14 January 2016

West Africa: Lessons Learnt From Ebola

Photo: UNICEF / Tanya Bindra
Volunteers go door-to-door telling residents of Freetown how to prevent the virus (fie photo).

The World Health Organization (WHO) has finally declared all of West Africa Ebola free. The two-year-long outbreak left 11,300 people dead and many children orphaned. So, did we learn something from it?

It's been 42 days since Liberia's last Ebola patient tested negative. That means an end to the current Ebola crisis, at least for now. The epidemic started in December 2013 and over 28,500 cases were recorded, with the epicenters in Liberia, Guinea and Sierra Leone. This was the biggest Ebola outbreak to date. This is what Ebola experts as well as residents of three countries identified as the lessons learnt.

There is a life after Ebola

While past Ebola outbreaks had a death rate of up to 90 percent, in this recent outbreak, about half of the people who were infected survived. The survivors were found to be largely immune to the disease, and in many cases they were the ones who donated blood, buried their dead and cared for the sick. The sad side to the survivor story is that many lost their families, were orphaned and stigmatized within their communities.

There is always the risk of a relapse

"While this is an important milestone ... the job is still not done," Rick Brennan, WHO director of emergency risk assessment and humanitarian response, told reporters in Geneva. The virus still exists in the bodies of some of the survivors. It can for instance survive for up to 12 months in male semen, and Brennan added, although the risk is very low, it is still there. "We still anticipate more flare-ups," he said.

We have to act faster

"It was only after a delay of more than six months that the necessary global response was finally initiated," Luis Encinas, an Ebola expert with Medecins San Frontieres (MSF), wrote in an MSF opinion piece on January 14, 2016. "We must avoid a repeat of the paralysis," he wrote. The WHO has in the meantime admitted that this was one of its weak points. "We're going to be using the Ebola experience to be more operational, more agile and be able to react more quickly to future problems," Peter Graaff, who headed the UN mission in West Africa, told reporters. He spoke of a reform of the organization's emergency system but didn't give further details.

A health issue is a global issue

Airlines canceled their flights, entire villages were quarantined, anyone travelling in and out of Africa underwent obligatory temperature checks at airports. Nevertheless, the virus got out, causing a total of 36 cases and 15 deaths in the United States, Spain and Nigeria. Panic went around the world.

Ebola has the ability to disrupt the entire social structure

And it did. "This disease affected every sector in the country," as Sierra Leonean social worker, Hassan Koroma, who worked on the frontline of the epidemic, told DW. Schools were shut down, the economy went down the drain, people kept to themselves and weren't even able to mourn their dead as their traditions demanded. A resident of neighboring Guinea said, "It affected our entire social life and made us unpopular."

Shortcomings of the health system

The virus did however prepare the three countries for future health crises. "It left us with an increased awareness of health issues among Sierra Leoneans," Koroma told DW. Before Ebola, the countries were poorly resourced, the WHO's Graaff stated. During the crisis health centers were overwhelmed and patients who came with malaria or to give birth were often turned away. In July 2015, the international community pledged $3.4 billion (3.1 billion euros) to support the country's recovery. Although skeptical over countries' level of preparedness, Nigerian virologist Oyewale Tomori summarized their needs. "Prepare means: get all our people, the surveillance systems, the laboratory systems, the community involved." According to David Heymann, community understanding is actually the most important component in addressing health issues. "Now after the outbreak, there's a great opportunity to continue making sure that they understand risks from any infection," he said.

Liberia, Guinea, Sierra Leone equipped to handle flare-ups

The countries of West Africa are equipped to manage new infections which may flare up, international experts agree. According to Rick Brennan, all of the WHO's 70 field offices are still in place to support the national health systems and will remain until the end of 2016. Since any new cases are expected to be isolated, Brennan believes that the surveillance and rapid response services in place will be able to manage. Yet, as Tomori points out, the preparedness is confined to the three countries. "We have Lassa fever in [Nigeria] right now. And close to 50 percent of the [affected] people have died. And it's been spreading since November last year. So it means we are not ready."

Vaccines developed

The Ebola epidemic ignited a fresh phase of creativity amongst drug producers and the medical world. Blood from Ebola survivors was used to help those who were sick, vaccine trials were fast-tracked and even anti-malarial drugs have been found to effectively treat the patients. However, a recent study found that the blood donations were not as effective as had been thought. The international community was heavily criticized for its reluctance to develop drugs and for the preferential treatment of people who were not from the affected countries.

Friederike Müller-Jung, Karim Kamara and Murtala Kamara contributed to this article.

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