21 August 2014 As the World Health Organization (WHO) ramps up its response to the unprecedented outbreak of the Ebola virus disease in West Africa, the wider United Nations, led by Secretary-General Ban Ki-moon, has launched a system-wide coordination initiative to assist Guinea, Liberia, Nigeria, and Sierra Leone in their efforts to halt the spread of the virus, which has left more than 1,000 people dead and is now affecting more than 1 million people throughout the region.The Organization’s efforts got a major boost last week when Mr. Ban appointed Dr. David Nabarro, British physician and public health expert, as Senior UN System Coordinator for Ebola, in support of the work done by WHO Director-General Dr. Margaret Chan and her team to counter the outbreak of the virus, first identified this past March in rural Guinea and which, the agency has subsequently designated a “public health emergency of international concern.”
Speaking to the UN News Centre before heading out on his first mission to West Africa, Dr. Nabarro, tasked with ensuring that the UN system makes an effective, coordinated contribution to the global effort to control the outbrI want to be clear, very clear, there is no justification for stopping people from traveling to countries that are currently affected by the Ebola disease outbreak.eak, touched on some critical issues – strengthening the health sectors in the affected countries, ensuring protection for frontline health workers, and tackling fear and stigma associated with Ebola – that the region’s Governments, with the support of the United Nations family, will be grappling with in the coming days and weeks.
UN News Centre: Could you tell us a bit about the current situation in the (mainly West African) countries where people are affected? What is WHO doing to protect health workers in the region?
David Nabarro: Ebola virus disease has been spreading in four countries in West Africa during the last few months. In three of those countries, it really is a severe outbreak. Perhaps the first country to be affected was Guinea, and it’s had some waves of infection. But now we’re looking particularly at two other countries – Liberia and Sierra Leone – where the infection rates seem to be picking up. We’re seeing new cases reported every day in different parts, particularly of Liberia and Sierra Leone. The situation in Guinea is slightly more stable. And as we look forward into the future, we are concerned that the outbreak will continue to spread and perhaps will not be got quickly under control.
David Nabarro on Ebola - UN News Centre interview
UN News Centre: And is WHO taking specific measures to protect health workers in the region?
David Nabarro: So this outbreak of the disease is particularly of concern to the health sector. And when I talk about the health sector, I mean the ministries of health, also the partner organizations who work with the ministries of health in order to help people maintain good health and to be free of disease, and international organizations like the World Health Organization, which has been particularly involved in this effort. And what WHO and others have been doing is encouraging two things to happen. Firstly, is that the health sector is able to help diagnose people who are thought to have Ebola virus disease, and then to enable them to have the proper treatment that they need.
In the case of all the affected countries, it is the national health services that are taking the lead and they are supported by partner organizations and then also by the World Health Organization, which is taking particular action to try to enable health care staff to provide proper treatment and themselves to remain free of disease. It is a challenge because the Ebola virus is infectious. But if proper precautions are adopted, then infection does not take place. What we know is that the virus moves from one person to another through body fluids. That means through, for example, vomit or faeces or perhaps even saliva. If you can protect yourself from contact with the body fluids of an infected person, you will not get infected.
From the very highest level in our United Nations system there is an absolute commitment to stick with [the affected countries] and to help them and their people to cope with the current outbreak of Ebola virus disease.
So the health sectors, with the various partner organizations and WHO, are advising on the right precautions to take in order to prevent infection. And that is the key to trying to find ways to help get the disease under control, to provide proper treatment and then at the same time avoid health workers and others from getting infected.
UN News Centre: What are the chances of the virus spreading to countries outside the region and what is the UN doing to prevent this from happening?
David Nabarro: As news about the Ebola virus infection has spread, the countries of the world have asked the World Health Organization to come up with guidance on what should be done about it. Firstly, WHO convened a meeting of its Emergency Committee, and that Committee concluded that the Ebola virus outbreak in West Africa is a public health emergency of global importance. That means that there is a selection of actions that are taken to control the outbreak and also to help the people affected by the outbreak in the affected countries, and also to try to prevent the spread of the disease to other countries in the region. That does mean trying to find people who are infected, putting some kind of restrictions on their movements so they cannot travel to infect other people, and also containing them in locations where they can get proper treatment and support but, at the same time, stop them from moving to places and transmitting the virus to others. That’s the basis of the efforts to prevent spread.
Now of course that does not mean that you stop all people from traveling from the affected countries. It also does not mean that you stop all travel to the affected countries. It’s focusing on the people who themselves are likely to have the disease or to have been exposed to the disease. They’re the ones who we try to prevent from moving and also who become part of the area of containment when the outbreak is present.
UN News Centre: How is the epidemic affecting UN peacekeeping and other vital operations in West Africa? Can UN staff travel between the most affected countries?
David Nabarro: I want to be clear, very clear, that there is no justification for stopping people from traveling to countries that are currently affected by the Ebola disease outbreak. The issue here is that you want to stop people from coming into close contact with people with Ebola virus disease, specifically from touching them. That means identifying the people who have the disease and helping them to avoid contact with other people. But it doesn’t mean that you have some kind of overall prevention of travel to the affected countries.
And that means of course that United Nations personnel can continue and do continue to work in countries affected by Ebola virus disease. That applies to the peacekeepers as well. They have a vital role to play in some of the countries in the region, and of course we are encouraging the peacekeepers to take the precautions that are necessary to prevent themselves from being exposed to people with the disease and to prevent themselves from having close contact with people with the disease. But that does not mean that their travel is unduly restricted and also it does not mean that there is any ban or any restriction indeed on travel of UN personnel between the countries affected by Ebola virus disease. I want to be very clear about that.
People who are battling Ebola virus disease are courageous people. People who are supporting them are courageous people. If anybody says they should be shunned or avoided, I am saying to them, you’re missing a huge potential. These are the real champions.
UN News Centre: You’ve met with the representatives of the affected countries. What were their main messages to you?
David Nabarro: The representatives of the countries affected by Ebola virus disease met me today, and they made the point to me that they and their people are very committed indeed to reducing the transmission of this disease. They want to be involved in the effort to bring the disease under control. They want the United Nations system, led particularly by the World Health Organization, to help them to have strong health services that can get better care to people who are affected by or at risk of Ebola virus disease.
The representatives of the affected countries said to me that bear in mind that the reaction to Ebola virus disease is having big economic and social consequences for our people. And please could you do your best, they said, to get accurate information about the disease – about ways in which it is transmitted, about ways in which infection can be avoided. They asked that the whole UN system come together in a coordinated way and support them, and also that we link up closely with partners outside their region to see if they can bring help. They asked us to be with them as they go through the current outbreak of Ebola virus disease and help to rebuild afterwards.
They reminded us that they’ve come out of civil war quite recently and they’ve been developing very well. This is quite a serious setback and they said help us to get back on course. I was able to reassure them that from the very highest level in our United Nations system there is an absolute commitment to stick with these countries and to help them and their people to cope with the current outbreak of Ebola virus disease.
UN News Centre: What can be done to prevent the public from panicking? Is social media being used to get the UN message out?
David Nabarro: First of all, the message that all health workers are trying to communicate is that we have to work together to try to prevent Ebola virus disease from affecting communities and from spreading. And working together means all of us understanding the nature of how the disease is transmitted, all of us working to enable people who have been infected to get access to proper treatment, all of us working to enable people who have been infected to avoid passing it on to others. It involves the whole of society. It involves a social movement working to get this under control. It can’t just be done by a few specially uniformed doctors and nurses.
And that means that communication is key. Social mobilization is key. Social media are a vital means of communication. We know from talking to communities that there are certain practices, particularly associated with caring for people or indeed helping them when they are dying, that are particularly important in enhancing transmission of the virus. And that means by working with the communities, spreading accurate information about how to prevent yourself from being infected, it’s possible to enable them to avoid infection.
That’s where social media is an absolute key approach. These are already being used in the region by health professionals. And the World Health Organization and other organizations within the United Nations, including the whole peacekeeping community, are supporting this through radio, through other media and through direct inter-personal communication.
These videos in the playlist were produced in 2014 related to the outbreak in West Africa. Credit: WHO
UN News Centre: What is the latest information on experimental drugs being used to treat Ebola? What is the UN position on this?
David Nabarro: Recently, there’s been a lot of interest in experimental medicines that have been produced by certain laboratories for the possible treatment of Ebola virus disease. There’s also been interest in the use of vaccines, some of which are under test. The first thing I have to say is that these medicines and vaccines have not yet been through the full pre-production testing that is necessary for a medicine to go on the market and be recommended for treatment or prevention.
However, the World Health Organization recently brought together a number of different bodies to provide ethical guidance on how the access to these experimental treatments could be speeded up for communities and individuals who affected by Ebola virus disease. There is still a lot of distance to go. There is still a lot of work to be done. But I am assured by my colleagues in the World Health Organization that they are seeking to speed up access, working with the different producers, and also trying to help mobilize funding to make this possible. So let’s watch this space and see what happens. It’s certainly an area that’s receiving very urgent attention.
UN News Centre: Given the stigma and fear attached to the virus, what can be done to integrate survivors back into society?
David Nabarro: People who are battling Ebola virus disease are courageous people. People who are supporting them are courageous people. This courage is extraordinary. When I hear and see that people have survived Ebola virus disease, I see them as people who not only have demonstrated huge courage but also who have massive potential. Increasingly, these people are volunteering to serve to support the treatment of others who are actually still infected with the virus. Increasingly, they are becoming ambassadors for the community of people who are at risk of Ebola virus disease.
They are true partners. If anybody says they should be shunned or avoided, I am saying to them, you’re missing a huge potential. These are the real champions. These are the people with whom you should be working because they are increasingly becoming the mainstay of community-based action to try to prevent Ebola virus infection and also to encourage better treatment facilities.
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