Since the first cases of the Ebola Virus appeared in West Africa last year, there have been concerns regarding the spread of this disease to other countries in the region. The World Health Organization certified Mali free of the virus last week, the third country to receive the clearance after Nigeria and Senegal. Schools have reopened in Guinea leading many to believe that the outbreak is finally over.
There may be a premature rush to declaring the outbreak over but certainly the end is in sight as the number of cases have declined overall in Guinea, Liberia and Sierra Leone. The latest figures from the Center for Disease Control as of January 20, 2015 are 21724 total cases with 8641 resultant deaths.
Last week, Congresswoman Karen Bass (D – CA), held a breakfast meeting in Washington, DC updating the media, government and health officials on the latest news regarding the Ebola Virus outbreak in Africa. Dr. Tom Frieden was cautiously optimistic about the future indicating that while cases maybe declining overall, the world cannot get complacent because the virus could burn at a low rate for some time and it will exploit any opportunity it sees to coming roaring back. In order to prevent this from occurring, the health experts must ensure that no new cases appear, essentially we are at zero new cases. He reiterated his caution many times throughout the meeting making sure all participants knew that “we are not out of the woods “, and he stated late last year,” CDC staff will be in West Africa continuing to fight the Ebola epidemic until the last spark is extinguished. The vulnerability of any country is our vulnerability as well.”
The effort to eradicate this virus has taught us many lessons. These lessons were learned at a dear cost and it is hoped that they will be regarded in future public health crisis situations. The first of these was the lack of global capacity to fight the outbreak among many of the Non-Governmental Organizations (NGO’s) involved in health. In essence, for many months the sole organization providing assistance was Doctors Without Borders (known by its French acronym MSF). The military forces from the United States, United Kingdom and France stepped to assist along with the National Health Service from Great Britain. All three countries are likely to remain in West Africa until certain the virus is at the zero level sought.
Second, the health authorities in all three countries were operating with reduced infrastructure especially in Liberia and Sierra Leone. As a result of the civil wars and recent conflicts all primary and secondary health and social infrastructure was virtually nonexistent. One of the lessons learned regarding infrastructure came from Nigeria. When cases were first detected there, a polio crisis center was repurposed for the Ebola outbreak thus providing a readymade health facility to handle a widespread outbreak.
Third, it is the local NGO, familiar with the local cultures, customs and behavior patterns that will facilitate strategies far more efficiently and successfully than foreign NGO’s. Jeremy Konyndyk, Director of Foreign Disaster Assistance for the USAID indicated that a local team is essential for the success of any eradication program.
Fourth, this crisis was driven in many ways by technology. The air travel of many individuals could have been a weak spot in prevention leading to a collapse and impairment of progress but many countries took immediate steps to keep that from happening. This included many neighboring countries such as Cote D’Ivoire closing and securing its borders.
Some positives came out of this experience as well. Director Konyndyk indicated that new stronger and easier to use Personal Protective Suits (PPE) for medical personnel are being developed as a result of the experience in both Africa, Europe and the United States. These will be one piece, simpler to enter garments with a fabric more resistant to ripping and tearing. Additionally, newer, more accurate testing kits are being developed that will reduce the time to access test results. Finally, the education systems of all West African nations have begun educating their students about the importance of basic personal hygiene especially basic hand washing technique.
Saran Kaba Jones, CEO of Face Africa, an NGO that was involved in developing clean water sources and community hygiene programs in Liberia developed Ebola specific hygiene kits and directed her teams away from current projects towards mobilizing against the virus. Her teams in many cases were far more successful than health teams from local medical facilities. This is only one of the myriad questions that have to be examined in the wake of the outbreak.
While the positive news is creating a new sense of optimism, the Ebola Virus still remains a regional concern in West Africa for the coming months. As Representative Charles Rangel (D – NY) said, “I never thought of this as a crisis that affected Africa but as a crisis of civilization.” As we have learned throughout the past months it requires all of us from far way to remain as vigilant as those working against Ebola in Africa.