Editorial
Ahmed Jallanzo/epa/Corbis
1 year on—lessons from the Ebola outbreak for WHO
For the AP story see http:// bigstory.ap.org/article/2489c78 bff86463589b41f3faaea5ab2/ emails-un-health-agencyresisted-declaring-ebolaemergency For the MSF report see http:// www.msf.org.uk/sites/uk/files/ ebola_-_pushed_to_the_limit_ and_beyond.pdf
This week has seen what is likely to be the beginning of an onslaught of criticism levelled against WHO for its handling of the Ebola outbreak in west Africa. First, ahead of the 1-year anniversary of the outbreak’s start, an article by the Associated Press (AP) reported that WHO deliberately delayed declaring the Ebola epidemic as an emergency in early June, 2014, waiting instead until Aug 8 to finally make the announcement. AP obtained internal emails and documents suggesting that senior WHO officials were not only told of the desperate situation, but also received anguished pleas for help. Instead of taking urgent and decisive action, the article said WHO decided that managing the political repercussions in countries would outweigh the benefits that declaring an emergency would bring. It “could be seen as a hostile act”, said one memo. Downplaying the epidemic may have cost lives, said AP. In response, WHO insisted that the spread of the virus was unprecedented, and the lack of resources and intelligence on the ground hindered its ability to act.
Second, Médecins Sans Frontières (MSF), who did more than any other organisation to bring the world’s attention to Ebola and who led the operational response against the outbreak, published their searingly critical report—Pushed to the limit and beyond—this week. Despite early warnings about the severity of the outbreak and urgent calls for help, MSF were ignored by governments and WHO. They dubbed the response a “global coalition of inaction”. MSF described the horrors of having to turn patients away because their health centres and staff were simply overwhelmed. This year will see at least three further international, independent investigations into WHO’s conduct in the Ebola response. Regrettably, it is likely that WHO’s reputation is going to suffer more wounds in the coming months. The Lancet’s focus will be to try and draw larger lessons from the Ebola outbreak. In early May, we will be publishing a collection of essays on global health security, together with one of the first analyses of the deeper consequences of Ebola. The Lancet
Moodboard/Corbis
Perinatal mental health—towards a robust system of care
For Falling through the gaps: perinatal mental health and general practice see http:// www.centreformentalhealth. org.uk/pdfs/falling_through_ the_gaps.pdf For the research on mental health trust funding see http://www.communitycare. co.uk/2015/03/20/mentalhealth-trust-funding-8-since2010-despite-coalitions-driveparity-esteem/ For the Lancet Series on perinatal mental health see http://www.thelancet.com/ series/perinatal-mental-health
1152
The experiences of pregnancy and birth transform the lives of mothers and their families. Caring for children has the potential to enrich the lives of all involved, but accompanying health and social challenges are common. As discussed in a recent Lancet Series on perinatal mental health, perinatal depression, for example, occurs in an estimated 6·5–12·9% of mothers at different stages of pregnancy and during the year after birth. The financial costs of perinatal mental disorders, estimated at more than £8 billion in the UK for each annual cohort, are a scant reflection of their effect on the wellbeing of affected parents, and that of children at a vulnerable stage in their development. On March 18, Falling through the gaps: perinatal mental health and general practice was published by the UK’s Royal College of General Practitioners and others, with funding from the Boots Family Trust. The largely qualitative research was based on responses from 43 selected GPs and a survey of 1547 women, among other methods, but many will recognise women’s descriptions of “…a predominantly rushed, reactive and unreliable system
of identification and support which often led them to fall through the gaps in this system of care”. The report’s recommendations include elimination of inconsistencies in the availability of specialist perinatal mental health care, and strengthening of GP training. In the febrile atmosphere preceding May’s UK general election, the Coalition Government has promoted “parity of esteem” for mental health, and in March’s budget promised an additional £75 million over 5 years for perinatal mental health care. However, research published by Community Care highlights the real-term fall in funding of 8·25% for 43 of 56 mental health trusts in England during 2010–15 (an absolute decline from £6·7 to £6·6 billion). Mental disorders, often hidden and underestimated in their effects, are growing in recognition and prominence. Safe and equitable systems of care for perinatal mental disorders are essential to achieve optimum health for the parents of today and the future, and systematic research on perinatal mental health provision in the UK should be a priority. The Lancet www.thelancet.com Vol 385 March 28, 2015
Ahmed Jallanzo/epa/Corbis
1 year on—lessons from the Ebola outbreak for WHO
For the AP story see http:// bigstory.ap.org/article/2489c78 bff86463589b41f3faaea5ab2/ emails-un-health-agencyresisted-declaring-ebolaemergency For the MSF report see http:// www.msf.org.uk/sites/uk/files/ ebola_-_pushed_to_the_limit_ and_beyond.pdf
This week has seen what is likely to be the beginning of an onslaught of criticism levelled against WHO for its handling of the Ebola outbreak in west Africa. First, ahead of the 1-year anniversary of the outbreak’s start, an article by the Associated Press (AP) reported that WHO deliberately delayed declaring the Ebola epidemic as an emergency in early June, 2014, waiting instead until Aug 8 to finally make the announcement. AP obtained internal emails and documents suggesting that senior WHO officials were not only told of the desperate situation, but also received anguished pleas for help. Instead of taking urgent and decisive action, the article said WHO decided that managing the political repercussions in countries would outweigh the benefits that declaring an emergency would bring. It “could be seen as a hostile act”, said one memo. Downplaying the epidemic may have cost lives, said AP. In response, WHO insisted that the spread of the virus was unprecedented, and the lack of resources and intelligence on the ground hindered its ability to act.
Second, Médecins Sans Frontières (MSF), who did more than any other organisation to bring the world’s attention to Ebola and who led the operational response against the outbreak, published their searingly critical report—Pushed to the limit and beyond—this week. Despite early warnings about the severity of the outbreak and urgent calls for help, MSF were ignored by governments and WHO. They dubbed the response a “global coalition of inaction”. MSF described the horrors of having to turn patients away because their health centres and staff were simply overwhelmed. This year will see at least three further international, independent investigations into WHO’s conduct in the Ebola response. Regrettably, it is likely that WHO’s reputation is going to suffer more wounds in the coming months. The Lancet’s focus will be to try and draw larger lessons from the Ebola outbreak. In early May, we will be publishing a collection of essays on global health security, together with one of the first analyses of the deeper consequences of Ebola. The Lancet
Moodboard/Corbis
Perinatal mental health—towards a robust system of care
For Falling through the gaps: perinatal mental health and general practice see http:// www.centreformentalhealth. org.uk/pdfs/falling_through_ the_gaps.pdf For the research on mental health trust funding see http://www.communitycare. co.uk/2015/03/20/mentalhealth-trust-funding-8-since2010-despite-coalitions-driveparity-esteem/ For the Lancet Series on perinatal mental health see http://www.thelancet.com/ series/perinatal-mental-health
1152
The experiences of pregnancy and birth transform the lives of mothers and their families. Caring for children has the potential to enrich the lives of all involved, but accompanying health and social challenges are common. As discussed in a recent Lancet Series on perinatal mental health, perinatal depression, for example, occurs in an estimated 6·5–12·9% of mothers at different stages of pregnancy and during the year after birth. The financial costs of perinatal mental disorders, estimated at more than £8 billion in the UK for each annual cohort, are a scant reflection of their effect on the wellbeing of affected parents, and that of children at a vulnerable stage in their development. On March 18, Falling through the gaps: perinatal mental health and general practice was published by the UK’s Royal College of General Practitioners and others, with funding from the Boots Family Trust. The largely qualitative research was based on responses from 43 selected GPs and a survey of 1547 women, among other methods, but many will recognise women’s descriptions of “…a predominantly rushed, reactive and unreliable system
of identification and support which often led them to fall through the gaps in this system of care”. The report’s recommendations include elimination of inconsistencies in the availability of specialist perinatal mental health care, and strengthening of GP training. In the febrile atmosphere preceding May’s UK general election, the Coalition Government has promoted “parity of esteem” for mental health, and in March’s budget promised an additional £75 million over 5 years for perinatal mental health care. However, research published by Community Care highlights the real-term fall in funding of 8·25% for 43 of 56 mental health trusts in England during 2010–15 (an absolute decline from £6·7 to £6·6 billion). Mental disorders, often hidden and underestimated in their effects, are growing in recognition and prominence. Safe and equitable systems of care for perinatal mental disorders are essential to achieve optimum health for the parents of today and the future, and systematic research on perinatal mental health provision in the UK should be a priority. The Lancet www.thelancet.com Vol 385 March 28, 2015
