For the past several months, West Africa has been plagued by an unprecedented Ebola epidemic, which continues to grow and is quickly becoming an international health threat. We know how to stop the virus, the challenge is to strengthen the current system. Fortifying the global health system will be difficult - mobilizing the international community through financial and technical assistance, educating populations and other public health efforts are all needed to curb the epidemic.
The current outbreak is the largest in history, and the first in West Africa. The Guinean Ministry of Health (with other authorities, including the Ministry of Health and Sanitation of Sierra Leone, Ministry of Health and Social Affairs of Liberia, and the Nigerian Ministry of Health) is working with national and international partners to address the spread of Ebola. As of September 10, the epidemic in West Africa has infected 4,293 people and killed 2,296.(1)
On March 23, 2014, the Ministry of Health of Guinea (MoH) notified the World Health Organization (WHO) of a rapidly evolving outbreak of Ebola in forested areas of southeastern Guinea. To date, the MoH believes there have been 860 cases of Ebola, including 678 laboratory-confirmed cases, and 557 deaths in Guinea. Currently affected districts include Conakry, Guéckédou, Forecariah, Macenta, Dubreka, Coyah, Siguiri, Pita, Nzérékoré, and Yomou.
However, by early July, there was hope in Guinea. There were no more than two confirmed cases left in the country, both of whom were being tended to in the treatment centers of Guéckédou and Conakry. MoH authorities anticipated the epidemic was winding down. Unfortunately, new cases were identified in the district of Macenta, close to where the virus was first detected deep in Guinea’s forest region.
In Guinea, we have been tirelessly mobilized for months, with the support of our international partners, we have implemented an unprecedented plan to inform and educate the population, treat those infected, detect cases and track contacts, and deploy a range of stringent public health measures. Guinea is fighting against Ebola, but also against the stigmatization of affected countries. Our nation is attentive and vigilant, but everyday life continues.
Today, with the accelerating spread of the virus in Liberia and neighboring Sierra Leone, Guinea is not the only concerned country, and everyone must respond more quickly and effectively. Affected countries share local communities, making it hard to stop the outbreak as long as there are cases reported. Ebola will remain a global threat as the number of cases continue to increase. To protect those who are not yet affected, we must support all the countries are presently reporting cases of Ebola. It is the duty of public policy makers, private sector and civil society at the national, sub-regional, continental and international levels, to intensify the battle against Ebola.
Managing Ebola epidemics in the African setting can be a major challenge, as the corner stone for ending an outbreak is interrupting the viral transmission chain. In order to reduce transmission, strict public health measures must be implemented, including the isolation of patients, barrier precautions and identification and tracking Ebola-infected contacts.
To combat the fear surrounding Ebola and promote public health, accurate information must be disseminated to all citizens. This early education is essential to increase awareness and promote key public health measures: the need for people to quickly receive treatment, to isolate themselves if they suspect they might be infected, and to properly bury those whom have died from the disease.
Guinean authorities have implemented a large-scale information plan aimed at educating all citizens through posters, leaflets, radio, text messages on mobile phones and TV spots. To manage the epidemic, educating one family member is not enough, and to control the chain of disease transmission, authorities must earn the trust of nearly every individual. This is a mammoth task, requiring greater involvement from the religious and political authorities to raise awareness about the disease.
On August 30th, I issued a Presidential Decree establishing the National Coordination Committee for Monitoring and Control of the Ebola Epidemic, under the chairmanship of Dr. Sakoba Keita and the vice chairmanship of Dr. Sekou Conde. This committee is empowered to organize all necessary measures for the epidemiological monitoring of citizens visiting Guinea, informing the public about protective measures, and training staff on the use of disease surveillance and protection.
The MoH has also activated the national and district emergency management committees to coordinate the response. The approach has a proven track record: districts previously affected, such as Fria, Télémélé, Boffa, Dabola, Kissidougou and Dinguiraye, are now areas where the outbreak is extinguished for more than 42 days; and the outbreak in two others, Siguiri and Kouroussa, is close to be extinguished. This proves that the disease can be defeated, as many healings attest, but we continue to watch over these areas tirelessly to not allow a recurrence of the virus.
The African Development Bank (AfDB) has also offered to help the region with a grant of USD 60 million, in order to strengthen the health systems. An AfDB statement specified the grant will be managed by the Center for sub regional coordination of Ebola of the WHO, based in Guinea Conakry, given its extensive experience in the fight against epidemics.(2) Further, the World Bank has offered USD 200 million to the affected countries.(3) The aid is intended to support the efforts of governments to reduce morbidity and mortality, and to break the transmission chain, strengthening public health.
The international community is also responding in kind. The WHO, the CDC and other partners are mobilizing and deploying additional experts to provide support to the MoH. Multidisciplinary teams have been deployed to the field to actively search and manage cases; trace and follow-up contacts; and to sensitize communities on the outbreak prevention and control. Médecins Sans Frontières (MSF) is working valiantly in the affected areas and is assisting with establishment of isolation facilities, and supporting the transport of the biological samples from suspect cases and contacts to international reference laboratories for urgent testing. Other partners are also working on the biological tracking and identification, the Emerging and Dangerous Pathogens Laboratory Network is working with the Guinean VHF Laboratory in Donka, the Institut Pasteur in Lyon, the Institut Pasteur in Dakar, and the Kenema Lassa fever laboratory in Sierra Leone to make available appropriate Filovirus diagnostic capacity.
The global community is doing its utmost, but much more is needed to stop the spread of Ebola. The more we will fall behind in this mobilization, the harder it becomes to quickly conclude the epidemic. This is a race between the spread of the disease and our response capabilities.
Strengthening and accelerating the response must be based in concrete and effective action, not the escalation of alarmist statements. These are futile and risky. Spreading panic and feeding psychosis contributes only to isolate and weaken our states and the response to the epidemic, and they by no means help improve the situation. Yes, we have reason to worry - the situation is very serious - and we treated it as such from the beginning. But we still lack resources, equipment and personnel. In our stage of development, decades of failing regimes and bad governance have left gaping scars of poverty. Inadequate and fragile infrastructure health is one of the painful scars of this history.
All these efforts are essential. They need to be strengthened and accelerated as Ebola continues to spread. We need action now to scale up the response. We know how to stop Ebola. The challenge is to scale it up to the massive levels of education and other public health efforts needed to stop this outbreak. The virus is moving faster than anyone anticipated. We need to move faster.