The current outbreak of Ebola hemorrhagic fever has captured the world’s attention for the past several months. Centered in West Africa (with a few isolated cases in the United States and Europe), this ongoing crisis has been deemed a “public health emergency of international concern” as well as a global security threat. As national governments and international bodies struggle to contain this outbreak, a number of issues have come to the fore – which include global and national governance, health systems strengthening, public health preparedness – and more fundamentally, questions of ethics, human rights, and social justice.
To respond to some of these questions, the O’Neill Institute for National and Global Health Law at Georgetown University, the Kennedy Institute of Ethics, and Georgetown University Law Library are pleased to announce the launch of “The Ebola Outbreak: A Global Conversation and Resources.”
This university-wide resource on the current Ebola Outbreak highlights the expertise across all campuses within Georgetown University to inform and assist our university community, members of the interested public, and those working to contain, treat, and prevent Ebola.
Georgetown faculty are exploring the impact and implications of the crisis from various perspectives, including infectious disease control, global health law, national security, human rights, epidemiology, and public health preparedness. Read More
Posted in FDA, Global Health, Health reform, Human Rights, National Healthcare, Resources, Trade, WHO; Tagged: Ebola, global health, human rights, IHR, infectious disease, law, O'Neill Institute, public health, WHO.
Time and again, the global community finds a way to express its collective view – the view of the powers-that-be – that some members of our community are worth less than others, that lofty rhetoric and human rights law to the contrary, your life means less to the world if you are poor. And so we see it again in the response to Ebola.
I refer to policies on medical evacuations of Ebola patients from West Africa. Foreigners who are infected are evacuated to their home country, where they have an enhanced chance of surviving. Citizens of Liberia, Sierra Leone, and Guinea, though, have no such lifeline. Medical evacuation is not an option even if there is no bed for them in a treatment center, and they are to be sent back to their community, more likely than not to perish. Home they will go, to communities where they will be shunned, and where lack of isolation means that they may further spread the virus, contributing to the exponentially growing number of deaths and infections in Liberia and Sierra Leone, the hardest hit countries.
The possibility of medical evacuation of West Africans does not appear to be receiving serious consideration. Even as the United Nations has, to its credit, recently stepped in to fill a leadership gap, its September 16 overview of requirements to confront the epidemic includes medical evacuations as among the non-financial needs, but explicitly for international staff. Likewise, the UN Security Council includes the need for medical evacuation facilities in a section of its September 18 resolution that is about international medical and humanitarian relief workers.
I find it hard not to conjure up images of Western troops swooping into Rwanda in 1994 to rescue their nationals, leaving behind the Rwandans who were their friends and co-workers, who were seeking shelter in the same places, and who left behind had little chance of escaping the ongoing genocidal slaughter.
Yet particularly for a world that was devastatingly slow to respond, and with the number of new infections in Liberia and Sierra Leone continuing to rise quickly, medical evacuation of citizens from those two countries, and if needed those of other countries in the region, deserves serious consideration – and I would say, action. There are at least four reasons; you, the reader, might think of more. Here they are:
The author wrote this post in collaboration with Lawrence O. Gostin, Faculty Director, O’Neill Institute for National and Global Health Law.
On September 30, 2014, the Centers for Disease Control and Prevention (CDC) announced the first diagnosis of Ebola made in the United States (previous US cases were medical evacuees, who were already known to be infected). The patient, Thomas Eric Duncan, had traveled from Monrovia, Liberia to Dallas, TX to visit family.
On Mr. Duncan’s first visit to a hospital emergency room, he was advised to return home after being diagnosed with a “low-grade, common viral disease”—despite informing a nurse of his recent presence in West Africa. After two symptomatic (and thus contagious) days in public, he returned to the emergency room after his symptoms worsened. Here, finally, the hospital recognized his possible Ebola infection and isolated him. It seems likely that his infection was contracted while helping transport an Ebola-infected woman in Liberia to and from a hospital.
This post originally appeared in TIME on October 1, 2014. Professor Peter Piot is Director of the London School of Hygiene & Tropical Medicine, and former Executive Director of UNAIDS and Under Secretary-General of the United Nations. He co-discovered Ebola in 1976. The text is re-posted here, in part, with the permission of the author. The full text can be found here.
The international community took too long to react to the outbreak. We must now put in place mechanisms to handle better the next inevitable epidemic.
The news from Dallas that the first Ebola case outside of Africa has been diagnosed on U.S. soil is a stark reminder that epidemics on the other side of the world are a threat to us all. No epidemic is just local.
As long as this still expanding Ebola epidemic in West Africa continues, there is a constant source for it to spread to other countries – in the first place to neighboring African countries. This outbreak is the largest and longest ever, with 7,157 cases and 3,330 deaths so far. It is the first outbreak that involves multiple and entire countries, and the first one that affects capital cities.
With increasing global mobility, it was always possible that someone traveling from an infected country would be carrying this deadly virus with them, and it will happen again. Fortunately, the U.S. and other high income countries have robust infection control measures and clinical practices to stop the onward spread of the virus within the country. Health services are well equipped to isolate the patient, to trace everyone he has been in contact with, and to put those contacts under surveillance for signs of fever. Health workers need to be alert for anyone with early symptoms of Ebola by always asking about people’s travel history (which is good practice any way). The risk to citizens is extremely small. Read More
On November 4, many Americans will go to the polls to vote in the midterm elections. And like all election seasons, issues threatening public health are chief among this nation’s top concerns.
In researching for this post, I came up with a fairly long “short-list” of pressing public health issues – women’s health and contraception, states that have not expanded Medicaid, food insecurity, domestic violence, immigration, climate change, tobacco control – to name a few. Each of these issues is socially and politically complicated, nuanced, and frankly not new. We will be fighting these issues this year, in four years and sadly in eight and twelve.
Posted in FDA, Health reform, National Healthcare, Uncategorized, Updates; Tagged: Antibiotic resistance, Campaign on Human Health and Industrial Farming, Eric Lander, Everytown for Gun Safety, Gun Safety, Mary Woolley, Presidential Advisory Council, Research!America.
This post was written by O’Neill Institute Law Fellows Sarah Roache and Daniel Hougendobler
The West African Ebola epidemic is an international public health crisis, and a threat to international security. For so many of us – the public health community, humanitarian and aid organizations, governments, ethicists, policy-makers, and engaged citizens – the epidemic triggers important and complex questions.
Why, for example, is this epidemic spreading at exponential rates, while more than 20 previous outbreaks subsided with relatively few deaths? Why did the international community take so long to ramp up its response, and are we doing enough to contain the epidemic? How can we quickly improve the level of care available to those who are infected? How do we build trust in medical personnel among people who believe that Ebola does not exist? How can we prevent future infectious disease outbreaks from becoming endemic?
This post was written by Eric A. Friedman, O’Neill Institute Associate, Lawrence O. Gostin, O’Neill Institute Faculty Director, Sarah Roache, O’Neill Institute Law Fellow and Daniel Hougendobler, O’Neill Institute Law Fellow. For questions or comments about this post please contact Lawrence Gostin at firstname.lastname@example.org.
Yesterday, on the same day that the United Nations issued an appeal for nearly $1 billion to control Ebola, President Obama announced several new U.S. measures in the global fight, focusing on the worst-hit country, Liberia. The President’s pledge is commendable, encompassing perhaps the first major military deployment to stem an ongoing epidemic. The U.S. military is uniquely positioned to provide sorely needed logistical support and engineering know-how, with troops well trained in dealing with the risks of hemorrhagic fevers. But even with a surge response by the U.S., global efforts are still wholly incommensurate with the enormity of the needs on the ground.
A new study – Prevalence and impacts of genetically engineered feedstuffs on livestock populations – published last week has brought more evidence to the forefront on the safety profile of genetically modified food (aka GMO).
Transgenic GMO agriculture was first authorized for use in the United States in 1996. Genetic modification of food through the use of artificial selection has been part of agriculture since agriculture started centuries ago. However, since 1996 there’s been a consistent allegation that GMO food is unhealthy for a variety of reasons, primarily stemming from concerns regarding pesticide usage. While I won’t discuss it here, it’s important to remember that pesticides were used before GMO and continue to be used in both GMO and organic farming today.
The authors of this study have taken a novel approach to evaluating whether GMO foods have any negative health effects. Whilst referring to the literally hundreds of safety studies that have been done on transgenic GMO crops since their introduction, the authors looked at the health outcomes of animals raised through the meat and dairy industry. Data on livestock health and productivity have been kept by the USDA since at least 1983 and the authors have compared the data relating to the more than 100 billion animals that have been raised in the United States since the introduction of GMO foods (the primary consumers of GMO foods) to the data on animals raised prior to the introduction of GMO to determine whether there’s been any discernible change in the health of the animals. The results are below:
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This post was written by Lawrence O. Gostin, Faculty Director, O’Neill Institute for National and Global Health Law, and Sarah Roache, Law Fellow, O’Neill Institute for National and Global Health Law. For more information or questions about this post, please contact Sarah Roache at email@example.com.
The West African Ebola epidemic has become a national and global security threat, with Médecins Sans Frontières (MSF) calling for an international military mobilization. An entire region is facing not only a health crisis, but also a humanitarian and security crisis. The epidemic has severely disrupted essential goods and services such as food, clean water, and basic healthcare; travel, trade, and commerce; and peace and security. Ultimately, we believe the United Nations Security Council should authorize international peacekeeping troops to provide security for health workers and facilities; logistical support for essential health facilities and equipment; and a disciplined chain of command—answering the much asked question on the ground: who is in charge?
343. For many Americans, that number will always be shorthand for heroism and sacrifice, for risking your own life to save others. It is the number of firefighters who died in the September 11 attack on the World Trade Center, among the 414 emergency workers killed that day. (The actual toll due to increased levels of cancer and respiratory illnesses among first responders is higher.)
134. That number, almost sure to grow, represents the health workers in Liberia, Sierra Leone, Guinea, and Nigeria who have fallen victim so far to Ebola during the present West African outbreak.
The firefighters of September 11, the health workers on the frontline of Ebola, both have placed the lives of others above their own, risking all to carry out the life-saving responsibilities of their chosen professions. A New York Times article details the tragedy, resilience, and heroism of workers at one government hospital in Sierra Leone, which lost 22 health workers to Ebola. Fifteen nurses died there, most early in the outbreak when they lacked the full body personal protective equipment that health workers treating people with Ebola require. We are reminded, too, of the commitment of often forgotten members of health teams, such as cleaners at high risk of coming into contact with body fluids of Ebola victims, drivers who bring Ebola victims to the hospital, and people who handle the bodies of those who have succumbed to the virus.
Josephine Finda Sellu, the hospital’s deputy nurse matron, is one of only three nurses who were at the hospital at the start of the Ebola outbreak and have managed to avoid infection. She captures the courage of so many health workers who have remained at their posts despite the immense risk: “You have no options. You have to go and save others. You are seeing your colleagues dying, and you still go and work.”
After September 11, New York City took steps to create a safer future for NYC firefighters, giving them and other emergency workers a greater chance of surviving a future disaster by improving the NY Fire Department communications systems, including better integration with the police and other emergency services.
What will be the legacy of Ebola? Will the legacy be akin to that of September 11, with focused, important steps – such as the improved communication systems – but with a broader legacy of missed opportunity and even misdirected responses? Read More
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The views reflected in this blog are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.