Since late November, the World Health Organization's Ebola situation reports have included interactive maps.  These maps allow the reader to see where new health clinics are being built, and track the progress of response efforts geographically.  It is particularly interesting to examine the maps across time and not the rate of change for various factors. 

According to the latest situation report, the epidemic is responsible for 6,915 reported deaths.  However, cases and deaths as a result of ebola have been and continue to be under-reported.  Although infection rates continue to fluctuate in Guinea and have increased in Sierra Leone, the number of new cases has declined in Liberia. 

All three intense-transmission countries have increased their capacity to provide medical care for EVD patients, although there remain serious difficiencies in rural areas.  This means that many health facilities in rural areas do not have full isolation and treatment capabilities.  In some cases, community care centers have few resources necessary for treatment of patients.  As a result, patients in some rural areas would need to travel long distance in order to received treatment.  

The good news is that one key goal has been met.  There are currently 225 safe burial teams trained and in place.  Guinea, Sierra Leone, and Liberia now all have capacity to safely bury all reported EVD-related fatal cases (although there remain distributional problems that result in lack of capacity in some districts).  This is a fundamental factor in halting the spread of ebola.

The new objectives for the UN Mission for Ebola Emergemcy Response is to isolate and treat 100% of EVD cases and provide safe burial for 100% of EVD related fatal cases by January 1, 2015.

Finding information about the coordinated response by both international and local actors remains difficult.  Little information about budgets, and the disbursment of monies is difficult to come by.  However, for those of us ghouls how have not only humanitarian, but academic interest in the response efforts, the interaction between state and international actors in responding to the epidemic has provide intriguing.  UN General Secretary Ban Ki-moon made his first visit to the affected region over the weekend.  On Saturday, Ban stated that the UN emergency ebola response mission (UNMEER) should be wound down quickly once the epidemic was halted.  He specifically compared UNMEER to UN peacekeeping and the need to keep UNMEER temporary.  

While Ban argued that if ebola was not controlled within a year then the mission may be considered a failure, the politics behind the message is also interesting. Why begin discussing winding down the international mission while the rate of new infections continues to fluctuate? The statement may be an indication of the broader politics of global infectious disease responses --- sovereignty concerns in intense-transmission states, funding concerns by donors, reluctance to take responsibility and funding shortfalls in IOs.  

Morbidity and Mortality Weekly Report for December 5 has an interesting field note this week on the transmission of chikungunya in the continental US.  Chikungunya is an illness caused by the chikungunya virus, which is transmitted through mosquitos.  Until June, all known cases of chikungunya in the US had been acquired by tourists to the Caribbean and South America.  In June of this year, the first locally transimitted case was confirmed in Florida.  Accoring to the MMWR note, there have been 11 locally acquired cases since June.   

The number of cases of chikungunya in the US has increased dramatically over the last two years.  The disease occurs regularly in Africa, Asia and the Indian subcontinent.  In recent decades travel and the spread of the mosquito vectors for chikungunya has increased the virus' range to include much or Europe.  Despite ongoing control efforts, it has also been identified in several countries in the Caribbean and South America, and now in the US.  Its spread, however, is difficult to track, particularly in South America.  Chikungunya causes symptoms similar to dengue, another mosquito transmitted virus, which is common in Central and South America.  Yet, unlike dengue --- for which primates are the only hosts --- cattle, rodents, birds and primates can all be reservoirs for chikungunya.  

As a result, controlling chikungunya is more complex than controlling diseases such as dengue.  While it is possible to increase the control of infected humans and livestock (although these measures are in no way foolproof), control of other hosts is difficult.  In addition, over the last several decades, vector control efforts have proven ineffective.  Thus, the most effective response remains prevention --- avoiding being bitten by infected mosquitos.  

Yet, with new, locally acquired cases emerging in the US, hikungunya, it will be interesting to see if the international response changes.  Given that winter generally slows mosquito activity in much of the US, and chikungunya generally doesn't kill patients, my guess is that the response will remain largely fragmented and domestic.  If, however, Puerto Rico becomes the 51st state, the response to chikungunya by US officials might change dramatically.   Puerto Rico has experienced a growing number of locally acquired cases in the last year after chikungunya was imported via tourism and vector movement. If Puerto Rico becomes a US state, US health officials would likely have increased interest in an heightened international response to better control the movement of vectors and infected hosts.

Full text available here: 
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6348a4.htm?s_cid=mm6348a4_w

The Daily Show had a nice interview with Sophia Delaunay, the Executive Director of Doctors Without Borders.  

Stewart started with a job at the media --- isn't the outbreak of ebola over now that no Americans have been affected in the last few weeks?  Of course, Delaunay responded the way any international observer of global health specialist would "I wish that were the case."  The interview not only highlights the ongoing crisis, but Delaunay also provides excellent explanations for why the support has been inefficient.  Not only has aid been slow to arrive, by the time it arrives, needs have changed. 

I recently participated in a panel about Ebola arranged by the MPA students.  They wanted me to talk about the role of federalism in responding to Ebola in the US.  I spoke a little bit about the role of federalism and how the CDC fits into the broader health system.  But I then launched into a discussion about the need for international response --- arguing that the best way to protect US citizens and health care workers was to be proactive in dealing with health threats around the world.  Delaunay makes the point equally well.  Viruses do not respect borders.  

One of the primary difficulties in responding to Ebola has been the availablity of funds.  Many observers, individuals and states alike, have argued that the funds for responding to the crisis should come from existing budgets --- hospital budgets, WHO budgets, and other agency budgets.  The problem is that these budgets are planned in advance and are generally fully allocated to specific programs, leaving few funds available for unanticipated crises.  Moreover, much of the budgeting and allocation process leaves little flexibility for responding to rapidly changing circumstances.  For example, the minutes from an International Incident Management System meeting in Liberia illustrated an ongoing disagreement between Liberian officials and donors.  Two European and one Asian donor had allocated funds to build medical units in Monrovia.  Yet Liberian leaders argued that such units should be built in rural areas because the need in Monrovia had declined.  In fact, hospitals in Monrovia had free beds, whereas in rural areas people were still being turned away due to limited capacity.  The donors were reluctant to change their plans because they had promised their domestic populations that the funds would build units in Monrovia.

The politics of where and how resources get allocated are an essential part of the success of international responses and play a role in who lives and who dies.  Where the political calculations outweigh the calls from folks like Delaunay, consequences are grave.

A new study on the origins of the gender gap, published in the Harvard Business Review, has been making the rounds on Facebook.  The study, conducted by Harvard Business School professor Robin Ely among others, suggests that much of the conventional wisdom on women's career success is incorrect.  A brief summary and the link to the full article are available below.

Full Text: https://hbr.org/2014/12/rethink-what-you-know-about-high-achieving-women