Ebola

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Find out more about the first-ever Universal Health Coverage Day


Universal Health Coverage Day

Universal Health Coverage Day

A new global coalition of more than 500 leading health and development organizations worldwide is urging governments to accelerate reforms that ensure everyone, everywhere, can access quality health services without being forced into poverty. The coalition was launched today, on the first-ever Universal Health Coverage Day, to stress the importance of universal access to health services for saving lives, ending extreme poverty, building resilience against the health effects of climate change and ending deadly epidemics such as Ebola.

Universal Health Coverage Day marks the two-year anniversary of a United Nations resolution, unanimously passed on 12 December 2012, which endorsed universal health coverage as a pillar of sustainable development and global security. Despite progress in combatting global killers such as HIV/AIDS and vaccine-preventable diseases such as measles, tetanus and diphtheria, the global gap between those who can access needed health services without fear of financial hardship and those who cannot is widening. Each year, 100 million people fall into poverty because they or a family member becomes seriously ill and they have to pay for care out of their own pockets. Around one billion people worldwide can’t even access the health care they need, paving the way for disease outbreaks to become catastrophic epidemics.

“The need for equitable access to quality health care has never been greater, and there is unprecedented demand for universal health coverage around the world,” said Michael Myers, Managing Director of The Rockefeller Foundation, which is spearheading Universal Health Coverage Day. “Universal health coverage is an idea whose time has come – because health for all saves lives, strengthens nations and is achievable and affordable for every country.”


For much of the 20th century, universal health coverage was limited to a few high-income countries, but in the past two decades, a number of lower- and middle-income countries have successfully embraced reforms to make quality health care universally available. Countries as diverse as Brazil, Ghana, Mexico, Rwanda, Turkey and Thailand have made tremendous progress toward universal health coverage in recent years. Today, the two most populous countries, India and China, are pursuing universal health coverage, and more than 80 countries have asked the World Health Organization for implementation assistance.

“Putting people’s health needs ahead of their ability to pay stems poverty and stimulates growth,” said Dr. Tim Evans, Senior Director for the Health, Nutrition and Population Global Practice at the World Bank Group. “Universal health coverage is an essential ingredient to end extreme poverty and boost shared prosperity within a generation.”

The 500+ organizations participating in the first-ever Universal Health Coverage Day coalition represent a diverse cross-section of global health and development issues, including infectious diseases, maternal and child health, non-communicable diseases and palliative care. Across these issues, knowledge and technologies exist to save and improve lives in significant numbers, but the impact of these tools is severely hampered by lack of equitable access to quality health services.

“Ebola is only the most recent example of why universal health coverage is the most powerful concept in public health,” said Dr. Marie-Paule Kieny, Assistant Director-General for Health Systems and Innovation at the World Health Organization. “Investing in strong, equitable health systems is the only way to truly protect and improve lives, particularly in the face of emerging threats like the global rise of non-communicable diseases and increasingly severe natural disasters.”

Events in 25 Countries Mark First-Ever Universal Health Coverage Day

Organizations around the world are calling on policymakers to prioritize universal health coverage, and are hosting events on 12 December to catalyze action, including:

  • New York, USA: High-level event on Ebola and resilience, organized by the Permanent Missions of France, Japan, Germany and Senegal to the United Nations, in collaboration with The Rockefeller Foundation and the Columbia University Mailman School of Public Health.
  • London, UK: Expert panel at the London School of Hygiene & Tropical Medicine on creating resilient, equitable health systems, organized in partnership with The Rockefeller Foundation and Action for Global Health.
  • New Delhi, India: High-level event on universal health coverage implementation in both India and the global context, convened by the Public Health Foundation of India, Oxfam India and the World Health Organization Country Office for India.
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Deaths from Malaria dramatically reduced!


Malaria treatment? Jesuit's Bark

Malaria treatment? Jesuit’s Bark

The number of people dying from malaria has fallen dramatically since 2000 and malaria cases are also steadily declining, according to the World Malaria Report 2014. Between 2000 and 2013, the malaria mortality rate decreased by 47% worldwide and by 54% in the WHO African Region – where about 90% of malaria deaths occur.

New analysis across sub-Saharan Africa reveals that despite a 43% population increase, fewer people are infected or carry asymptomatic malaria infections every year: the number of people infected fell from 173 million in 2000 to 128 million in 2013.

“We can win the fight against malaria,” says Dr Margaret Chan, Director-General, WHO. “We have the right tools and our defences are working. But we still need to get those tools to a lot more people if we are to make these gains sustainable.”

Between 2000 and 2013, access to insecticide-treated bed nets increased substantially. In 2013, almost half of all people at risk of malaria in sub-Saharan Africa had access to an insecticide-treated net, a marked increase from just 3% in 2004. And this trend is set to continue, with a record 214 million bed nets scheduled for delivery to endemic countries in Africa by year-end.


Access to accurate malaria diagnostic testing and effective treatment has significantly improved worldwide. In 2013, the number of rapid diagnostic tests (RDTs) procured globally increased to 319 million, up from 46 million in 2008. Meanwhile, in 2013, 392 million courses of artemisinin-based combination therapies (ACTs), a key intervention to treat malaria, were procured, up from 11 million in 2005.

Moving towards elimination

Globally, an increasing number of countries are moving towards malaria elimination, and many regional groups are setting ambitious elimination targets, the most recent being a declaration at the East Asia Summit to eliminate malaria from the Asia-Pacific region by 2030.

In 2013, two countries reported zero indigenous cases for the first time (Azerbaijan and Sri Lanka), and 11 countries succeeded in maintaining zero cases (Argentina, Armenia, Egypt, Georgia, Iraq, Kyrgyzstan, Morocco, Oman, Paraguay, Uzbekistan and Turkmenistan). Another four countries reported fewer than 10 local cases annually (Algeria, Cabo Verde, Costa Rica and El Salvador).

Fragile gains

But significant challenges remain: “The next few years are going to be critical to show that we can maintain momentum and build on the gains,” notes Dr Pedro L Alonso, Director of WHO’s Global Malaria Programme.

In 2013, one third of households in areas with malaria transmission in sub-Saharan Africa did not have a single insecticide treated net. Indoor residual spraying, another key vector control intervention, has decreased in recent years, and insecticide resistance has been reported in 49 countries around the world.

Even though diagnostic testing and treatment have been strengthened, millions of people continue to lack access to these interventions. Progress has also been slow in scaling up preventive therapies for pregnant women, and in adopting recommended preventive therapies for children under five years of age and infants.

In addition, resistance to artemisinin has been detected in five countries of the Greater Mekong subregion and insufficient data on malaria transmission continues to hamper efforts to reduce the disease burden.

Dr Alonso believes, however, that with sufficient funding and commitment huge strides forward can still be made. “There are biological and technical challenges, but we are working with partners to be proactive in developing the right responses to these. There is a strong pipeline of innovative new products that will soon transform malaria control and elimination. We can go a lot further,” he says.

While funding to combat malaria has increased threefold since 2005, it is still only around half of the USD 5.1 billion that is needed if global targets are to be achieved.

“Against a backdrop of continued insufficient funding the fight against malaria needs a renewed focus to ensure maximum value for money,” says Fatoumata Nafo-Traoré, Executive Director of the Roll Back Malaria Partnership. “We must work together to strengthen country ownership, empower communities, increase efficiencies, and engage multiple sectors outside health. We need to explore ways to do things better at all levels.”

Ray Chambers, who has served as the UN Secretary-General’s Special Envoy for Malaria since 2007, highlights the remarkable progress made in recent years. “While staying focused on the work ahead, we should note that the number of children dying from malaria today is markedly less than 8 years ago. The world can expect even greater reductions in malaria cases and mortality by the end of 2015, but any death from malaria remains simply unacceptable,” he says.

Gains at risk in Ebola-affected countries

At particular risk is progress on malaria in countries affected by the Ebola virus. The outbreak in West Africa has had a devastating impact on malaria treatment and the roll-out of malaria interventions. In Guinea, Sierra Leone and Liberia, the three countries most severely affected by the epidemic, the majority of inpatient health facilities remain closed, while attendance at outpatient facilities is down to a small fraction of rates seen prior to the outbreak.

Given the intense malaria transmission in these three countries, which together saw an estimated 6.6 million malaria cases and 20 000 malaria deaths in 2013, WHO has issued new guidance on temporary measures to control the disease during the Ebola outbreak: to provide ACTs to all fever patients, even when they have not been tested for malaria, and to carry out mass anti-malaria drug administration with ACTs in areas that are heavily affected by the Ebola virus and where malaria transmission is high. In addition, international donor financing is being stepped up to meet the further recommendation that bednets be distributed to all affected areas.

Note to editors

Globally, 3.2 billion people in 97 countries and territories are at risk of being infected with malaria. In 2013, there were an estimated 198 million malaria cases worldwide (range 124-283 million), 82% of which were in the WHO African region. Malaria was responsible for an estimated 584 000 deaths worldwide in 2013 (range: 367 000 – 755 000), killing an estimated 453 000 children under five years of age.

Based on an assessment of trends in reported malaria cases, a total of 64 countries are on track to meet the Millennium Development Goal target of reversing the incidence of malaria. Of these, 55 are on track to meet Roll Back Malaria and World Health Assembly targets of reducing malaria case incidence rates by 75% by 2015.

The World Malaria Report 2014 will be launched on 9 December 2014 in the United Kingdom Houses of Parliament. The event will be co-hosted by the All-Party Parliamentary Group on Malaria and Neglected Tropical Diseases (APPMG) and Malaria No More UK.

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Ebola crisis – Frequently asked questions about the Ebola crisis from the World Health Organisation.


Ebola crisis

Ebola crisis

Yesterday the World Health Organisation shared some responses to a number of frequently asked questions they have received from journalists and members of the public about the ongoing Ebola crisis.

At PatientTalk we thought it would be useful to share these with our readers.

Are the Ebola outbreaks in Nigeria and Senegal over?

Not quite yet.

If the active surveillance for new cases that is currently in place continues, and no new cases are detected, WHO will declare the end of the outbreak of Ebola virus disease in Senegal on Friday 17 October. Likewise, Nigeria is expected to have passed through the requisite 42 days, with active surveillance for new cases in place and none detected, on Monday 20 October.


For Nigeria, WHO confirms that tracing of people known to have contact with an Ebola patient reached 100% in Lagos and 98% in Port Harcourt. In a piece of world-class epidemiological detective work, all confirmed cases in Nigeria were eventually linked back to the Liberian air traveller who introduced the virus into the country on 20 July.

The anticipated declaration by WHO that the outbreaks in these 2 countries are over will give the world some welcome news in an epidemic that elsewhere remains out of control in 3 West African nations.

In Guinea, Liberia, and Sierra Leone, new cases continue to explode in areas that looked like they were coming under control. An unusual characteristic of this epidemic is a persistent cyclical pattern of gradual dips in the number of new cases, followed by sudden flare-ups. WHO epidemiologists see no signs that the outbreaks in any of these 3 countries are coming under control.

How does WHO declare the end of an Ebola outbreak?

A WHO subcommittee on surveillance, epidemiology, and laboratory testing is responsible for establishing the date of the end of an Ebola outbreak.

The date is fixed according to rigorous epidemiological criteria that include the date when the last case with a high-risk exposure completes 21 days of close medical monitoring and tests negative for the virus.

According to WHO recommendations, health care workers who have attended patients or cleaned their rooms should be considered as “close contacts” and monitored for 21 days after the last exposure, even if their contact with a patient occurred when they were fully protected by wearing personal protective equipment.

For health care workers, the date of the “last infectious contact” is the day when the last patient in a health facility tests negative using a real-time reverse-transcriptase polymerase chain reaction (RT-PCR) test.

For WHO to declare an Ebola outbreak over, a country must pass through 42 days, with active surveillance demonstrably in place, supported by good diagnostic capacity, and with no new cases detected. Active surveillance is essential to detect chains of transmission that might otherwise remain hidden.

Incubation period

The period of 42 days, with active case-finding in place, is twice the maximum incubation period for Ebola virus disease and is considered by WHO as sufficient to generate confidence in a declaration that an Ebola outbreak has ended.

Recent studies conducted in West Africa have demonstrated that 95% of confirmed cases have an incubation period in the range of 1 to 21 days; 98% have an incubation period that falls within the 1 to 42 day interval. WHO is therefore confident that detection of no new cases, with active surveillance in place, throughout this 42-day period means that an Ebola outbreak is indeed over.

The announcement that the outbreaks are over, in line with the dates fixed by the subcommittee on surveillance, epidemiology, and laboratory testing, is made by the governments of the affected countries in close collaboration with WHO and its international partners.

WHO recommendations for testing for Ebola virus disease and confirming a case

WHO is alarmed by media reports of suspected Ebola cases imported into new countries that are said, by government officials or ministries of health, to be discarded as “negative” within hours after the suspected case enters the country.

Such rapid determination of infection status is impossible, casting grave doubts on some of the official information that is being communicated to the public and the media.
• For early detection of Ebola virus in suspected or probable cases, detection of viral ribonucleic acid (RNA) or viral antigen are the recommended tests.
• Laboratory-confirmed cases must test positive for the presence of the Ebola virus, either by detection of viral RNA by RT-PCR, and/or by detection of Ebola antigen by a specific Antigen detection test, and/or by detection of immunoglobulin M (IgM) antibodies directed against Ebola.
• Two negative RT-PCR test results, at least 48 hours apart, are required for a clinically asymptomatic patient to be discharged from hospital, or for a suspected Ebola case to be discarded as testing negative for the virus.
• Laboratory results should be communicated to WHO as quickly as possible, in addition to reporting under the requirements and within the timelines set out in the International Health Regulations, which are administered by WHO.

WHO recommends that the first 25 positive cases and 50 negative specimens detected by a country without a recognized national reference viral haemorrhagic fever laboratory should be sent for secondary confirmatory testing to a WHO collaborating centre, designed as specialized in the safe detection (at biosafety level IV) of viral haemorrhagic fevers.

Similarly, for countries with a national reference laboratory for viral haemorrhagic fevers, the initial positive cases should also be sent to a WHO collaborating centre for confirmation.

If results are concordant, laboratory results reported from the national reference laboratory would be accepted by WHO.
• For more information read WHO recommendations on laboratory guidance for the diagnosis of Ebola virus disease

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Ebola crisis update -Public Health England began enhanced screening for Ebola at Heathrow airport today.


Special Needs Route

Special Needs Route

Public Health England (PHE) is helping to roll out enhanced screening for Ebola starting at Heathrow, then Gatwick and St Pancras (Eurostar), in passengers that Border Force officers identify as having travelled from Sierra Leone, Guinea and Liberia.

Passengers will have their temperature taken and complete a questionnaire asking about their current health, recent travel history and whether they might be at potential risk through contact with Ebola patients. Based on the information provided and their temperature, passengers will either be given advice and allowed to continue their journey, or undergo a clinical assessment by PHE staff and if necessary be transferred to hospital for further tests.

Dr Paul Cosford, director for health protection and medical director at PHE, said:

Anyone who is well but may have been at increased risk of contact with the Ebola virus will be given printed information and a PHE contact number to call in case they develop symptoms. People infected with Ebola can only spread the virus to other people once they have developed symptoms, such as a fever. Even if someone has symptoms, the virus is only transmitted by direct contact with the blood or body fluids of an infected person.



It’s important to remember this is just 1 part of the screening process. PHE is also working with the international community and local health authorities to ensure robust exit screening remains in place at airports in Sierra Leone, Guinea and Liberia, which will pick up anyone who is symptomatic before they leave these countries.

Although no system can completely prevent a case of Ebola coming into the UK, enhanced screening in high volume ports of entry will ensure that individuals at risk know exactly what to do if they start feeling ill, and can receive the expert advice they need immediately.

Overall the risk of Ebola in the UK remains low, and we have a world-class domestic health system that is ready to respond if we do see a case in the UK.

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Ebola and Spain – World Health Organisation comments on Spanish Ebola Crisis


Ebola Crisis

Ebola Crisis

Just in from WHO.  For your information.

“On 6 October 2014, the World Health Organization (WHO) was informed of the first confirmed autochthonous case of Ebola virus disease (EVD) in Spain. This case represents the first human-to-human transmission of EVD outside Africa.

The case is a female healthcare worker with no travel history to West Africa but who participated in the medical care of an EVD case in a Spanish citizen, who had been infected in Sierra Leone and evacuated to Madrid, Spain on 22 September 2014 and who died on 25 September 2014. She was in contact with the repatriated EVD case twice; on 24 and 25 September 2014. On both occasions she is reported to have worn appropriate personal protection equipment (PPE).

Following the Spanish national protocol for EVD cases, the healthcare worker was considered a low risk contact and monitored accordingly. The female case developed a fever on 29 September 2014 and was admitted into isolation on 6 October 2014 at Alcorcon Hospital in Madrid. The case was then transferred to La Paz-Carlos III Hospital in Madrid and is being treated under isolation.

Samples were collected and sent for testing to the National Reference Laboratory on 6 October 2014. Results were positive for Ebola virus on the same day.

The Spanish public health authorities are conducting an investigation to elucidate the mode of transmission. Identification of close contacts for daily monitoring for 21 days after exposure is underway for the recent case and is continuing for contacts of the Spanish citizen who was treated in Spain.


As for all countries reporting EVD cases, future WHO updates on EVD in Spain will not be posted on the Disease Outbreak News. Further information will be available in WHO’s Ebola situation reports which provide regular updates on the WHO response:

WHO does not recommend any travel or trade restrictions to be applied by countries except in cases where individuals have been confirmed or are suspected of being infected with EVD or where individuals have had contact with cases of EVD. Contacts do not include properly-protected health-care workers and laboratory staff.

Temporary recommendations from the Emergency Committee with regard to actions to be taken by countries can be found at: