The magnitude of the Ebola outbreak in west Africa, which has killed more than 1,000 people, has been vastly underestimated and will require “extraordinary measures, on a massive scale” if it is to be contained, the World Health Organisation has warned.
The admission came as Médecins sans Frontières (MSF), the medical charity, said the disease was spreading “faster than we can respond to”, and accused the WHO of being too slow to react.
The outbreak, which is the worst to date, has killed 1,069 people, with 1,975 cases recorded in Guinea, Liberia, Sierra Leone and Nigeria. However, the WHO fears the figures are unreliable.
“Staff at the outbreak sites see evidence that the numbers of reported cases and deaths vastly underestimate the magnitude of the outbreak,” it said.
“WHO is coordinating a massive scaling up of the international response, marshalling support from individual countries, disease control agencies, agencies within the UN system, and others.”
It was using “practical, on-the-ground” intelligence to map the outbreak, pinpoint the areas of ongoing transmission, and decide where health workers and new isolation facilities were most needed.
The WHO said the US Centres for Disease Control and Prevention were equipping the hardest-hit countries with technology to enable real-time reporting of cases and analysis of trends.
Efforts are under way to help those trapped in quarantined areas, with the World Food Programme seeking to deliver food to more than 1 million people trapped on the borders of Guinea, Liberia and Sierra Leone.
Such steps, said the WHO, had been taken in “recognition of the extraordinary measures needed, on a massive scale, to contain the outbreak in settings characterised by extreme poverty, dysfunctional health systems, a severe shortage of doctors and rampant fear”.
Ernest Bai Koroma, Sierra Leone’s president, painted a stark picture of the outbreak in the country with the highest death toll, admitting that the government’s initial response had been too slow but saying more help could have come from countries with greater resources and expertise.
After observing a minute’s silence in memory of those who died, a sombre-looking president said:“I wasn’t happy with the response because we have all been slow, and this is a crisis that requires quick action in terms of response. What we can do as a government, I believe we have done. We look forward to the international community to increase their response.”
“This is a call we’re now making to the world because we need treatment centres. And in the treatment centres, we need clinicians that require specialised training. We don’t have that. And if people are dying the response should be an extraordinary response. We must limit bureaucracy.”
Sierra Leone had received less than $2m in direct international funding, Koroma said, although millions more had been channelled through aid organisations.
MSF, which warned almost a month ago that the outbreak was already “out of control”, issued a bleak assessment of the situation on Friday.
“It is deteriorating faster – and moving faster – than we can respond to,” said Joanne Liu, MSF international president. “It is like wartime.”
Speaking at a press conference in Geneva, Liu criticised the WHO for not declaring the outbreak an international public health emergency until 8 August, adding: “I think the wake-up call was too late”.
Now that a common understanding had been reached, she said, the world needed to see concrete action in the field.
“If we don’t stabilise Liberia, we will never stabilise the region,” she told Reuters. “Over the next six months we should get the upper hand on the epidemic; this is my gut feeling.”
Liu’s warning was echoed by Dr Unni Krishnan, Plan International’s head of disaster preparedness and response, who said a decisive moment had been reached in the battle against the disease.
“Time is running out fast and millions of lives are at stake,” he said. “Turning the tide of this deadly disease is now the collective responsibility of the world.”
The best way to deal with the outbreak and prepare for future ones, Krishnan added, was to invest in public health systems and improve the care of infected people.
Although some airlines have suspended flights to parts of west Africa, the WHO has stressed that the danger posed to air travellers remains low.
“Unlike infections such as influenza or tuberculosis, Ebola is not airborne,” said Dr Isabelle Nuttall, WHO’s director of global capacity alert and response. “It can only be transmitted by direct contact with the body fluids of a person who is sick with the disease.”
Nuttall said the risk of Ebola transmission on flights was so low that the WHO did not consider airports to be a particular danger.
