WHO urges vaccinations in Ebola-hit countries where health care disrupted

The World Health Organization (WHO) warned on Friday of an outbreak risk for measles, whooping cough and other diseases in West African countries hit by Ebola, and urged for a rapid increase of immunizations.

The Ebola epidemic has killed more than 10,200 people, mostly in Guinea, Liberia and Sierra Leone, and has reduced general vaccination coverage as health clinics and health care workers focus on fighting the unprecedented outbreak.

In recent months, Ebola has started to wane with the number of cases falling significantly, though a spike in Guinea this week highlighted the risk of complacency.

The epidemic has disrupted delivery of routine childhood vaccines against measles, polio and tuberculosis, and of a combined shot against meningitis, pneumonia, whooping cough, tetanus, hepatitis B and diphtheria.

Jean-Marie Okwo-Bele, WHO's vaccines director, told a briefing in Geneva that the health agency wanted an intensification of immunization services and mass measles vaccination campaigns in all areas where feasible.

"Campaigns will only be conducted in areas that are free of Ebola virus transmission," he said, stressing that clinics and health workers administering vaccines would be required to adhere to very strict infection control measures.

WHO sent a warning note to affected countries this week saying: "Any disruption of immunization services, even for short periods ... will increase the likelihood of vaccine-preventable disease outbreaks."

A study published last week by researchers at Johns Hopkins Bloomberg School of Public Health in Baltimore warned that measles cases could almost double in countries hit hardest by Ebola.

The researchers calculated that for every extra month that health care systems were disrupted, up to 20,000 children aged between nine months and five years were put at risk.

Measles is a viral disease that killed around 146,000 people globally in 2013, mostly children under five, according to latest data. That equated to almost 17 deaths every hour.

One of the most transmissible diseases, measles outbreaks often follow humanitarian crises as vaccination campaigns falter and populations are displaced and impoverished.

Edward Kelley, WHO's director of service delivery and safety, said the focus on boosting vaccination coverage rates was "part of the early recovery work [as the Ebola outbreak wanes] and one of the very pressing recovery pieces that needs to get done."

WHO resisted declaring that Ebola was an international emergency for two months in 2014 after senior staffers warned the agency about the scope of the problem, according to emails obtained by the Associated Press.

The U.N. health agency resisted sounding the international alarm until August 2014, a delay that some argue may have cost lives. Internal documents obtained by AP show WHO's top leaders were informed of how dire the situation was, but they held off on declaring an emergency in part because it could have angered the countries involved, interfered with their mining interests or restricted the Muslim pilgrimage to Mecca in October.

Declaring an emergency was "a last resort," Dr. Sylvie Briand, who runs WHO's pandemic and epidemic diseases department, said in a June 5 email to a colleague who floated the idea. "It may be more efficient to use other diplomatic means for now."

Five days after Briand's email, WHO Director-General Dr. Margaret Chan was sent a memo that warned cases might soon appear in Mali, Ivory Coast and Guinea Bissau. But it went on to say that declaring an international emergency or even convening a committee to discuss it "could be seen as a hostile act."

Critics and former WHO staff dismiss that reasoning.

"That's like saying you don't want to call the fire department because you're afraid the trucks will create a disturbance," said Michael Osterholm, a prominent infectious diseases expert at the University of Minnesota.

Lawrence Gostin of Georgetown University said it was "perverse" to let politics interfere with declaring a health emergency and that the countries probably suffered worse economic damage because of the postponed alert.

"The longer you wait," he said, "the worse it's going to be for your trade and your economy and your tourism."

Wire services