Enclosed: Four articles and three items weblinked
1. How the West made the Ebola problem much worse, by Tony Burman, special to the Toronto Star, Oct 18 2014
2. What went wrong in response to the Ebola crisis?, by Jennifer Yang, global health reporter, Toronto Star, Oct 18, 2014
3. We need medical boots on the ground now, by Amy Goodman, Truthdig, Oct 15, 2014
4. Australian gov’t resists pressure to deploy medical specialists to west Africa, by Daniel Hurst, The Guardian, Oct 16, 2014
5. Ebola, capitalism and the idea of society, By Rob Urie, Counterpunch, Oct 18, 2014 (weblink only)
6. Visualized: How ebola compares to other infectious diseases, in The Guardian, Oct 15, 2014
And see:
* In the medical response to Ebola, Cuba is punching far above its weight, Washington Post, Oct 4, 2014
* Ebola, capitalism and the idea of society, by Rob Urie, Counterpunch, Oct 17, 2014
* Cuba’s impressive role on ebola, Editorial, New York Times, Oct. 19, 2014
* * *
1. How the West made the Ebola problem much worse
Budget cuts to the World Health Organization have allowed the virus to spread
By Tony Burman, special to the Toronto Star, Oct 18 2014
Isn’t life becoming a drag? First, we hear about fears that we may be beheaded on our way to the grocery store. And now, the nightmare of deadly Ebola infecting us as we come out of the grocery store. Why can’t people just be happy?
Strap yourself in, because this ride is only beginning. Just as many politicians and their media echo chamber have misrepresented the international threat of Islamic State extremists, the same thing seems to be happening with Ebola.
In an environment where fear trumps fact, with the spectre of racism never far away, it is easy to lose the plot. Given this, let us keep certain things in mind.
Of course, this is a human catastrophe of epic proportions. The UN’s World Health Organization has described it “the most severe, acute health emergency seen in modern times.” The UN Security Council has declared Ebola “a threat to international peace and security.”
But lost in the debate is something central to the future. According to many experts, the Ebola outbreak has been an entirely “avoidable” crisis that can be largely traced to the impact of budget cuts. It was made possible by a series of brutal reductions — supported by the world’s industrialized countries, including Canada — to the UN’s main health organization, effectively preventing it from responding to the outbreak earlier. In addition, several countries (including Canada) cut budgets to national health institutes, which have delayed research for a vaccine.
But even though political anxiety about Ebola seems to be rising in North America, it is not a genuine health issue of any scale in Canada or the United States. This is, after all, where thousands of our fellow citizens die each year from the flu. But elaborate and costly precautions are still being considered. This is ironic given the World Bank estimate that 90 per cent of the economic costs of any outbreak “come from irrational and disorganized efforts of the public to avoid infection.”
The Ebola crisis is centred on three West African countries — Sierra Leone, Liberia and Guinea — with the risk of it spreading to neighbouring countries, and perhaps beyond. For this to be avoided, and for the soaring death toll to be controlled, there needs to be an urgent, well-funded international rescue effort. But to this point, there is no sign of that.
The UN’s World Health Organization has been criticized for acting too slowly, but even experts who share that view point to the straitjacket in which the WHO operates. In recent years, its budget has been consistently slashed, particularly by the United States at the insistence of congressional Republicans. This means there is effectively no major UN body that has the power and resources to respond to overwhelming humanitarian crises.
In the Ebola outbreak, this has placed a particular burden on private international medical aid groups that have no direct connection to governments. The leading one in this epidemic has been Médecins Sans Frontières, also known as Doctors Without Borders. Months before anyone else, MSF sounded the alarm about Ebola and was initially rebuffed. Dr. Joanne Liu, its international president and a Canadian, told a UN general assembly meeting in late September that UN resolutions on Ebola are useless unless they trigger immediate action.
Although there are dozens of individual Canadians, many of them medical personnel, who have been courageously volunteering in West Africa with organizations such as MSF, the official Canadian government response has been late and limited. This is, after all, the same Canadian government that, according to an international report released last week, made the biggest monetary cut to foreign aid of any country in 2013. This was in spite of the fact that global spending last year on international development reached a new high.
Should we compare that to another country in our hemisphere which has also responded to the Ebola crisis? The country providing the largest international medical team to fight the Ebola virus in West Africa is Cuba, a nation of only 11 million people.
Memo to Castro brothers: Please phone S. Harper in Ottawa, and tell him how.
Tony Burman, former head of CBC News and Al-Jazeera English, teaches journalism at Ryerson University. Reach him at @TonyBurman tony.burman@gmail.com
2. What went wrong in response to the Ebola crisis?
As the death toll from Ebola continues to mount in West Africa, the World Health Organization is shouldering much of the blame.
By Jennifer Yang, global health reporter, Toronto Star, Oct 18, 2014
The warnings began days after the first Ebola case was confirmed in West Africa. As more bodies piled up, the alarms grew louder, clearer and more urgent.
March 31: “We are facing an epidemic of a magnitude never before seen …”
Two weeks later: “(Our) teams are facing an unprecedented phenomenon …”
Another month passed. “The epidemic is out of control.”
This last warning came in late June, when Ebola had already infected more than 600 people in three of the world’s poorest countries. It was hard to imagine the situation getting worse, but this week Ebola’s infection toll surpassed 9,000 and the World Health Organization warned that by early December there could be up to 10,000 cases — every week. This virus, believed to originate in bats, has now crossed continents for the first time, with infections in Spain and the United States sowing fear and distrust.
The case count today is 15 times worse than in late June but the warnings haven’t changed. There are no adjectives left for capturing a disaster that is several magnitudes worse than “out of control.”
A cruise ship was turned away from Mexico after a possible Ebola case on board was revealed.
How did we get here? Joanne Liu, international president of the aid organization Médecins Sans Frontières, shakes her head in frustration. For months, her people have repeated the above warnings — both through the media and in meetings with the World Health Organization, which took five months to declare an international health emergency. By that point, nearly 1,000 people had died.
The WHO has shouldered much of the blame and the agency itself has acknowledged — internally, at least — that the response has been bungled.
“Nearly everyone involved in the outbreak response failed to see some fairly plain writing on the wall,” the WHO wrote in an internal draft document obtained by The Associated Press on Friday. “A perfect storm was brewing, ready to burst open in full force.”
According to the document, Dr. Bruce Aylward, a WHO assistant director-general, wrote in an email that some of WHO’s partners, including national health agencies and charities, felt the UN health agency was “compromising rather than aiding” the Ebola response.
In an interview with The Star two weeks ago, Liu said her people had been “screaming” at WHO from the beginning. But when asked who to blame for the catastrophe, she refused to point fingers.
“The reality is, we failed as an international community,” she said. “It’s the 21st century. With all of what we’ve got in this world, how come we let things deteriorate to that level in West Africa? Ebola has somehow highlighted all the gaps that we have right now, in a very dramatic way.”
The West Africa outbreak began like every Ebola flare-up before it: A mysterious illness sweeps through a remote African village; doctors begin falling sick and dying; a sample of blood is finally drawn and the diagnosis is confirmed. Ebola.
For the WHO, established procedures immediately clicked into place: risk assessments, daily meetings and a call-out for international experts to come to West Africa. MSF also hit the ground running, setting up treatment centres and activating its emergency team in Brussels.
Ebola was new to West Africa but at this early stage, there was no reason to believe it would end any differently than those outbreaks before it: brutally — often leaving many bodies and broken families in its wake — but quickly. Ebola flare-ups tend to burn out quickly because the virus, which is transmitted through bodily fluids, usually kills its victims before they can spread it too far.
This Ebola outbreak, however, followed a different playbook. A highly mobile population quickly spread the virus to Conakry, the capital of Guinea, the first time Ebola had ever reached an urban centre. Cases also began appearing across the border in Liberia, where MSF quickly deployed to set up isolation centres.
After a few weeks, cases stopped showing up in Liberia and MSF decided to pack up and leave. In Guinea, things started to go quiet too. People relaxed. Then, in late May, the outbreak hit a second wave.
“The problem was Sierra Leone,” said Marie-Christine Ferir, an MSF emergency co-ordinator in Brussels.
At the time, MSF was not involved in Sierra Leone. They had approached the Ministry of Health in April but were told the situation was under control, according to Ferir. MSF, being busy at the time in Guinea and Liberia, didn’t press the issue.
But once Sierra Leone announced its first cases, it was obvious the virus had been spreading there silently for some time. In late June, MSF opened a 50-bed treatment centre that quickly filled up.
“It was a big shock for the team,” said Marc Poncin, emergency co-ordinator for MSF in Guinea. “They (had been) closing down one transmission chain after the other … then all of a sudden it restarted.”
Perhaps the first key mistake was a failure to fully appreciate the culture of the Kissi, an ethnic group that consists primarily of farmers living in small mud-hut villages.
The Guinean region where the outbreak began is called Gueckedou, an oddly shaped appendage of land — dubbed the “parrot’s beak” — that juts out from the country’s bottom edge and pushes into Sierra Leone.
Sierra Leone also has a patch of land that extends up toward Guinea, wrapping around the parrot’s beak. These two puzzle pieces click together here like a yin and a yang — and on both sides of the border, there are Kissi people. To Sierra Leone’s east is also Liberia, where more Kissi reside.
The Kissi are members of the same tribe who intermarry, trade and speak the same language. Crossing international boundaries is as simple as taking a quick walk or boat ride.
“Within that forest area, they just walk across the border and they are there,” said Dr. Brima Kargbo, Sierra Leone’s chief medical officer, in an interview in August. “They can just shout over there ‘Jennifer!’ and Jennifer will cross over. They see themselves as one community.”
In 1991, guerrillas with the Revolutionary United Front crossed from Liberia into Sierra Leone to attack a town called Koindu, kicking off the country’s 11-year civil war. In late May, Koindu also became the site where Sierra Leone’s first cluster of Ebola cases was identified — the virus apparently brought over by a traditional healer who had treated an Ebola patient in Guinea.
WHO always suspected Ebola would spread to Sierra Leone. In fact, the day after the first Guinea case was confirmed, WHO contacted American virologist Joseph Fair and asked him to come to Sierra Leone and help the country prepare for Ebola.
But the WHO’s response to an outbreak, which began in a community stretching over three countries, was initially concentrated on Guinea. Of the 110 experts deployed to West Africa in the first two months, 75 per cent went to Guinea. A regional operations centre in Conakry, meant to facilitate co-ordination between the three countries, also wasn’t opened until the end of July, four months after the initial case was confirmed.
“This thing was happening at the nexus of three countries that do not see any difference between themselves. I don’t think the world was taking that into account,” said Fair, who has lived and worked in Sierra Leone for much of the past decade. “We were classifying it by country; we were saying the outbreak was in Guinea. So you had skeleton teams in Sierra Leone and Liberia.”
Fair, then working with an organization called Metabiota, was sent to Sierra Leone by the U.S. Defense Department and teamed up with two other Metabiota employees, including 65-year-old Jean-Paul Gonzalez, who has been responding to Ebola outbreaks since 1979. They were also joined by Sierra Leone’s top virologist, Dr. Sheik Humarr Khan, who worked with Gonzalez to conduct workshops, training health workers to handle potential Ebola cases.
“We trained medical officers, the nurses, the physicians, the health officers at the border,” Gonzalez recalls. “In three to four days, we trained 400 people, who were kind of future trainers. And then these people went in the field to do active surveillance with one of my colleagues and we trained again more than 500 people.”
Meanwhile, the health ministry worked on educating the public on Ebola. In the first two months, a government laboratory in the city of Kenema also tested more than 140 samples of suspected Ebola cases, according to Kargbo, the chief medical officer — all negative.
When Fair left Sierra Leone in late May, he was exhausted but felt as though “we’d dodged a bullet.” But the morning after he left West Africa, he woke up to the bad news: Ebola had surfaced in Sierra Leone. In just two months, nearly 600 people were infected, including Khan, who worked with Fair and Gonzalez to help his colleagues prepare for the virus.
So why, despite their best efforts, was Sierra Leone not prepared? “When these things happen in this type of country, we have to mobilize the community,” Gonzalez said. “We have to do social mobilization, people need to be in charge. I said that very, very early and it’s not the first time I’ve said that for Ebola. We didn’t pay enough attention to that.”
But in Sierra Leone, there is also just one doctor for every 50,000 people — barely enough to provide basic health care, let alone shore the country up against a viral tidal wave.
“When the first case of Ebola arrived in Sierra Leone, how many people were actually working for preparedness and response to Ebola? Five,” Gonzalez says. “We needed people.”
Nobody could have predicted where this outbreak has wound up. According to projections by the U.S. Centers for Disease Control and Prevention, the epidemic could reach 1.4 million cases by late January if current trends continue. These numbers are unfathomable; there are only 4.4 million people in all of Liberia, the country now hardest hit by the outbreak.
“You’d be looking at casualties on the scale of the conflicts that engulfed the area,” Fair says. “There’s no best-case scenario now. It’s the least worst-case scenario.”
But from the beginning, there were red flags that this outbreak was on a fast track toward disaster. Dr. Isabelle Nuttall, WHO’s director for global capacity and response, said the WHO called a news conference in April indicating this outbreak was “quite different” and in June, the agency held a summit in Ghana with 11 health ministers from the region. “There were communications at that meeting explaining how dangerous the situation was,” she said.
In the internal document made public on Friday, however, the WHO acknowledged it should have realized that traditional containment methods weren’t going to work in a porous region with bare-bones health-care systems.
MSF, on the other hand, quickly read the tea leaves. But nobody listened when they publicly sounded the alarm; they are a private organization, not a global health agency with clout, credibility and authority. That would be the WHO — but from MSF’s point of view, they weren’t getting the message either. “Since day one it’s been a struggle,” Liu said.
In July, Liu met with the WHO’s director-general, Dr. Margaret Chan, and urged her to ratchet up the response. “When I told her it’s out of control, she said I don’t want to be pessimistic,” Liu recalled. “I told her, ‘I’m not being pessimistic, Dr. Chan. I’m just being realistic.”
Chan did not respond to interview requests from The Star. But according to the internal document obtained by The Associated Press, by the time Chan met with Liu, she was already aware of WHO’s poor performance in West Africa. In June, she received a six-page letter from the WHO’s network of experts “spelling out what they saw as severe shortcomings in WHO’s response to the deadly virus,” according to the Associated Press.
“This (was) the first news of this sort to reach her,” the document read. “She is shocked.”
In September, Chan told the New York Times that the WHO is not like MSF or the Red Cross, “who are working on the ground to provide … direct services.”
“WHO is the UN specialized agency in health. And we are not the first responder,” she said. “You know, the government has first priority to take care of their people and provide health care. WHO is a technical agency.”
Lawrence Gostin, a professor of global health law at Georgetown University, criticized this interpretation of the WHO’s mission in an editorial in the Lancet earlier this month, in which he called for a commission to investigate the failings of the Ebola response.
“I just think WHO has lost sight of its historic mission,” said Gostin, who serves on advisory committees for the UN agency and is director of a WHO collaborating centre on public health law and human rights. “If Ebola was the event that proved why WHO was created, it failed.”
In Guinea, where Marc Poncin has been an emergency co-ordinator with MSF since April, the WHO has been “really incapable of managing the epidemic,” he says. While the situation seems to have recently improved — a United Nations mission is now overseeing the Ebola response — “at one point, I was really angry at them.”
“You can’t even imagine how bad it was,” he said. “I was there for a few months and I have had like four or five counterparts at WHO; they were changing every month. And some people leading the response to Ebola had no previous experience in managing Ebola.”
Poncin recalled meeting a WHO-deployed doctor who was sent to Guinea without any clue what he was supposed to be doing there. At one point, he found himself co-ordinating a strategy meeting and calling on partners to attend, including the WHO — a role he believes should have been taken up by the UN health agency.
“The problem is we can’t stop this epidemic without the WHO and at one point they needed to wake up,” he said. “I still have some optimism because I see some people arriving and I hope they will do a better job. But it’s much too late. We’ve lost six months and the situation now is 10 times worse.”
Poncin said that WHO officials from Geneva often seemed more realistic about the reality of the situation than their African counterparts. In the internal document released Friday, WHO hinted at problems with its regional staff, noting that its country offices in Africa are “politically motivated appointments” made by the agency’s regional director, Dr. Luis Sambo. In one “particularly alarming” instance, the document noted, the head of WHO’s Guinea office refused to help get visas for an expert Ebola team to come in.
The WHO’s complex architecture — which consists of a headquarters in Geneva and six regional offices, with regional leaders elected by member states — has long been considered a problem. According to a May 2014 report from the think tank Chatham House, the WHO’s regional leaders feel as though they owe their “principal allegiance to ministries of health in the region which elect it, rather than to the director-general in Geneva.”
Often, WHO country offices have close relationships with health ministries, sometimes even working out of the same office space. “(This can) distort country office perspectives so that they become ‘demandeurs’ from regional offices and headquarters on behalf of the countries, rather than a source of independent advice and expertise,” the report noted.
Both Poncin and Ferir with MSF echoed these concerns. When asked whether WHO’s country representatives in West Africa have been a weak link in the Ebola response, Nuttall points out that three of them have recently been replaced. “I leave it to you to draw your conclusions,” she said.
Nuttall acknowledges that recent budget cuts have weakened WHO’s ability to respond. Her own department recently lost 17 people. In June 2013 — just six months before a 2-year-old child died in Guinea, believed to be the country’s patient zero — the WHO saw its infectious disease budget slashed by $72 million.
Its budget for “outbreak and crisis response” was cut by 51 per cent. Many experts walked out the door, along with institutional memories of how to handle Ebola outbreaks. When the current epidemic began, the WHO also had just one technical expert in viral hemorrhagic fevers, according to the New York Times.
Nuttall expects that when the outbreak is over, the WHO will conduct an extensive review of its own response to the crisis. She admits that it hurts to hear criticisms of WHO, especially when so many of her colleagues are devastated by the outbreak and have been working non-stop since March. “I’m personally convinced that there are many responsible parties involved and everything will be brought to light later,” she said.
The curse of a public health agency, she agreed, was that one is always damned if they do and damned if they don’t. “It’s so easy to criticize,” she said. “During H1N1 (flu pandemic in 2009), we were so highly criticized for having done too much. And now we’re criticized for not doing enough.”
Whether we like it or not, the WHO is what we have right now, says Liu with MSF. And at the end of the day, the agency’s success depends on countries like Canada, which fund and shape its priorities.
Canada, which is the WHO’s third-largest country donor, contributed $107.8 million in 2013-2014 — $45 million less than what it gave in 2004-2005.
“What we need to reflect on is if we think the WHO today is not the entity that can respond to this kind of crisis, who will in the future?” she said. “Either we empower them to do the job that we want them to do … or we create something else.”
Inside MSF, some joke that they should have copyrighted the phrases “unprecedented” and “out of control” back in the spring. These days, their language — once criticized for being overly alarmist — is being used by everyone from WHO to U.S. President Barack Obama in describing the epidemic.
But the joke is edged with bitterness because even today, the world is dragging its heels when it comes to helping West Africa. Dr. Ian Norton, who is currently heading WHO’s efforts to recruit foreign health workers, says the emergency response still needs at least 20 more medical teams — and each team requires 25 members, who will in turn have to hire and train 200 national staff in order to safely manage treatment centres.
When Typhoon Haiyan hit the Philippines last year, 151 medical teams responded from around the world, Norton said; with Ebola, there were only four organizations on the ground. Governments and organizations are simply ignoring WHO’s pleas for help.
“We can’t take no for an answer; we don’t have any other option,” he said. “We need thousands of workers, national and international, and we are building these ETCs (Ebola treatment centres) … We’re now having to ask ourselves, ‘What happens if the world’s medical teams don’t come?’”
MSF is not a perfect organization, Liu said, but it has exposed itself to major risks. For 15 years, not a single MSF staffer died from Ebola; since March, 16 of their people have been infected, nine fatally.
It is time for other non-profit organizations and countries like Canada to put some skin in the game, Liu said. The world can no longer claim it hasn’t heard the warnings.
“We have a lot of people who organize stuff, co-ordinate stuff, but when it comes time to roll up your sleeves and do something, God, it’s hard to find people,” Liu says. “There are really few actors who are really working and caring for people directly and I think that’s a sign of our failure.”
3. We Need Medical Boots on the Ground Now
By Amy Goodman, Truthdig, Oct 15, 2014
The headlines shift hourly between Ebola and ISIS. The question is often asked, “Should we put boots on the ground?” The answer is yes—but not in the Middle East. We need tens of thousands of boots on the ground dealing with Ebola: boots of doctors, nurses, health professionals, dealing with this wholly preventable global health disaster.
Ebola is a small virus that is revealing very large problems with the world’s public health systems. The few known cases here in the United States have provoked a climate of fear and a growing awareness of just how vulnerable we are to a virulent illness let loose in our society. Imagine how people feel in the impoverished West African nations of Guinea, Sierra Leone and Liberia, where the number of cases is in the thousands, and the infrastructure is simply incapable of dealing with the burgeoning number of infected people.
“This is an international humanitarian and health crisis. It threatens the stability of the region politically, economically, and, of course, human health matters most,” said Lawrence Gostin, faculty director at the O’Neill Institute for National and Global Health Law at Georgetown University. Speaking on the “Democracy Now!” news hour, he said, “For the second time in the history of the United Nations, the U.N. Security Council called a health threat—AIDS was the first, Ebola is the second.” He was speaking as news arrived that a second health worker in Dallas tested positive for Ebola. “We should be mobilizing much, much more,” he said. “We should have done it earlier. We should do it now.”
The World Health Organization announced the latest Ebola outbreak in Guinea on March 23 of this year. The outbreak grew, spreading to neighboring countries and jumping over several to reach Africa’s most populous country, Nigeria. It killed tens, then hundreds, but largely stayed off the world stage until two white, American aid workers contracted the disease. Dr. Kent Brantly and missionary Nancy Writebol were separately flown back to the United States. With the first Ebola patients ever to set foot in the U.S. shrouded in isolation suits, the disease became the lead story across the country.
Remarkably, as people were dying en masse of Ebola in West Africa, these two Americans survived, treated to some of the few existing doses of the experimental drug known as ZMapp. These are positive outcomes made possible with a well-funded health-care system.
Enter Thomas Eric Duncan. He, too, had been infected by the Ebola virus. His illness progressed quite differently. His nephew, Josephus Weeks, summed it up eloquently in a piece published by The Dallas Morning News:
“On Friday, Sept. 25, 2014, my uncle Thomas Eric Duncan went to Texas Health Presbyterian Hospital Dallas. He had a high fever and stomach pains. He told the nurse he had recently been in Liberia. But he was a man of color with no health insurance and no means to pay for treatment, so within hours he was released with some antibiotics and Tylenol.”
Duncan went home to be cared for by his family, but got progressively sicker. Two days later, he went back to the hospital, where he was admitted with suspicion of Ebola. He rapidly declined and died on Oct. 8, as Weeks wrote, “alone in a hospital room.” Within days, we learned that one of his health-care workers, critical-care nurse Nina Pham, had contracted Ebola. Then another nurse, Amber Vinson, showed symptoms. Hours before she was diagnosed, she was on a plane with more than 130 people, flying back from Cleveland to Dallas. What if we had a health-care system that guaranteed thorough treatment, regardless of whether or not patients have private health insurance?
Republican Congressman Pete Sessions, who represents part of Dallas, told CNN that he wanted to block flights from West Africa from entering the U.S., though he said he would allow U.S. citizens through. I asked Lawrence Gostin for his response: “That is such a bad idea. … We live in a modern, globalized world; you can’t put a cellophane wrapper around a whole region and expect to keep germs out. It doesn’t work that way. And so, we think we’re trying to save ourselves, but actually we’re making ourselves at greater risk.”
The small island nation of Cuba has sent more than 160 doctors to West Africa to treat patients and help stem the spread of this epidemic. We should learn from Cuba. Instead, President Barack Obama sent in the Marines. They will soon be building field hospitals. But who will staff these new facilities? United Nations Secretary-General Ban Ki-moon has created an emergency task force to confront the Ebola crisis. The world must come together to save lives and stop this preventable catastrophe that threatens us all.
Denis Moynihan contributed research to this column.
4. Ebola: Tony Abbott resists pressure to deploy medical specialists to west Africa
By Daniel Hurst, The Guardian, Oct 16, 2014
Tony Abbott is holding firm against calls to send Australian medical experts to west Africa to help contain the Ebola virus, saying that other countries have yet to give firm commitments to assist in evacuations.
The opposition renewed its calls for the prime minister to deploy medical teams to the region to help prevent the spread of Ebola, which has killed more than 4,500 people. Labor’s foreign affairs spokeswoman, Tanya Plibersek, said it was “beyond belief” that the Australian government was not able to negotiate with the US or European countries to provide assurances for Australian medical staff should they need to be evacuated.
The Australian Medical Association (AMA) has called on the government to review the nation’s preparedness to deal with Ebola cases, amid concerns about the second positive test in the US.
“The last thing we want to do is to make people panic or fearful but I think we need to have a very considered approach in terms of Australia’s role in treating this particular problem and its global response,” said the AMA president, Brian Owler.
“I don’t think it is the time to put our heads in the sand and suggest that Australia should shut its doors and just pretend the problem is a west African problem and let other nations handle the problem by themselves.”
It is understood Australian diplomatic officials have been talking “for several weeks” with other countries, including the US, UK and EU member states, seeking guaranteed assistance in the event an Australian sent to west Africa was infected.
Officials are concerned that an airlift back to Australia could take at least 30 hours, during which time the person could die, and a more suitable arrangement would be an evacuation to a closer country.
The government would require an “ironclad guarantee” from a partner country that an Australian requiring treatment, regardless of condition, would be flown there and receive treatment.
A general statement that a country would endeavour to help was inadequate, diplomatic officials said. Despite public statements from world leaders about the need to confront Ebola, no country had yet given an unequivocal guarantee to satisfy Australia’s conditions.
In some cases obstacles included those countries’ immigration constraints. Australian officials believe countries are focused on processes to repatriate their own citizens first and that their acceptance of infected non-nationals could set a precedent for others.
Australian Defence Force (ADF) officials have expressed concern about the risk to people sent to west Africa, given that the Ebola virus had a death rate of up to 70% of people infected. It is believed the ADF has no portable isolation units.
Plibersek and the opposition’s health spokeswoman, Catherine King, wrote to ministers on Thursday saying Australia could not afford to keep standing by as the world confronted “the most serious health emergency of the modern era”.
The letter said the government should make “immediate arrangements” to deploy Australian medical assistance teams and support other specialist Australian personnel such as doctors and nurses.
In a media conference, Plibersek said: “It is certainly not beyond the ability of the Australian government to organise evacuation protocols for any Australians who may become infected with Ebola, if Australians should go to the assistance of the west African nations who are most affected … The worst-case scenario for Australia is an unchecked Ebola virus that spreads beyond the west African countries that are affected now, to become a global problem.”
Abbott said Australia had provided $18m to the efforts in west Africa, on top of the $40m annual contribution to the World Health Organisation, and was “focused on being prepared here at home and in our region”.
“I have to say that at the moment, we are focused on ensuring that our hospitals here in Australia are well-prepared to receive any Ebola patients should they get here,” the prime minister said.
“What I am very reluctant to do is to direct Australian personnel into Ebola hot spots when we don’t have any means of effectively evacuating such personnel back to Australia and we have no commitments from other countries to treat them there either.
“I think it would be a little irresponsible of an Australian government to order Australian personnel into this very dangerous situation if we didn’t have effective risk mitigation strategies in place and at the moment there is no way of doing that.”
The AMA called on the Australian government to step in and provide assistance, saying the problem must be tackled at the source to ensure it did not spread.
Owler said he understood the government’s reluctance to send people into harm’s way and he was not calling for people to be deployed against their will, but some were willing to “do this dangerous work”.
“Unless we respond and control this with a global effort, unfortunately, the cases are going to spiral out of control,” he said.
Owler also called on Australia to review its preparedness to deal with cases here, after the second case in Texas raised the prospect that procedures and protocols had failed. He said he was surprised that the government had not convened a meeting of experts to consider the Australia’s domestic and international response.
The health minister, Peter Dutton, said authorities were “continuing to monitor our borders” and had interviewed 700 people on arrival from west Africa. “We have obviously had now 11 suspected cases [of Ebola], all of which have been negative after testing,” he said.
Dutton said it was “very important for Australians to understand” that Ebola spread via bodily fluids and was “not like the common flu”.
“If people are coughing and sneezing, you can easily catch the flu. Ebola is not like that,” he said.
The immigration minister, Scott Morrison, said he was “puzzled at the naivety” of Plibersek’s position. “You can’t govern on sentiment,” he told the ABC.
