Dr. Abou Beckr Gaye, WHO representative for Guinea (left); Dr. Sakoba Keita, Ebola response national coordinator for Guinea (center); and Dr. Bruce Aylward, WHO executive director for outbreaks and health emergencies (right). Courtesy of WHO/M. Winkler
Health authorities from Guinea, Liberia and Sierra Leone and representatives of partner organizations have expressed confidence in the capacity of the three Ebola-impacted countries to effectively manage residual risks of new Ebola infections—pointing to the rapid government-led containment of recent flare-ups of the disease.
The review of prevention, detection and response capabilities of the three countries, as well as progress in expanding clinical care and screening for survivors came at a meeting March 1-2, 2016 in Conakry, Guinea, convened by the World Health Organization (WHO) and attended by some 80 participants. WHO, partners and Ministry of Health staff from the three countries have been meeting regularly throughout the epidemic to assess tactics, tools, research and operations and chart strategies accordingly.
Dr. Sakoba Keita, Guinea’s national Ebola response coordinator, opened the meeting, asserting collective progress in meeting Phase 3 response goals: “We have enhanced our systems, are detecting and stopping small outbreaks of Ebola, identifying weak links and working together to minimize and manage risks of Ebola,” he said. “We are currently at zero cases, but we hope to be at zero risk.”
WHO believes that all original chains of transmission in the epidemic have been halted, but it continues to stress that small flare-ups are anticipated due to virus persistence in the fluids and tissues of some survivors. While the risk is declining as the virus clears from survivors, it still necessitates strong surveillance and response capacity, including the ability to detect new and suspect cases, rapid diagnosis, case isolation and management, contact tracing, community awareness and participation, safe burials and care, counseling and screening for survivors.
Dr. Thelma Nelson, emergency preparedness and response coordinator and Dr. Philip Bemah, case management program coordinator, Ministry of Health, Liberia. Courtesy of WHO/M. Winkler
At the Conakry meeting, representatives of the three countries and partners provided detailed assessments of advancements, challenges and resource needs in these areas, as well as efforts to adapt and integrate Ebola-focused programs into broader national strategies to address other diseases and health emergencies.
As an example of progress, participants evaluated the swift containment of recent flare-ups of Ebola in Liberia and Sierra Leone and the response to suspect cases in Guinea, and reviewed real-time tests of investments made in lab strengthening and diagnostics, simulations and training, rapid response teams and infection prevention and disease control at health facilities.
“These recent events show us what these countries are capable of when there is strong government leadership, experienced responders, ongoing support from partners and regional coordination," said Peter Graaff, director of WHO’s Ebola response, noting that Guinea deployed a ring vaccination team to Sierra Leone to vaccinate contacts while both Liberia and Sierra Leone dispatched veteran epidemiologists to each other’s country to support case investigations and testing —“drawing on the region’s expertise to curb the potential spread of Ebola to affected communities.”
All three countries pointed to community engagement and surveillance as one of the biggest gaps and challenges.
“We need to do much more to allay fear and improve communication and confidence at the community level,” said Dr. Roland Conteh, head of disease surveillance programs in Sierra Leone’s Ministry of Health. “When there is community involvement and when focal points and health workers are trained at the community level, we know it improves cooperation and surveillance. But massive training is needed.”
Dr. Ian Crozier, WHO advisor, clinical care for survivors. Courtesy of WHO/M. Winkler
Concerns about human resources and long-term funding streams were repeatedly raised—to maintain lab capacity, to establish and train rapid response teams and Infectious Diseases Surveillance and Response systems and to ensure Ebola survivors have access to specialized services for health complications like eye and neurology care, as well as semen and breast milk testing programs.
Participants stressed the need to track unregistered survivors and monitor the health of all survivors, to ensure they have proper clinical care, mental health services and other counseling, as well as to garner their assistance in understanding short and long-term health implications of Ebola.
The overarching goals of Phase 3 are to interrupt all remaining chains of transmission and to identify, manage and respond to the consequences of residual Ebola risks.