, safe burial, social
mobilization
 Estimated cost $ 490 million

18. Responses to the Ebola virus epidemic in
West Africa
Organizations from around the world have responded to help stop the
2014 Ebola virus epidemic in West Africa. In July, the World Health
Organization convened an emergency meeting with health ministers
from eleven countries and announced collaboration on a strategy to co-ordinate
technical support to combat the epidemic. In August, they
declared the outbreak an international public health emergency and
published a roadmap to guide and coordinate the international response
to the outbreak, aiming to stop ongoing Ebola transmission worldwide
within 6–9 months. In September, the United Nations Security Council
declared the Ebola virus outbreak in West Africa a "threat to
international peace and security" and unanimously adopted a resolution
urging UN member states to provide more resources to fight the
outbreak; the WHO stated that the cost for combating the epidemic will
be a minimum of $1 billion.

19. United Nations
UN Mission for Ebola Emergency Response
• UNMEER has been tasked to coordinate all relevant United Nations actors in
order to ensure a rapid, effective, efficient and coherent response to the
Ebola crisis. UNMEER's objective is to work with others to stop the Ebola
outbreak. UNMEER will work closely with governments, regional and
international actors, such as the African Union (AU) and the Economic
Community of West African States (ECOWAS), and with UN Member States,
the private sector and civil society.
World Health Organization
Report that they "are on the ground establishing Ebola treatment centres
and strengthening capacity for laboratory testing, contact tracing, social
mobilization, safe burials, and non-Ebola health care" and "continue to
monitor for reports of rumoured or suspected cases from countries
around the world."

20. WHO Roadmap
A. Immediate actions to support the three EVD affected
countries
1. Urgently strengthen the field response
Output 1: local response team in place in each “hot
spot”
Output 2: Provision of field logistical support
Output 3: Provision of care to patients
Output 4: Chains of transmission broken through active
surveillance, case investigation, contact tracing and
follow-up
Output 5: Public relations and reputation management,
social mobilization, and risk communications strengthened

21. 2. Coordinate the outbreak response
2.1. Manage the WHO Sub-regional Ebola Operations Coordination Centre
Output 1: Field coordination, collaboration and operational management
of the outbreak response strengthened
Output 2: Cross-border coordination strengthened
2.2. WHO's leadership and coordination of EVD outbreak response
strengthened at all levels
Output 1: Logistics management systems strengthened
Output 2: Disease-related and other content-based expert support and
expert networks mobilized
Output 3: Global communication and information provided
Output 4: External relations strengthened
Output 5: Clinical support strengthened
Output 6: Development of new medical treatments and interventions
against EVD advanced

22. B. Preparedness in countries at-risk
• Output 1: Preparedness plans activated and tested
• Output 2: Active surveillance strengthened
• Output 3: Laboratory diagnostic capacity strengthened
• Output 4: Public information and social mobilization
enhanced
• Output 5: Case management and infection prevention and
control capacities strengthened

23. World Food Programme
On 18 August, plans to mobilize food assistance for an
estimated 1 million people living in restricted access
areas. In an 18 September WHO Ebola Response Roadmap
Situation Report it was reported that as of that date the
WFP have delivered an estimated 3,000 metric tonnes of
food to the worst affected areas, enough to feed 147,500
people. They have also assisted in the transportation of
400 cubic meters of medical cargo.[25]

24. International organizations
Médecins Sans Frontières
According to a WHO report released on 18 September, the humanitarian
aid organisation Médecins Sans Frontières (Doctors Without Borders) is
the leading organization responding to the crisis. Currently it has five
treatment centers in the area with two in Guinea, two in Liberia and one
in Sierra Leone. The centers are staffed by 210 international workers in
collaboration with 1,650 staff from the affected regions
European Union
The European Union has committed €150 million funding to fight the
outbreak, including the provision of 3 mobile laboratories, funding to
strengthen healthcare capacity, support to help cushion the
macroeconomic impact, and support to the deployment of an African Union
medical mission.

25. Economic Community of West African States
In March, the Economic Community of West African States (ECOWAS)
disbursed US$250,000 to deal with the outbreak. In response to the ECOWAS
Special Fund for the Fight Against Ebola, in July the Nigerian government
donated 3.5 million dollars to Liberia, Guinea, Sierra Leone, the West
African Health Organization, and the ECOWAS Pool Fund, to aid in the fight
against the epidemic.
World Bank Group
The World Bank Group has pledged US $230 million in emergency
funding to help Guinea, Liberia, and Sierra Leone contain the spread
of Ebola infections, help their communities cope with the economic
impact of the crisis, and improve public health systems throughout
West Africa. On 25 September The World Bank made additional
funding of $170 million available to help curtail the spread of the
Ebola virus. The funds will be used to finance medical supplies and
increase the number of healthcare workers.

26. National responses
A number of governments across the world have put measures in
place to protect their populations from Ebola. These include:
• Advisory notices to warn travellers of the potential risk of
travel to countries affected by the epidemic. (Germany, Spain,
UK, USA, Colombia, Philippines, Saudi Arabia. )
• Withholding visitor visas from nationals of the affected
countries, closing borders and cancelling flights. (Equatorial
Guinea, Kenya, Sri Lanka, Nigeria, South Africa, Chad, Seychelles,
Mauritania)
• Precautions such as isolation facilities, training of staff,
biocontainment exercises, and health screening for incoming
travellers. (Malta, Colombia, India, South Africa, Morocco, Mali,
Germany, Philippines, Mauritania, United States, Canada, UK)

27. Charitable organizations, foundations and
individuals
• International Charter on Space and Major Disasters
• International Committee of the Red Cross
• GOAL
• International Medical Corps
• Bill & Melinda Gates Foundation
• Paul G. Allen Family Foundation
• Samaritan's Purse

28. Drawbacks
*Inadequacy of International Community’s initial response to this
unusually fast spreading outbreak.
*WHO’s weakened capacity in face of budget and staff , Lack of
emergency response fund at the outset of outbreak.
*Lack of centralised global command and control structure to enable
swift deployment of resources and trained personnel

29. • The National governments responses of some of the african countries towards the
outbreaks has been badly Misjudged.
• Lack of Trust of people on their Government , International agencies , Other
organizations .
• It was only on Aug 8, after a meeting of the International Health Regulations
Emergency Committee, that WHO declared the outbreak a “public health emergency
of international concern”. Such delays have probably enabled the outbreak to spread
rapidly

30. The key to epidemic control is rapid diagnosis, isolation, and treatment of
infected individuals.
This strategic approach was not taken in time during the present Ebola
outbreak in west Africa.
There are Fewer than 24 established/planned laborataries equipped to use PCR
in all the three countries.

31. Adequate number of Testing sites and Mobile testing sites are lacking.
 Delay in the deployment of drugs --- Zmapp , TKM Ebola. Safety and tolerability studies yet to be
conducted.
Limited Production of drugs from the company. Need to Cope up with adequate supply to combat
epidemic.
Vaccines proved Effective in primates , yet to clear in Clinical Trials going on in US, Africa, UK.

32. How can India Contribute to this war against
Ebola ?
• India can contribute to global efforts to fight against Ebola crisis.
• It has a large cadre of epidemiologists, laboratory scientists, doctors and nurses who are
experienced in epidemic control.
• They can help support diagnosis, the training of health workers, or clinical services in Ebola
treatment units
• India also has a large number of social mobilisers who have proved their abilities in health
campaigns such as the polio eradication campaign. They could contribute their experiences in
community empowerment (one of the cornerstones of the Ebola response), address rumours
and fears and help communities regain trust in the humanitarian response

33. STATE
Union Government has issued advisories to state disease surveillance units to
ensure protection from Ebola.
SDS Units are alert for early detection and management of travel related cases
reported from community.
Laboratory capacity is strengthened at Neurovirology lab at NIMHANS
Bangalore to diagnose Viral disease and disburse report on timely basis apart
from National Institute of Virology Pune.

34. Karnataka Health and family welfare department is on a
preparedness mode
It has already identified the nodal officers and designated hospitals
like Rajiv Gandhi Institute of Chest diseases with isolation wards to
respond to any possible cases.
Bangalore International Airport Authority has commenced screening
of passengers coming in /Transiting from West Africa via State.

35. Loopholes at country level
 No sustained Health awareness messages / sessions regarding the disease over mass media.
 Inadequate Health Education sessions , Health awareness campaigns among community regarding the Ebola
disease , its transmission and preventive measures to be taken.
Insufficient training to how to use PPE and adherence to Usage of Personal Protective measures by health care
professionals ( ex:- gloves etc).
India has only two facilities capable of testing for the virus.
 The prevalence of Malaria, Dengue and other fever inducing illness in India could make it especially difficult to
isolate who might show an early onset of Ebola.
Lack of availability of the candidate promising drugs and vaccines.

36. REFERENCES
www.un.org/ebolaresponse/
WHO Response : Global Alert Response
www.who.int/csr/don/2014_04_ebola/en/
en.wikipedia.org/wiki/
Ebola_virus_epidemic_in_West_Africa

37. Thank you