Wednesday, July 29, 2015

Ending Transmission in Guinea: The French and Russian Contributions


"France has been mobilized since the beginning of the crisis, in conjunction with the World Health Organization (WHO) and the authorities of the countries concerned. It is providing technical support and expertise to contain the epidemic. Our embassies, particularly in Guinea (which also has jurisdiction for Sierra Leone) and Liberia, are in close contact with the health monitoring and care facilities established in each of those countries. France particularly supports the high-security mobile laboratory project implemented by Inserm in partnership with the Pasteur and Mérieux Institutes. This laboratory makes it possible to safely and more accurately diagnose outbreaks. It will supplement the facilities already in place, particularly the Pasteur Institute’s laboratory in Dakar as well as a European laboratory. It receives funding from the European Commission." Source:http://www.ambafrance-uk.org/France-is-helping-deal-with-ebola 

While headlines on ending the Ebola crisis in West Africa seem to take a 'first in' approach as if this were a competition, the 'last out' will surely be the determining factor which brings the Ebola epidemic to an end. Both France and Russia have made impressive contributions toward ending this outbreak and their long term approach to building a public health infrastructure across West Africa will no doubt protect local and global populations for years to come. The low key approach taken by the French, Russians and the disaster medicine organization Medicines sans Frontieres, in contrast to rushing in (usually with press in tow) and pulling out swiftly once the media has moved on to a different calamity, by some governments, should well be noted for future outbreaks of emerging and re-emerging disease. It is the opinion of this author that attitudes toward war bear a striking resemblance to fighting a war on disease. The first in, while making headlines don't always factor into the longer term solutions.


The quiet contributions of the French and Russians, combined with the highly resolute Medecins sans Frontieres, has probably been one of the most enduring efforts which will bring Ebola to an end while simultaneously supporting a devastated public health infrastructure. According to France Diplomatie, the French contribution in Guinea involves several pillars which provide long term solutions: 

"In 2014, France launched an emergency response plan based on the following pillars: medical treatment (funding equipping and setting up Ebola Treatment Centres (ETC's), setting up of laboratories); training and protecting those combating the crisis (training centres, a health-care worker treatment centre, medical evacuations); supporting local communities (awareness-raising activities, safe and dignified burials). This plan has proved effective in the countries concerned but the battle against the epidemic has not yet been won. In 2015, France is adapting its plan to respond appropriately as the epidemic develops. It is pursuing three main objectives: controlling and eradicating the epidemic; tackling other health emergencies that are not related to Ebola; anticipating future crises." (http://www.diplomatie.gouv.fr/en/french-foreign-policy/health-education-gender/fight-against-the-ebola-epidemic/article/fight-against-the-ebola-epidemic-19978). In addition to this the French Government has a longer term support plan in place. 

"The Agence Française de Développement (French Development Agency - AFD) is providing €4 million for the creation of an Institut Pasteur in Conakry. To complement this, France is funding the Institut Pasteur and Fondation Mérieux to build laboratory capacities in Guinea. The aim is to provide:
- equipped laboratories that meet international standards, offering permanent on-site diagnosis facilities;
- trained staff to support the actors combating infectious diseases and viral haemorrhagic fevers at both local and regional levels;
- national quality control capacities.
Strengthening the primary health care system which is critical to long term public health infrastructure in Guinea, AFD is providing €10 million, over three years, for a cooperation project with the European Union and the Guinean Ministry of Health to improve the health facilities in Guinea’s forest region (prevention, maternal and child care). Some of this support has been channelled into the fight against Ebola." (see:http://www.diplomatie.gouv.fr/en/french-foreign-policy/health-education-gender/fight-against-the-ebola-epidemic/article/fight-against-the-ebola-epidemic-19978) 

The long term planning and investment of the French government eclipses the short term efforts of some EU/NATO states who sent a warship for three months, with no real long term value added to the patients and people of West Africa. Superficial and short term solutions like this, designed with media photo ops in mind, is not helpful to the long term and very serious work which must occur in order to end transmissions and to rebuild public health infrastructures. When the media leaves its interesting who is still on the ground, who is in it for the long term and for the greater good of the West African public. 

Russia too is a major contributor to the fight against Ebola who've made significant contributions in Guinea. "The Russian government gave the government in Conakry, Guinea, a mobile diagnostic laboratory equipped to work with the lethal virus." (http://outbreaknewstoday.com/russia-donates-ebola-lab-to-guinea-65088/ ) In an article posted by Robert Herriman in Outbreak News Today, Herriman notes: According to the Russian head of immunological and virological laboratory Alexander Semenov, “In addition to the equipment of the latest generation we are a group of a dozen Russian scientists came to work in Guinea to stop the chain quickly spread of the virus and see extent available locally a vaccine against the disease. This means that we are heart with our brothers and sisters Guinean whose cooperation between our two states date back over 50 years.” The report notes this demonstrates the excellent relations of friendship  between the two countries. President of the Republic Professor Alpha Condé sent a special thanks to the people and Government of Russia and especially the President of the Russian Federation Vladimir Putin, according to the news report. " (http://outbreaknewstoday.com/russia-donates-ebola-lab-to-guinea-65088/). 

According to a report from Russia Beyond the Headlines, " A center for microbiological research and medical treatment of patients infected with epidemic diseases was dedicated in a ceremony in Kindia, Guinea [ ] as part of Russia's effort to assist the fight against Ebola and to strengthen the local healthcare system, the Russian Foreign Ministry said." "The center is intended to diagnose, treat and prevent infectious and highly contagious diseases, and ranks among the most advanced medical centers of its kind to be set up in Western Africa.""The Centre was built and equipped by RUSAL, a leading global aluminium producer with active assistance from the Russian embassy in Conakry. Investment amounted to over 10 million dollars. The Centre's premises include an infection hospital, a provisional hospital, a mobile laboratory and a blood and plasma transfusion department with a laboratory. The Centre will initially serve as a hospital for the treatment of those infected with the Ebola virus. The Russian operator, that has been working in Guinea since 2002 and is one of the largest investors in the local economy, is the world's only public health company to have implemented such a large-scale project to check the global spreading of the Ebola virus." (http://rbth.com/news/2015/01/17/russia_opens_ebola_center_in_guinea_42952.html) Again, these are deep and long term investments which no doubt will serve to protect the local community as well as the greater global health community. 

Russia and France offer a model of how investment in public health care infrastructures in fragile states will end transmission of the worst outbreak of Ebola in history. These efforts should well be considered by the EU and other states, specifically those with short term agenda's. Ending transmission will require continued investment in every technology related to public health security from diagnostics to vaccines and everything in between. A sustainable financial package should be considered which will provide graded increases over at least a ten year period. if not longer. Failure to do this will bring not only cyclical outbreaks of Ebola as we've seen in Uganda, South Sudan, the DRC, Congo and Gabon, but higher mortality rates from a range of preventable diseases, endemic diseases (malaria) and child birth related deaths as well. 








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