In­ter­view: David Nabarro, UN Spe­cial En­voy on Ebola

Africa Renewal - - Contents - — David Nabarro

Fol­low­ing the Ebola virus out­break, the United Na­tions set up its first-ever pub­lic health mis­sion — the UN Mis­sion for Ebola Emer­gency Re­sponse (UNMEER) — to deal with the pan­demic. In this in­ter­view with New­ton Kan­hema for Africa Re­newal, David Nabarro, the UN Sec­re­tary- Gen­eral’s Spe­cial En­voy on Ebola, dis­cusses the UN’s ef­forts to bring the virus un­der con­trol.

Africa Re­newal: Can you tell us the sta­tus of the UN re­sponse to the Ebola out­break? David Nabarro:

The out­break is a com­pletely un­prece­dented sit­u­a­tion. We have had out­breaks of Ebola over the last 40 years, but we’ve never had one on this scale. That’s why the global com­mu­nity de­cided to mount an ex­tra­or­di­nary re­sponse. The UN is sup­port­ing the ef­forts of gov­ern­ments, non-gov­ern­men­tal part­ners and other in­ter­na­tional donors. We are bring­ing to­gether all the dif­fer­ent parts of the UN un­der UNMEER. We an­tic­i­pate that 70% of peo­ple in­fected with Ebola will be un­der treat­ment by the end of Novem­ber and that at least 70% of all buri­als will be safe and dig­ni­fied.

We also an­tic­i­pate that the dis­ease spread would be­gin to di­min­ish in the speed it was ac­cel­er­at­ing and that the out­break curve would start bend­ing down­wards by the be­gin­ning of Jan­uary 2015. There is still a long way to go in terms of peo­ple com­ing un­der treat­ment, but the buri­als are safer and more dig­ni­fied and in some parts of the re­gion the out­break curve is be­gin­ning to bend. But I want to stress that we are still a long way from the out­break be­ing un­der con­trol and end­ing.

We have seen more than 5,000 fa­tal­i­ties in the three most-af­fected coun­tries of Liberia, Sierra Leone and Guinea. Is the sit­u­a­tion sta­bi­liz­ing?

Well, the sit­u­a­tion is var­ied across the af­fected coun­tries. In some coun­ties in Liberia, there are re­ports that the ac­cel­er­a­tion rate is slow­ing down. In other ar­eas, par­tic­u­larly some of the ur­ban com­mu­ni­ties and par­tic­u­larly in parts of Sierra Leone, it’s still ex­pand­ing at a rapid rate. We don’t have the full data. It is un­even but it’s what we ex­pected: as the re­sponse in­ten­si­fies we be­gin to see im­prove­ments in some ar­eas.

How far do you think we are from see­ing the end of this pan­demic?

I can see a light at the end of the tun­nel, but it’s quite a long way away. I’m not sure what lies be­tween now and the end of the tun­nel. The dif­fi­culty with an out­break like this is that it is un­pre­dictable and can take a sud­den turn for the worse at any time. There can be new chains of trans­mis­sion and we might find that fa­tal­i­ties have shot up more than two or three weeks ago. I’m re­ally wary about mak­ing pre­dic­tions, ei­ther how long it’s go­ing to take or how bad it will be be­fore we get it un­der con­trol. If I put a date on it, then I will almost cer­tainly end up be­ing wrong.

Is the cur­rent virus strain in West Africa more vir­u­lent than the strain we have seen in Cen­tral Africa?

There are no dif­fer­ences in the spread pat­tern. What re­ally mat­ters here is that every­body should know that if peo­ple come un­der treat­ment early, then there’s a good chance that they’re go­ing to sur­vive.

About $1 bil­lion is needed to con­trol the spread of the dis­ease. How far have we gone to­wards that tar­get?

In Septem­ber 2014 the UN ap­pealed for nearly $1 bil­lion. As of now, we have re­ceived nearly $800 mil­lion. How­ever, be­cause the dis­ease has spread fur­ther since the ap­peal, we have re­vised it up­ward to $1.5 bil­lion so as to at­tend to the 70% of the cases un­der treat­ment and 70% safe buri­als up to March 2015. There may be a need for more re­sources after the end of March.

There have been com­plaints that some coun­tries are giv­ing less than what is ex­pected of them. How would you char­ac­ter­ize the in­ter­na­tional re­sponse so far?

Well, in gen­eral, gov­ern­ments, the wider pub­lic, and busi­nesses have been in­cred­i­bly gen­er­ous. What has hap­pened is that some­times they’ve gone back to na­tional trea­suries and asked them to re-ex­am­ine the amounts they were putting up and to per­haps come up with fur­ther con­tri­bu­tions. One coun­try has had four tranches of as­sis­tance.

Sev­eral other coun­tries have pro­vided fur­ther bursts of as­sis­tance, hence I am not keen to crit­i­cise any coun­try. We’ve also seen in­cred­i­ble gen­eros­ity from foun­da­tions. For ex­am­ple, the Paul G. Allen Fam­ily Foun­da­tion put in $100 mil­lion, the Bill & Melinda Gates Foun­da­tion gave $50 mil­lion, and the Chil­dren’s In­vest­ment Fund Foun­da­tion gave $20 mil­lion. In­di­vid­ual mem­bers of the pub­lic are putting money into char­ity ap­peals. Business peo­ple from all over the world have also been gen­er­ous.

What is your as­sess­ment of con­tri­bu­tions by African coun­tries?

I’ve talked a lot with African lead­ers, with the African Union, ECOWAS [Eco­nomic Com­mu­nity of West African States], the East African Com­mu­nity, and also with African business peo­ple and civil so­ci­ety. Africans are ex­tremely con­cerned about this out­break and are do­ing their share.

We also hear some pledges have not been met. Is this true?

Most of the coun­tries that pledged have ac­tu­ally re­mit­ted or com­mit­ted their funds ex­tremely quickly. I know of no coun­try or or­ga­ni­za­tion that pledged and has not made the funds avail­able. If there are any is­sues, they may be the nor­mal ad­min­is­tra­tive bot­tle­necks that some­times oc­cur with this kind of as­sis­tance.

In that case, the $800 mil­lion pledged has been de­liv­ered?

Not all the money is in bank ac­counts, but there’s a term called “com­mit­ment,” which has le­gal value be­cause it means that the money will come, and we can af­ford, there­fore, to spend against that money. It is only a pledge that must be re­ceived be­fore be­ing spent. The $800 mil­lion re­flects com­mit­ments. It’s been a very ex­tra­or­di­nary re­sponse.

What is the UN do­ing to avoid de­lays, if there are any, in terms of the money com­ing in?

What I have been do­ing, for ex­am­ple, on the trust fund that the Sec­re­tary-Gen­eral has set up and I am re­spon­si­ble for, is to es­tab­lish a sys­tem so that we have a sev­en­day cy­cle. When the money comes in, we get pro­pos­als of how that money will be spent within those seven days.

Do you think this out­break could have been avoided?

My role is to fo­cus on where we are now. I’m sure that at some point there will be a need to do a his­tor­i­cal anal­y­sis – what we call in medicine a “post-mortem.” That is not for me to do; it is not my area of ex­per­tise.

When SARS hit Asia, you were play­ing the same role as now. Can you tell us what is dif­fer­ent this time round?

This out­break is in a part of the world where health sys­tems are not the strong­est. It’s also a virus with high death rates. It re­quires very close con­tact trac­ing. We have seen that coun­tries that are able to act fast can get it un­der con­trol, es­pe­cially when they are pre­pared: Nige­ria and Sene­gal are ex­am­ples, Mali is also re­act­ing quickly. We’ve also seen that in cer­tain coun­ties and dis­tricts in the af­fected coun­tries where the re­sponse has been ro­bust and in­tense, the virus’ ac­cel­er­a­tion has been re­duced. So you need a high de­gree of or­ga­ni­za­tion and dis­ci­pline. This means preparedness.

Go­ing for­ward, what have we learnt?

Three words: preparedness, vig­i­lance and sol­i­dar­ity. Be­ing ready, be­ing alert and work­ing to­gether, be­cause dis­eases don’t re­spect bor­ders. We must re­mem­ber what this dis­ease has done and put up de­fences so that this kind of suf­fer­ing and mis­ery doesn’t hap­pen again.

UN Photo/Eskinder De­bebe

David Nabarro, Spe­cial En­voy of the UN Sec­re­tary- Gen­eral on Ebola.

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