Ebola: This catastrophe must never happen again

Following the Ebola virus outbreak, the United Nations set up its first-ever public health mission – the UN Mission for Ebola Emergency Response (UNMEER) to deal with the pandemic. In this interview with Newton Kanhema for Africa Renewal, David Nabarro, the UN Secretary-General's Special Envoy for Ebola, discusses the UN's efforts to bring the virus under control.

Africa Renewal: Can you tell us the status of the UN response to the Ebola outbreak?
David Nabarro: The outbreak is a completely unprecedented situation. We have had outbreaks of Ebola over the last 40 years but we've never had one on this scale. That's why the global community decided to mount an extraordinary response.  The UN is supporting the efforts of governments, non-governmental partners and other international donors. We are bringing together all the different parts of the UN under UNMEER. We anticipate that 70% of people infected with Ebola will be under treatment by the end of November and that at least 70% of all burials will be safe and dignified.

We also anticipate that the disease spread would begin to diminish in the speed it was accelerating and that the outbreak curve would start bending downwards by the beginning of January 2015.  There is still a long way to go in terms of people coming under treatment, but the burials are safer and more dignified and in some parts of the region the outbreak curve is beginning to bend. But I want to stress that we are still a long way from the outbreak being under control and ending.

We have seen more than 5,000 fatalities in the three most-affected countries of Liberia, Sierra Leone and Guinea. Is the situation stabilizing?
Well, the situation is varied across the affected countries. In some counties in Liberia, there are reports that the acceleration rate is slowing down.  In other areas, particularly some of the urban communities and particularly in parts of Sierra Leone, it's still expanding at a rapid rate. We don't have the full data. It is uneven but it's what we expected: as the response intensifies we begin to see improvements in some areas.  

How far do you think we are from seeing the end of this pandemic?
I can see a light at the end of the tunnel, but it's quite a long way away. I'm not sure what lies between now and the end of the tunnel. The difficulty with an outbreak like this is that it is unpredictable and can take a sudden turn for the worse at any time. There can be new chains of transmission and we might find that fatalities have shot up more than two or three weeks ago.  I'm reticent about making predictions, either how long it's going to take or how bad it will be before we get it under control.  If I put a date on it, then I will almost certainly end up being wrong.  

Is the current virus strain in West Africa more virulent than the strain we have seen in Central Africa?
There are no differences in the spread pattern. What really matters here is that everybody should know that if people come under treatment early, then there's a good chance that they're going to survive.

About $1 billion is needed to control the spread of the disease. How far have we gone towards that target?
In September 2014 the UN appealed for nearly $1 billion. As of now, we have received nearly $800 million. However, because the disease has spread further since the appeal, we have revised it upward to $1.5 billion so as to attend to the 70% of the cases under treatment and 70% safe burials up to March 2015. There may be a need for more resources after the end of March.  

There have been complaints that some countries are giving less than what is expected of them.  How would you characterize the international response so far?
Well, in general, governments, the wider public, and businesses have been incredibly generous. What has happened is that sometimes they've gone back to national treasuries and asked them to re-examine the amounts they were putting up and to perhaps, come up with further contributions. One country has had four tranches of assistance. Several other countries have provided further bursts of assistance, hence I am not keen to criticise any country. We've also seen incredible generosity from foundations. For example, the Paul G. Allen Family Foundation put in $100 million, the Bill & Melinda Gates Foundation gave $50 million, and the Children's Investment Fund Foundation gave $20 million. Individual members of the public are putting money into charity appeals. Business people from all over the world have also been generous.  
   
What is your assessment of contributions by African countries?
I've talked a lot with African leaders, with the African Union, ECOWAS [Economic Community of West African States], the East African Community, and also with African business people and civil society.  Africans are extremely concerned about this outbreak and are doing their share. 

We also hear some pledges have not been met. Is this true?
Most of the countries that pledged have actually remitted or committed their funds extremely quickly.  I know of no country or organization that pledged and has not made the funds available.  If there are any issues, they may be the normal administrative bottlenecks that sometimes occur with this kind of assistance.

In that case, the $800 million pledged has been delivered?
Not all the money is in bank accounts, but there's a term called "commitment," which has legal value because it means that the money will come, and we can afford, therefore, to spend against that money.  It is only a pledge that must be received before being spent.  The $800 million reflects commitments.  It's been a very extraordinary response.
 
What is the UN doing to avoid delays, if there are any, in terms of the money coming in?
What I have been doing, for example, on the trust fund that the Secretary-General has set up and I am responsible for, is to establish a system so that we have a seven-day cycle. When the money comes in, we get proposals of how that money will be spent within those seven days. 

Do you think this outbreak could have been avoided?
My role is to focus on where we are now. I'm sure that at some point there will be a need to do a historical analysis – what we call in medicine a "post-mortem." That is not for me to do; it is not my area of expertise

When SARS hit Asia, you were playing the same role as now.  Can you tell us what is different this time round?
This outbreak is in a part of the world where health systems are not the strongest.  It's also a virus with high death rates. It requires very close contact tracing. We have seen that countries that are able to act fast can get it under control, especially when they are prepared: Nigeria and Senegal are examples, Mali is also reacting quickly.  We've also seen that in certain counties and districts in the affected countries where the response has been robust and intense, the virus' acceleration has been reduced. So you need a high degree of organization and discipline. This means preparedness. 
  
Going forward, what have we learnt? 
Three words: preparedness, vigilance and solidarity. Being ready, being alert and working together, because diseases don't respect borders. We must remember what this disease has done and put up defences so that this kind of suffering and misery doesn't happen again.