Many people remember the West African outbreak of Ebola, which started at the end of 2013 and was declared over in the middle of 2016. This unprecedented outbreak led to more than 11,000 people losing their lives in Liberia, Sierra Leone and Guinea. That outbreak also inflicted US$2.8 billion in economic damages. The governments of these countries and the international community, as well as the UN and WHO, were unable to contain this outbreak rapidly.
Few people might recall the Ebola outbreak of 2017, which took place in the Democratic Republic of Congo’s (DRC's) northern province of Bas Uele. Only four people died in this outbreak and four people survived the disease. This was in large part due to the international community's rapid, coordinated and effective response, with regular situation reports updating all partners and stakeholders.
For our part, WHO in the African region was able to respond so effectively as a consequence of internal reforms started in 2015 to ensure that we became a more proactive, results-driven, and accountable organization to support countries in their efforts to keep their citizens healthy.
A new unified programme was created in 2016 to bring speed and preparedness to WHO’s emergency responses. We are now detecting outbreaks and other emergencies on a daily basis—152 emergencies in 39 countries last year alone. Moreover, within 48 hours after risk assessment and grading we have responded to all of these, coordinated through a high-tech operations room. Weekly online bulletins have relayed the status on the ground in real-time.
We have also become better at preventing emergencies and assessing country risk. In 2016, a mapping of the risk and distribution of epidemics in the Region was done of all epidemics reported in Africa from 1970 to 2016, which is helping us anticipate and prepare for emergencies. In a little over two years, we have assessed the risk of outbreaks in 24 countries, conducted reviews after outbreaks in 13 countries, held simulations of outbreaks in 17 countries, and conducted evaluations to assess country capacities in 34 countries. These achievements will prevent many outbreaks before they even become a problem.
As we rapidly scale up to contain the latest outbreak of Ebola Virus Disease—taking place in the western part of the Democratic Republic of Congo, in Equateur Province—we are putting WHO's strengthened health security apparatus into operation once again. Ebola can be a scary disease, one that, as we know, has a high fatality rate and can cause massive disruptions in society that lead to significant economic losses.
Last year, in Bas Uele province, within days of the first case being identified, we set up a rapid response team, issued personal protective equipment, initiated community-based surveillance, collected samples from people who could have been infected, trained the community on safe hygiene and burial practices, and mandated that all response teams coordinate their work frequently. Less than two months after the first case was detected, the outbreak had been effectively controlled and an end was declared.
Today, we are moving quickly to help the government limit the outbreak in Equateur province, and the global community has mobilized to support our efforts. Aid and support from the United Nations, the British Department for International Development and the Wellcome Trust are boosting our own emergency funding. DRC’s response teams are working with our own specialists and other partners and a mobile laboratory has been installed at the centre of the outbreak.
Notably, a new Ebola vaccine is being deployed—one whose effectiveness was assessed positively at the tail end of the West African outbreak. Even though the confirmed cases to date number in the dozens, the potential of this outbreak to spread to larger population areas is greater because of the geography and movement of people. This is a real threat that requires the concerted action of all stakeholders. We must work together, acknowledging that no organization is an island, to defeat this contagious virus.
Disease outbreaks and other emergencies often occur in areas where poverty intersects with a lack of provision of basic health care. With a renewed momentum towards universal health coverage and the sustainable development goals, we have developed a Framework of actions to guide the strengthening of health systems. When all citizens receive services—either in the cities, the countryside or anywhere in between—they can have the dignity and security to live healthy productive lives. In Africa, we are not there yet, but we have made progress in this journey.
One of the first things that George Weah, the new president of Liberia, said upon winning his election is that “Liberia is open for business.” I applaud this attitude, for it means not just that the Ebola has been put to an end in his country, but that his people have recovered. Liberia’s health services are being rebuilt better than before—which has also been a WHO priority.
Earlier in this decade, Africa had some of the fastest growing economies in the world. Five years ago, the World Bank placed sub-Saharan Africa’s growth in GDP at 5 percent; in 2017 the growth rate was half of that. There is no reason we cannot rebound—as long as we look after the health of our people.
One could even say that President Weah’s comments have revealed to us a new outbreak—an outbreak of confidence, that our continent has turned a corner and is, once again, ready to grow. Ebola and other outbreaks to come will test that readiness—but we will still move forward.
By Dr Matshidiso Moeti