(task) Nigerian virologist delivers scathing analysis of Africa's response to Ebola | Science/AAAS | News

GRS Africa RSs and RI

4 cover

Ebola

http://news.sciencemag.org/africa/2014/11/nigerian-virologist-delivers-scathing-analysis-africas-response-ebola

Nigerian virologist delivers scathing analysis of Africa's response to Ebola

VIENNA—After Oyewale Tomori finished his talk on Ebola here at the International Meeting on Emerging Diseases and Surveillance, there was stunned silence. Tomori, the president of the Nigerian Academy of Science, used his plenary to deliver a scathing critique of how African countries have handled the threat of Ebola and how corruption is hampering efforts to improve health. Aid money often simply disappears, Tomori charged, "and we are left underdeveloped, totally and completely unprepared to tackle emerging pathogens."

Trained as a veterinarian, Tomori was the World Health Organization’s (WHO's) regional virologist for the African region in 1995 during the Ebola outbreak in Kikwit in the Democratic Republic of the Congo (DRC). ScienceInsider sat down with him at the meeting in Vienna; questions and answers have been edited for brevity and clarity.

Q: You said in your talk that Ebola was "swimming in an ocean of national apathy, denial, and unpreparedness.” What did you mean?

A: We were totally unprepared. After the first cases occurred in West Africa, it took almost 3 months for WHO to know. When the first patient came to Sierra Leone and died, his son brought him back to Guinea and as far as Sierra Leone was concerned, it was Guinea’s problem. People abandoned their duty, they denied the problem, and when it became a big problem they became incapable of handling it.

This is not the first time Ebola has appeared in Africa. There have been more than 20 outbreaks since 1976. Not one of them has been declared a global problem. Of course, circumstances are different this time. But if we had been prepared, if we had learned from the past, we wouldn’t be where we are today.

Q: You seem angry.

A: Yes, I am, because I know Africa has the capacity and the capability to solve most of her problems, but Africa will not enable her human resources to perform effectively and efficiently. African leaders have little or no respect for their experts and would rather act on advice from external sources. In the end, they become the experts on Africa’s problems, not the Africans. This is why I am angry with Africa.

We have seen so many Ebola cases before, in the DRC, in Sudan, in Gabon. … Ebola is Africa’s problem. We should have put something in place. I remember in 1995, when we had the Kikwit epidemic, at the end we sat down at a table and discussed what we should do. There was a laboratory in Kinshasa built by the French; it was almost completed, but then abandoned. We had raised almost $2 million at the time. And we said: "Why not take a bit of that money and complete this lab and maintain it? Then at least when we have issues like this we can do quick testing." But nothing happened. The carcass is still there. Each time I pass the place, I think: "What a waste."

Q: But your own country seems to have been prepared. Nigeria managed to contain the virus after it was carried to Lagos by a traveler in July. There were only 19 infections, and WHO called the containment of the virus "a spectacular success story."

A: We were not prepared, we were lucky. Patrick Sawyer was already sick when he arrived, so he went straight to the hospital. And because our doctors were on strike, the public hospitals were not open, so he went to a private hospital. If Sawyer had gone into a public hospital, we would have had a bigger problem.

But within 2 to 3 days of Sawyer coming in, we knew it was Ebola from laboratory tests done in two of our university laboratories, and then action was taken. I praise Nigeria for that. We had this emergency center from the polio network and we brought people in and traced almost 1000 contacts. This was not passive tracing; people went to contacts' homes on a daily basis.

Q: So why are African countries so badly prepared? Is it a question of money?

A: People say African countries are poor. But it’s not poverty. It’s misuse of what we have. As we are talking, with all the crises that are going on, the presidents of our countries are still traveling in the best of conditions. Some will come to New York in their private jets, although their national airlines collapsed years ago; in addition, they will bring along a long retinue of private, personal, and public assistants, all lodged in the best hotels. I am not saying the president should not be treated well, but these are issues we need to look at.

Take my country: We do not have a national airline, but the number of private jets we have is more than all the airlines in Africa have together.

It’s a matter of priorities. I do not believe there is an African country that cannot buy gloves for its staff. Personal protective equipment may be very costly, they may need assistance on that. But let us participate. As long as we are wringing hands waiting for the next glove to come, we will never be ready. There are certain things we can do now, with the resources we have.

Q: So African leaders should be held more accountable for what they spend money on?

A: GAVI [a public-private partnership that funds vaccines for low-income countries] just sanctioned Nigeria after a critical audit report. GAVI gave us money to do certain things, and we could not account for $2 million or $3 million of it. GAVI insisted that Nigeria must pay back that money, and the government agreed. But our government should not just agree to pay back the money, the government should find out who misused the money, get the money back from those persons and not from public coffers. And those people should be brought before the courts to answer for the deaths of the children who did not receive the vaccines that the GAVI money would have provided.

Q: So how should African countries contribute to fighting the Ebola outbreak?

A: To give you one example, there are 600 Nigerian health care workers who want to go to Liberia. But the process of getting them there has been going on for months. If the African team, the African Union, the Economic Community of West African States, and the West African Health Organisation all get their acts together, there are more than enough people in Africa—health care workers from Gabon, DRC, Uganda, Sudan—who have experience with this.

But we must find the funds to provide insurance for all national and international health workers who are currently working or have volunteered to work in the Ebola-affected areas of Africa. Bear in mind, in Africa we do not have a welfare system. I am the welfare system for my family, my brothers, my uncle. So when I go to an Ebola region, I am thinking of the 23 other people that depend on me. If there is no insurance, I will stay home.

Q: There has been a lot of criticism of the WHO regional office in Africa.

A: I am angry at them, too. They should take the lead of Ebola control efforts—not Geneva, not Washington, not New York. The [Centers for Disease Control and Prevention] can help, [Doctors Without Borders] can assist, but it is WHO's African region that should coordinate and take the lead. It’s all meetings and reports. Nothing on the ground.

Q: As it happens, they are meeting in Benin this week; on the agenda is the election of a new regional director.

A: These elections are just horse-trading. If the person who wants to get elected requires the vote from Nigeria for example, because it is the ministers of health who do the voting, I might say: "OK, I will vote for you, but I need one directorship from my country.” If he accepts that, he has to accept whoever I bring, regardless of how competent the person is. That is what has messed up Africa. WHO's regional office has never been able to solve Africa’s problems because of this system of electing its leaders.

You want to find the most competent person. Vote on that basis. Not because I visited you and I promised you this or that.

Q: Do you think this unprecedented outbreak will change things?

A: I wish I could say with confidence that in 10 years’ time we will not be where we are now with Ebola. But the countries have totally lost control of what is going on. If you go to Sierra Leone or Liberia today, there must be at least 10 international groups there. At the end of this epidemic, everybody will pack their bags and leave. The African countries will be left not really knowing what has happened to them. Like someone hit them smack in the face, totally disoriented. There will be millions of scandals about how money was misspent and so on. We will focus on those and move on. Ten years from now, people will have forgotten that there was Ebola and we will be back to where we started.

*The Ebola Files: Given the current Ebola outbreak, unprecedented in terms of number of people killed and rapid geographic spread, Science and Science Translational Medicine have made a collection of research and news articles on the viral disease freely available to researchers and the general public.