VIENNA—After Oyewale
Tomori finished his talk on Ebola here at theInternational
Meeting on Emerging Diseases and Surveillance, there was stunned
silence.
Tomori, the president of the Nigerian Academy of Science, used his
plenary to deliver a scathing critique of how African countries have handled
the threat of Ebola and how corruption is hampering efforts to improve health.
Aid money often simply disappears, Tomori charged, "and we are left
underdeveloped, totally and completely unprepared to tackle emerging
pathogens."
Trained as a veterinarian, Tomori was the World
Health Organization’s (WHO's) regional virologist for the African region in
1995 during the Ebola outbreak in Kikwit in the Democratic Republic of the
Congo (DRC). ScienceInsider sat down with him at the meeting in
Vienna; questions and answers have been edited for brevity and clarity.
Q: You said in your talk that Ebola
was "swimming in an ocean of national apathy, denial, and unpreparedness.”
What did you mean?
A: We were totally
unprepared. After the first cases occurred in West Africa, it took almost 3
months for WHO to know. When the first patient came to Sierra Leone and died,
his son brought him back to Guinea and as far as Sierra Leone was concerned, it
was Guinea’s problem. People abandoned their duty, they denied the problem, and
when it became a big problem they became incapable of handling it.
This is not the first time Ebola has appeared in
Africa. There have been more than 20 outbreaks since 1976. Not one of them has
been declared a global problem. Of course, circumstances are different this
time. But if we had been prepared, if we had learned from the past, we wouldn’t
be where we are today.
Q: You seem angry.
A: Yes, I am, because I know
Africa has the capacity and the capability to solve most of her problems, but
Africa will not enable her human resources to perform effectively and
efficiently. African leaders have little or no respect for their experts and
would rather act on advice from external sources. In the end, they become the
experts on Africa’s problems, not the Africans. This is why I am angry with
Africa.
We have seen so many Ebola cases before, in the
DRC, in Sudan, in Gabon. … Ebola is Africa’s problem. We should have put
something in place. I remember in 1995, when we had the Kikwit epidemic, at the
end we sat down at a table and discussed what we should do. There was a
laboratory in Kinshasa built by the French; it was almost completed, but then
abandoned. We had raised almost $2 million at the time. And we said: "Why
not take a bit of that money and complete this lab and maintain it? Then at
least when we have issues like this we can do quick testing." But nothing
happened. The carcass is still there. Each time I pass the place, I think:
"What a waste."
Q: But your own country seems to have
been prepared. Nigeria managed to contain the virus after it was carried to
Lagos by a traveler in July. There were only 19 infections, and WHO called the
containment of the virus "a
spectacular success story."
A: We were not prepared, we were
lucky. Patrick Sawyer was already sick when he arrived, so he went straight to
the hospital. And because our doctors were on strike, the public hospitals were
not open, so he went to a private hospital. If Sawyer had gone into a public
hospital, we would have had a bigger problem.
But within 2 to 3 days of Sawyer coming in, we knew
it was Ebola from laboratory tests done in two of our university laboratories,
and then action was taken. I praise Nigeria for that. We had this emergency
center from the polio network and we brought people in and traced almost 1000
contacts. This was not passive tracing; people went to contacts' homes on a
daily basis.
Q: So why are African countries so
badly prepared? Is it a question of money?
A: People say African countries
are poor. But it’s not poverty. It’s misuse of what we have. As we are talking,
with all the crises that are going on, the presidents of our countries are
still traveling in the best of conditions. Some will come to New York in their
private jets, although their national airlines collapsed years ago; in
addition, they will bring along a long retinue of private, personal, and public
assistants, all lodged in the best hotels. I am not saying the president should
not be treated well, but these are issues we need to look at.
Take my country: We do not have a national airline,
but the number of private jets we have is more than all the airlines in Africa
have together.
It’s a matter of priorities. I do not believe there
is an African country that cannot buy gloves for its staff. Personal protective
equipment may be very costly, they may need assistance on that. But let us
participate. As long as we are wringing hands waiting for the next glove to
come, we will never be ready. There are certain things we can do now, with the
resources we have.
Q: So African leaders should be held
more accountable for what they spend money on?
A: GAVI [a public-private
partnership that funds vaccines for low-income countries] just sanctioned
Nigeria after a critical audit
report. GAVI gave us money to do certain things, and we could not
account for $2 million or $3 million of it. GAVI insisted that Nigeria must pay
back that money, and the government agreed. But our government should not just
agree to pay back the money, the government should find out who misused the
money, get the money back from those persons and not from public coffers. And
those people should be brought before the courts to answer for the deaths of
the children who did not receive the vaccines that the GAVI money would have
provided.
Q: So how should African countries
contribute to fighting the Ebola outbreak?
A: To give you one example, there
are 600 Nigerian health care workers who want to go to Liberia. But the process
of getting them there has been going on for months. If the African team, the
African Union, the Economic Community of West African States, and the West
African Health Organisation all get their acts together, there are more than
enough people in Africa—health care workers from Gabon, DRC, Uganda, Sudan—who
have experience with this.
But we must find the funds to provide insurance for
all national and international health workers who are currently working or have
volunteered to work in the Ebola-affected areas of Africa. Bear in mind, in
Africa we do not have a welfare system. I am the welfare system for my family,
my brothers, my uncle. So when I go to an Ebola region, I am thinking of the 23
other people that depend on me. If there is no insurance, I will stay home.
Q: There has been a lot of
criticism of the WHO regional office in Africa.
A: I am angry at them, too. They
should take the lead of Ebola control efforts—not Geneva, not Washington, not
New York. The [Centers for Disease Control and Prevention] can help, [Doctors
Without Borders] can assist, but it is WHO's African region that should
coordinate and take the lead. It’s all meetings and reports. Nothing on the
ground.
Q: As it happens, they are meeting in Benin
this week; on the agenda is the election of a new regional director.
A: These elections are just
horse-trading. If the person who wants to get elected requires the vote from
Nigeria for example, because it is the ministers of health who do the voting, I
might say: "OK, I will vote for you, but I need one directorship from my
country.” If he accepts that, he has to accept whoever I bring, regardless of
how competent the person is. That is what has messed up Africa. WHO's regional
office has never been able to solve Africa’s problems because of this system of
electing its leaders.
You want to find the most competent person. Vote on
that basis. Not because I visited you and I promised you this or that.
Q: Do you think this unprecedented
outbreak will change things?
A: I wish I could say with
confidence that in 10 years’ time we will not be where we are now with Ebola.
But the countries have totally lost control of what is going on. If you go to
Sierra Leone or Liberia today, there must be at least 10 international groups
there. At the end of this epidemic, everybody will pack their bags and leave.
The African countries will be left not really knowing what has happened to
them. Like someone hit them smack in the face, totally disoriented. There will
be millions of scandals about how money was misspent and so on. We will focus
on those and move on. Ten years from now, people will have forgotten that there
was Ebola and we will be back to where we started.
*The Ebola Files: Given the current
Ebola outbreak, unprecedented in terms of number of people killed and rapid
geographic spread, Science and Science Translational
Medicine have made a collection of research and news
articles on the viral disease freely available to
researchers and the general public.
SOURCED: SCIENCE INSIDER
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