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Building the human capacity to deal with Ebola: How can we prevent future disease outbreaks?
November / December 2014 | Volume 13, Issue 6
Opinion by Fogarty Director Dr Roger I Glass
It has been heartbreaking to see the images and learn of the horrific details emerging from the Ebola outbreak in West Africa, where the health systems are fragile and medical research capacity is lacking. With health care workers on the front lines, many have become infected themselves. Liberia has lost 96 already, according to a recent Washington Post op-ed by that country's leader, President Ellen Johnson Sirleaf. "This is a huge hit for a country that had barely 50 doctors to care for a population of 4.4 million at the start of this outbreak," she observed.
In the 24 previous occurrences of Ebola, the virus was controlled early by rapid response, active surveillance and quarantine. This time, the outbreak is occurring in countries recovering from conflict, without the health infrastructure or quantity of trained personnel to effectively deal with the problem.
With health officials and care providers overwhelmed by the sheer number of people stricken by this terrible virus, it's no wonder that little attention is being given to studying the outbreak in any detail. There is barely time to count the dead. Without trained epidemiologists tracking the epidemic, studying its transmission, noting what care is provided, how many recover and how many succumb - we are losing the opportunity to learn vital information that could help us discover new and better ways to contain this or future outbreaks.
It is imperative that the international community provide Liberia, Sierra Leone and Guinea with not only the immediate assistance it so desperately needs, but also an investment in long-term capacity building to improve medical education, increase the quantity and quality of doctors and health care workers, and develop scientific expertise and disease surveillance skills.
As none other than smallpox veteran Dr. D. A. Henderson recently noted, it is distressing that there is still such an utter lack of epidemiological data - months after the alarm was sounded and the world began taking notice. As he pointed out, there is so much that can be learned from age distribution curves, intervals between dates of onset of patients in households, viral load and other information from lab tests and more.
It's just this kind of scientific capacity the NIH's Fogarty International Center has been working to develop in low- and middle-income countries for more than a quarter century. Four years ago, we began a partnership aimed at revitalizing African medical education. Known as the Medical Education Partnership Initiative (MEPI), the program is funded by the President's Emergency Plan for AIDS Relief (PEPFAR) and NIH, and is administered jointly by Fogarty and our sister agency, the Health Resources and Services Administration (HRSA).
With MEPI support, African medical schools are dramatically increasing enrollment, broadening curricula, upgrading Internet access and providing cutting-edge skills labs and other technologies. Where students used to fight to use shared text books, they are now each issued notebook computers loaded with the latest instructional materials and equipped to access current journal articles. The pace of change is astonishing and we hope will result in sustainable health improvements across the continent. Sadly, the countries hardest hit by Ebola did not submit successful proposals to receive MEPI awards. And yet we must join together to share information and resources to help them recover and move forward.
MEPI was envisioned by PEPFAR to address the terribly inadequate supply of health and medical personnel required to support health programs in sub-Saharan Africa, particularly around HIV/AIDS but extending to other medical needs as well. By investing in education in medicine and the allied health sciences, MEPI is building human capacity for health in Africa by strengthening the medical education system in an environment that values and nurtures research. Why do we see research as integral to this endeavor?
In the 1980s, the world was challenged by the emergence of a new virus - HIV - that was uniformly fatal and was to become most problematic in Africa. Since then, research discoveries have informed care and treatment so that a diagnosis of HIV/AIDS has been transformed from a death sentence to a manageable chronic illness. Much of this research has been conducted by African investigators working in African academic institutions at African field sites with African populations, often but not always in collaboration with academic colleagues in the U.S. This research has been truly game changing and could not have been conducted as quickly, carefully, or effectively without outstanding local scientific leadership and implementation of solutions. The results have included the development of rapid diagnostics for detecting and monitoring HIV infections, new drugs for treatment, and new strategies for prevention, such as avoiding mother-to-child transmission, voluntary medical male circumcision, and treatment as prevention.
MEPI has been built on the idea that outstanding academic institutions in the health sciences must be excellent in education, service and research. Research can play a key role in producing effective and sustainable leadership in health, the development of knowledge and practice for the delivery of care, and for building academic centers in sub-Saharan Africa. The research perspective provided to students and faculty, the ability to raise and answer questions, and the idea that medical knowledge and practice are continually changing are being supported by MEPI sites and will hopefully endure long after the program ends.
Finally, as bandwidth expands across Africa, it's vital we take advantage of the opportunities for online research collaborations, distance learning, mobile apps for data collection and analysis, telemedicine and other approaches that have the potential to revolutionize how we conduct research and training in low-resource settings. Some of these technologies are being deployed in the Ebola fight, which has been an encouraging sign, but much study is needed to find out how to effectively adapt these tools for the local environment and circumstances - and that will take resources.
A modest investment in health infrastructure - including training health care workers, doctors and researchers - could provide the tools countries like Liberia need to halt disease outbreaks in their tracks and prevent the need for large-scale emergency efforts like the one we're assembling to fight Ebola.
The U.N. is calling on the international community to provide $1 billion to stop this epidemic. I join Liberia's president in encouraging some funds be directed to strengthen medical education and research training in Western Africa to prevent a future disaster on this scale. In her words, "We owe it to the thousands of citizens and health workers who have so far lost their lives to be prepared."
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