Donal Brown, who led the UKโs Ebola taskforce in Sierra Leone, says the outbreak revealed serious failings in the worldโs ability to deal with health crises
Donal Brown says the debate over whether the Ebola outbreak was a health or a humanitarian emergency hampered efforts to combat it.
Donal Brown says the debate over whether the Ebola outbreak was a health or a humanitarian emergency hampered efforts to combat it. Photograph: DFID
Failure to learn the lessons of the Ebola outbreak will have unthinkable consequences when the next global health emergency erupts, the former head of the UKโs Ebola taskforce in Sierra Leone has warned.
Donal Brown, who led British efforts to tackle the disease in the west African country, said the outbreak had exposed serious technical and collaborative failings in the international communityโs response mechanisms.
โWe got off lightly on Ebola as a global community and we couldnโt even respond properly to that,โ he said.
Brown declared that not only was the response late because international alert systems were not working properly, it was also hampered by โan ongoing debateโ as to whether the outbreak should be treated as a health emergency or a humanitarian one.
โIt was both, very clearly โ and we need to ensure that weโve got systems that speak to each other so weโre not in a thing about should it be the World Health Organisation (WHO) leading this or should it be a UN humanitarian response. This is a complex health-humanitarian emergency and our systems need to be able to lead that together,โ he said.
Brown, a former vet who is now head of the Department for International Developmentโs (DfID) global funds department, said that the situation would have been immeasurably worse if the world had been dealing with a respiratory-borne infection rather than one spread, like Ebola, through bodily fluids.
โI have seen the consequences in animal populations of airborne diseases and I just cannot contemplate that in a human population,โ he said.
โWe have to learn the lessons. There is no option. It is so frightening if we donโt learn the lessons. I will keep going and ensure that whether itโs the Department for International Development in London or anywhere else, itโs something we donโt let drop.โ
We got off lightly on Ebola as a global community and we couldnโt even respond properly to that
Donal Brown
Brown welcomed David Cameronโs announcement of the creation of a team of โdisease detectivesโ โ epidemiologists and infection control specialists who would be ready to deploy in response to outbreaks โ but said the challenges of epidemics could not be met by technology alone.
โThe UK and the international community can bring all the weapons โ the labs and the treatment centres โ but weโre foreigners,โ he said.
โWe can support you, but we canโt change behaviours. We donโt even understand the subtleties of your culture. I think people underestimate just how difficult it is. You canโt just press a button and change behaviour. You canโt just sign a cheque and change behaviour. Itโs about person-to-person engagement. Itโs about verbal communication.โ
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Brown pointed to Sierra Leone, which reported 15 cases of Ebola in the week ending 7 June, saying such flare-ups were inevitable because of secret burials โ โwhich have been just a nightmareโ โ and the reliance on traditional herbalists.
โItโs all about behaviour change and cultural practices,โ he said. โPeople still go to herbalists โ and you canโt blame them, because in the UK youโll get people going to herbalists or to alternative medicine when itโs clear that it has its place but it certainly wonโt cure certain things. In a quite uneducated, poor population, itโs even harder to change that behaviour.โ
Equally difficult, if equally understandable, said Brown, was the complacency resulting from peopleโs desire to reclaim their lives and routines.
โThatโs what this is all about, complacency from everybody โ government, population and so on โ because people are so fed up with Ebola they just want a normal life,โ he said.
โThey want their school to function properly, they want to be able to go to shops and restaurants and so on. So you get the complacency and then you get people who still go on with traditional practices, which just fuel it each time.โ
Despite the new cases, Brown said he was reassured to note that the Western Area of Sierra Leone โ which includes the capital, Freetown โ had just recorded its first week without a single case of Ebola.
โWhen I left in February, we were down to just under 50 cases a week from 500 cases a week in mid-November and we all agreed that this was going to be a long, bumpy tail,โ he said.
โWe canโt be complacent but I wouldnโt say Iโm unduly worried because itโs gone up from 10 to 15 each week. If you look at it, itโs gone up a bit and down a bit. It hasnโt gone up massively.โ
But Brown added there was still more to be done to make sure more cases were recorded on contact lists to minimise infection and on tackling the disease in Guinea and shoring up its border with Sierra Leone.
โWe know thereโs a lot of movement across that border and we know itโs going to be very difficult to totally eradicate Ebola in Sierra Leone until you get on top of it in Guinea,โ he said.
Brown, who was awarded a CBE for services to international development in the Queenโs birthday honours list, said he hoped that humanitarian and health agencies would learn to work better together in the wake of Ebola and in the run-up to next yearโs world humanitarian summit.
โOne of the key things we need to do is not only ensure that the lessons are learned around WHO, but itโs equally important that lessons are learned about why the humanitarian response could have been better,โ he said.
LONDON GUARDIAN
