Why Canada must approach Ebola outbreak like a natural disaster
Thousands of local, hundreds of foreign health workers needed to help fight contagion
With dire predictions of 20,000 people — more than six times the current toll — becoming infected with Ebola, calls are mounting for countries, including Canada, to treat the outbreak like a natural disaster and deploy military teams.
It’s an unprecedented request, but so, too, is the outbreak.
The current outbreak is the longest and most deadly in history, infecting more than 3,500 so far according to numbers from health officials. Three of the countries affected are among the world’s poorest, with health-care systems that are on the verge of collapse.
"It's time to treat this Ebola outbreak in the way we would treat a natural disaster, because it is a natural disaster," said Dr. Keith Martin, a former Liberal MP who now heads the Washington-based Consortium of Universities for Global Health.
Canada and other countries have military medical teams, personnel knowledgeable in how to handle biohazards, and field hospitals — all skills and equipment desperately needed to contain the hemorrhagic fever.
Médecins Sans Frontières, the non-governmental medical organization on the front lines of the battle against Ebola, says its more than 1,800 staff are overwhelmed trying to contain the disease and train other NGOs interested in helping join the battle. That’s why they’ve turned to governments capable of rapidly deploying military units and running self-contained field hospitals.
"What we do know is the governments' civil defence and military have played important roles in natural disaster response. We've seen that in Haiti and the tsunami," said MSF Canada’s executive director Stephen Cornish. "So governments can be part of the solution, and in this case they simply must be part of the solution."
The WHO estimates that it requires up to 250 health care workers to treat 80 Ebola patients. That means the crisis requires thousands of local health care workers and hundreds of international volunteers on top of the people already in place in the affected countries.
Meanwhile, at least 150 health workers have died from Ebola and many others are too afraid to come to work.
Costs are soaring as well, from the equipment needed for health care workers to the hazard pay. About $600 million in supplies are needed, with only an estimated $110 million committed by last week, according to Reuters.
Adding to the woes, food in the region is already becoming more expensive and the United Nations food agency is predicting that it will become scarcer as farmers are unable to work their fields.
On Thursday, a letter published in The Lancet said the crisis could have been averted if governments and health agencies had created a $100 million US contingency fund to rapidly deploy in public health emergencies, as the WHO proposed in 2011. Instead, the international response has been "fractured and delayed," as the international body scrambles to raise the necessary funds, wrote Lawrence Gostin, the O'Neill Chair in Global Health Law at Washington, D.C.-based Georgetown University.
But Cornish warns that at this point, this is not a disaster that governments can “fund away.” MSF says the international response has been "lethally inadequate," and the world is losing the battle to contain it.
Right now, Cornish stresses, the crisis first and foremost requires trained medical teams on the ground.
A 'robust response'
NDP MP Hélène Laverdière, the official opposition critic for international development, says Canada and other countries can, and should, do more to help.
"The appeals for immediate action are numerous and non-stop, and I think anybody who stops and listens to what's happening ... cannot but agree that something needs to be done now. And if it's not done now, then it will be worse later," said Laverdière.
She suggested countries may not be heeding the call to action because they are preoccupied with crises in the Middle East and the Ukraine.
But Dr. Peter Singer, CEO of Grand Challenges Canada, a federally-funded global health group, suggests Canada has already stepped up to the plate.
"Canada has already provided a robust response relative to other nations," said Dr. Singer, citing the labour-intensive creation of a potential vaccine, as well as monetary contributions and lab expertise.
To date, Canada has donated more than 800 doses of an experimental Ebola vaccine, which was developed by the Public Health Agency of Canada, to the WHO. The vaccine must still undergo months of human testing before it’s ready for use in West Africa.
Canada sent a rotating team of three scientists to staff a mobile laboratory in eastern Sierra Leone that did rapid diagnostic Ebola tests. The latest team was evacuated last week after people in their hotel were diagnosed with the disease. That departure forced the lab to temporarily shut down, slowing operations in the area. Health Canada says a team will return once they can "ensure a safe living environment." No data was given.
The federal government has also contributed $5 million to support humanitarian, security and public health needs in trying to contain the disease.
"Canada remains one of the largest country donors to the Ebola crisis response," Health Canada said in a written statement. "[It's] is continually reviewing how it can better assist its international partners to provide aid in the affected regions."
A 'Band-Aid' solution
For some, however, that’s not enough.
"It's quite nice to send a bit of money and offer up lab services, but this is less than a Band-Aid. It's about one cent of a Band-Aid on a large, big crisis. So, I think we should do more, not only Canada but the international community as a whole," said Laverdière.
Dr. Martin notes that Canada has the capacity to help with its Disaster Assistance Response Team (DART) and additional medical expertise.
DART is a military unit that can rapidly deploy in natural disasters and humanitarian emergencies for up to 40 days.
It’s most recent deployment came after Typhoon Haiyan hit the Philippines on Nov. 8, 2013. The team treated 6,500 patients, cleared roads and delivered supplies. Canada also sent more than 2,000 military personnel, a field hospital and helped treat 22,000 patients to help after a devastating earthquake struck Haiti on Jan. 12, 2010.
Though typically used in natural disasters, the origins of DART stem from the 1994 deployment of two field ambulances to Rwanda to help with an outbreak of cholera in refugee camps housing hundreds of thousands of people.
"We have a military medical response mechanism," said Dr. Martin. "We have portable hospitals, medical personnel ... primary care and advanced care systems to treat those affected by Ebola, to effectively deal with the dead, to educate the public about what the virus is."
The Canadian team only deploys when another government wants its help. As in any emergency, Dr. Martin stresses that the countries affected by Ebola must request military medical help before it’s deployed.
In calling for military medical help, MSF was careful to emphasize that any military assets and personnel deployed should not be used for quarantine, since "forced quarantines have only bred fear and unrest, rather than stem the virus."
World must 'step up'
A former medical advisor to Health Canada's deputy minister, Dr. Paul Gully, agrees that Canada should step up and provide more help in this crisis, but he notes that any deployment will require extensive resources.
"It is part of the global community and therefore should work with other member states ... to then have a unified and co-ordinated response, hopefully led by WHO," said Dr. Gully.
He notes that any deployment requires consular support, the ability to evacuate workers if needed, money to pay health workers and insure them, plus training, food, lodging and travel.
"It's a lot of coordination that would be required. Canada has probably some capacity that it could share,” he said. “But it's not simple.”
MSF says that their NGO has become the de-facto leader in this crisis and its time for governments to commit resources.
"It simply isn't a responsibility, a role that is ours to shoulder," said Cornish. "The world has to step up to this emergency.
“If the call is unanswered, this could clearly turn into a disease and an outbreak of cataclysmic proportions.”