tag:theconversation.com,2011:/us/topics/tedros-adhanom-ghebreyesus-83475/articlesTedros Adhanom Ghebreyesus – The Conversation2022-08-02T03:00:00Ztag:theconversation.com,2011:article/1879172022-08-02T03:00:00Z2022-08-02T03:00:00ZMonkeypox in Australia: should you be worried? And who can get the vaccine?<p>On July 23, World Health Organisation Director-General Tedros Adhanom Ghebreyesus took the unprecedented step and <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01419-2/fulltext">declared</a> the monkeypox outbreak a “public health emergency of international concern” – the highest global alert level for a disease outbreak. </p>
<p>Following this and with <a href="https://www.health.gov.au/health-alerts/monkeypox-mpx/about#current-status">45 cases in Australia</a>, Chief Medical Officer Paul Kelly <a href="https://www1.racgp.org.au/newsgp/clinical/monkeypox-now-a-disease-of-national-significance?feed=RACGPnewsGPArticles">declared</a> last week that monkeypox is now a “communicable disease incident of national significance”.</p>
<p>So what is monkeypox? And who’s eligible for a vaccine?</p>
<p>Most cases in the current global outbreak are occurring among men who have sex with men. How can this group and others who are at risk protect themselves?</p>
<h2>What is monkeypox?</h2>
<p>Monkeypox <a href="https://news.un.org/en/story/2022/07/1123212">is not a new disease</a>, it was found in the late 1950s in lab primates in Denmark, and was first diagnosed in humans in an infant in the 1970s in the Democratic Republic of Congo.</p>
<p>In the past, monkeypox has mainly been <a href="https://www.who.int/news-room/fact-sheets/detail/monkeypox">transmitted</a> from infected animals to humans (it is a zoonotic disease), and has been endemic to West and Central Africa. Transmission can occur through contact with infected animals including rodents, mice, rats, squirrels, monkeys and other primates.</p>
<p>But in this outbreak we’re seeing human-to-human transmission.</p>
<p>There are two distinct <a href="https://www.who.int/news-room/fact-sheets/detail/monkeypox">strains</a> of monkeypox. These are the Central African and the West African types, the latter of which is believed to be one linked to the current global outbreak.</p>
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<p>According to US Centers for Disease Control and Prevention (CDC) data, 23,620 cases have been <a href="https://www.cdc.gov/poxvirus/monkeypox/response/2022/world-map.html">reported</a> since May in 80 countries, with 73 countries that had no previous reported monkeypox cases. </p>
<p>There have been at least <a href="https://www.smh.com.au/world/south-america/first-monkeypox-deaths-recorded-outside-africa-in-brazil-and-spain-20220730-p5b5vf.html">seven deaths</a>. </p>
<p>Most of the cases in Australia have been in New South Wales and Victoria, among returned travellers and men who have sex with men, and in the age group 21-40 years.</p>
<p>The <a href="https://www.abc.net.au/news/2022-07-28/monkey-pox-declared-a-disease-of-significance-australia/101277158">declaration</a> that monkeypox is now a disease of national significance means the outbreak requires national policies, interventions and public health messaging, with the deployment of more <a href="https://www.health.gov.au/news/chief-medical-officers-statement-declaring-monkeypox-a-communicable-disease-incident-of-national-significance">resources</a> to assist affected areas and groups most at risk.</p>
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<h2>Symptoms and transmission</h2>
<p>The incubation period – the time taken to develop the disease after exposure to the virus – is usually around <a href="https://www.who.int/news-room/fact-sheets/detail/monkeypox">6-13 days</a>.</p>
<p>Transmission generally requires <a href="https://www.who.int/news-room/fact-sheets/detail/monkeypox">close contact</a> with an infected person. It can be transmitted via respiratory droplets.</p>
<p>It can also be transmitted through direct contact with body fluids or the rash (“lesions”), often through skin-on-skin contact, or indirect contact such as through contaminated clothing or bedding.</p>
<p>Transmission <a href="https://www.bmj.com/content/bmj/378/bmj-2022-072410.full.pdf">may occur</a> from people without symptoms, or with barely-detectable symptoms.</p>
<p><a href="https://www.who.int/news-room/fact-sheets/detail/monkeypox">Symptoms</a> are similar to smallpox, though less severe. They can include:</p>
<ul>
<li>fever</li>
<li>headache</li>
<li>aches</li>
<li>fatigue</li>
<li>sweats and chills</li>
<li>cough and sore throat</li>
<li>a rash that can look like blisters or pimples, which can be painful. These “lesions” typically go through several stages before eventually falling off.</li>
</ul>
<p>The CDC <a href="https://www.cdc.gov/poxvirus/monkeypox/symptoms.html">says</a> most people who get the virus will develop the rash.</p>
<p>A <a href="https://www.bmj.com/content/378/bmj-2022-072410">study</a> in the British Medical Journal published last week also found 88% of 197 people with monkeypox in London had lesions on their genitals or anus. </p>
<p>Symptoms generally last between two and four weeks, and the disease usually resolves on its own. Most adults with a healthy immune system <a href="https://www.who.int/news-room/fact-sheets/detail/monkeypox">won’t have severe illness</a> and won’t experience long-term harmful effects.</p>
<p>There’s no specific treatment for monkeypox yet. People with the infection should be given supportive treatment and light dressings on the rash, depending on the symptoms. Antivirals such as “tecovirimat” have been made available to patients in some countries who have or are at high risk of severe disease, such as being <a href="https://www.cdc.gov/poxvirus/monkeypox/treatment.html">immunocompromised</a>.</p>
<p>People with the infection should <a href="https://www.cdc.gov/poxvirus/monkeypox/clinicians/isolation-procedures.html">isolate</a> immediately for the duration of the illness – usually two to four weeks, until the lesions heal. </p>
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<h2>Higher risk groups</h2>
<p>Monkeypox can affect anyone. But men who have sex with men are at higher risk at the moment. WHO Director-General Tedros Adhanom Ghebreyesus <a href="https://twitter.com/DrTedros/status/1552382934300200960">said</a> 98% of cases so far are among men who have sex with men. </p>
<p>It’s important we provide as much information about the virus as possible, and it’s absolutely crucial we do this in a way that is not stigmatising.</p>
<p>This outbreak is seeing cases spread via close prolonged contact from sexual activity in the LGBTIQ+ group. Many from this group want to take proactive actions to help their community.</p>
<p>Specific actions governments can take <a href="https://cdc.gov/poxvirus/monkeypox/sexualhealth/index.html">include</a>: </p>
<ul>
<li>prioritising vaccines as a matter of urgency for those most at risk</li>
<li>targeting public health messaging so the LGBTIQ+ community can make informed decisions.</li>
</ul>
<p>Actions individuals can take include:</p>
<ul>
<li>maintaining contact details of sexual partners in case of need to follow up </li>
<li>avoiding sex if you have a rash until you get tested </li>
<li>considering avoiding skin to skin contact during large gatherings</li>
<li>if diagnosed with monkeypox, <a href="https://www.cdc.giov/ngpoxvirus/monkeypox/clinicians/isolation-procedures.html">avoiding</a> close physical contact, including sexual contact, with other people for the duration of the illness.</li>
</ul>
<p>The CDC says condoms <a href="https://www.cdc.gov/poxvirus/monkeypox/sexualhealth/index.html">may help</a> lower the risk of spread if the lesions are confined to the genital and/or anal region, but they’re likely not enough to prevent transmission on their own.</p>
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Read more:
<a href="https://theconversation.com/monkeypox-this-is-an-entirely-new-spread-of-the-disease-184085">Monkeypox: ‘This is an entirely new spread of the disease’</a>
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<h2>Who should have the vaccine?</h2>
<p>Australia has secured small supplies of two smallpox vaccines, which provide protection against monkeypox.</p>
<p>The vaccine advisory body, the Australian Technical Advisory Group on Immunisation (ATAGI), has recommended key risk groups be administered the vaccines. They <a href="https://www1.racgp.org.au/newsgp/clinical/monkeypox-now-a-disease-of-national-significance">include</a>: </p>
<ul>
<li>those identified as a high risk monkeypox contact in the past 14 days</li>
<li>men who have sex with men who are at high risk of exposure. This includes those living with HIV, or with a recent history of a high number of sexual partners or group sex</li>
<li>sex workers, with clients in high-risk categories</li>
<li>and anyone in the risk categories planning travel to a country experiencing a significant outbreak, with vaccination recommended four to six weeks prior to leaving.</li>
</ul>
<p>ATAGI has <a href="https://www.health.gov.au/sites/default/files/documents/2022/08/atagi-clinical-guidance-on-vaccination-against-monkeypox-atagi-clinical-guidance-on-vaccination-against-monkeypox_0.pdf">stated</a> that vaccination within four days of exposure to someone who’s infectious with monkeypox will provide the highest chance of preventing disease.</p>
<p>Avoiding close contact with people who have the infection can help prevent transmission. Monkeypox doesn’t spread as easily as the coronavirus and can be kept under control if we are cautious.</p>
<h2>The need for vaccine equity and global health leadership</h2>
<p>We can’t repeat the “vaccine nationalism” we’ve seen during COVID with rich countries hoarding vaccine doses, as this will unjustly prolong the outbreak.</p>
<p>Currently, <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01419-2/fulltext">according</a> to The Lancet medical journal, a smallpox vaccine sold as “Jynneos” in the US costs around US$100 a dose. The WHO has <a href="https://www.who.int/news/item/23-07-2022-second-meeting-of-the-international-health-regulations-(2005)-(ihr)-emergency-committee-regarding-the-multi-country-outbreak-of-monkeypox">called on</a> countries and manufacturers to ensure the vaccines, as well as diagnostics and therapeutics, are made available “at reasonable cost” where most needed.</p>
<p>Thus we have major political and policy challenges ahead and will need strong global health leadership going forward.</p>
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Read more:
<a href="https://theconversation.com/why-vaccine-nationalism-could-doom-plan-for-global-access-to-a-covid-19-vaccine-145056">Why 'vaccine nationalism' could doom plan for global access to a COVID-19 vaccine</a>
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<img src="https://counter.theconversation.com/content/187917/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jaya Dantas is Professor of International Health in the Curtin School of Population Health where she teaches a core unit in the Masters in Public Health and Master of Sexology course and leads a program of research in refugee and migrant health. She is currently lead CI on grants funded by Healthway and CI on a DISER grant. Jaya is the International Health SIG Convenor of the Public Health Association of Australia, has been appointed to the Global Gender Equality in Health Leadership Committee of Women in Global Health, Australia and is on the Editorial Advisory Group of the Medical Journal of Australia. She has lived experience of infectious diseases in India and Africa.</span></em></p>Most cases in the current global outbreak are occurring among men who have sex with men. So how can this group and others who are at risk protect themselves?Jaya Dantas, Deputy Chair, Academic Board; Dean International, Faculty of Health Sciences and Professor of International Health, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1754412022-01-28T07:12:15Z2022-01-28T07:12:15ZWHO head Tedros faces a challenge all humanitarians know well<figure><img src="https://images.theconversation.com/files/441932/original/file-20220121-19-xq9p76.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">World Health Organisation Director-General Tedros Adhanom Ghebreyesus.</span> <span class="attribution"><span class="source">Fabrice Coffrini/AFP via Getty Images</span></span></figcaption></figure><p>In 2017, the World Health Organisation (WHO) appointed <a href="https://www.who.int/director-general/biography">Dr Tedros Adhanom Ghebreyesus</a> as its director general. He’s the first African and the first person from the global south to occupy this high office. </p>
<p>His <a href="https://www.bmj.com/content/357/bmj.j2605.full">election process</a> was equally historic: a secret ballot that gave equal voting opportunity to all member states for the first time in WHO’s 70-year history. The post had been filled previously <a href="https://www.statnews.com/2017/05/23/who-director-general-tedros/">by a vote</a> of the executive board. Tedros – as he is popularly known – got an overwhelming two-thirds majority.</p>
<p>This triggered great jubilation in his home country of Ethiopia that he had served with <a href="https://www.france24.com/fr/20170524-ethiopien-tedros-nouveau-patron-oms-afrique-onu">distinction</a> as health and foreign minister. But now, the mood in Addis Ababa has turned toxic. As Tedros stood poised to <a href="https://healthpolicy-watch.news/who-board-supports-tedros-nomination-as-us-lays-down-financing-conditions/">renew</a> his mandate at WHO, the Ethiopian government launched a blistering attack on him, <a href="https://newbusinessethiopia.com/politics/ethiopia-files-complaint-against-who-chief-tedros-adhanom/">accusing</a> him of gross misconduct by interfering in the country’s internal affairs.</p>
<p>Ethiopia’s endorsement is not needed to re-elect Tedros as his first-term performance stands on its own merits, and no candidates oppose him. Nevertheless, Ethiopia is determined to <a href="https://healthpolicy-watch.news/ethiopias-dispute-with-tedros-may-spill-into-vote-for-new-director-general/">embarrass him</a>, as a distracting political manoeuvre on the global stage.</p>
<p>What has drawn such ire? Addis was acutely embarrassed when Tedros <a href="https://english.alarabiya.net/News/world/2022/01/12/We-are-witnessing-hell-in-Tigray-it-s-an-insult-to-humanity-WHO-s-Tedros">drew attention</a> to the catastrophic health and humanitarian situation in Tigray: a “hell” that is an “insult to humanity”. </p>
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<p>The <a href="https://www.nytimes.com/article/ethiopia-tigray-conflict-explained.html">civil war</a> includes ethnically-directed war crimes against civilians and a blockade on medicines and food into Tigray. The egregious violations of international humanitarian law and human rights conventions have been likened to <a href="https://www.theguardian.com/commentisfree/2021/nov/26/ethiopia-genocide-warning-signs-abiy-ahmed">genocide</a>.</p>
<p>Colouring the picture is Tedros’s own Tigrayan identity and history as a prominent member of Ethiopia’s previous administration dominated by the <a href="https://www.jstor.org/stable/3518491">Tigray People’s Liberation Front</a>. This is now the bitter enemy of current Prime Minister Abiy Ahmed. </p>
<p>Tedros’s own family and friends have been targeted in the conflict. This is quite unprecedented for a UN agency head but not unknown among other senior staff. I was myself subjected to death threats as head of the United Nations in Sudan for <a href="https://www.youtube.com/watch?v=WEUWU8JwnDI&t=9s">speaking</a> against its government committing <a href="https://www.icc-cpi.int/darfur">crimes against humanity in Darfur</a>. The intimidation touched my family, and continued even after I left Khartoum for the relatively safe haven of Geneva.</p>
<p>Tedros is well-known worldwide because of his strong health leadership, especially in relation to Ebola and COVID-19. As a prominent global influencer, what he says matters.</p>
<h2>Speak up or stay silent?</h2>
<p>The vilification of the elected head of a United Nations agency raises disturbing wider issues. Should the leaders of international organisations speak up or stay silent when they see gross abuses by member states against agreed norms and laws they are duty-bound to uphold?</p>
<p>The WHO is a multilateral development agency but its health work is substantially humanitarian. And never more so than in our pandemic age. Tedros’s dilemma is well-known to all humanitarians. They are damned by governments if they speak up for victims of their abuse or oppression. They are also damned by rights advocates if they don’t, because giving “voice to the voiceless” is a cardinal element of their mission. </p>
<p>But what should be voiced loudly and what can only be whispered privately? They are allowed to beg for resources for the hungry and sick, but not to challenge the inhumanities that generate suffering. Because that violates the bedrock <a href="https://www.unocha.org/sites/dms/Documents/OOM-humanitarianprinciples_eng_June12.pdf">humanitarian principles</a> of “neutrality” and “impartiality”. And in the case of multilaterals, it trespasses into the no-go zone of national sovereignty, the last defence of states violating the international norms they have signed.</p>
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Read more:
<a href="https://theconversation.com/comply-or-leave-the-dilemma-facing-humanitarian-agencies-165787">Comply or leave: the dilemma facing humanitarian agencies</a>
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<h2>Old rules don’t work</h2>
<p>The humanitarian space is rapidly shrinking in war theatres such as <a href="https://reports.unocha.org/en/country/ethiopia">Ethiopia</a>, <a href="https://reliefweb.int/report/yemen/yemen-humanitarian-access-snapshot-january-february-2021">Yemen</a>, and <a href="https://thediplomat.com/2021/12/report-myanmar-junta-restricting-lifesaving-humanitarian-aid/">Myanmar</a>. The old rules and associated civilities don’t work. </p>
<p>The defence shield of a multilateral system of frameworks and institutions such as the <a href="https://reliefweb.int/report/world/un-security-council-fails-support-global-ceasefire-shows-no-response-covid-19">UN Security Council</a>, Human Rights Council, International Criminal Court or the <a href="https://warontherocks.com/2021/09/what-tigray-portends-the-future-of-peace-and-security-in-africa/">African Union</a> and African Court on Human and People’s Rights is punctured by the geopolitics of powerful states with impunity to disregard or undermine them. </p>
<p>Idealists hold on to the <a href="https://www.proquest.com/openview/5fa9ea0c701964ce9ea7267ff8297c6e/1?pq-origsite=gscholar&cbl=18750&diss=y">myth</a> that humanitarianism is a non-political enterprise. Yet it is shamelessly manipulated and blatantly shackled to partisan objectives, as graphically shown by current <a href="https://foreignpolicy.com/2021/12/22/afghanistan-aid-taliban-kabul-un-starvation-insecurity/">Afghanistan</a> and <a href="https://www.thenewhumanitarian.org/podcast/2021/11/10/politicisation-of-aid-in-Ethiopia-rethinking-humanitarianism">Ethiopian</a> experiences. The political economy of humanitarian work is undergoing a tectonic shift as authoritarian superpowers and their dependent client states in Africa, Eastern Europe and Asia challenge the dispensations of a <a href="https://institute.global/policy/authoritarian-challenges-liberal-order">retreating liberal order</a>.</p>
<p>Humanitarian bodies – multilateral and civil society – don’t know how to respond to the wicked new world. Ethiopia provides a telling illustration. Before Dr Tedros put his head above the parapet, Addis had already <a href="https://www.csis.org/analysis/humanitarian-suspensions-and-politicization-aid-ethiopia">suspended</a> humanitarian agencies such as the Norwegian Refugee Council, MSF and Al Maktoum Foundation, and <a href="https://www.reuters.com/world/africa/ethiopia-expels-seven-senior-un-officials-2021-09-30/">expelled</a> UN humanitarian staff.</p>
<p>Nowadays, humanitarians may only operate in Ethiopia if they submit to the will of the national authorities. The new rules are “see no evil, hear no evil, speak of no evil”. Even this could be swallowed if it meant that the desperate victims of famine and disease received help. But that is not happening and, instead, humanitarians risk getting co-opted into the total war on Tigray through their enforced passivity.</p>
<h2>Shrinking impact</h2>
<p>In past difficult circumstances, aid workers took inspiration from the <a href="https://www.icrc.org/en/who-we-are/movement">Red Cross Red Crescent Movement</a> that includes the International Committee of the Red Cross (ICRC), International Federation of Red Cross (IFRC) and Red Crescent Societies, and national societies in almost every country. They pioneered the modern humanitarian enterprise, giving us the <a href="https://www.icrc.org/en/war-and-law/treaties-customary-law/geneva-conventions">Geneva Conventions</a> and the <a href="https://www.icrc.org/sites/default/files/topic/file_plus_list/4046-the_fundamental_principles_of_the_international_red_cross_and_red_crescent_movement.pdf">fundamental humanitarian principles</a>. But their collective impact shrinks worldwide as their noble vision collides with the realities of a harsher world. </p>
<p>Perhaps this explains why, unlike the voices of courageous leaders of some UN agencies such as <a href="https://www.cbsnews.com/news/tigray-ethiopia-famine-rapes-tipping-point/">OCHA</a>, <a href="https://www.unicef.org/press-releases/children-feared-dead-and-injured-recent-attacks-refugee-and-internal-displacement">UNICEF</a> and <a href="https://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=27448">OHCHR</a> that have rung out over Ethiopia, the leaders of ICRC and IFRC are strangely muted. The Ethiopian Red Cross, which once championed humanity through many previous cycles of violence, is heavily constrained by its controlling government. Despite their self-restraint, there is little to suggest that the Red Cross in Ethiopia has any privileged access to the most needy and vulnerable, especially in Tigray.</p>
<p>Under such circumstances, if speaking up or not doesn’t make a difference to whether or not humanitarians can succour the vulnerable, what should they do? The question should be posed to the recipients. Research is limited but <a href="https://www.goodreads.com/book/show/50406030-no-stranger-to-kindness">experience</a> indicates that potential beneficiaries of humanitarian assistance are not naive.</p>
<p>They are aware of what agencies cannot do if they are denied access by vengeful or cruel authorities. Under such circumstances, they are desperate not to be abandoned or forgotten, even if they can’t be practically helped. They still get huge comfort and courage when caring people of influence speak up because they can’t speak for themselves or won’t be heeded.</p>
<p>Tedros found himself between the devil of a situation in Tigray and the deep blue sea of his constraints as a top international civil servant. His compassion and conscience provided the rock from which he spoke for humanity, without fear or favour. Other leaders in responsible positions must do the same. Over the longer term, that may perhaps save more lives and even humanitarianism itself.</p><img src="https://counter.theconversation.com/content/175441/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mukesh Kapila has held senior humanitarian and global health roles in the past in the UK Government and at the United Nations, World Health Organization, and International Federation of Red Cross and Red Crescent Societies. </span></em></p>Humanitarians are stuck in a dilemma: challenging practices that cause suffering could risk access to the vulnerable people they serve.Mukesh Kapila, Professor Emeritus in Global Health & Humanitarian Affairs, University of ManchesterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1553552021-02-16T01:03:33Z2021-02-16T01:03:33ZGlobal weekly COVID cases are falling, WHO says — but ‘if we stop fighting it on any front, it will come roaring back’<p>The number of reported <a href="https://news.un.org/en/story/2021/02/1084742">global weekly COVID cases is falling</a> and has dropped nearly 50% this year, the World Health Organization (WHO) said overnight. This incredibly encouraging news shows the power of public health measures — but we must remain vigilant. Letting our guard down now, when new variants are emerging, could easily reverse the trend.</p>
<p>According to a WHO <a href="https://news.un.org/en/story/2021/02/1084742">press release</a>: </p>
<blockquote>
<p>“Last week saw the lowest number of reported weekly cases since October”, Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO) told journalists at a regular press briefing in Geneva. </p>
<p>Noting a nearly 50% drop this year, he stressed that “how we respond to this trend” is what matters now. </p>
<p>While acknowledging that there is more reason for hope of bringing the pandemic under control, the WHO chief warned, “the fire is not out, but we have reduced its size”. </p>
<p>“If we stop fighting it on any front, it will come roaring back”. </p>
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Read more:
<a href="https://theconversation.com/are-vaccines-already-helping-contain-covid-early-signs-say-yes-but-mutations-will-be-challenging-154479">Are vaccines already helping contain COVID? Early signs say yes, but mutations will be challenging</a>
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<p>This welcome news shows that when governments respond rapidly by putting in place public health measures, we reap the benefits even before widespread vaccine rollouts. That’s a really important message now, and for when the next pandemic hits (and another one eventually will).</p>
<p>As good as this news is, though, we are still seeing infections in fairly large numbers worldwide. And, as we have regrettably seen in the past, subsequent waves of infection can easily emerge.</p>
<p>We also now have a series of variants to contend with. Even as begin to understand how the variants now circulating will affect the effectiveness of current vaccines, it’s possible we could see yet another new variant emerge that would reverse the downward trend. This remains a real risk when there are still so many new infections worldwide and when so few countries have been able to start vaccinating.</p>
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<a href="https://images.theconversation.com/files/384356/original/file-20210216-23-pwpn7r.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/384356/original/file-20210216-23-pwpn7r.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/384356/original/file-20210216-23-pwpn7r.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/384356/original/file-20210216-23-pwpn7r.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/384356/original/file-20210216-23-pwpn7r.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/384356/original/file-20210216-23-pwpn7r.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=532&fit=crop&dpr=1 754w, https://images.theconversation.com/files/384356/original/file-20210216-23-pwpn7r.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=532&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/384356/original/file-20210216-23-pwpn7r.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=532&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="attribution"><a class="source" href="https://ourworldindata.org">Our World in Data</a></span>
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<h2>It’s too early to see vaccine effect</h2>
<p>Some countries, such as Israel and the United Kingdom, have already vaccinated huge swathes of their population. That’s a tremendous achievement and we will start to see the benefits in the coming months. But fundamentally, it’s too early to see the effect of the vaccine rollout in widespread reduction of infection. </p>
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<a href="https://images.theconversation.com/files/384357/original/file-20210216-24-4kojyj.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/384357/original/file-20210216-24-4kojyj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/384357/original/file-20210216-24-4kojyj.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/384357/original/file-20210216-24-4kojyj.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/384357/original/file-20210216-24-4kojyj.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/384357/original/file-20210216-24-4kojyj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=532&fit=crop&dpr=1 754w, https://images.theconversation.com/files/384357/original/file-20210216-24-4kojyj.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=532&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/384357/original/file-20210216-24-4kojyj.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=532&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="attribution"><a class="source" href="https://ourworldindata.org/covid-vaccinations">Our World in Data</a></span>
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<p>On the other hand, we have recently seen a much greater focus on public health measures in places such as Europe, the Middle East and the United States. These places have been significantly affected by COVID outbreaks and are dealing with <a href="https://time.com/5929246/uk-coronavirus-third-wave/">third waves</a>, as some are preparing for <a href="https://www.reuters.com/article/us-health-coronavirus-iran-idINKBN2AD0KQ">their fourth</a>.</p>
<p>It’s likely these public health measures — such as lockdowns, physical distancing, mask-wearing and increased hygiene measures — are what’s driving the global downward trend. That shows the benefit when leaders do engage and bring their populations with them.</p>
<p>To keep that trend going in the right direction, we need high levels of public compliance with those public health measures and more equitable access to vaccines globally.</p>
<h2>Unequal global access to vaccines is a major risk</h2>
<p>Very few low-income countries have started a widespread vaccine rollout, and many are struggling to secure doses. Having unequal access globally to vaccines is obviously <a href="https://www.ft.com/content/797e3d7b-0091-4bfd-8cae-c0b5be380772">morally wrong and dangerous</a> — but it also represents a great economic risk to high income countries like Australia. </p>
<p>Having high-income countries buying up all the stock of vaccines and leaving poorer nations with little recourse will <a href="https://www.foreignaffairs.com/articles/world/2020-12-29/vaccine-nationalism-will-prolong-pandemic">prolong the pandemic</a>. And that’s bad news for the global economy, with estimates suggesting the pandemic will cost <a href="https://jamanetwork.com/journals/jama/fullarticle/2771764">US$16 trillion dollars</a>.</p>
<p>Even if Australia were able to maintain its success so far, having the pandemic run out of control in other countries means no travel, will continue to make it hard for Australians to return home, and could lead to shortages of products and materials from other countries. As the global financial crisis showed, economic strife in other parts of the world can have profound impact locally, even when Australia is doing relatively OK.</p>
<p>The risk this poses to lives and to the global economy is one reason the WHO has <a href="https://news.un.org/en/story/2021/02/1084372">called for</a> vaccine rollouts to begin in all countries in the first 100 days of 2021, and for health-care workers in lower- and middle-income countries to be protected first. </p>
<p>The WHO has issued a <a href="https://www.who.int/campaigns/annual-theme/year-of-health-and-care-workers-2021/vaccine-equity-declaration">vaccine equity declaration</a> calling for, among other things, world leaders to increase contributions to the UN-led vaccine equity initiative, COVAX, and to share doses with COVAX even as they roll out their own national campaigns. </p>
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<p>We also clearly need to upscale <a href="https://cepi.net/news_cepi/preparing-for-the-next-disease-x/">vaccine research and manufacturing capacity</a> around the world, which would also help us respond to the next pandemic, too.</p>
<p>There’s still <a href="https://www.wsj.com/articles/will-we-be-ready-for-the-next-pandemic-11613145677">a lot of work</a> to be done.</p>
<h2>Relaxing too soon can undo our progress</h2>
<p>As the WHO’s Director-General said overnight, the fire is not out and “if we stop fighting it on any front, it will come roaring back”. </p>
<p>That’s why sticking to the fundamentals of infection control is so important. That means keeping up with the hand-washing and physical distancing. It means wearing a mask if you can’t physically distance and complying with lockdowns and other public health orders. Yes, it’s hard to maintain a high level of commitment, but the alternative is far worse.</p>
<p>When people start to hear that global case numbers are improving, there’s a tendency to relax — and that’s risky. Now is the time we need to work together to see this contained, and ideally suppressed. </p>
<p>We may never completely eradicate this virus. But if we stick with the public health measures, and vaccinate as many people as possible worldwide, we can keep the trend going in the right direction.</p>
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Read more:
<a href="https://theconversation.com/uk-south-african-brazilian-a-virologist-explains-each-covid-variant-and-what-they-mean-for-the-pandemic-154547">UK, South African, Brazilian: a virologist explains each COVID variant and what they mean for the pandemic</a>
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<img src="https://counter.theconversation.com/content/155355/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Kamradt-Scott is an Associate Professor in the Centre for International Security Studies, University of Sydney, and a Non-Resident Fellow of the United States Studies Centre. He receives funding from the Australian Research Council and the Canadian Institute for Health Research. Adam is also a director of the Global Health Security Network.</span></em></p>When people start to hear that global case numbers are improving, there’s a tendency to relax — and that’s risky.Adam Kamradt-Scott, Associate professor, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1422662020-07-09T02:36:57Z2020-07-09T02:36:57ZLives at ‘grave risk’: Trump’s withdrawal from the WHO is a hit to global health<p>This week US President Donald Trump made good on his threat to withdraw the United States from the World Health Organisation (WHO) by sending a <a href="https://edition.cnn.com/2020/07/07/politics/us-withdrawing-world-health-organization/index.html">formal letter of withdrawal</a> to the UN Secretary-General. </p>
<p>In so doing, the president has initiated the Congressionally-mandated 12-month countdown to withdrawal that will take effect in July 2021. That is, unless it is over-turned, as presumptive Democratic nominee <a href="https://twitter.com/JoeBiden/status/1280603719831359489">Joe Biden has immediately pledged to do</a> if elected.</p>
<p>But if the United States’ exit goes ahead, it will be a hit to global health cooperation and place lives at risk in the US and beyond.</p>
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<p>Questions persist about the president’s legal authority to <a href="https://crsreports.congress.gov/product/pdf/LSB/LSB10489">unilaterally withdraw</a> the United States from the WHO. But under the conditions imposed by the <a href="http://www.loc.gov/law/help/statutes-at-large/80th-congress/session-2/c80s2ch469.pdf">US Congress in 1948</a>, the president must first ensure payment of any outstanding dues before the withdrawal can take effect.</p>
<p>According to some estimates, the US government currently owes <a href="https://www.rollcall.com/2020/06/10/congress-weighs-next-steps-on-who-relationship/">US$58 million to the WHO</a> in unpaid dues, as well as a further <a href="https://www.miamiherald.com/opinion/op-ed/article243874762.html">$110 million</a> to the Pan-American Health Organisation, the branch of the WHO covering North and South America. </p>
<h2>The withdrawal threatens US lives</h2>
<p>According to the American Medical Association, American lives will be placed at “<a href="https://www.ama-assn.org/press-center/ama-statements/statement-withdrawal-us-world-health-organization">grave risk</a>” if Trump’s withdrawal from the WHO is not reversed. Digging a little deeper, it’s not hard to see why. </p>
<p>Twice a year, for example, the WHO <a href="https://www.who.int/influenza/gisrs_laboratory/en/">Global Influenza Surveillance and Response System</a> (GISRS) provides WHO member states with vital information on the dominant influenza strains circulating around the world. This data is then used to develop life-saving influenza vaccines. If enacted, the United States’ withdrawal will mean it’s officially excluded from this global network, placing the country at a distinct disadvantage ahead of every flu season. </p>
<p>The implications could be profound, given that in 2018-2019, <a href="https://www.cdc.gov/flu/about/burden/2018-2019.html">34,200 Americans died of seasonal influenza-related illness</a> despite having access to vaccines developed using GISRS data.</p>
<p>Likewise, important international discussions about <a href="https://thehill.com/policy/international/506291-trump-who-withdrawal-could-boomerang-on-us">vaccine research and development</a> on diseases that threaten American lives will likely now occur without US scientists being involved. International guidelines on best medical practice will continue to be produced by the WHO but without US input.</p>
<p>The US has benefited for decades from obtaining advance warning about disease outbreaks in other parts of the world through the <a href="https://www.who.int/ihr/alert_and_response/en/">WHO’s Event Information System</a>, but this will no longer be possible. The US would be effectively cut off from such alerts, forced to rely on foreign media or public WHO announcements.</p>
<p>Aside from the notable health consequences, withdrawing from the WHO will mean the country no longer has a seat at the negotiating table on what future reforms are needed to make the WHO a more effective global health agency. This is something many of Trump’s advisers and supporters had <a href="https://www.politico.com/news/2020/04/10/trump-aides-debate-demands-who-179291">wanted to see happen</a>, but the president’s actions will relegate the United States to the sidelines.</p>
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Read more:
<a href="https://theconversation.com/the-world-agreed-to-a-coronavirus-inquiry-just-when-and-how-though-are-still-in-dispute-138868">The world agreed to a coronavirus inquiry. Just when and how, though, are still in dispute</a>
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<h2>The future of global public health is at stake</h2>
<p>The United States has traditionally remained one of the most generous contributors to WHO-led global health initiatives, providing almost <a href="https://time.com/5847505/trump-withdrawl-who/">twice as much as most other donors</a>. Because of US withdrawal, the future viability of polio eradication, tuberculosis control, and access to HIV/AIDS treatment initiatives, just to name a few, <a href="https://time.com/5847505/trump-withdrawl-who/">are now all at risk</a>.</p>
<p>US withdrawal is likely to have a significant impact on public health in the region. The Pan-American Health Organisation (PAHO) is <a href="https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)31489-6.pdf">on the verge of insolvency</a> as a result of unpaid dues. The US is currently the primary debtor, owing 67% of the unpaid fees. </p>
<p>Even before the COVID-19 pandemic, PAHO provided vital technical assistance and expertise unavailable throughout many Latin American countries. In the event PAHO is allowed to go bankrupt, the impact on regional health programs such as <a href="https://www.paho.org/hq/index.php?option=com_content&view=article&id=15043:joint-project-seeks-to-improve-the-health-of-indigenous-women-and-children-in-the-south-american-chaco&Itemid=135&lang=en">maternal and child health</a>, not to mention the pandemic response, will likely contribute to considerable loss of life. </p>
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<p>For the World Health Organisation, the departure of the United States will be a significant blow. For many years the level and extent of technical cooperation between the global health agency and the US Government has contributed to making the world safer and healthier. Such collaboration is now under threat. </p>
<p>As with the EU’s approach to negotiations on the United Kingdom’s “Brexit”, the WHO’s remaining member states now have to make an example of the United States, ensuring that it is excluded from multiple WHO initiatives. If they do not, it risks more countries threatening to withdraw. The future of global public health is at stake, and the actions of one country cannot be allowed to undermine decades of multilateral efforts to improve the health and well-being of all peoples of the world.</p>
<p>In the event the United States does withdraw from the WHO it will sit in a unique category: that of a global health pariah. </p>
<p>America First is increasingly looking like the new reality will be America Alone.</p>
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Read more:
<a href="https://theconversation.com/the-next-once-a-century-pandemic-is-coming-sooner-than-you-think-but-covid-19-can-help-us-get-ready-139976">The next once-a-century pandemic is coming sooner than you think – but COVID-19 can help us get ready</a>
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<p><em>This article is supported by the <a href="https://theconversation.com/au/partners/judith-neilson-institute">Judith Neilson Institute for Journalism and Ideas</a>.</em></p><img src="https://counter.theconversation.com/content/142266/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Kamradt-Scott is a Non-Resident Fellow at the United States Studies Centre and the Centre for International Security Studies at the University of Sydney. He is a director of the Global Health Security Network, and co-convenor of the global health security conferences. Adam has previously received funding from the Australian Research Council and the Canadian Institute for Health Research.</span></em></p>The actions of one country cannot be allowed to undermine decades of multilateral efforts to improve the health and well-being of all peoples of the world.Adam Kamradt-Scott, Associate professor, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1418842020-07-05T08:40:23Z2020-07-05T08:40:23ZCultural factors are behind disinformation pandemic: why this matters<figure><img src="https://images.theconversation.com/files/345502/original/file-20200703-33926-52umy7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">To contain and mitigate the virus of misinformation needs multi-levelled, socio-cultural approaches. </span> <span class="attribution"><span class="source">GettyImages</span></span></figcaption></figure><p>The <a href="https://en.unesco.org/fightfakenews">prevalence of disinformation</a> about the <a href="https://theconversation.com/africa/covid-19">coronavirus pandemic</a> has prompted Tedros Adhanom Ghebreyesus, the Director-General of the World Health Organization (WHO) to warn that:</p>
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<p><a href="https://www.un.org/en/un-coronavirus-communications-team/un-tackling-%E2%80%98infodemic%E2%80%99-misinformation-and-cybercrime-covid-19">We’re not just fighting an epidemic; we’re fighting an infodemic</a>. </p>
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<p>The infodemic is <a href="https://www.who.int/news-room/events/detail/2020/06/30/default-calendar/1st-who-infodemiology-conference">defined as</a> an overabundance of information, some accurate and some not, during an epidemic. It makes it hard for people to know which sources are trustworthy and reliable. Part of the problem is the widespread occurrence of misinformation.</p>
<p>To fight this infodemic, we need to understand how misinformation spreads in particular host environments. This requires a study of culture, context and lived experience of media users. </p>
<p>To contain and mitigate the virus of misinformation we need multi-levelled, socio-cultural approaches and methods. </p>
<p>One such tool of analysis available in the media and cultural literature is the classic concept of the <a href="https://uk.sagepub.com/en-gb/eur/doing-cultural-studies/book234568">“circuit of culture”</a>. This model explains the complex, interrelated moments and processes involved in the development of socio-cultural phenomena. It can help explain how misinformation travels, is consumed, and amplified or restrained in relation to a range of factors. </p>
<p>In addition to the political and economic contexts within which misinformation is produced and consumed, it is also important to also consider cultural aspects. When we understand how these different moments in the circuit of culture are interlinked, we can design more appropriate interventions. There are the five moments in the circuit of culture that are useful to keep in mind.</p>
<h2>Five moments in the circuit of culture</h2>
<p><strong>Representation</strong>: Texts are sites of struggle, where meanings are contested and counter-meanings produced. Messages are encoded and decoded in relation to their environments. If information, say about the wearing of masks, is coded by health authorities in a technical manner, to explain how they prevent the spread of the virus, but decoded by audiences as an attack on their liberty, a slippage of meaning has occurred. </p>
<p>It is in these slippages that misinformation can easily insert itself. Cultural studies can help us understand how misinformation is constructed in ways so as to appeal to people’s everyday emotions, fears and anxieties and which political discourses resonate with them.</p>
<p><strong>Identity</strong>: How does consuming and sharing misinformation give people a sense of belonging and community? Previous studies have shown that <a href="https://misinforeview.hks.harvard.edu/article/misinformation-in-action-fake-news-exposure-is-linked-to-lower-trust-in-media-higher-trust-in-government-when-your-side-is-in-power/">political affiliation</a>, age demographic and similar identity positions might make people more likely to share misinformation.</p>
<p><strong>Production:</strong> The digital media ecology has blurred the lines between production and consumption of information. Parody, rumour, memes and jokes have become a lingua franca. Users can find confirmation of their personal biases and beliefs – from conspiracy theories about <a href="https://www.who.int/images/default-source/health-topics/coronavirus/myth-busters/web-mythbusters/eng-mythbusting-ncov-(15).png?sfvrsn=a8b9e94_4">5G-towers</a> as a cause of the virus to <a href="https://www.who.int/images/default-source/health-topics/coronavirus/myth-busters/web-mythbusters/26-revised.png?sfvrsn=7d5199ac_2">pseudo-scientific remedies</a> - in “echo chambers” or “filter bubbles”. The implications of this shift in media production are important to grasp when dealing with the infodemic.</p>
<p><strong>Consumption:</strong> Cultural studies sees media users as active participants in the making of meaning, not passive recipients. Media users don’t merely receive misinformation, but shape it, curate it and share it. A <a href="https://www.tandfonline.com/doi/abs/10.1080/23743670.2019.1627230?src=recsys&journalCode=recq21">high percentage</a> of African social media users admit to sharing a news story that they knew was made up. </p>
<p>Why is this the case? </p>
<p>We can only answer that question from the perspective of the users’ lived experience and context. A lack of trust in official sources of information may lead people to imbue alternative sources of information with more authority. </p>
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Read more:
<a href="https://theconversation.com/laughter-in-the-time-of-a-pandemic-why-south-africans-are-joking-about-coronavirus-133528">Laughter in the time of a pandemic: why South Africans are joking about coronavirus</a>
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<p>The legacy of state-owned media in Africa has for a long time turned people to the <a href="https://www.ascleiden.nl/publications/tuning-pavement-radio">informal circuits</a> of gossip, jokes and humour to undermine illegitimate sources of authority. Although there has been a <a href="http://www.digitalnewsreport.org/">global surge in news media consumption</a> during the Covid-19 pandemic, overall levels of trust globally now seem to be at their lowest point ever. Fewer than four in ten (38%) of people surveyed by the <a href="http://www.digitalnewsreport.org/">Reuters Institute</a> say they trust most news most of the time. </p>
<p>Information overload and “noise” have also led to the erosion of trust and the inability to make informed decisions. The same study found that 56% of people still did not know what online information was real or fake.</p>
<p><a href="https://www.tandfonline.com/doi/abs/10.1080/23743670.2019.1627230?src=recsys&journalCode=recq21">In Africa,</a> people who report higher levels of exposure to disinformation also report lower levels of media trust.</p>
<p>Contradictory and speculative reports about treatments and vaccines, or confusing guidance about the use of masks, for example, may have intensified these trends. </p>
<p>Skepticism in official narratives may make people more susceptible to misinformation. A study in the US suggests that the ongoing and systemic failure of the public health system for black people, has made this community </p>
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<p><a href="https://shorensteincenter.org/wp-content/uploads/2020/06/Canaries-in-the-Coal-Mine-Shorenstein-Center-June-2020.pdf">skeptical of government interventions and medical authorities</a>. </p>
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<p>This, the study suggests, means these communities might rely instead on community knowledge for their survival. This could also expose them to dangerous misinformation.</p>
<p><strong>Regulation:</strong> Attempts by some countries (like <a href="https://cpj.org/2020/03/south-africa-enacts-regulations-criminalizing-disi/">South Africa</a> and <a href="https://www.hrw.org/news/2020/06/24/brazil-reject-fake-news-bill">Brazil</a>) to criminalise disinformation about Covid-19 have met with strong resistance from human rights and free speech watchdogs because of the fear that it would stifle free expression and political accountability.</p>
<p>When we have a better sense of why people do not trust mainstream media, or what their motivations may be for sharing misinformation, we can consider more appropriate interventions. Some motivations suggested in the literature are: financial or political gain, to express one’s feelings, cope with uncertainty, build relationships or to mobilise against a political order.</p>
<h2>No panacea</h2>
<p>A <a href="https://cyber.harvard.edu/sites/default/files/2019-12/%20Audience%20Motivations%20for%20Sharing%20Dis-%20and%20Misinformation.pdf">focus group research</a> by my colleagues and I in six African countries show some additional motivations. The most common reason for our respondents to share misinformation was to raise awareness out of a (misplaced) sense of civic duty. The second most common reason was to make others aware of misinformation. </p>
<p>Thirdly, media users in sub-Saharan countries said they shared misinformation “for fun”. Humour, gossip and satire seems to be a refuge for media users overwhelmed by serious or depressing news, to create conviviality and community.</p>
<p>It is these contextual, social and cultural differences that emphasise the importance of considering misinformation practices as socio-cultural phenomena. From that perspective we can evaluate what type of responses may be most appropriate for particular contexts, rather than attempting to administer a panacea.</p>
<p><em>This article is based on a keynote address given to the World Health Organization’s frist global infodemiology conference held virtually <a href="https://www.who.int/teams/risk-communication/infodemic-management/1st-who-infodemiology-conference">from 30 June to 21 July</a>. The address can be viewed <a href="https://youtu.be/jIX8R-xOVPg">here</a>.</em></p><img src="https://counter.theconversation.com/content/141884/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Herman Wasserman receives funding from the National Institute of Humanities and Social Sciences </span></em></p>In Africa, people who report higher levels of exposure to disinformation also report lower levels of media trust.Herman Wasserman, Professor of Media Studies and Director of the Centre for Film and Media Studies, University of Cape TownLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1389592020-05-20T14:17:01Z2020-05-20T14:17:01ZThe World Health Organization must answer these hard questions in its coronavirus inquiry<p>If the World Health Organization (WHO) wants to maintain its legitimacy on the world stage, it must now answer some tough questions about the extent it has kowtowed to China during the coronavirus pandemic. </p>
<p>It now has a chance to do so, after its members agreed to adopt a <a href="https://edition.cnn.com/2020/05/19/china/wha-pandemic-inquiry-resolution-vote-intl/index.html">resolution for an inquiry</a> into the global handling of the pandemic at a virtual meeting of its annual World Health Assembly on May 19. But there are still many other questions that need to be answered before it can restore its credibility. </p>
<p>We have <a href="https://www.tandfonline.com/doi/full/10.1080/17441690701524471">studied China’s engagement</a> with global health institutions such as the WHO, China’s compliance with global public health norms and how far it succeeds in creating and promoting its <a href="https://brill.com/view/journals/gg/20/2/article-p297_8.xml">own norms around the world</a>. Amid the global crisis caused by the coronavirus pandemic, which has infected nearly <a href="https://coronavirus.jhu.edu/map.html">five million people and killed more than 320,000</a> in just a few short months, understanding the relationship between China, where the outbreak began, and the WHO is crucial to the future of global public health. </p>
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<a href="https://theconversation.com/the-world-agreed-to-a-coronavirus-inquiry-just-when-and-how-though-are-still-in-dispute-138868">The world agreed to a coronavirus inquiry. Just when and how, though, are still in dispute</a>
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<h2>Uncritical of China</h2>
<p>The WHO’s leadership has come under <a href="https://www.reuters.com/investigates/special-report/health-coronavirus-who-tedros/">unprecedented scrutiny</a> during the pandemic for giving the impression that it has been swayed by, and beholden to, China. In <a href="https://www.fmprc.gov.cn/mfa_eng/zxxx_662805/t1737014.shtml">late January</a>, in the early days of the outbreak, the WHO’s director general, Tedros Adhanom Ghebreyesus, heaped unqualified praise on China’s COVID-19 policy measures and the leadership of Xi Jinping. He <a href="https://www.who.int/news-room/detail/28-01-2020-who-china-leaders-discuss-next-steps-in-battle-against-coronavirus-outbreak">commended</a> the “seriousness” with which China was taking the outbreak, “the commitment from top leadership, and the transparency they have demonstrated”.</p>
<p>But <a href="https://www.cambridge.org/core/journals/american-political-science-review/article/how-the-chinese-government-fabricates-social-media-posts-for-strategic-distraction-not-engaged-argument/4662DB26E2685BAF1485F14369BD137C">non-transparency and censorship</a> are pervasive in all levels of China’s system of government. Tedros had been warned by his <a href="https://www.reuters.com/investigates/special-report/health-coronavirus-who-tedros/">aides of the potential repercussions</a> of his effusive praise of China, but reportedly ignored them. It appears the WHO also took the initial <a href="https://twitter.com/WHO/status/1217043229427761152?s=20">information and data</a> about the epidemic transmitted to it by China at face value.</p>
<p>In late March, Japan’s deputy prime minister, Taro Aso, <a href="https://www.washingtonexaminer.com/news/japanese-deputy-prime-minister-says-who-should-be-renamed-china-health-organization">quipped</a> that the WHO should be renamed the “Chinese Health Organization”. The US president, Donald Trump, went further – <a href="https://www.bbc.co.uk/news/world-us-canada-52213439">criticising the WHO</a> of being too “China-centric” in handling the pandemic and of an “alarming lack of independence” <a href="https://twitter.com/realDonaldTrump/status/1262577580718395393">from China</a>. </p>
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<a href="https://theconversation.com/chinas-coronavirus-cover-up-how-censorship-and-propaganda-obstructed-the-truth-133095">China’s coronavirus cover-up: how censorship and propaganda obstructed the truth</a>
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<h2>Investigation battlefield</h2>
<p>The WHO now needs to restore its global credibility. The call for an independent, comprehensive review of the COVID-19 pandemic quickly became a <a href="https://www.washingtonpost.com/national/coronavirus-death-toll-who-trump/2020/04/23/d5c37400-8580-11ea-ae26-989cfce1c7c7_story.html">battlefield</a> between China and Western countries, especially Australia and the US. What was eventually adopted on May 19 without objection was a compromise resolution, submitted by the European Union and endorsed by more than 100 other countries. </p>
<p>The resolution does not refer to China, but asks the WHO to work with the World Organisation for Animal Health and the Food and Agriculture Organization, now led by the Chinese scientist Qu Dongyu, to: “Identify the zoonotic source of the virus and the route of introduction to the human population, including the possible role of intermediate hosts.” The resolution also looks forward, pointing to potential <a href="https://apps.who.int/gb/ebwha/pdf_files/WHA73/A73_CONF1Rev1-en.pdf">intellectual property right</a> issues surrounding a new vaccine. </p>
<p>Speaking at the World Health Assembly the day before the resolution was adopted, Xi framed China as a staunch supporter of multilateral global health governance and committed US$2 billion ($1.6 billion) to the international campaign to combat COVID-19. He <a href="https://www.globaltimes.cn/content/1188716.shtml">promised</a> that Chinese vaccines would be “global public goods”, directly confronting fears of a rise in <a href="https://www.theguardian.com/world/2020/may/18/former-who-board-member-warns-world-against-coronavirus-vaccine-nationalism">vaccine nationalism</a> in the West. But China’s moves were principally aimed at improving its tarnished reputation.</p>
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<h2>Tasks for the inquiry</h2>
<p>With the resolution adopted, the battle will now centre on who should lead the inquiry. If this inquiry is to be genuinely independent, it must address unanswered questions about who was China’s “patient zero” and <a href="https://www.newscientist.com/article/mg24532764-000-the-hunt-for-patient-zero-where-did-the-coronavirus-outbreak-start/">when and how they were infected</a>. </p>
<p>A real test would be whether the WHO-led delegation could meet, independently of Chinese authorities, some of the key figures involved in managing the initial stages of the country’s COVID-19 outbreak. It would be enlightening for them to hear at firsthand from frontline doctors in Wuhan hospitals who treated the first batch of COVID-19 patients, such as <a href="https://www.theguardian.com/world/2020/mar/11/coronavirus-wuhan-doctor-ai-fen-speaks-out-against-authorities">the doctor Ai Fen</a>. Others they may want to meet are the Wuhan Institute of Virology’s <a href="https://www.scientificamerican.com/article/how-chinas-bat-woman-hunted-down-viruses-from-sars-to-the-new-coronavirus1/">Shi Zhengli</a>, known as China’s “bat woman” and the heads of the genomics laboratories which were <a href="https://www.straitstimes.com/asia/east-asia/how-early-signs-of-the-coronavirus-were-spotted-spread-and-throttled-in-china">reportedly asked to destroy</a> the samples after testing. </p>
<p>Zhang Yongzhen of Fudan University in Shanghai would also be worth speaking to. Zhang has rarely appeared in Chinese official narratives, but his team concluded that the virus was of the coronavirus family, and their results were <a href="https://www.nature.com/articles/s41586-020-2008-3.pdf">published in the journal Nature</a> in early February. It later emerged that his laboratory had been <a href="https://www.scmp.com/news/china/society/article/3052966/chinese-laboratory-first-shared-coronavirus-genome-world-ordered">ordered to close</a> in early January, with no reason given. </p>
<p>Besides the inquiry into the origins of the virus, another key question is whether the WHO delayed declaring an international emergency after coming under pressure from China, a claim reported by <a href="https://magazin.spiegel.de/SP/2020/20/170816271/index.html">Der Spiegel</a> and <a href="https://www.newsweek.com/exclusive-cia-believes-china-tried-stop-who-alarm-pandemic-1503565">Newsweek</a>. According to Newsweek, citing a CIA report, the delay allowed China to hoard essential medical supplies and personal protective equipment from abroad. </p>
<p>Like other UN organisations, the WHO cannot enforce its decisions and policies without the support of its member states. Its success relies on whether it <a href="https://global.oup.com/academic/product/the-power-of-legitimacy-among-nations-9780195061789">can persuade politicians and officials</a> to comply with its decisions. Maintaining legitimacy is crucial if the WHO is to effectively tackle the future health crises that affect all of humanity.</p><img src="https://counter.theconversation.com/content/138959/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The WHO’s legitimacy is at stake – it must answer tough questions on whether it kow-towed to China.Lai-Ha Chan, Senior Lecturer in International Relations, University of Technology SydneyPak K Lee, Senior Lecturer in Chinese Politics and International Relations, University of KentLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1366202020-04-20T14:05:07Z2020-04-20T14:05:07ZDefunding the WHO was a calculated decision, not an impromptu tweet<p>It wouldn’t make much sense to sack the fire service during a forest fire, yet that’s effectively what US President Donald Trump has done by <a href="https://www.ft.com/content/693f49e8-b8a9-4ed3-9d4a-cdfb591fefce">suspending funding to the World Health Organization (WHO)</a> in the middle of a pandemic. The WHO is by no means perfect, but undermining the world’s only global public health agency does not serve US interests.</p>
<p>The US is the biggest contributor to the 194-member WHO, providing around <a href="https://www.bbc.co.uk/news/world-us-canada-52289056">US$400 million</a> (£322 million) annually, which makes up about a fifth of the budget. The organisation has been asked to do more with less for decades and is already in a fairly <a href="https://twitter.com/laurie_garrett/status/1250454778011934720?s=12">perilous</a> financial situation. </p>
<p>Although the move is characteristically shortsighted, this time Trump’s decision was premeditated. On April 10, he <a href="https://www.bloomberg.com/news/articles/2020-04-10/trump-suggests-he-may-hold-500-million-meant-for-who">hinted</a> that US funding would be withdrawn, adding: “We’re looking at it very, very closely … we’ll have a lot to say about it.”</p>
<p>The following week he confirmed the suspension of funding and blamed the WHO for <a href="https://twitter.com/WhiteHouse/status/1250194670031974400?ref_src=twsrc%5Etfw%7Ctwcamp%5Etweetembed%7Ctwterm%5E1250194670031974400&ref_url=https%3A%2F%2Ftwitter.com%2FWhiteHouse%2Fstatus%2F1250194670031974400">“severely mismanaging and covering up the spread of coronavirus”</a>. He argued that the organisation had been too slow to investigate the outbreak and had been complicit in China’s suppression and misreporting of cases.</p>
<p>Was he correct? Well, there is evidence that local officials attempted to <a href="https://www.bbc.co.uk/news/world-asia-china-51453848">cover up</a> the early outbreak, and the WHO director general, Tedros Adhanom Ghebreyesus, has stood by his endorsement of China’s heavy-handed tactics. As with decisions to honour Turkey’s <a href="http://www.euro.who.int/en/countries/turkey/news/news/2018/10/ministry-of-health-of-turkey-receives-award-for-ncd-prevention-and-control">president, Recep Erdogan</a>, and former Zimbabwean ruler <a href="https://theconversation.com/robert-mugabe-as-who-goodwill-ambassador-what-went-wrong-86244">Robert Mugabe</a>, Tedros’ stance has been <a href="https://www.wsj.com/articles/the-world-health-organization-draws-flak-for-coronavirus-response-11581525207">roundly criticised</a>. In his defence, it does seem to stem from a genuine desire to win engagement in order to deliver his mandate of achieving <a href="https://www.who.int/dg/priorities/health-for-all/en/">health for all</a>. </p>
<p>Interestingly, President Trump was one of the few world leaders who seemed to agree that China was doing a good job, praising the government’s <a href="https://twitter.com/realDonaldTrump/status/1220818115354923009?ref_src=twsrc%5Etfw%7Ctwcamp%5Etweetembed%7Ctwterm%5E1220818115354923009&ref_url=https%3A%2F%2Fwww.bbc.co.uk%2Fnews%2Fworld-us-canada-52294623">“hard work and transparency”</a> in January and commending Xi Jinping’s handling of the mounting pandemic in a <a href="https://www.politico.com/news/2020/04/15/trump-china-coronavirus-188736">string of further comments</a> during February. </p>
<p>Trump had two other aims in mind when he pulled the rug from under the WHO’s feet. In the short term, most pundits agree that Trump’s main motivation for cutting WHO funding was to deflect blame from his own bungled handling of COVID-19 on home soil. His <a href="https://www.axios.com/trump-coronavirus-approval-rating-442a186f-0b10-467b-afb0-8ec408d8e349.html">approval ratings</a> are at an all-time low and the US now has <a href="https://coronavirus.jhu.edu/map.html">more cases</a> of coronavirus than any other country. </p>
<p>In the longer term, withdrawing from multilateral partnerships aligns with Trump’s zero-sum worldview. As with <a href="https://money.cnn.com/2017/01/24/news/donald-trump-nato-spending/">Nato</a>, the <a href="https://www.nytimes.com/2019/12/08/business/trump-trade-war-wto.html">World Trade Organization</a> and virtually every other international body, Trump feels that the US is getting a bad deal from its WHO contribution. And he bristles at the thought of foreign nations exploiting American generosity. </p>
<p>Former presidents have worked to develop, maintain and promote an Anglophone, dollar-backed international world order built on American values of capitalism, liberalism, democracy, integration and the transparent rule of law. This has fostered an <a href="https://www.huffpost.com/entry/we-enjoy-the-most-peaceful-period-on-earth-ever_b_57ab4b34e4b08c46f0e47130?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAAJ-nITOdRIWCMCTezN_XkHM7PHCk_fAkCeefxRvpEtdflAqiirefCmFl4zyjm1wVgTBUaNXECdkcgcqvrksLt19ROYH2475HHa8rTookRgtGzIcphwfbCegSZsja8g1a3ytqo22NrXYfkXelBwK3WLzQSNZtD4SXXdsPRZ_vB0LE">unprecedented era</a> of peace, stability, international cooperation and integration of markets (as well as massive socioeconomic inequality) – projecting American soft power and allowing national firms to enter formerly closed markets. </p>
<p>In Trump’s view, his predecessors were chumps who allowed other countries to abuse American generosity while flouting the rules: from Nato allies shirking their responsibilities to China’s currency manipulation, intellectual property theft and disproportionate access to the WHO.</p>
<p>Yet defunding the WHO is a microcosmic act that illustrates the folly of Trump’s “America first” approach. The sums involved are peanuts to the administration – less than it costs to run a large hospital. Yet the US gets enormous bang for its buck. Its citizens are over-represented among WHO leadership and technical staff, and as a member state, it has never been afraid to use its clout to veto documents and clauses that threaten its commercial interests. The WHO’s irreplaceable work in sharing information and promoting science-based practice also benefits American citizens during the pandemic. </p>
<h2>Eastward shift in power</h2>
<p>Withdrawing from the international stage also leaves a superpower-sized leadership hole that only China can fill. If Trump wants the WHO to be more effective and less China-centric, then surely the remedy is more US engagement, not less.</p>
<p>Besides expediting the eastward shift of power, the bigger picture is that continued disengagement from lopsided international partnerships will hurt his base more than anyone else. It will lead to higher export tariffs, increasingly expensive imports, higher costs of living – and later on, geopolitical instability and weakened alliances. </p>
<p><a href="https://www.bbc.co.uk/news/world-us-canada-52291654">World leaders lined up</a> to condemn Trump’s assault on multilateralism, sparking a rare moment of coordination in a pandemic hitherto marked by international fragmentation. Selfish, reckless or misguidedly patriotic – whatever your take on Trump’s castigation, there is no denying that it couldn’t come at a worse time for the fragile states depending on the WHO to guide them through this raging inferno. It seems this move will achieve the exact opposite of everything Trump has intended: a worse deal for ordinary US citizens, a weaker America and an ever more China-centric global order.</p><img src="https://counter.theconversation.com/content/136620/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Luke Allen is a health policy researcher at the University of Oxford. He regularly performs independent consultancy work for the World Health Organisation and has also consulted for the US government as part of a G7 contract. </span></em></p>Trump pulling US funding from WHO served to deflect blame from his own bungled handling of coronavirus.Luke Allen, Researcher, Global Health Policy, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1329922020-03-04T11:46:39Z2020-03-04T11:46:39ZThe DRC is on the road to being Ebola free: how it got here<figure><img src="https://images.theconversation.com/files/318648/original/file-20200304-66074-1hnefgs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">WHO Director-General Tedros Adhanom at an Ebola treatment centre in Itipo.</span> <span class="attribution"><span class="source">Getty images/ Junior D. Kannah</span></span></figcaption></figure><p><em>At the beginning of March the authorities in the Democratic Republic of Congo (DRC) announced that the last Ebola patient had been <a href="https://www.afro.who.int/news/democratic-republic-congos-last-ebola-patient-discharged">discharged</a> from a treatment centre. The country has been in the grip of an Ebola outbreak since <a href="https://theconversation.com/ebola-returns-to-the-drc-for-the-10th-time-heres-what-we-know-101048">August 2018</a>. More than <a href="https://www.who.int/csr/don/27-february-2020-ebola-drc/en/">3,300</a> cases were confirmed and 2,264 people died. The last case was reported on February 17th. Now the countdown towards declaring the end of the world’s second largest Ebola outbreak begins. The World Health Organisation has put a time line of 42 days on this. The Conversation Africa’s Ina Skosana spoke to Yap Boum about the latest developments.</em> </p>
<p><strong>The last patient being treated for Ebola in the DRC has been discharged. What does this mean for the outbreak?</strong></p>
<p>The first thing is that it’s evidence of all the work that’s been done by those in the field as well as remotely. This has ranged from tracing patients to raising funds, engaging the communities and testing samples. And it shows that collaboration and coordination are the only ways to handle a complex problem such as the Ebola outbreak. </p>
<p>For the DRC it means that we can now count down the 42 days (two incubation phases of the virus) to declare the country Ebola-free. During that time community engagement and contact tracing will continue to ensure no case is left behind. Treatment centres will remain open but will slowly decrease their staffing based on the evolution of the outbreak. </p>
<p>Teams will be on standby to administer vaccinations if need be. This is because the <a href="https://theconversation.com/ebola-vaccine-is-key-in-ongoing-efforts-to-contain-the-drc-outbreak-110924">rVSV vaccine</a> is only administered to people who are in contact with someone who has been diagnosed. There’s still an ongoing study involving the <a href="https://theconversation.com/the-uganda-vaccine-trial-how-african-researchers-are-tackling-ebola-121517">JnJ vaccine</a>. This will carry on until the participants have completed the protocol, including the second dose of vaccine. </p>
<p><strong>This outbreak has been raging on for 19 months. What was the turning point?</strong></p>
<p>In my opinion, the turning point was the change in leadership to manage the outbreak response. After the elections in 2018 there was a change of government with <a href="https://theconversation.com/tshisekedis-victory-in-the-drc-is-historic-but-controversial-109673">President Félix Tshisekedi</a> at the helm. In <a href="https://theconversation.com/tshisekedi-has-taken-over-the-drcs-ebola-response-how-he-can-make-a-difference-121595">July 2019</a> the president appointed Professor Jean-Jacques Muyembe as the chairman of the response, leading to the resignation of the Minister of Health, Dr Oly Ilunga Kalenga. </p>
<p>These changes signalled a new, more inclusive approach to managing the crisis. As a result communities became more engaged and involved in the response. People from the affected areas became more engaged in managing a disease that was affecting them. </p>
<p>To be honest, we don’t yet know what the secret ingredient was. But by the time we declare the country Ebola-free we hope Professor Muyembe will tell us more about it. We imagine that his long experience with the disease and its management has paid a significant role in coordinating all those who were involved in the response. Not an easy task at all, I can tell you. </p>
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<a href="https://theconversation.com/tshisekedi-has-taken-over-the-drcs-ebola-response-how-he-can-make-a-difference-121595">Tshisekedi has taken over the DRC's Ebola response. How he can make a difference</a>
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<p>But there were other contributory factors we can list. There was the impressive involvement of the WHO through its teams in the field as well as its Director-General, Dr Tedros Adhanom Ghebreyesus, and Dr Michel Yao, who was in charge in the DRC. </p>
<p>On top of this, partners such as Doctors Without Borders, <a href="https://www.alima-ngo.org/en/democratic-republic-of-congo">Alima</a> and others managed to play the roles allocated to them by the coordination team. </p>
<p>A major development was the WHO’s decision in July 2019 <a href="https://www.who.int/ihr/procedures/pheic/en/">to declare</a> the outbreak a Public Health Emergency of International Concern. I must stress this wasn’t the <a href="https://theconversation.com/why-declaring-ebola-a-public-health-emergency-isnt-a-silver-bullet-120685">silver bullet</a>. The outbreak of a deadly disease within a conflict zone – and then in a major city – can’t be solved with a technical solution, such as more funding. But the decision gave the DRC’s Ministry of Health more flexibility to ensure response teams reached even the most remote areas. The decision had a critical effect on the response. It provided a second breath to address the new phase of the outbreak, paving the way to the point we’ve arrived at now.</p>
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<a href="https://theconversation.com/why-declaring-ebola-a-public-health-emergency-isnt-a-silver-bullet-120685">Why declaring Ebola a public health emergency isn't a silver bullet</a>
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<p>It is also important to mention that the outbreak was unlikely to last forever. The people and communities were more and more aware of the precautions needed to prevent and manage Ebola. People accepted that certain steps were critical in stopping the outbreak: these included screening people’s temperatures, washing hands and safe burial practices. </p>
<p>But we still have to wait for the 42 days and remain vigilant before we can celebrate.</p>
<p><strong>What are the key breakthroughs to come out of this?</strong></p>
<p>The key lesson from breakthrough to come out of the ending Ebola outbreak is that we don’t solve a complex problem using technical solutions. Implementing an Ebola response requires political and community engagement – globally, at the highest level of the country, and locally. </p>
<p>The ability to listen to all partners, to negotiate based on interest, the capacity to advocate and finally decision-making power all contributed to stopping the outbreak in DRC. </p>
<p>Everything starts and ends with leadership. </p>
<p>Beyond stopping the outbreak it is important to note that Ebola is now a preventable and curable disease. We now have a vaccine <a href="https://theconversation.com/ebola-vaccine-is-key-in-ongoing-efforts-to-contain-the-drc-outbreak-110924">(rVSV)</a> that’s proven efficient in a large outbreak. Another is being assessed, while the <a href="https://www.nature.com/articles/d41586-019-02442-6">drugs</a> Mab114 and Regeneron have been found to be effective. </p>
<p>The development of drugs and vaccines is further evidence of the critical impact that research can have on improving health while saving lives.</p><img src="https://counter.theconversation.com/content/132992/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Yap Boum is the regional representative for Epicenter Africa, the research arm of Médecins sans Frontières. He is involved in the Ebola outbreak and the use of the Ebola vaccine for MSF/Epicenter.</span></em></p>Everything starts and ends with leadership.Yap Boum, Professor in the faculty of Medicine, Mbarara University of Science and TechnologyLicensed as Creative Commons – attribution, no derivatives.