By early June of last year, the Ebola epidemic in West Africa was the deadliest ever recorded. There weren't enough beds for patients and many were refusing to seek treatment, driving the outbreak underground.
Senior staffers in Africa at the World Health Organization raised the prospect of declaring an international emergency. The answer from WHO's Geneva headquarters: Wait.
According to internal emails and documents obtained by The Associated Press, the UN health agency resisted sounding the international alarm until August, a two-month delay that some argue may have cost lives.
More than 10,000 are believed to have been killed by the virus since WHO announced the outbreak a year ago.
WHO has acknowledged acting too slowly to control the Ebola epidemic. In its defense, the agency says the virus' spread was unprecedented and blames factors including lack of resources and intelligence from the field.
Internal documents obtained by AP, however, 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," 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 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.
