Ebola Fight Requires Massive War Chest

David Greene talks to World Health Organization Director-General Margaret Chan and David Nabarro, head of the U.N.'s effort against Ebola, about the current outbreak in West Africa.

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DON GONYEA, HOST:

This is MORNING EDITION from NPR News. I'm Don Gonyea.

DAVID GREENE, HOST:

And I'm David Greene. Good morning. The Ebola outbreak in West Africa has now officially claimed more than 1,900 lives. Health officials believe thousands more people will die before the virus is brought under control.

GONYEA: There is growing pressure on the international community to do more. After all the countries hardest hit - Liberia, Sierra Leone and Guinea - have weak healthcare systems that have been overwhelmed.

GREENE: But officials at the United Nations and the World Health Organization worry that taking over the effort to fight Ebola would undermine confidence in those country's governments.

GONYEA: And while Ebola has made headlines, the international community is struggling with other deadly diseases - like malaria - all on limited resources.

GREENE: Two top officials were in Washington this week trying to raise money for the international response to Ebola and they came by our studios. David Nabarro is the United Nations senior coordinator for the fight against Ebola. He just returned from West Africa and he says he is confident more medical workers in these countries can be found to fight the disease.

Dr. Nabarro it sounds like these healthcare systems in these countries are under tremendous strain - doctors exhausted, doctors in some cases on strike. What gives you the confidence that you can find enough healthcare workers to battle a virus that seems to be spreading so much?

DAVID NABARRO: During my recent visit I explored the challenges faced by healthcare workers - by that I mean doctors and nurses, but also people who maintain the hospitals and clean them and so on. And it turns out that there are difficulties with them getting their basic pay, but also they have been promised additional hazard pay to enable them to keep working despite the dangers associated with Ebola virus disease and the money hasn't been getting through. So we've been looking at ways of getting the money through more reliably using mobile banking, using alternative routes to get money out because a lot of aspects of government are not quite working well. And we've also got support from the World Bank to help lubricate the money that is going through the system.

GREENE: You think the money is a big part of the problem?

NABARRO: Money is a huge part of the problem - exactly the same here. If we had hospitals and we were asking to do extra work with a more dangerous disease, but we couldn't guarantee that people would get their allowances and their overtime and all these other things, after a bit they would say I've had enough. And so there have been strikes, but I'm absolutely confident that with the work that we've been doing here in Washington to absolutely make certain that money is getting through that will overcome that problem. And we will see more doctors and nurses working in very, very near future.

GREENE: We also sat down with Doctor Margaret Chan, she's director general of the World Health Organization, and I asked her if the time could come when peacekeeping troops might be needed in these countries to help bring order to the response.

MARGARET CHAN: When we talk about troops we are fighting a disease, OK? If we are going to go to war with Ebola we do need resources. An anti-war trust is not going to do it so we need money. We also need troops - we need doctors, nurses, statisticians, you know, a laboratory of scientists. And of course we also need weapons - do we have the protective gears to protect our health care workers so that they can take care of patients?

GREENE: If I may, it sounds like you're talking about medical troops, as you put it - medical weapons? Could we reach a point where there might need to be actual UN peacekeepers on the ground or actual forces in a more traditional sense to bring some order and make sure the things are being carried out to control this?

CHAN: You ask an excellent question. In fact as we are talking we have UN Meals in Liberia. This is a peacekeeping force and they have been providing their logistic capacity which is, you know, excellent to reinforce the transport of materials, people to places where we need them to provide the care.

GREENE: How many people are we talking about here? Who are they? Where are they going to be coming from?

CHAN: In order to deal with this we're talking about thousands of healthcare workers. So clearly we cannot expect to deploy them from the international community. Most of them have to come from the local communities, the local healthcare workers.

GREENE: Doctor Chan, the WHO has come under some criticism. The New York Times had an editorial suggesting the agency was shamefully slow, as they put it, they snoozed. And there was a moment when there were, you know, fewer than 200 deaths back in the spring when the WHO seemed to downplay the severity of this outbreak. Do you regret that at this point that that was the initial response?

CHAN: Well, let me be clear - this is an outbreak, very unprecedented. The responsibility in providing the responses to the country - the WHO cannot replace the government. I have to say all organizations involved in this - including our friends from MSF - they have also said there is full of uncertainty.

GREENE: The Doctors Without Borders, yeah.

CHAN: That's right. We don't understand why does viruses spreading so quickly? We all underestimated the complexity, how this would play out in a country where it has very little capacity. Let's be, you know, frank about that.

GREENE: You keep telling me that this is about the countries themselves responding to this. Why is that so important? Why can't the international community - the WHO, the UN - get involved much more aggressively, perhaps even take over here if this thing spreads?

CHAN: I think the international community have an important role to play and we should come around and support the government. And, you know, diseases happen in people - OK? If every time a country has an outbreak outside people begin to take over, I don't think this is the kind of situation we want to get ourselves into. We respect country leadership - national country leadership - they need to do their part and we can do our part to help them.

GREENE: You've been in the trenches of fighting diseases over your career - avian flu, the SARS disease - it sounds like this one really caught you off guard and brought uncertainty that you didn't really expect.

CHAN: I think this outbreak caught everybody off guard in a sense. And yet not so much off guard because the know-how is there, you know, we have almost 40 years history of dealing with Ebola. In the past every outbreak was controlled and there's no exception. We can do it and we will do it, but, you know, this is happening in countries that just came out of war with health systems - meaning doctors and nurses - virtually, you know, at a very rudimentary level. I give you just one figure to illustrate upon it - two doctors take care of 100,000 people. This is the kind of situation we are dealing with.

GREENE: Before I let you go I just want to return to this line that you have drawn. It sounds like there's going to be a surge - there's going to be more equipment, there's going to be more supplies, the world community is going to be doing a lot in the coming weeks as you're telling us, but you still say this is not for the international community to take over. These countries have to do this on their own. What do you tell someone who doesn't understand that and who says if this becomes a huge crisis I want the United Nations, I want the WHO, I want the international community to take over here?

CHAN: Well, I'm not hearing that. All the countries that we've been talking to - all the agencies that have been supporting - they are saying that we are prepared to do our part to support the national leadership to do the job.

GREENE: This sounds like a wonderful plan, but based on what we know about these healthcare systems in these countries, I mean, is there a chance you're being overly optimistic that you can mobilize so many people?

CHAN: I'm optimistic and I have learned as you said, David, over 40 years, you know, in managing crisis you need to have a sense of hope, optimism and being pragmatic and take fast action.

GREENE: And do you feel like the WHO has acted as fast as you would have liked in this crisis?

CHAN: Within the limits, yes - faster than what we normally do.

GREENE: That's Doctor Margaret Chan, Director General of the World Health Organization. We also heard from Dr. David Navarro, head of the UN's effort to fight the Ebola epidemic in West Africa. We'll hear more from Dr. Chan, the WHO's director general, elsewhere in the program. She'll tell us about how the Ebola virus may be mutating and what that might mean. You're listening to MORNING EDITION from NPR News.

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