Disinfecting spectators’ hands with hand sanitizing gel at the Africa Cup of Nations, Equatorial Guinea, 2015. WHO/Nicolas Isla
Thanks to preparedness activities by Equatorial Guinea’s Ministry of Health, FIFA and the World Health Organization (WHO), the 1 million people gathered in Equatorial Guinea for the 2015 Africa Cup of Nations are able to focus more on footie than on fears of Ebola.
So what does it take to ensure that capacities are in place to prevent, identify and respond to potential Ebola virus transmission at such a large mass gathering?
"Large mass gatherings like the FIFA World Cup, the Olympic Games or the Africa Cup of Nations are highly visible events and offer the occasion to promote long lasting health legacies," says Dr. Maurizio Barbeschi, WHO scientist and team leader for the WHO preparedness and mass gatherings team. Barbeschi and colleagues have published numerous articles on mass gatherings and disease surveillance and control, including a recent series inThe Lancet.
"Mass gatherings require extensive preparation," adds Nicolas Isla, WHO technical officer within the same team, now deployed in Equatorial Guinea for AFCON. "Coordinated surveillance and alert systems have to be installed in each point of entry, stadium and hospital. Rapid response teams, dedicated healthcare facilities and labs must be developed and ready to handle any potential cases. Health authorities must ensure that local and visitor populations are educated about early symptoms of Ebola and how to protect themselves. Handwashing areas, mobile toilets, isolation areas and personal protective equipment must be placed in strategic areas. This is no small feat."
These activities are in addition to regular large mass gathering preparedness activities that also must be in place, such as plans for controlling crowds and dealing with traumatic injuries, food and water borne illnesses, weather and physical structure disasters, and terrorism concerns.
In coordinating this work, WHO drew from decades of mass gathering and preparedness experience, including work helping Nigeria prepare for three
large festivals in July 2014, right in the midst of its Ebola outbreak: the Igbo Ukwu New Yam festival, the Sango festival, and the two-week long Osun Osogbo festival which worships the goddess of fertility. "We took what we learned from each mass gathering and applied it to the Nigeria context," says Dr. Maurizio Barbeschi, who was in Nigeria to control the outbreak. We were encouraged by how much had been already done in Equatorial Guinea, especially given the amount of work that is needed to prepare for an event like the Africa Cup of Nations. We really worked hand in hand to establish and implement protocols for preparing, detecting and managing suspect and confirmed cases. Many measures had to be discussed and agreed on with the organizers and with Ebola response leadership and then carefully communicated to the public. For example, at the Osun Osogbo festival, a carnival-like, joyous event with international participation, the decision during the Ebola outbreak was to limit participation to Nigerians and to tell everyone to minimise physical contact."
In the lead-up to the 2015 Africa Cup of Nations, WHO worked with FIFA with the original 2015 AFCON host Morocco, and with final AFCON host Equatorial Guinea. In Equatorial Guinea, this work included supporting the Ministry of Health to develop standard operating procedures for the Ebola response and establishing epidemic surveillance and response systems for Ebola virus disease, involving airports, stadiums, and select healthcare centers across the country.
The team also trained healthcare workers in infection prevention and control and provided advice on the finalization of three Ebola Treatment Centres being built.
"We were encouraged by how much had been already done in Equatorial Guinea, especially given the amount of work that is needed to prepare for an event like the Africa Cup of Nations. We really worked hand in hand to establish and implement protocols for preparing, detecting and managing suspect and confirmed cases," says Isla, WHO technical officer. "The country has done a tremendous amount of social mobilization around Ebola and is carrying out temperature screening at airports and stadiums. At stadiums they are also disinfecting spectators' hands with hand sanitizing gel as they enter – people are very receptive to this."
In addition to preparing for the Africa Cup of Nations, and to fighting Ebola in the West Africa Ebola-affected countries, WHO has been extensively involved in assisting neighboring countries with preparedness plans.
Technical and financial partners convened with preparedness staff from these countries in Geneva on 14-16 January 2015 to review custom 90-day operational plans for strengthening response readiness in each country to identify priority needs for each country. Each country now has a tailored 90-day plan to strengthen operational readiness for response. Participating countries included Benin, Burkina Faso, Cameroon, Central African Republic, Cote d’Ivoire, Ethiopia, Gambia, Ghana, Guinea Bissau, Mali, Mauritania, Niger, Senegal and Togo.