H5N1

Ebola response in Beni: 30 neighborhood leaders demand six months of arrears from their premiums

Via Radio Moto Butembo-Beni: Ebola response to BENI: 30 neighborhood leaders demand six months of arrears from their premiums. This sounds depressingly like what happened in West Africa: people fighting Ebola on the ground get little or nothing while their income vanishes somewhere higher up the food chain. The Google translation:

To claim their rights, 30 heads of Beni neighborhoods accompanied by their deputies held a sit-in at the office of Beni health zone on Monday, April 8, 2019. They say claim six months of arrears of their premium with the coordination of response activities.  

In a memorandum, they state that they are divorcing from any activity related to the response to the Ebola response. 

"All the chiefs are active. When it comes to money, these people refuse to pay us. Since the month of August, they have paid only one month. Even the units, the leaders do not receive. If all the leaders rise up, it's because of that. We resigned en bloc. While they continue with their IT ... If there are games of pulls and resistances, we raise our hands. We come to claim our right, but they run away from us and do not want to reach a consensus with us," said one of these leaders while the other said: "We live in risks. That is finally the population understood that the disease really exists. So we who have made efforts in this direction, they should not abandon us like that. See, for example, you die in this work ... They do not even come to sympathize ... Not even a reward to the family?" 

Until the evening of this Monday, April 8, 2019, no member of the coordination of the response team has pronounced on this subject.

An epidemic of suspicion — Ebola and violence in the DRC

Via NEJM, an absolute must-read by Dr. Vinh-Kim Nguyen of MSF: An Epidemic of Suspicion — Ebola and Violence in the DRC. Excerpt:

Until the 2014 Ebola epidemic in West Africa, Ebola outbreaks had been sporadic, small, and largely confined to isolated rural villages in Central Africa. But the 2014 epidemic broke all the rules and killed more than 15,000 people; since then, more outbreaks have been reaching larger urban centers, sometimes resulting in uncontrolled spread. 

The current epidemic in the Democratic Republic of Congo (DRC) has triggered a massive international response, which has been met by violence, culminating in attacks at the end of February that partially destroyed Ebola treatment units in the regional hub of Butembo and its township, Katwa. This area is the epicenter of the epidemic, which is likely to be fueled by any breakdown of isolation and treatment efforts.  

Are these urban flares the new norm? What might the ebb and flow of intervention and violence bode for future epidemics? Insights from the front lines may offer some clues. 

As a medical team leader for Médecins sans Frontières (MSF), I work halfway between Butembo and Goma, North Kivu’s capital city and a transport hub. In late January, five Ebola cases were identified in Kayna and Kanyabayonga; MSF opened a center in Kayna to isolate patients with suspected cases and test them for Ebola virus disease (EVD). I soon suspected that most patients would turn out to have diseases other than EVD. 

The standard “isolate and test” model often leads to expectant management for such patients — the tendency is to “cover” patients with antimalarials and broad-spectrum antibiotics, wait for EVD test results, and then discharge patients without Ebola. We instead took a more active approach, treating severe cerebral malaria, typhoid, sepsis, and even cholera. 

I have witnessed how such active clinical management for all patients, along with MSF’s long-term presence in North Kivu, has contributed to the community’s acceptance of our Ebola unit. Having patients emerge from isolation in improved health is powerful evidence that we aim to make everyone better, not just to stop Ebola’s spread.  

Indeed, I’ve come to realize that the most important part of my job is building trust with the communities we serve. Greater trust means more patients presenting early, and early presentation strongly affects the prognosis for many conditions. Building trust starts with relationships with patients and families, which can be nurtured even if patients are in isolation. 

I saw the impact that these relationships had on trust during the 2014–2015 Ebola epidemic in Guinea. Many attempts to engage with affected communities during Ebola epidemics have been tone-deaf: little effort has been made to understand the public’s concerns or to find out what they understand from the messages being conveyed to them. 

Recognizing the need to listen to the community and be prepared to answer hard questions truthfully, we shifted from a health promotion strategy of delivering rote messages — about viral transmission from bats or the importance of hand washing — toward genuine community engagement. We recruited trusted community members and trained them in active listening and communication techniques, discussing how to address questions they would receive from the public. 

The questions the public asked us reflected their sense of anger and betrayal at “Ebola profiteers” and their worries that the focus on Ebola would be short term and would not address more common and equally deadly everyday health issues. We found that acknowledging and addressing issues of poverty and injustice, and using examples drawn from the questioners’ experience, went a long way toward allaying the concerns underlying these questions.  

Yet much of the fundamental work of engaging communities and building trust is still based on outdated health education models and is often led by specialists with little understanding of social science. Such practices continue despite clear epidemiologic evidence that current containment efforts are failing. In the wake of violent attacks on health workers and treatment units, there is growing recognition that more needs to be done to gain community acceptance.

Ebola DRC - Evolution of the Ebola epidemic in North Kivu and Ituri on Thursday February 7 2019

The Ministry of Health has published Ebola DRC - Evolution of the Ebola epidemic in North Kivu and Ituri on Thursday February 7 2019. Excerpt from the Google translation:

EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI 

Thursday 7 February 2019   

The epidemiological situation of the Ebola Virus Disease  dated February 6, 2019: 

• Since the beginning of the epidemic, the cumulative number of cases is 791, 737 confirmed and 54 probable. In total, there were 492 deaths (438 confirmed and 54 probable) and 267 people cured. 

• 189 suspected cases under investigation. 

• 2 new confirmed cases, including 1 in Butembo and 1 in Kyondo  

• 4 new confirmed deaths: 

º 2 community deaths, including 1 in Butembo and 1 in Kyondo 

º 2 deaths at Katwa CTE

  

 /! \  The data presented in this table is subject to further changes after thorough investigation and after redistribution of cases and deaths in their health areas. 

News of the response 

Women's safety during the response  

The Ministry of Health is challenged by the circulation of messages on social networks alleging that women have been victims of sexual advances in exchange for work in the response to Ebola.   

Although local women's NGOs have already denounced some of these messages as rumors aimed at tarnishing the image of women working in the response, the Ministry of Health can not ignore these allegations and takes them very seriously.   

Thus, the Ministry of Health asks people who have been victims or witnesses of such incidents to report them confidentially through the free numbers of the civil protection of North Kivu: +243 999 009 405 or +243 820 800 001.  

The Ministry of Health recalls that ALL services related to the response to the Ebola outbreak (vaccination, treatment at the Ebola treatment center, psychological monitoring, dignified and secure burial, etc.) are FULLY FREE . Anyone who offers such services for payment in kind or in cash must be reported.   

In addition, recruitment procedures in the response respond to selection criteria based on professional competence and experience. Only a limited number of Ebola counterparts, identifiable through their official badge, have the capacity to recruit new people to the response.  

Thus, for safety reasons, it is recommended that women ensure:  

• Always ask the person claiming to be a recruiter to have an official badge confirming their position in the response;  

• Do not accept appointments outside the coordination offices of the response; and 

Report any inappropriate behavior.   

Vaccination  

• Since the start of vaccination on 8 August 2018, 75,526 people have been vaccinated , including 20,473 in Beni, 18,784 in Katwa, 8,317 in Butembo, 6,064 in Mabalako, 2,736 in Kalunguta, 2,200 in Komanda, 2,131 in Goma, 1,844 in Oicha. , 1,663 in Mandima, 1,157 in Karisimbi, 1,054 in Bunia, 1,153 in Kayina, 1,082 in Kyondo, 953 in Vuhovi, 920 in Masereka, 744 in Mutwanga, 700 in Lubero, 590 in Rutshuru, 567 in Biena, 527 in Nyankunde, 510 in Musienene, 355 in Tchomia, 306 in Mangurujipa, 254 in Alimbongo, 207 in Kirotshe, 125 in Nyiragongo, 97 in Watsa (Haut-Uélé) and 13 in Kisangani.  

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 19 May 2018.

China disciplines more than 80 officials linked to major vaccine scandal

Via the South China Morning Post, an AFP report: China disciplines more than 80 officials linked to major vaccine scandal. 

China’s corruption watchdog on Saturday said it had disciplined more than 80 officials linked to a vaccine scandal last year that inflamed public fears over the safety of domestically produced drugs. 

Changchun Changsheng Biotechnology – a major Chinese manufacturer of rabies vaccines – was slapped with a US$1.3 billion fine in October after it was found to have fabricated records. 

Four officials from the China Food and Drug Administration (CFDA), including former deputy director Wu Zhen, have been handed over to prosecutors, the Central Commission for Discipline Inspection said in a statement on Saturday. 

State-run news agency Xinhua detailed the allegations against Wu including nepotism and taking bribes. He has also been expelled from the Communist Party, it said.

“Being ‘ruthless to the people’, Wu allegedly abused his power in drug regulation, severely jeopardising the state’s supervision over drugs,” Xinhua said, citing the corruption watchdog.

The Central Commission for Discipline Inspection also said it would “seriously deal with” more than 80 other provincial or local officials from multiple government organisations, without offering details.

These officials have already been fired or demoted, it said. 

Authorities earlier said the faulty rabies vaccines did not enter the market. But the case provoked outrage from customers fed up with recurring product-safety scandals, particularly in the drug sector. 

The drug company’s chairwoman and 14 employees were arrested after the scandal came to light last July, while more than a dozen national, provincial and local officials were sacked.

Hospitals attacked in Khartoum, Sudan

A letter in The Lancet: Hospitals attacked in Khartoum, Sudan.

The Lancet recently highlighted the humanitarian crisis in Sudan (Jan 19, p 199). In the past weeks, tens of thousands of people across Sudan have been reported to have taken to the streets, calling for an end to President Omar al-Bashir's 30-year rule. According to credible reports received by Amnesty International, security forces had killed 37 protestors by Dec 24, 2018. 

The violent crackdown escalated, with security forces reportedly attacking hospitals in Omdurman on Jan 9, 2019, and Bahri on Jan 13, 2019. Crossing the threshold of hospital grounds is a saddening precedent for a government response that appears to deliberately target health professionals through violence and detention. 

That Sudan had repeated outbreaks of yellow fever, cholera, and Chikungunya, reported as recently as October, 2018, suggests a vulnerability of Sudan's neglected health system. This is in a country whose ruler was alleged in 2010 to have stashed billions of dollars in UK bank accounts. 

As Sudan's health professionals use their voices and bodies to peacefully demand a better health system, the international community should amplify these calls and hold the government to account when they shamefully defy norms by attacking hospitals, patients, and clinicians.

Senior WHO official accused of using Ebola cash to pay for girlfriend's flight

Via The Guardian: Senior WHO official accused of using Ebola cash to pay for girlfriend's flight. Excerpt:

Claims that a senior employee at the World Health Organization misused Ebola funds to fly his girlfriend to west Africa are among a tide of allegations under investigation by the agency.  

An internal inquiry has been launched by the WHO following a series of anonymous whistleblower emails that alleged widespread racism, sexism and misspending.  

The emails, sent to senior management last year, claimed there was systematic discrimination against African staff and that recruitment processes are corrupt.  

Whistleblowers have also alleged that staff misused money intended to fight the Ebola outbreaks in west Africa that began in 2013, as well as an outbreak in the Democratic Republic of the Congo. The author of one email wrote that “corruption stories about logisticians and procurement in WHO [health emergencies department] are legendary”.  

The WHO’s director general, Tedros Adhanom Ghebreyesus, a former health minister of Ethiopia, has instructed the agency’s office of internal oversight to investigate the claims. 

The allegations, some of which were reported by the Associated Press on Thursday, were raised in a series emails, the first of which was sent in April.  

The Guardian has learned that the allegations include claims that funds intended for the Ebola outbreak in west Africa were misused, with staff fabricating a mission so that a senior employee’s girlfriend, a junior professional, could join him during the Ebola response.  

It has also been claimed that, during an Ebola outbreak in DRC last year, a plane was hired to transport three vehicles from a warehouse in Dubai at the cost of $1m (£773,000). Tarik Jašarević, a spokesperson for the WHO, rebutted the claim, and said the agency had shipped 10 vehicles from Dubai in May because “there were no vehicles available for sale in DRC that met minimum UN safety standards at the time”. Jašarević said the cost of transporting the vehicles was $237,801. 

In a statement, the WHO added that the allegations had been “addressed openly by Dr Tedros in global meetings with staff in which he stressed that WHO has zero tolerance for misconduct or discrimination of any kind”.  

The statement added that the WHO’s senior management team is “one of the most diverse and gender-balanced of any United Nations agency”. 

However, whistleblowers reported pervasive racism, and cited a recent example in which a senior staff member had allegedly “humiliated, disgraced and belittled” a colleague from the Middle East.

WHO statement on reports of alleged misconduct

Via email from WHO:

WHO is aware of a news story published today about allegations of misconduct in the organization.

The allegations are being investigated according to WHO’s established procedures, having been referred to WHO’s Office of Internal Oversigh Services by the Director-General, Dr Tedros Adhanom Ghebreyesus.

The anonymous allegations, which had been circulating internally, were also addressed openly by Dr Tedros in global meetings with staff in which he stressed that WHO has zero tolerance for misconduct or discrimination of any kind.

Since Dr Tedros took office as Director-General in July 2017, he has championed openness, transparency and diversity. WHO’s senior management team is now one of the most diverse and gender-balanced of any United Nations agency. All regions of the world are represented and almost two-thirds are women. WHO is working consistently to increase geographical diversity and improve gender balance at all levels as part of its ongoing transformation process.

WHO has established mechanisms by which anyone inside or outside the organization can report concerns about any form of suspected misconduct by WHO personnel. WHO has recently strengthened the capacity of its internal oversight mechanisms and has proven processes for reporting and dealing with allegations of misconduct.

These include an independently-run integrity hotline which anyone can use to report concerns confidentially and anonymously. We regularly report the outcome of substantiated allegations arising from independent investigations to Member States in our reports to Governing Bodies. All these reports are posted on our public website.

WHO listens to all feedback so we can learn and improve and provide the best possible advice and assistance to countries.

UN health chief orders probe into misconduct

Thanks to Mary Marshall for sending me the link to this alarming report from The Associated Press: AP Exclusive: UN health chief orders probe into misconduct. Excerpt (but you'd better read the whole story):

The head of the World Health Organization has ordered an internal investigation into allegations the U.N. health agency is rife with racism, sexism and corruption, after a series of anonymous emails with the explosive charges were sent to top managers last year. 

Three emails addressed to WHO directors — and obtained by the Associated Press — complained about “systematic racial discrimination” against African staffers and alleged other instances of wrongdoing, including claims that some of the money intended to fight Ebola in Congo was misspent.  

Last month, WHO Director-General Tedros Adhanom Ghebreyesus told staffers he had instructed the head of WHO’s office of internal oversight to look into the charges raised by the emails. He confirmed that directive to the AP on Thursday.  

Critics, however, doubt that WHO can effectively investigate itself and have called for the probe to be made public.  

The first email, which was sent last April, claimed there was “systematic racial discrimination against Africans at WHO” and that African staffers were being “abused, sworn at (and) shown contempt to” by their Geneva-based colleagues. 

Two further emails addressed to WHO directors complained that senior officials were “attempting to stifle” investigations into such problems and also alleged other instances of wrongdoing, including allegedly misspent Ebola funds. 

The last email, sent in December, labeled the behavior of a senior doctor helping to lead the response against Ebola as “unacceptable, unprofessional and racist,” citing a November incident at a meeting where the doctor reportedly “humiliated, disgraced and belittled” a subordinate from the Middle East.  

Tedros — a former health minister of Ethiopia and WHO’s first African director-general — said investigators looking into the charges “have all my support” and that he would provide more resources if necessary.  

“To those that are giving us feedback, thank you,” he told a meeting of WHO’s country representatives in Nairobi last month. “We will do everything to correct (it) if there are problems.”  

But Tedros refuted claims that WHO’s hiring policies are skewed, arguing that his top management team was more geographically diverse and gender-balanced than any other U.N. organization after adopting measures to be more inclusive. 

“There is change already happening,” he said during the December staff meeting, according to an audio recording provided to the AP. 

WHO’s in-house investigation into misconduct comes after other U.N. agencies have been rocked by harassment complaints.  

At UNAIDS, chief Michel Sidibe agreed to step down after an independent report concluded in December that his “defective leadership” had created a toxic working environment, with staffers asserting there was rampant sexual harassment, bullying and abuse of power. 

The author of the anonymous WHO emails also charged there were “crooked recruitment and selection” processes that were “tantamount to fraud, corruption and abuse of authority.”  

In the latest anonymous message, the author singled out the supposedly flawed hiring process of a senior director in WHO’s emergencies department, suggesting that might have led to mistakes being made by incompetent officials involved in efforts to stop Ebola in Congo.

What these medical journals don’t reveal: Top doctors’ ties to industry

Via The New York Times: What These Medical Journals Don’t Reveal: Top Doctors’ Ties to Industry. Excerpt:

This article was reported and written in collaboration with ProPublica, the nonprofit journalism organization.  

One is dean of Yale’s medical school. Another is the director of a cancer center in Texas. A third is the next president of the most prominent society of cancer doctors. 

These leading medical figures are among dozens of doctors who have failed in recent years to report their financial relationships with pharmaceutical and health care companies when their studies are published in medical journals, according to a review by The New York Times and ProPublica and data from other recent research.

Dr. Howard A. “Skip” Burris III, the president-elect of the American Society of Clinical Oncology, for instance, declared that he had no conflicts of interest in more than 50 journal articles in recent years, including in the prestigious New England Journal of Medicine. 

However, drug companies have paid his employer nearly $114,000 for consulting and speaking, and nearly $8 million for his research during the period for which disclosure was required. His omissions extended to the Journal of Clinical Oncology, which is published by the group he will lead. 

In addition to the widespread lapses by doctors, the review by The Times and ProPublica found that journals themselves often gave confusing advice and did not routinely vet disclosures by researchers, although many relationships could have been easily detected on a federal database. 

Medical journals, which are the main conduit for communicating the latest scientific discoveries to the public, often have an interdependent relationship with the researchers who publish in their pages. Reporting a study in a leading journal can heighten their profile — not to mention that of the drug or other product being tested. And journals enhance their cachet by publishing exclusive, breakthrough studies by acclaimed researchers. 

In all, the reporting system still appears to have many of the same flaws that the Institute of Medicine identified nearly a decade ago when it recommended fundamental changes in how conflicts of interest are reported. Those have yet to happen.

“The system is broken,” said Dr. Mehraneh Dorna Jafari, an assistant professor of surgery at the University of California, Irvine, School of Medicine. She and her colleagues published a study in August that found that, of the 100 doctors who received the most compensation from device makers in 2015, conflicts were disclosed in only 37 percent of the articles published in the next year. 

“The journals aren’t checking and the rules are different for every single thing.”

Sierra Leone revives Ebola funds probe

Via The East African, a reminder that post-Ebola syndrome also includes political symptoms: Sierra Leone revives Ebola funds probe. Excerpt:

The vexing issue of alleged misuse of funds meant to fight the deadly West African Ebola epidemic is back on the spotlight in Sierra Leone. 

The Anti-Corruption Commission (ACC) says it has re-opened files for an unspecified number of cases that did not get the attention they deserved.  

An official said thorough probing into the matters was necessary to ensure proper justice for the taxpayer.  

The Ebola epidemic, which erupted in early 2014 in Guinea and spread to Liberia and then Sierra Leone, claimed nearly 12,000 lives, mainly in the three neighbouring countries, among nearly 30,000 cases recorded in the region, and as far as the US and Europe. 

Hundreds of millions of US dollars were poured into the fight from both foreign and local sources.  

The Sierra Leone government itself put aside $10 million (80 billion leones) for the period. 

The mandate 

There were reports that much of the money in the three countries was diverted into personal accounts of officials in charge of the battle against the virus.  

In Sierra Leone, the issue notably attracted international attention as it became a subject of a row between parliament and ACC, over who had the mandate to investigate it. 

Eventually, the Public Accounts Committee (PAC) of the House held a public hearing, where officials named in a damning auditor’s report were drilled over their role in the misuse of the funds.  

The Auditor General's report found that a third of taxpayers’ money allocated to the fight against the virus in the first six months of the epidemic was not accounted for. 

The authors pointed out that payments were made to hospitals without proof that the monies were going to health workers.  

The report also noted that the failure to spend the funds appropriately might have slowed Sierra Leone’s response to the epidemic, thereby causing unnecessary loss of life. 

The epidemic  

About 4,000 people died in Sierra Leone alone due to the epidemic. 

About 40 individuals, including high-profile medical officials, were invited to provide documentation to show how the funds were disbursed.  

Some of the accused paid back monies they were found guilty of misappropriating. 

While parliament, at the time, said it was satisfied with the manner in which it handled the issue, very few people outside the House were impressed by its response. 

Mr Emmanuel Amara, the Coordinator of Operations at the anti-graft agency, said ACC was now going after people with outstanding payment with no answers.  

“The PAC’s work wasn’t as exhaustive as the scope of the Ebola operations required,” Mr Amara said in a radio interview.