26 June 2019

Africa: Ebola - Lack of Funding Worrying

The announcement by the World Health Organisation (WHO) that despite the crucial nature of Ebola preparedness in Africa, funding for this key work has slowed down over the last four months should be taken with all seriousness it deserves.

With the budget for the four most affected countries nearly US$70 million over the past year, there remains a 40 percent funding gap going forward into the next six months.

WHO Regional Director for Africa Dr Matshidiso Moeti confirmed this during a teleconference with journalists last Friday.

"Despite the crucial nature of Ebola preparedness funding, we are regretting the fact that funding for this aspect of the work has slowed down.

"So, over the last few four months, we have received relatively little funding for continuing the Ebola preparedness in the surrounding countries and actually have about 40 percent funding gap in relation to the amount that the WHO had estimated is necessary.

"So, lack of funding has reached a crucial juncture, and I'd just like to quote what the Emergency Committee on the Ebola Outbreak in the Democratic Republic of the Congo said in their statement, that they are "deeply disappointed that WHO and the affected countries have not received the funding and resources needed for this outbreak," she said.

Support from donors has been crucial for the rapid scale-up and evolution of the Ebola response. Between March 2014 and April 22, 2016, WHO received over US$459 million in direct and in-kind contributions from over 60 donors.

Donations were from the African Development Bank Group, the Bill and Melinda Gates Foundation, Australia Department of Health, Andorra, Bhp Billiton Sustainable Communities, the Wellcome Foundation, Centres for Disease Control (US), GAVI Alliance, Equatorial Guinea, Germany Federal Office just to name a few.

The current outbreak of the Ebola Virus Disease (EVD) in the Democratic Republic of Congo began on August 1, 2018 and is the country's 10th recorded outbreak.

What is worrying is the latest outbreak comes at a time funding taps are drying. Apart from having a vaccine, the disease needs to be contained to prevent spread.

Risk of spread

According to WHO, porous borders, community resistance and mistrust, displacement of people and ethnic violence mean that the risk of the disease spreading to the nine countries neighbouring the DRC is high.

At most risk are the countries close to the epicentre of the outbreak. WHO placed the nine countries neighbouring DRC into two categories, Priority 1 and 2. Under Priority 1 are countries that include Burundi, Rwanda, South Sudan and Uganda.

Priority 2 has countries namely Angola, Central Africa Republic (CAR), Republic of Congo, Tanzania and Zambia.

According to the World Health Organisation, the response to the latest Ebola epidemic has proven uniquely complex, but experience of managing previous outbreaks is proving key in containing the spread of the disease within the DRC and to the nine high risk countries which share its borders.

"We can't say there's one magic bullet. It requires a combination of measures that are already being put in place. I believe for example that the advances that have been made in research and the fact that we have now an effective vaccine that has been deployed in this outbreak has made a very significant difference in terms of the spread of the outbreak, the numbers of deaths, etc. Even as we acknowledge that this is a very serious outbreak," said Dr Moeti.

Regional Emergencies Director, WHO Regional Office for Africa Dr Zabulon Yoti said he was happy that over 500 people have successfully gone through the disease process.

He attributed this to experimental drugs which have given them additional tools over and above what they used to use. This, he revealed, is making people survive better.

"The drugs have been incorporated into the response, just like we did in West Africa and in the past outbreaks.

"The survivors' first testimony is you can recover from this disease.

"They give that powerful information to the community that it is possible to survive from Ebola. After survival, they have immunity against reinfection. They can work within the treatment centre, can help with feeding and cleaning, and also in interventions in the community," he revealed.

Epidemiological situation

As of June 19, 2019 there were a total of 2 204 cases (2 110 confirmed and 94 probable), including 1 479 deaths.

A recent period of improved security has allowed access to communities and for response teams to operate more freely.

As a result, indicators over the past two weeks provide early signs of an easing of the transmission intensity.

In Uganda, the three confirmed cases have all died. As of June 19, there was no confirmed EVD case in Uganda. Four remaining suspect cases in Uganda tested negative.

According to WHO, by June 19, a total of 106 contacts of the three confirmed cases had been listed and follow up of the contacts initiated. A total of 135 contacts and contacts of contacts have been vaccinated.

Preparedness activities

WHO adds that the aim of the preparedness work is to ensure that countries have put in place systems which allow them to detect, investigate and report potential Ebola cases, as well as treat any confirmed cases.

"Screening of travellers is important and there have been 66 million screenings at national and international borders since the outbreak. The screenings resulted in the detection of 19 confirmed cases, including the most recent three in Uganda."

"Similarly, we can also look at alerts reported in that period, from countries in the region and in DRC provinces outside the Ebola area. There have been 1 073 alerts reported and investigated . . . All of them were systematically ruled out. This shows a working alert system and response capacity."

Other key preparedness activities put in place include having a good coordination mechanism at both the national and district level, well-trained rapid response teams which can investigate cases quickly and vaccinating health and frontline workers so they can work safely.

Further key preparedness activities include a good lab system so that cases can be detected in a timely way, the capacity to treat Ebola patients in a safe manner and people trained to conduct safe and dignified burials.

For example, in East African Community (EAC), Kenya, Tanzania and WHO have just wrapped up a simulation exercise involving 150 experts on the Kenya-Tanzania Border.

The exercise identified strengths (rapid response to alerts, timely communication), but also weaknesses (efficiency of ambulances at points of entry, more effective communication) which need to be improved to improve countries' response to outbreaks like Ebola.

WHO has also supported full scale simulation exercises to test readiness for Ebola in Rwanda and Uganda and are planning similar exercises in seven other countries at high risk.

WHO said it is also ready to support all countries to conduct such exercises.

Other preparedness activities include better coordination. As such, functional public health emergency operations centres have been established in six countries.

Three hundred and fifty experts have been trained to be part of rapid response teams, while at least one Ebola Treatment Centre and multiple isolation units have been established in all nine countries.

A little more than 9 000 health workers have been vaccinated in Uganda, South Sudan and Rwanda. Burundi is finalising preparations for vaccination.

More importantly, preparation of the other countries neighbouring the DRC, but at lower risk is ongoing for the approval of the Ebola vaccines.

There is ongoing sensitisation of communities and health workers in all the nine countries.

The decrease in Ebola funding calls for a financial model that is built on shared responsibility and African countries partnerships rather than just depend on charity.

There is need to increase domestic health spending that can be sustained over time to address health priorities in Africa in the event that taps of traditional donors run dry.

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