TIME Infectious Disease

‘We Are Not Prepared For Another Epidemic': World Bank Survey

LIBERIA-HEATH-EBOLA
Getty Images A woman, suspected of carrying ebola, looks on while under quarantine in the red zone of the Elwa clinic, an ebola treatment center in Monrovia on July 20, 2015. AFP PHOTO / ZOOM DOSSO (Photo credit should read ZOOM DOSSO/AFP/Getty Images)

A new World Bank poll reveals many countries are fearful of epidemics like Ebola and do not think the world is prepared to handle them

Correction appended, July 23

Many people living in developed countries do not think the world is prepared to appropriately respond to another infectious disease epidemic like the ongoing Ebola outbreak, a new World Bank survey shows.

The new data comes from a World Bank Foundation survey released Thursday morning. Researchers polled 4,000 people in the general public living in the regions as well as what the organization classified as opinion elites (defined as people with a university diploma who closely follow global news) and discovered that people around the world are highly concerned about global disease outbreaks, are not convinced the global community is well equipped to handle such outbreaks, and are in support of more funding for protections.

When asked to rank which global issues are most concerning, the people polled collectively ranked global health and epidemics third, after climate change and terrorism. Concern over epidemics was higher than that for global poverty and human rights abuses. When asked specifically about which global health problems concerned people most, global infectious diseases beat out other issues including HIV/AIDS, obesity and hunger.

Not only is concern over epidemics high, but twice as many people think there will be another epidemic like Ebola than people who do not. In addition, a high proportion of the people surveyed expect there could be an epidemic in their own country. That’s especially interesting, the researchers pointed out in a press conference, given that most of the countries had very few people with Ebola if any at all.

People living in the United States, France and the United Kingdom were especially unconvinced that the world is prepared to handle another outbreak. The Ebola outbreak has infected over 27,700 people and killed over 11,260. It’s been widely acknowledged that the world did not react fast enough, and a recent report cited major cultural problems at the World Health Organization (WHO) that interfered with the agency’s leadership during the outbreak and contributed to its failures to adequately respond.

The poll highlights the fact that members of the general public recognize the risk epidemics pose and support investment to prevent them. Nearly 60% of those surveyed said they support funding and policy changes in developing countries that will help protect their own country from risk, and about 70% say strengthening the health systems in developing countries will save money.

Pledges from countries to aid in the Ebola outbreak as well as vows from global agencies to reform their processes to better respond in the future have been made throughout the last year. Whether these translate to real changes and increased capacities to prevent and respond to the next outbreak remains to be seen, but it’s clear from the new poll that it’s what the people want.

Correction: The original version of this story misstated group that conducted the poll. It’s the World Bank Group.

TIME ebola

Ebola Doctor Recounts His Battle with the Virus in New Book

WaterBrook Press

Dr. Kent Brantly and his wife Amber detail the physician's work on Ebola—and his survival of it

A year after Dr. Kent Brantly captivated the world as the first American with Ebola to be treated in the United States, the medical missionary and his wife Amber have penned a new book, Called for Life: How Loving Our Neighbor Led Us Into the Heart of the Ebola Epidemic, which chronicles their experiences as two medical missionaries unexpectedly propelled into a devastating outbreak.

Among the most captivating—and disturbing sections—are the Brantlys’ retelling of when Ebola first crept into West Africa, and Kent’s detailed description of what it felt like when the virus invaded his body. “I also developed a petechial rash: small red spots from my chest out to my arms,” Kent writes, clinically describing the progression of symptoms. “Their appearance meant blood vessels had broken in those areas. Over the next couple of days, the rash would progress until the spots coalesced into generalized, large red erythematous rash from head to toe.”

Though the year of Ebola epidemic news coverage has increased public understanding of the virus, Kent’s narrative reiterates how devastating and serious an Ebola diagnosis was, and still remains. He vividly describes moments of panic when during which he wrapped himself around the ankles of victims’ family member, begging them not to take the contagious bodies of their loved ones home.

While the Brantly family—among a handful of other patients—put a face to the outbreak, the couple dedicate a large portion of the book to describe Ebola’s unseen victims. There was Harris the plumber, who tried to help a woman get her Ebola-infected husband to a hospital, only to catch and die from the disease himself. There was Lusu, a mother who watched both her daughters die before she succumbed herself. The Brantlys also recount some of the factors that contributed to the epidemic’s spread, like the dearth of latex gloves in hospitals. Despite the fact that Liberia is one of the largest producers of raw latex, most of it is exported.

The Brantlys’ story is also emotional, tacking between Kent and Amber’s recollections of the same events: Kent, in Liberia, unsure he can breathe much longer, while a heartbroken Amber prays in the United States that her husband makes it through the night. Those who followed the Brantly family’s story in real-time will remember how often Kent thanked God for his life during his discharge press conference from Emory University Hospital. The book is written in a similar vein, with plenty of references to Bible versus and prayer. Brantly addresses potential critics head-on, writing that he’s never used his medical position to evangelize, and he explains his own occasional struggles to reconcile God with science:

“I know that some consider it controversial for me to claim that God saved my life when I had received an experimental drug and some of the greatest medical care available in the world. I can see how these two realities appear to contradict each other. I also feel the dissonance with claiming God saved my life while thousands of others died. These issues are not clear-cut for me. I wrestle with these tensions… Some may call it a grand coincidence, and I couldn’t argue against them. But when I see the unlikely and highly improbable events that occurred—not only during my illness, but also for decades preceding the Ebola epidemic in West Africa—I see the hand of God at work, and I give him the credit.”

The Brantly family recently returned to Liberia to visit the country they previously called home. In May Liberia was declared Ebola-free, but by July 1 officials announced the country has new cases of the disease. So far, Ebola has infected over 27,690 people in Liberia, Sierra Leone, and Guinea, killing over 11,260.

TIME Liberia

4 Remaining Ebola Patients in Liberia Have Recovered

The Ebola virus treatment center where four people are currently being treated is seen in Paynesville, Liberia on July 16, 2015.
James Giahyue—Reuters The Ebola virus treatment center where four people are currently being treated is seen in Paynesville, Liberia on July 16, 2015.

However, Liberia cannot be declared Ebola transmission-free again until it goes 42 days without any new cases

(MONROVIA, Liberia) — The four remaining patients infected during Liberia’s recent string of Ebola cases have recovered, meaning there are currently no confirmed cases in the country though more than 100 people are still under surveillance, a health official said Friday.

“There are no Ebola cases anywhere in Liberia as we speak,” Deputy Health Minister Tolbert Nyenswah told The Associated Press.

In an interview earlier with state media, he said the four patients had recovered and would be discharged in a ceremony on Monday.

“It is still too early to say is it is over,” Nyenswah cautioned in the interview, noting that 123 contacts were being monitored.

Ebola killed more than 4,800 people in Liberia before the country was declared Ebola transmission-free on May 9. But in late June, a 17-year-old boy died from the disease. That transmission chain has produced five more cases, including the four patients Nyenswah said had been cured and a woman in her 20s who died earlier this week.

The cases originated in Nedowein, a community about 30 miles (48 kilometers) southeast of the capital, Monrovia. Samples taken from the 17-year-old boy show the virus is genetically similar to viruses that infected many people in the same area more than six months ago, the World Health Organization has said.

That finding by genetic sequencing suggests it is unlikely the virus was caught from travel to infected areas of Guinea or Sierra Leone, where the disease is hanging on, or from an animal, the organization said.

Liberia cannot be declared Ebola transmission-free again until it goes 42 days — twice the maximum incubation period — without any new cases.

TIME Innovation

How Student Loans Make College More Expensive

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

These are today's best ideas

1. Cheap student loans are helping colleges boost tuition costs. Find out how.

By Bob Sullivan in Money

2. Americans are living longer. That’s not a good thing.

By Michael Grunwald in Politico

3. Subject to whim and shrouded in mystery, America’s prison parole system must be reformed.

By Beth Schwartzapfel in the Marshall Project

4. This needle-free Ebola vaccine could change everything.

By Anna Almendrala in the Huffington Post

5. Food powder from expired produce could feed the world’s hungry.

By Kathleen Wong in Mashable

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME ebola

Ebola Kills Woman in Liberia

The country had been disease-free for nearly two months

A Liberian woman has died from Ebola, igniting fears of a comeback of the virus that ravaged the region from December 2013 through early this year.

The newest cases are centered around Montserrado County, home to the country’s capital Monrovia, and neighboring Margibi County, where the disease was first reported to have emerged last month, according to Reuters. There have now been six confirmed cases of the virus in the area.

The woman died only a few hours after being admitted to the hospital.

Liberia had been celebrating nearly two months of being Ebola-free prior to the latest reemergence of the virus. Health experts believe the virus was dormant during that time, but could have been transmitted sexually by an Ebola survivor.

The first death of the most recent outbreak occurred earlier in July when a teenage boy died from the virus.

TIME global health

Here’s How Much More Money Is Needed to Improve Global Health

Outbreaks like Ebola highlight the gaps in the way money is raised and used for protecting people’s health, a new study finds

In a report published in the journal Lancet, researchers point out large gaps in the money raised and dispatched for public health purposes and the medical needs of countries, particularly in the developing world, to keep their populations healthy.

Despite recurrent outbreaks of pandemic infections such as SARS and, most recently, Ebola, donors have committed less than a third of the estimated $3.4 billion that is needed to maintain a strong pandemic preparedness system, according to the World Bank. Overall, donor countries have spent only half of the $6 billion that the World Health Organization says is needed to maintain global public health.

What’s lacking, the study authors say, is a more focused system for investing in global health that emphasizes programs designed to achieve certain public health functions, such as vaccinating a particular population or corralling antibiotic resistance or the spread of multi-drug resistant tuberculosis. It’s an approach championed by philanthropic organizations such as the Bill & Melinda Gates Foundation, the organization that funded the study. Part of the funding conditions of its programs include specifying outcomes and a timeframe for achieving them.

“For example, countries like China and India would substantially benefit from market shaping to lower drug prices and increased international efforts to control multi-drug resistant tuberculosis,” Dr. Marco Schaferhoff, association director of SEEK Development in Germany and one of the co-authors of the report, said in a statement. “At the same time…donor countries should also ensure that vulnerable and marginalized populations in middle-income countries, such as ethnic minorities who suffer discrimination, refugees, and people who inject drugs, receive sufficient support.”

TIME ebola

What It’s Like To Fight Ebola When the World Stops Listening

My first deployment into the Ebola outbreak was in September, when I was sent to Liberia. After three months there I was eventually stationed in Guinea, another Ebola-affected region where I am currently serving as an emergency response coordinator.

Over the last year, the Ebola outbreak has infected more than 27,500 people in Liberia, Guinea and Sierra Leone and killed more than 11,200 of those people. It’s still ongoing. When I first joined the response, the situation was very serious. Cases were increasing exponentially, and Médecins Sans Frontières/Doctors Without Borders (MSF) was putting out calls for help and for more actors to get involved. The calls were largely ignored and unfulfilled until later.

Today in Guinea there are many people and organizations involved, but there is virtually no external interest. Despite the fact that we are still seeing cases of Ebola every week—something that would have been considered a disaster just two years ago—the outbreak has stopped dominating the public conversation and news cycle.

Have we noticed the world has stopped paying attention? Yes, we have. Are we surprised by it? No, we’re not. It’s the news cycle, and we know that. Many of my colleagues have a healthy dose of cynicism that goes along with idealism. We wouldn’t pursue this job if we didn’t, because you don’t last long if you let yourself be disappointed. People lose interest. It happened with Haiti, it happened with Nepal, it happens every single time. In some ways, it reinforces our conviction that this is the right place for us to be.

We still have about twelve to eighteen cases of Ebola per week in Guinea, and a third of the cases we saw last week were not on a contact list—meaning they were surprises. When there are unexpected cases, it’s dreadful from a public health point of view. The current situation is better than it has been, but it’s not as good as it should be. In an absolutely perfect and best-case scenario, we could see an end for Ebola in Guinea by October. But that’s an optimistic estimate.

We are aware everyone is tired. The national authorities are tired— they have been working on this non-stop and they just want the outbreak to end. The people of Guinea are tired of the uncertainty and fear. This is an observant Muslim country, and people are very affected by the fact that they can’t go on pilgrimage to Mecca until the epidemic is over. The public is tired of hearing about Ebola. MSF has been working on this for more than a year. We are tired.

But the outbreak is not over yet. And while the lack of attention is normal, it’s not very helpful. The problems that contributed to the scale of this outbreak still exist in many places. People need to realize that the World Health Organization (WHO) is only as good as its member states. If people want to help, they should insist that their country respects its commitments to donations and spending. They should realize that these problems do not exist in isolation and that to some extent they affect everybody.

We understand that people cannot believe that the Ebola outbreak is not over. Neither can we. But we can’t stop paying attention.

Anna Halford is the Ebola Emergency Coordinator in Guinea for Médecins Sans Frontières/Doctors Without Borders (MSF).

TIME ebola

WHO Politics Interfered With Ebola Response, Panel Says

The World Health Organization (WHO) headquarters building in Geneva, Switzerland on Wednesday, March 11, 2015 .
Raphael Satter — AP The World Health Organization (WHO) headquarters building in Geneva, Switzerland on Wednesday, March 11, 2015 .

Office politics were largely responsible for the WHO's slow Ebola outbreak response, a panel says

An advisory panel selected to assess the response of the World Health Organization (WHO) to the Ebola outbreak blamed the agency’s politics and rigid culture for the poor response to the epidemic. The outbreak has infected more than 27,500 people and killed more than 11,200 in West Africa.

In a report published Tuesday, the panel blamed the organization as a whole for being late in activating emergency procedures, despite early warnings from other groups like Doctors Without Borders/Médecins Sans Frontières. The panel concluded that the agency made noise about the outbreak with little action and poor preparation: “Although WHO drew attention to the ‘unprecedented outbreak’ at a press conference in April 2014, this was not followed by international mobilization and a consistent communication strategy,” the authors write.

The panel argues that the culture at the WHO greatly prohibited action, writing:

“WHO does not have a culture of rapid decision-making and tends to adopt a reactive, rather than a proactive, approach to emergencies. In the early stages of the Ebola crisis, messages were sent by experienced staff at headquarters and the Regional Office for Africa, including after deployments in the field, about the seriousness of the crisis. Either these did not reach senior leaders or senior leaders did not recognize their significance. WHO does not have an organizational culture that supports open and critical dialogue between senior leaders and staff or that permits risk-taking or critical approaches to decision-making. There seems to have been a hope that the crisis could be managed by good diplomacy rather than by scaling up emergency action.”

The panel says that a number of factors were responsible for the delay in declaring the outbreak a pubic health emergency of international concern, including a late understanding of the gravity of the situation, denial among country authorities, culture problems within the WHO and a failure of the international community as a whole to take notice.

The report suggests instituting a variety of reforms and priorities, including focusing on fast-tracking vaccines and drugs and calling upon WHO member states and partners to immediately contribute $100 million in voluntary contributions for an emergency fund.

Response to the report has been mixed. As the Associated Press reports, some members of the public health community involved were disappointed that individuals were not called out by name and that the agency was already focusing on lessons learned, when the outbreak is still ongoing.

TIME ebola

Ebola Cases Resurface in Liberia After 2 Months of Being Ebola-Free

Liberia Ebola West Africa
Abbas Dulleh—AP Health workers wash their hands after taking a blood specimen from a child to test for the Ebola virus in an area where a 17-year old boy died from the virus on the outskirts of Monrovia, Liberia, on June 30, 2015.

A teenage boy died from the virus and may have infected others

Liberia has reported its second case of Ebola on Tuesday after nearly two months of being Ebola-free.

Liberia had been declared officially Ebola-free on May 9 after it had gone 42 days with no new cases.

On Sunday, the body of a teenage boy was discovered in a rural area outside of the capital Monrovia and was confirmed to have the virus, Reuters reports. The news was not made public until Tuesday. People who came into contact with the boy have been isolated, and at least one of those patients has tested positive.

Though Liberia was declared free from Ebola infections in May, the outbreak has continued in Guinea and Sierra Leone, which share borders. “There is no known source of infection and there’s no information about him traveling to Guinea or [Sierra Leone],” a spokesperson for the ministry of health told Science.

So far, Ebola has infected 27,400 people in all three countries, killing over 11,200.

TIME Photojournalism Links

The 10 Best Photo Essays of the Month

A compilation of the 10 most interesting photo essays published online in June, as curated by Mikko Takkunen

This month’s Photojournalism Links collection highlights 10 excellent photo essays from across the world, including Tomas Munita’s powerful work on Burma’s persecuted Rohingya minority. The photographs, made on assignment for The New York Times, capture a camp in Sittwe, Burma, where some 140,000 Rohingya live in bamboo huts without electricity, in conditions that partly explain why thousands of the Muslim ethnic group have tried to migrate across Asia these past few months.

Tomas Munita: For the Rohingya of Burma, a Hardscrabble Existence (The New York Times)

James Nachtwey: The Plight of the Rohingya (TIME LightBox) TIME’s contract photographer travelled to Thailand, Indonesia and Malaysia, to document the plight of Asia’s newest boat people.

Pete Muller: Seeking the Source of Ebola (National Geographic) World Press Photo winner Muller’s excellent pictures track the Ebola outbreak from Democratic Republic of Congo to Sierra Leone, Guinea, and Ivory Coast.

Rena Effendi: In the Footsteps of Gandhi (National Geographic) Effendi’s beautiful color photographs look at the great Indian leader’s impact, past and present.

Robin Hammond: Chronicling the Struggles of LGBT People Around the World (TIME LightBox) Moving portraits series on survivors of discrimination

David Guttenfelder: Illuminating North Korea (The New York Times) Yet another fascinating look at the hermit kingdom by the National Geographic Society Fellow.

Matt Black: Geography of Poverty (MSNBC) The new Magnum nominee is expanding his project documenting poverty from California to rest of the U.S.

Philip Montgomery: Scott Walker and the Fate of the Union (The New York Times Magazine) Stunning black and white pictures document the fight to protect workers’ rights in Wisconsin.

Arnau Bach: Stranded in Marseille (The New Yorker Photo Booth) Bach won the Pierre and Alexandra Boulat grant in 2013 and used the funds to make a portrait of one of the poorest French cities.

Charles Ommanney: The Black Route to Europe (The Washington Post) These photographs track one Syrian family’s journey from Aleppo to Austria| More on the Washington Post In Sight blog: Pt.1 and Pt. 2.

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