IN terms of disease-control targeting priorities, infectious diseases top the agenda for all developing countries. As a developing country, Pakistan’s public health challenges include dealing with malaria, tuberculosis, measles, diarrhoea and even polio. Given our history of infectious diseases, Pakistan should be doing all it can to prevent any single importation of the Ebola virus turning into a full-blown outbreak.

Unfortunately, that does not seem to be the case. We do not appear to have an Ebola focal person or a team responsible for coordinating Ebola preparedness activities which should include provision of personal protective equipment, practical training and standard operating procedures for quarantine and Ebola treatment units.

Inadequate infection control measures in our health systems, poor water and sanitation at the community level and the weak response capacity in our civilian administration structure that has minimal capacity in terms of first responders such as ambulances, trained paramedics, and coordination issues between law enforcement partners, make Ebola preparedness and response planning among the top public health issues for Pakistan.

The current outbreak in West Africa started in March 2014 with an outbreak in Guinea. In the same month Liberia reported cases of Ebola. By April of 2014 both these countries were reporting cases from multiple jurisdictions — an indication that this was no longer a single source outbreak. Genetic sequencing of viral isolates from cases showed a strong relation with earlier outbreaks in Gabon and the Democratic Republic of Congo.

Pakistan must implement national Ebola prevention and response strategies.

On May 26 and 29, Sierra Leone reported first and second Ebola outbreaks, respectively. On July 2014, a traveller from Liberia brought the virus to Lagos, Nigeria. The traveller died five days later, but by then many people had already been exposed to the virus in Nigeria. In total Nigeria reported 19 confirmed cases of Ebola: out of them 12 recovered and seven died. On Aug 8, the World Health Organisation (WHO) declared the current Ebola outbreak a public health emergency of international concern and advocated a coordinated international response.

In August, one case from Guinea was diagnosed with Ebola in Dakar, Senegal. The patient later died. No further cases from Senegal have been reported since then. On Oct 23, Mali reported its first confirmed Ebola case; over 80 contacts have been identified and are being followed up. In October, a Liberian travelled to the US; he was later diagnosed and died of Ebola complications. Two nurses treating the patient caught the infection but they recovered. WHO declared Nigeria and Senegal Ebola free after no cases were reported for 21 days.

Due to Ebola’s 50pc to 70pc fatality rate, international NGOs that come rushing during other types of humanitarian emergencies have not been able to assist the affected countries. Moreover, WHO and other UN agencies working in the health sector, which tend to have little operational capacity in general, will not be of much assistance beyond the provision of technical assistance on paper.

In fact, WHO, as the UN agency entrusted with the task of monitoring and responding to public health threats of global concern, is being heavily criticised. Firstly, for ignoring the Ebola outbreak in West Africa during the early stages; secondly, for underestimating the impact of the outbreak in terms of the number of infectious cases and fatalities in WHO published projections — which of course turned out to be inaccurate; and finally, for failing to plan and coordinate international Ebola response measures in a timely manner.

It is, therefore, highly pertinent that Pakistan’s ministry of national health services and all the provincial departments of health should rise to the occasion and design and implement natio­nal Ebola prevention and response strategies.

Given the critical nature of biological agents for warfare and their impact on national security, the bio-defence aspect of the aforementioned national Ebola prevention and response plan is also crucial. The US government through its centres for disease prevention and control is providing world class training on standard operating procedures in Ebola treatment units.

Though primarily designed for healthcare and public health professionals deploying to West Africa, the response framework, epidemiology, infection control and rigorous practical training can be adapted for all resource-poor health systems. The author participated in this training and believes that it can be tailored to the needs of the health system in Pakistan.

Preparedness and response planning for Ebola could, in fact, be the first step towards building a national framework to deal not only with threats of deadly viral haemorrhagic diseases but also other highly infectious microbial agents that could pose a threat to the health of the citizens and national security.

The writer is a public health professional based in the US.

Published in Dawn, December 29th, 2014