Lessons for India from the Ebola epidemic

Source : Hindustan Times dated 06/05/2021 https://www.hindustantimes.com/opinion/lessons-for-india-from-the-ebola-epidemic-101620217055295.html

Context : Recently the  WHO Director-General congratulated the Democratic Republic of the Congo as 12th Ebola outbreak was declared over and stressed the need to maintain vigilance to prevent virus’s return.
The West African Ebola epidemic, which infected 28,616 and killed 11,310 in Sierra Leone, Liberia and Guinea between 2014 and 2016, may seem at first like a localised, regional public health emergency compared to the global Covid-19 pandemic. Yet, India has many lessons to be learnt from the Ebola epidemic, as this article highlights.

What is Ebola Virus Disease?
  • Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a rare but severe, often fatal illness in humans.
  • The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission.
  • EVD first appeared in 1976 in 2 simultaneous outbreaks, one in what is now Nzara, South Sudan, and the other in Yambuku, DRC. 
  • The 2014–2016 outbreak in West Africa was the largest Ebola outbreak since the virus was first discovered in 1976. The outbreak started in Guinea and then moved across land borders to Sierra Leone and Liberia.
  • Vaccines to protect against Ebola have been developed and have been used to help control the spread of Ebola outbreaks in Guinea and in the Democratic Republic of the Congo (DRC).
  • Two monoclonal antibodies (Inmazeb and Ebanga) were approved for the treatment of Zaire ebolavirus (Ebolavirus) infection in adults and children by the US Food and Drug Administration in late 2020.
Covid -19 scenario in India

As on 05 May 2021, India reported 378,075 new cases accounting for 47% of new cases reported globally and 276 daily cases per million population.

So at a time when the second wave is crushing India, at both the micro- and macro-level, what lessons can we take away from the Ebola crisis management?

  1. Like Ebola, Covid-19 must be treated as a caregiver’s disease,
    •  to validate the efforts (and vulnerabilities) of doctors, nurses and paramedical caregivers
    • to recognise small, everyday acts of caregiving in the home, hospital, clinic and cremation grounds.(Eg. acts of caregiving in cremation grounds, graveyards and mortuaries , most often by those who belong to lower caste and class backgrounds ,should be  recognised by the State and they should be provided insurance like other frontline workers.
  2. Negatives of Control over care paradigm: Imposing containment without adequate care giving facility limits results and leads to resentment against state
    • CASE STUDY : SIERRA LEONE When Sierra Leone found itself in the grip of Ebola in September 2014, authorities imposed an unprecedented 72-hour nationwide lockdown. The government recruited and deployed scores of health teams door to door, or “Ose to Ose Ebola Tok” in Krio.
  3. Decentralised health care –  The overwhelmed tertiary care medical infrastructure has exposed the limits of the health systems in India.
    • In West Africa- Independent Ebola treatment units were set up through community mobilisation and sustained over two years in the absence of secondary or tertiary medicine.
    • Likewise India should focus on community care facilities such as oxygen-hubs, portable prefabricated health units and testing-treatment wards at the micro-level.
  4. Understand our social systems more effectively and sensitively
    • Viruses always track weaknesses in society and invade their cracks and fissures
    • In the case of Ebola, historical reasons such as colonialism and post-colonial civil wars, ethnic strife and exploitative structural adjustment programmes resulted in West Africa’s “clinical desert”-which lacked the basic staff, material, space and systems of care.
    •  In the Indian context, the State’s longitudinal lack of attention to health is exacerbated by divisions of caste,class, gender and ethnicity .
    • So social scientists, community volunteers and those who routinely track society at a granular level,must be involved in disaster preparedness alongside scientists and virologists.
  5. Traditional healers became allies in Ebola response
    • The World Health Organization (WHO), the Ministry of Health and other partners worked with traditional healers-providing them with kits to protect themselves. They were trained and received support in infection prevention and control.
    • Likewise AYUSH workers can be provided proper training and could be pressed into action now. It will help us to tackle such emergencies in the future also.
  6. Establishment of a vaccine stockpile
    • A global Ebola vaccine stockpile was established – to contain future Ebola epidemics by ensuring timely access to vaccines for populations at risk during outbreaks.
    • The Covax facility must be strengthened to counter growing vaccine nationalism and hence ensure timely and equitable access to all,especially the most vulnerable sections
    • Global Vaccine Divide :On an average in high-income countries, almost one in four people have received a Covid-19 vaccine. In low-income countries, it’s one in more than 500.

Way forward

The Astana Declaration(2018), signed by all 194 WHO member states including India, marked the 40th anniversary of the historical Alma Alta Declaration that declared health a human right for all and not just a privileged few and urged the world to make primary health care the mainstay of universal health coverage in 1978.
In addition to the goal of universal health coverage, learning from Ebola, we must remind ourselves that a good system that responds to viral threats is not an emergency system but an everyday system that responds to emergencies.

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