Numbers of cases refusing to diminish, new communities being infected, bodies buried in secret. Sound familiar? It should. But these are not just scenes from last year’s Ebola epidemic. They are playing out today in West Africa.
As head of Médecins Sans Frontières (MSF; also known as Doctors Without Borders), which has treated one-third of reported Ebola cases in the outbreak, I have witnessed how a lack of political will undermined the response in the early days of the epidemic. Now, fatigue and a waning focus are threatening the final push to end it.
In the past few months, a stream of intergovernmental panels has been convened to appraise the international response to the epidemic — by the World Health Organization (WHO), the World Bank and the G7 industrialized nations, among others. Meanwhile, an ever-growing list of philanthropic and academic institutions is preparing reports about ‘lessons learned’, to prevent future outbreaks. These include Harvard University in Cambridge, Massachusetts, and the Institute of Medicine, a US non-governmental organization (NGO).
Yet the Ebola epidemic in West Africa is far from under control. In the past three months alone, the number of cases — around 330 — is more than the third largest Ebola outbreak in history. Liberia, which was declared ‘Ebola-free’ in May, reported six cases by the end of June. And 20–27 cases have been confirmed across Guinea and Sierra Leone each week from mid-June to mid-July. A large proportion of these cases cannot be traced back to the lists of people known to have been in contact with infected people. Over the past two months, cases have also emerged in Guinea’s Boke province, which borders Guinea-Bissau, a country with a weak health system and almost non-existent epidemiological surveillance and laboratory blood-testing capacity.
Equally concerning is that governments and aid agencies are still failing to earn the trust of some communities in their efforts to combat the epidemic, even though numerous experiences in the past 18 months have demonstrated just how crucial this is. On 29 May, for instance, the Red Cross was forced to withdraw workers from the north Guinea town of Kamsar in Boke after two Red Cross cars and an employee’s home were attacked, and a warehouse containing equipment to enable safe burials was burnt down.
Albert Einstein defined insanity as doing the same thing over and over again, and expecting different results. As a global health community, we cannot talk about fighting future epidemics more effectively when we have failed to incorporate the lessons learned in this outbreak to bring it under control.
Getting to ‘no new cases in at least 42 days’ — twice the longest known incubation period for Ebola and the way in which the WHO defines the end of the epidemic — will require a major push. Ministries of health and aid agencies must do more to engage and empower communities in efforts to combat the disease, and to re-establish people’s trust in government officials and health workers. The surveillance systems to locate and track new Ebola cases across Sierra Leone, Guinea and Liberia need to be properly supported — including in the districts that have not had an Ebola case for months. Governments, donors and NGOs must rebuild basic health-care infrastructure so that the countries affected can better deal with Ebola and the many other illnesses and conditions common to life in West Africa.