Keeping Ebola away from Asia: Lessons from SARS

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Keeping Ebola away from Asia: Lessons from SARS
Gianna Gayle Herrera Amul, Mely Caballero-Anthony
RSIS


A man from East Asia wears a protective face mask while on the Hajj pilgrimage in Mecca, Saudi Arabia, last month

Even with the current cooperative mechanisms in place, the region cannot let its guard down against this grave threat to global health security

BANGKOK: -- With the Ebola epidemic in West Africa showing no signs of being effectively contained, and the latest news of a healthcare worker infected with the Ebola virus in the United States, prospects of the deadly disease hitting Asia can no longer be excluded. Anthony Banbury, chief of the United Nations' emergency Ebola mission has warned that the Ebola virus is "far ahead of us and every day the situation gets worse". Against this scenario, how can Asia prepare itself?

In 2013, East Asian states through the Asean+3 framework (including China, Japan and South Korea) committed to use cooperative mechanisms to improve disease surveillance and to boost pandemic preparedness and response in the region. Lessons from the SARs outbreak in 2003 had prompted countries in East Asia to establish this regional framework for combating highly infectious pandemic outbreak. While the response is more than timely under the threat of Ebola, further commitments and actions - increased financing, vigilance in disease surveillance and using mobile health infrastructure - are critical steps to prevent an Ebola outbreak in the region. Moreover, East Asia's contribution to boost the supply of qualified health workers in West Africa can go a long way in checking the spread of the Ebola epidemic beyond West Africa.

Critical global response

The Ebola virus has already killed about 4,000 people in West Africa since its outbreak this year. With the alarming rate of infection, the UN has called for a twentyfold increase in global epidemic response. Despite complaints of a belated global response - the WHO declared Ebola to be an international public health emergency only in August - several countries have now come forward to provide much needed financial assistance to affected countries in Africa.

The US tops the list of contributing countries with $168 million, followed by the United Kingdom and Germany at $19 million and $15.3 million respectively. Most recently, the IMF fast-tracked $130 million aid to fight the Ebola epidemic while the World Bank has contributed $105 million.

While financial assistance is critical, West African leaders and humanitarian workers on the ground have also urgently called for more assistance from qualified and trained health workers to be deployed in the affected areas to stem further infections. So far, East Asian countries have responded to the call for help.

The Philippines recently announced plans to deploy a substantial number of its health workers in West Africa, while Malaysia has pledged to send more than 20 million medical gloves. Japan has already given about $2 million to the WHO, Unicef and the Red Cross and Red Crescent since April and further pledged to provide personal protective equipment and laboratory experts. Meanwhile, China has sent two medical teams, mobile laboratories, around 170 health workers and more than $5 million in humanitarian aid.

Fast spread

With a fast-spreading Ebola, more can be done to combat the disease. The Ebola virus has evolved since its first outbreak in Central Africa in the 1970s. While transmission used to be limited to forested, remote and rural areas in West Africa, the latest outbreaks are now seen in urban areas. The rapid rate of infection has been caused by the weak and ineffective health systems in these countries. Since Ebola has similar symptoms to malaria, typhoid fever and meningitis, effective diagnosis has proven to be a tough challenge.

The Ebola outbreak has also seen an alarming feature of health workers at high risk of infection. So far, the WHO has reported 233 deaths of health workers while caring for Ebola-infected patients.

The health crisis is also proving to be very costly for less developed regions. With the WHO projecting Ebola infections to escalate to 20,000 over the next month, the World Bank estimates that the epidemic could financially cripple West Africa with $32.6 billion in losses by the end of 2015. The SARS outbreak caused East Asia $20 billion in economic losses.

How prepared is the region?

East Asia has always been susceptible to infectious diseases. But with Asean playing a central role, the region could hopefully put up a strong defence given existing regional frameworks and the lessons from SARS and combating outbreaks of avian flu. With its experience with SARS and bird flu, East Asia is more prepared than other regions to respond to a possible pandemic thanks mechanisms of surveillance and transparency already in place, the WHO notes.

One such mechanism is the Asean+3 regional disease surveillance mechanism which has a protocol for communication and information sharing on diseases that encourages member states to report all cases categorised as international public health emergencies.

Another Asean mechanism is the Regional Multi-Sectoral Pandemic Preparedness Strategic Framework. The framework combines collaborative pandemic preparedness with multilevel disaster management leveraging on the central role of the Asean Coordinating Centre for Humanitarian Assistance (AHA Centre).

In addition, the expertise in joint disease surveillance and clinical management of Asean's Field Epidemiology Training Network (FETN) can be utilised to conduct epidemiological studies and to share treatment protocols to comply with the Asean Minimum Standards on Joint Multi-sectoral Outbreak Investigation and Response. This framework has started discussions on the appropriate mechanisms to prevent and control Ebola.

In terms of transparency, timely information sharing and capacity building, another mechanism is the Asean Risk Communication Resource Centre (RCRC) which aims to support efforts in managing health emergencies.

Increased cooperation on emerging public health concerns is further under way. Last September, the 12th Asean Health Ministers' Meeting issued a joint statement with China to increase health workers' capacity and to prevent newly emerging infectious diseases including Ebola, H7N9, H5N1 and MERS-CoV.

Despite the WHO's pronouncement, East Asian countries cannot let their guard down. With more uncertainty confronting global health security, increased vigilance, stepped up efforts in surveillance and transparency, as well as heightened public awareness should always be the order of the day for the region.

Mely Caballero-Anthony is Associate Professor and head of the Centre for Non-Traditional Security (NTS) Studies, S Rajaratnam School of International Studies, Singapore. Gianna Gayle Herrera Amul is senior analyst with the RSIS Centre for NTS Studies.

Source: http://www.nationmultimedia.com/opinion/Keeping-Ebola-away-from-Asia-Lessons-from-SARS-30245612.html


-- The Nation 2014-10-17

[chooka]

Thailand has nothing to worry about, they are the only country in the world with the vaccine and the cure.

[wackybacky]

It will spread across Africa and before you know it, it will hit India and then Asia is a time bomb.

[asdecas]

It will spread across Africa and before you know it, it will hit India and then Asia is a time bomb.

In what other areas of epidemiology are you an expert?

[richusa]

Just keep away from Soi Africa.........Sukhumvit 1-25. What are they doing here anyways.

[KIWIBATCH]

...I would hazard a guess and say that someone with Ebola is already in Thailand.........

[RisingSun]

...I would hazard a guess and say that someone with Ebola is already in Thailand.........

Then he/she would have been in a care center and so must have infected others...don't you think your clueless guess is hazardous...

[RisingSun]

Just keep away from Soi Africa.........Sukhumvit 1-25. What are they doing here anyways.

...do you mean what you've just posted or...you don't understand what your finger(s) just typed?

[BKKBrit]

A good read to educate ourselves - http://news.nationalgeographic.com/news/2014/10/141015-ebola-virus-outbreak-pandemic-zoonotic-contagion/

There was also a virus specialist on BBC last week explaining that Ebola will mutate given that it function to spread becomes useless if the host dies rapidly. But school of thought on whether it can become airborne over time, is still out. No one can say for sure.

[mok199]

i like the idea of ''wyeing''instead of shaking hands,but...but...i have a new born and i have become very unpopular in my neibour hood telling thais they cant ''touch my child''it alomst came to blows a few weeks ago,as a stranger tried to lift my child out if his stroller...who needs thaifriends anyhow??.sawadee no (crap)..

[rickirs]

<script type='text/javascript'>window.mod_pagespeed_start = Number(new Date());</script>

A good read to educate ourselves - http://news.nationalgeographic.com/news/2014/10/141015-ebola-virus-outbreak-pandemic-zoonotic-contagion/

There was also a virus specialist on BBC last week explaining that Ebola will mutate given that it function to spread becomes useless if the host dies rapidly. But school of thought on whether it can become airborne over time, is still out. No one can say for sure.

If ebola hasn't mutated since the 1970's it is reasonable to expect that today it will not mutate to an airborne disease. Of course it's not to say that a nation could weaponize the disease into a vapor as a WMD. But the problem even with that is any test area would be as contaminated as radiation from a nuclear fallout.

[rickirs]

No where in the article is there any mention of any physical protocol procedures that will be implemented to detect ebola and treat infected people entering the country legally or illegally, whether by foot, rail, sea, car, bus, or air. Like the Junta's plan to deal with the Southern Malay-Thai insurgents, the plans are all about fluff with no substantive actions.

As we've seen from the Texas Hospital in the USA, a power point and You Tube video on ebola didn't contribute to actual detection and prevention of ebola infection. What does Thailand hospitals have to offer with regard to exposure controls, personal safety for caregivers, handling & storage of contaminated materials and human solid and liquid wastes?

Maybe the decline in tourism now is a gift in disguise.

[phantomfiddler]

It will spread across Africa and before you know it, it will hit India and then Asia is a time bomb.

In what other areas of epidemiology are you an expert?

Asdecas, have you no knowledge of mathematical probabilities ? Wackybacky is right on track and it is not a case of if but when, and in places like Bangkok where everyone is living in crowded conditions the results are going to be very VERY bad.

[h90]

i like the idea of ''wyeing''instead of shaking hands,but...but...i have a new born and i have become very unpopular in my neibour hood telling thais they cant ''touch my child''it alomst came to blows a few weeks ago,as a stranger tried to lift my child out if his stroller...who needs thaifriends anyhow??.sawadee no (crap)..

You are a paranoid.....friendly people won't infect your child and some "infections" are needed for the human body to work normal. If you grow up 100 % clean you get a weak immune system and a very high chance of allergics.

The farmer kids from the farmer with 10 kids, playing in the dirt with the animals are usually the most healthy....

[h90]

It will spread across Africa and before you know it, it will hit India and then Asia is a time bomb.

May or may not. These super dense populated cities in India might be a big risk.

[h90]

<script type='text/javascript'>window.mod_pagespeed_start = Number(new Date());</script>

A good read to educate ourselves - http://news.nationalgeographic.com/news/2014/10/141015-ebola-virus-outbreak-pandemic-zoonotic-contagion/

There was also a virus specialist on BBC last week explaining that Ebola will mutate given that it function to spread becomes useless if the host dies rapidly. But school of thought on whether it can become airborne over time, is still out. No one can say for sure.

If ebola hasn't mutated since the 1970's it is reasonable to expect that today it will not mutate to an airborne disease. Of course it's not to say that a nation could weaponize the disease into a vapor as a WMD. But the problem even with that is any test area would be as contaminated as radiation from a nuclear fallout.

No it is not reasonable to expect it. It could do it tomorrow or it could do it never. The reasonable thing is to assume it will mutate, and after it did not be happy that you are paranoid but alive. Instead of trusting but dead.

Most probably it won't mutate. But you wear the safety belt in the car even you most probably don't have an accident.....

[bendywire]

Just keep away from Soi Africa.........Sukhumvit 1-25. What are they doing here anyways.

And what are you doing here?

[Johpa]

There was also a virus specialist on BBC last week explaining that Ebola will mutate given that it function to spread becomes useless if the host dies rapidly. But school of thought on whether it can become airborne over time, is still out. No one can say for sure.

Given the ease at which the virus is currently spreading, I don't see any pressure for natural selection to prefer a mutation that adopts a slower more benign course for the virus. The virus is not depleting the host population so quickly that there is a lack of new hosts.

And the odds of the several random mutations that would cause the disease to become "airborne" is very, very small. Most successful single mutations cause but small changes at the protein level and allow the virus to better hide from the immune system. Ebola is a hemorrhagic fever, it targets cells within the circulatory system and not cells within the lungs as does influenza, the most common "airborne" virus. There is of course nothing to prevent a series of random mutations from allowing Ebola to target the lungs, but statistically we are far more likely to see the virus mutate to a less virulent form over time (decades) than to alter its life cycle.