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West Africa readies for Ebola battle

At least five people are known to have died of Ebola in Guinea. As the World Health Organisation rolls out a vaccination, neighbouring Sierra Leone and Liberia are preparing for the disease to cross the borders. About 225 people have been vaccinated in Guinea, since the virus broke out on 14 February in the N’Zerekore region, the United Nations says.

This is the first time in five years that Ebola has been detected in West Africa. The last outbreak, which lasted from 2014 to 2016, devastated Guinea, Sierra Leone and Liberia, killing more than 11 000 people

Health workers are hoping it will be different this time. They have a new weapon in their arsenal — a vaccine that was released in late 2019. The World Health Organisation (WHO) has already sent 11 000 doses of the rVSV-ZEBOV Ebola vaccine, to Guinea, with an additional 8 500 expected to arrive soon.

The initial vaccination drive is targeted at people in high risk areas, especially health workers and those who have been in direct contact with a patient. About 65 WHO professionals are on the ground to help the Guinean government respond to the outbreak. 

The Ebola vaccine has proved its effectiveness — it was instrumental in bringing the outbreak in the Democratic Republic of the Congo (DRC) under control

In Guinea, the WHO is supporting health officials to identify contacts, set up a treatment system, enhance surveillance and involve citizens in containing the virus. So far, 276 contacts are under surveillance, Guinea’s National Agency for Health says. It is also ramping up infection prevention and control of health facilities and reaching out to residents to improve response. 

Standing by

There has been no confirmation of cases in Sierra Leone and Liberia, but the two countries are on high alert because they share very porous borders with Guinea. 

In Sierra Leone, regular preparedness risk coordination meetings are taking place. Authorities use these sessions to talk about logistics, funds, training for the frontline personnel with emphasis on communication and the involvement of citizens.

“From 2014 to now, we know a lot. But, there is still a lot more to learn, says Harold Thomas, the risk communication lead in the directorate of health security and emergency at Sierra Leone’s ministry of health and sanitation. “That is why we’re counting on other relevant partners for help.” 

He says Sierra Leone has already placed an order for the Ebola vaccine through the WHO on compassionate grounds. The country plans to use the ring method of inoculation — vaccinating and monitoring the people around each infected individual — as done in Guinea, in the event of an outbreak of the hemorrhagic fever. 

There is strong regional collaboration between the three Mano River Union nations to help fight the outbreak in Guinea .“We support Guinea to help it contain the virus and this requires data sharing, increased surveillance of border-crossing areas and a robust search for active cases,” Thomas points out. 

Similar efforts are under way in Liberia, where President George Weah has tightened security along the borders with Guinea. The president has also mandated the ministry of health to increase surveillance and preparedness and placed health workers on high alert to avert any potential threats, reported Alloycious David, an investigative journalist from the Liberian capital of Monrovia. 

Better prepared

Even though Sierra Leone and Liberia are well advanced with planning and preparedness, threats of cross-border contamination remain real. Yusuf Kabba survived the 2014-16 Ebola outbreak in Sierra Leone. As president of the Sierra Leone Ebola Survivors Association, he knows that improvements in planning can be made.

“I do not think the border surveillance is appropriate enough at this point to prevent a possible spillover,” Kabba says. He adds that the situation in Guinea is scary for countries in the Mano River Union at a time when they are also battling the coronavirus pandemic. “We are facing a lot of threats from the outbreak in Guinea, considering the numbers of porous border crossing points. Traders are moving to and from Guinea. This represents a great threat to Sierra Leone’s fragile health system, food security and the erratic economy,” he warns.

N’zerekore is at the intersection of roads from Liberia and Côte d’Ivoire as well as from Kankan and Macenta in Guinea. Health workers bury a coffin of an Ebola victim in May 2019. Photo: John Wessels/AFP

Thomas is aware of the gaps in planning and the challenges that lie ahead. “With outbreaks, no country can ever prepare enough,” he says. 

When the first outbreak was recorded in 2014, Sierra Leone had only one laboratory, in the eastern city of Kenema, for testing Ebola samples. Now there are up to six laboratories and more beds in isolation and treatment centres plus an improved ambulance system, Thomas points out. 

But Kabbah also wants effective involvement with citizens, who, he say, played a critical role in ending transmission of the last outbreak. “The government should prioritise effective community engagement, especially with paramount chiefs, traditional healers and inter-religious council.” 

When it comes to regional preparedness, the WHO has given $1.25-million in support of Guinea’s response and to ramp up efforts in readiness for possible outbreaks in six countries at risk of cross-border contamination — Côte d’Ivoire Liberia, Sierra Leone, Guinea-Bissau, Mali and Senegal. 

“We’ve learned the hard lessons of history and we know … preparedness works,” the WHO’s Africa regional director, Matshidiso Moeti, said in a statement. She emphasises that systematic surveillance, comprehensive preparations and strong, cross-border coordination are crucial to detecting cases and ensuring quicker isolating and treatment. 

An additional $15-million has been released by the UN Central Response Fund to help Guinea and the DRC respond to the re-emergence of Ebola. The DRC has recorded eight Ebola cases with four deaths in the North Kivu province since early February this year.The Ebola virus spreads through contact with bodily fluids, including the blood, vomit and faeces of an infected person. The virus can also spread from contact with contaminated surfaces, including bedding and clothes. A rare, but fatal disease, the Ebola virus has an average death rate of about 50%, with rates having varied from 25% to 90% in past outbreaks, the WHO says.

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