Lessons from the Ebola epidemic: The key to ending Covid-19.
"Too many lives were lost. Countless families, communities, and nations were devastated… Our tireless efforts have been successful, but the final mile is always the hardest."
In an article published in the Los Angeles Times on September 29, authors David Heymann, Ashish Jha, and Edward Kelley quoted this statement made by UN Secretary-General Ban Ki-moon in April 2015 to world leaders regarding the crisis.Ebola outbreakin West Africa.
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| Medical staff wearing protective gear begin their shift at an Ebola treatment center in Beni, Congo, in July 2019. Photo: AP |
The authors further pointed out that, at the conference...Covid-19Last week, when President Joe Biden and his team asked heads of state and industry leaders to make renewed commitments to end the Covid-19 pandemic, they seemed to have forgotten the very issue that Ban Ki-moon raised six years ago: the final mile.
According to the analysis of three experts, the context of the two meetings is relatively different. In 2015, the question of how to strengthen the healthcare system was a focus from the outset when the pandemic broke out in several countries. That outbreak, although deadly, was short-lived. Today, the whole world is still battling Covid-19 nearly two years after the pandemic began, spreading and claiming the lives of more than 65,000 people every week.
Progress in the fight against Covid-19 has been limited, as only 2% of people in the developing world have been vaccinated against the SARS-CoV-2 virus. Most health systems have been stretched to their limits. UNICEF and the World Health Organization (WHO) say that disruptions to routine immunizations have caused 23 million children to miss standard vaccinations in 2020-2021, the highest number in a decade.
All of the above means that much of the work to address this pandemic is still ahead. Therefore, decisive and urgent action is needed to fulfill commitments regarding billions of vaccine doses, life-saving therapies and oxygen, and mechanisms to be implemented globally to better prepare for the future.
But one crucial element was left unaddressed in last week's summit goals: How will we actually vaccinate, save lives, and improve readiness to reach the billions of people who still lack access to effective healthcare systems?
Regarding global immunization, current priorities include distributing 2.4 billion vaccine doses to the developing world by the end of 2021 to reach 40% vaccination coverage. Every day, global partners strive to create hope with images of vaccines on airport runways. However, to date, only five countries have delivered 70% of this target.
COVAX, the global coordinated vaccine sharing mechanism, had to cut its plans by 30% in September. The WHO stated that more than a third of African countries are experiencing significant gaps in vaccine distribution capacity down to the district level, due to disruptions in "last-mile" distribution systems, as the UN Secretary-General referenced when discussing the 2015 Ebola outbreak.
More notably, we lack sufficient syringes for global vaccination. Current estimates indicate a global shortage of at least 5 billion syringes for the Covid-19 vaccination campaign. In 1999, a joint policy by the WHO, UNICEF, and the United Nations Population Fund called on all partners to fund "not only vaccines but also safe vaccine administration."
What is concerning is that most of the current aid to countries does not include syringes. Experts estimate that if this gap is not filled, we could see 2-3 million deaths from infections caused by the reuse of syringes.
Shifting the focus back to the goal of "saving lives" is also crucial. To date, solutions have primarily focused on purchasing equipment rather than on developing frontline healthcare and vaccination teams. What is needed now is to train and deploy frontline healthcare workers, finding ways for community health workers to be more actively involved in vaccination efforts, while medical personnel focus on COVID-19.
Meanwhile, efforts to rebuild disrupted systems have only just begun. Debates, which began at the World Health Assembly (WHA) last spring, will continue to rage after this meeting. So far, the most contentious topic is how to scale up production.
Once again, we are focusing only on the "first mile" issues and ignoring questions about how countries can actually manage the end of the vaccine supply chain—filling, completing, and safely distributing vaccines to the population.
In March 2015, countries made a commitment that was supposed to help create a world free from another Ebola outbreak. However, this did not live up to expectations because people forgot the most important part: the final stretch.
And the international community cannot allow the commitments of the recent conference to fall into the same trap, according to the three authors of the article.
David Heymann is a professor of infectious disease epidemiology at the London School of Hygiene & Tropical Medicine. Ashish Jha is the head of the Brown University School of Public Health. Edward Kelley is the global chief medical officer of ApiJect Systems Corp., a company specializing in injectable medicines.