David Nabarro, the UN Secretary General's Special Envoy on Ebola, provided an update after visiting affected countries in West Africa. He noted that the outbreak consists of many smaller outbreaks in varying stages. The response is being adapted to different areas, with a focus on community involvement and treatment. Sierra Leone is seeing reduced cases in the east but intense transmission in Freetown, while Guinea has grave concerns about new cases in the interior and north bordering Mali. With continued community negotiation and ownership, the overall direction of the response is positive, but more work remains to be done.

1. 12/11/14
JohnWaddill
DavidNabarro Briefing
David Nabarro SG Special Envoy on Ebola
 ReturnedtoEurope and US last weekaftervisitingGuinea,SierraLeone,LiberiaandMali
o Inspiredbythe progressmade since September
 Big shiftsinqualityand coverage of the response
 Outbreakisa collectionof alarge numberof smalleroutbreaks
o As manyas 100 of these small outbreaks
 Varyingstagesof evolutionandintensity
o Numberof casesreducingdayby day for the mostpart
 Response isbeingadapted tothe changingoutbreak
o Differentresponse inborderareavs.rural interiorareavs.urban area
o Reductioninnumberof infectedpeopleif communitiesare fullyinvolved
 Synchronized,localizedimplementation of treatment
 Gettingintocommunities,identifyingpeoplewhoare ill,treatingthem,
gettingcontactsidentifiedandmonitoringthem
 SierraLeone
o Easternpart- casesare reduced
o Westernpart (Freetown)- quite intensetransmission
 Guinea
o Interiorandthe north (borderwithMali)- amountof new casesis of grave concern
 Communitiesare beginningtoownthe outbreak
o Many are still frightened
 Negotiationbetweenhealthcare workersand community membersto go in
and treat those infected iskey to reducingnumber of newcases
 Confidentwe are goinginthe rightdirection
 People workingon response (thosefromthe region& those fromoutside) are amazing
o Puttinglivesonthe line everyday
o Continuingthe effortfeel like theycannotstopuntil the jobisdone
o Time’sPersonof the year = Ebola responders
 Coordination
o UN system
 Highlevel of coordinationin acomplex response
 Time to time there isstagnationwhen delaysandfrustrationsare
identified
 UN family,NGOS,donorsandgovernmentsare playingnice witheachother
 Example-TreatmentcenterinGuinea:
o BuiltbyWorld FoodProgram, moneyfromEU, run by NGO from
Niger,supportedbyRedCrossvolunteers,DoctorsWithout

2. Borders,moststaff are local Guineans,UN SecretaryGenerals
Trust Fund
o WHO is providingthe maindirectionforthe coordinatedeffort
 300 epidemiologistsinthe region
o UNICEF
 Social mobilization&communitycare
o UNDP
 Ensuringessential servicesare provided
 Private Sector
o Reductionof 11 to 4% growthof GDP Until there isa stabilizationof the impactof Ebola
 Businessesare key tocombatingEbola
 Withoutbusinessesoperating, eradicationisimpossible
o Paul G AllenFoundation
 $100 milliontowardsthe response through:
 NGOS,CDC foundation,MediaGroupsandCommunications
Organizations,Researchorganizations&medical evacuation
 The most importantgroupis “yourselves”
o A storyof tragedyand misery,somanyaffected
o Storyof solidarityandhope
 People sostronglycommittedatthe local leveltrue heroes
Q & A
 Q: We hear storiesof bedsbeingemptybecausethere are notenoughworkersand theyare not
showingupbecause theyare not gettingpaidenough
o People cannotgetaspirinandgeneralizedcare,onlythatrelatedtoEbola
 A: Making sure there are a lotmore beds
 Firststage:buildinghospitalsfor Ebolatreatment
 Special hospital workers are needed
o More trainingandequipment thannormal hospital workers
 Liberianhospitalsare staffedandopen
o Overcapacityforbedsin parts of Liberia
 What Nabarro wantsto seefunctioninghospitals that
are notfull
o Lack of bedsineasternLiberia though
 Workersstill beingtrained
 Confidentthisproblemwill be solvedinthe
nextcouple of weeks
 Problemwithhealthservices
 Unfortunate pregnantwomencannotgethelpeasily
o Hospitalsare still placesof danger& people gettingill,willopen
againslowly
 Q: WHO inSeptembersetatargetof zerotransmissionsbyJanuary1st
.Couldyoutell uswhy
and commentonthe Presidentof SierraLeone hopingtoendall Ebolatransmissionsinthe next
21 days due to only300-400 transmissionsaday inGuinea.

3. o A: Will be zerotransmissionsincertainlocations(urbanareas)
 Noteverywhere
 Increasingnumbersof areaswhere theyare low transmissionsin rural Liberia
and EasternSierraLeone
 Problemstill of hightransmissionsincertainareas- caneasilyspreadtoother
parts of the country
 ImpressedbyPresident AlphaConde’s determination
 If the numberof treatmentbedsare openandif there isnot a great
deal of movementof infectedpeople the eradicationof new infections
ispossible
 Doesnot like tosettargetsbecause itcan come back to alarmthem(if they’re
wrong)
 Q: Does the private sectornotcontribute enoughtothe response of Ebola?
o A: Opportunitiesforbusinessestocontribute
 Ex. Miningsector
o Veryimportantcontributingsectortoall three economies
(Liberia,SierraLeone,Guinea)
o Many of the personnel have leftthe region
o Once the staff are confidentthatthere employeeswillnotbe at
risk,come back because theyare vital to the local economy
 Businesscanhelpstabilizelocal economiesthathave
beenbadlyhitbythe outbreak
 Businessencourage theiremployeestokeepsafethis
leadstothemtellingthistotheir familieshow tokeep
safe too
 Q: Are there problemswith pledgesconvertingintofinance tothe region?Journalists are also
beingcrackeddownon forcriticizinggov’tresponse andreportingnew cases of Ebola.
Response?
o A: Balance betweenfree pressandgovernmentabilitytoactisa fine line
 Frustrationof gov’tofficials
 Reportershave notcoveredthe full storymakingthemlookbad
 Importantthat the pledgesbecome liquidcashasap
 In general pledgesare comingthroughascash
 Q: Any successof usingmobile phonestotackle the disease?
o A: Yes.Abilityto communicate what’shappening:if you’reill youcancall forhelp
 Helplinesopenedup topublic
 Bestway inwhich members of the publicgetaccessto help
 Can use GPS to identify newareas of infections
 Synchronizedtextmessagesforinformation
 Coverage canbe sparse inthe region,butstill veryhelpful
 Q: What kindof equipmentare youacquiringatthis point?
o A: Clothingfortreatingpeople whoare ill
 Protective equipment forworkers
 Chlorine andotherdisinfectants

4.  Vehicles
 Transportingpeople
 Transportingdeadpeople forburial
 Transportinggoods
 Fuel
 Portable accommodations
 Constructingcommunitycare centers
 Communicationsequipment
 i.e.cell phones
 Q: What longertermplansdo youhave to preventanyfurtheroutbreaksfromoccurring?
o A: Securityandcapacity to avoidthese outbreakshastobe made in individual countries
 Doctors, epidemiologistsandothermedical staff
 International systemslinkedtogether bythe WHO isimportant
 Unfortunatelyinternational work hasbeenseverelyunderfundedfor
years
o In-between crisesitisveryhardto getmoneyforpreparation
 Needtopersuade gov’tsto fundpreparation
 Q: Russianscientistshave beendoingresearchonvaccines.Isthe UN monitoringthese
developments?Lotof thingshave fallenthroughthe cracks,whatwere they?
o A: Many vaccinesappearedoverthe year
 Testingoccurringnow
 If it goeswell theywill be readyinthe middleof nextyear
 Vaccinestakingbackseatuntil postmortem(outbreakisover)
 now justcontainingthe outbreakistakingall of the time andresources
of the organizationsinvolved