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This Is What Experts Say We Need To Do To Prevent Another Ebola

This weekend at the G7 conference Angela Merkel is pushing for a big change in how the world responds to the threat of infectious diseases. This is what experts say needs to change.

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This weekend, the world's leaders are expected to unveil a global plan to combat disease outbreaks like the Ebola epidemic in west Africa.

A cemetery for victims of Ebola virus in Suakoko, Liberia. Reuters

This weekend, the leaders and finance ministers of seven of the world's most powerful countries are gathering at the G7 conference in Germany.

Germany is chairing the conference, and the German chancellor, Angela Merkel, is expected to propose a major restructuring of the WHO, so that future infectious diseases can be identified and addressed more quickly.

After more than a year and a half, the outbreak is finally dying out. But it's killed more than 11,000 people in three countries.

WHO / BuzzFeed / Via apps.who.int

And the World Health Organisation says that the 11,000 recorded deaths are likely to be a major underestimate of the true figure.

Now the world is trying to work out what to do to prevent it happening again.

Denis Balibouse / Reuters

The WHO has been heavily criticised for its response to the outbreak. An international panel of experts concluded that a faster response could have "averted the crisis", and the medical charity Médècins Sans Frontières saying that the global response was "lethally inadequate".

Merkel will say that four main steps need to be taken to improve the WHO's response, and to ensure that future infectious disease outbreaks can be identified and addressed more quickly.

The first key thing is an "emergency surge force", a sort of standing army of healthcare workers.

UN peacekeepers in the eastern Democratic Republic of Congo. Thomas Mukoya / Reuters

Prof Jeremy Farrar, the director of the Wellcome Trust, the world's largest medical charity, told BuzzFeed that the world needs "a medical task force, like the UN peacekeeping corps, able to contribute to the fight against diseases like Ebola in an efficient and streamlined way". It would be a workforce of health workers and epidemiologists, who can be available in short notice in case of epidemic, rather like military reservists but under the WHO's banner: "white helmets" comparable to the UN's "blue helmets".

Dr Devi Sridhar, a public health lecturer at the University of Edinburgh, says "The 'military reservists' model has been discussed quite a lot since Ebola. We need people who can be rapidly deployed, at least until developing countries have adequate health infrastructure of their own."

The second is a hugely improved disease surveillance system in the developing world.

A traveller has her temperature checked by South Korean border guards looking for cases of MERS. Bobby Yip / Reuters

"We need better surveillance for new pathogens in the developing world," says Farrar. As it stands, lots of underdeveloped countries lack proper systems for reporting emerging diseases. For instance, the Saudi Arabia outbreak of the Middle East respiratory syndrome coronavirus (MERS) was not properly reported: now it's spread to South Korea and has infected at least 41 people. The proposal is for three sites in each country, with modern labs for testing samples. The estimated cost will be about $15 million per country per year.

"We also need countries to agree to tell each other, promptly, when there's an outbreak," says Sridhar. At the moment, some countries attempt to cover up diseases, for propaganda purposes, so as well as governmental involvement, she says, there needs to be "an expansion of the Global Outbreak and Alert Response Network (GOARN) – a monitoring network of non-governmental organisations, so information can get out through unofficial, non-governmental channels".

The third is improved research and development.

A nurse holds a syringe full of an experimental Ebola vaccine. Denis Balibouse / Reuters

"We need to make sure that we're not left without drugs for these predictable nasties," says Farrar. Vaccines were in development for Ebola when the outbreak began, but research had stalled. Farrar says that we need a list of the diseases which have the potential to cause epidemics, and do the animal tests and early human tests, so that we know the drugs are at least safe. Then they can go to full trials quickly if there is an outbreak.

The fourth and most important is a radical reform of the WHO itself.

Pierre Albouy / Reuters

It is universally accepted that the WHO, and its bureaucracy-heavy approach, slowed the response to Ebola. "The WHO doesn't have the capacity at the moment," says Farrar. "We need something with more flexibility, more robustness, something that can lead."

The plan is to create a semi-autonomous unit within the WHO, with a director reporting to the WHO DG, and with protected funding. "The idea of setting up yet another UN bureaucracy is unworkable – it would further fragment the system, and it would take years," says Farrar. "So it's better to establish a semi-autonomous organisation with a ring-fenced budget to lead the coordination of responses to things like Ebola or MERS."

Sridhar agrees: "The debate was whether this should be inside the WHO or outside. It can't be outside, since this is exactly what the WHO is for, but the WHO sort of failed with Ebola. The solution is a sort of quasi-WHO unit, with WHO branding but with funding from elsewhere."

Farrar says that the other things are secondary to this. "The global task force akin to UN peacekeeping forces is very important, but it doesn't work without a global structure to deliver it."

All of this will cost money, but a lot less money than dealing with the outbreaks as they happen.

Baz Ratner / Reuters

A Wellcome spokesperson told BuzzFeed that the surveillance would cost around $15 million per country per year; that the R&D would cost $150 million to $300 million a year, and a force of 10,000 medical staff $150 million to $200 million a year. With a billion dollars a year you could do a lot, he said.

That's a large sum, but compared to the cost of responding to Ebola after the fact, it's cheap. "The world is spending billions reacting to Ebola – five, six, maybe 10 billion dollars, plus the damage to the countries' economies," says Farrar. "It would have been much cheaper to get ahead of it."

What's more, the world needs to be better protected. "We got lucky with SARS and other potential pandemics, but we won't always get lucky, and global health depends on us getting out ahead of it," he says.

The trouble is making the case and raising the funds. "Preventing things isn't sexy, and you don't get as much credit for it, because people often think that it wouldn't have happened anyway," he says. "You don't see the benefit in the same way you do for fighting diseases that are happening. Public health is a much harder sell."

There have been 41 cases of MERS in South Korea, and, at the time of writing, six deaths. A previous version of this piece said there had been 41 deaths.

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