The first Ebola outbreak ever in West Africa is spiraling out of control, we heard from CDC director Tom Frieden a few days ago, as anybody could see who is actually going to the affected countries. The window of opportunity to contain the epidemic is fast closing down, he said. International stakeholders are frantically (or is it finally ?) trying to get their act together, including the recent announcement by WHO of a roadmap to scale up the international response. It’s urgent indeed, as we can testify from Guinea. It’s fair to say a few crucial months were wasted, as MSF & Peter Piot have pointed out in recent weeks. Yet, not all blame should go to the international community. We shouldn’t wait for this scaling up of the international response, and instead begin with what we have and can do ourselves. Which many of us actually already did, even if so far the impact seems limited.
Africa might be ‘rising’, yet, some (West-) African stakeholders perhaps waited too long for an international – read: a WHO led – response to the Ebola outbreak. Also, some of the actions they did take were perhaps not the right ones.
For example, the closing of borders (by some neighbouring countries) might very well contribute to the spread of Ebola, in my opinion, as more poverty inevitably further jeopardizes hygiene. Instead, neighbouring countries could install medical staff on the ground, in border areas, to inform about the risks of Ebola Virus Disease (EVD) and make a rapid health assessment based on specific questionnaires addressing symptoms of EVD.
Most observers agree the lack of sensitization was a key factor in the spread of the disease. At the beginning of the outbreak in Guinea, traditional healers stated that they could cure the disease. The death of some of them proved them – quickly – wrong, but the damage had been done. Also socio-anthropologists were not much (or at least not enough) involved in the prevention strategy, the consequence was a misinterpretation of EVD which, for many ordinary people, now is a “disease created by the West to kill Africans”.
The lack of awareness about the looming threat of EVD led neighbouring countries to neglect some of the usual strategies of prevention, for too long. In my opinion, when there are Ebola cases around the corner, every possible way to inform populations should be used to provide good information about prevention, such as flyers, the use of social media popular in the region like Facebook ( check out for example the open Facebook group ‘West African Alliance Against Fever Ebola’), religious celebrations, town criers, … but also more traditional media such as radio and TV. My own experience with the Facebook group to spread info about prevention measures, “West African Alliance Against Fever Ebola”, taught me that this is a very cost effective strategy, because one just needs an internet connection, yet, it allows a rapid scale up of information. There’s one big drawback though: in sub-Saharan Africa 80% of the population can’t read or speak French or English. So it’s just one of the tools that should be used, together with others (see for example this recent Letter in the Lancet with some other suggestions) .
Another factor, well known by now, is that EVD kills a lot of healthcare workers. Indeed, many, if not all, healthcare workers (HCW) are working in fear, because of the lack of Personal Protective Equipment (PPE), gowns, gloves, and because particularly in this West African Epidemic many atypical cases are being diagnosed and are viremic, so they have contributed (and continue to contribute to) to the spread of the disease in the community. In many parts of West Africa, not just in Liberia, HCW hence went on strike because the government didn’t properly equip them. Health systems are crumbling – with the consequences one can expect also for other diseases, as has been reported in recent weeks and months. But can you blame these health care workers?
But there are also encouraging role models. In Central Africa, because of their past experience with EVD and other hemorrhagic fevers, a few years ago a doctoral school was launched in Franceville, Gabon. The school focuses on epidemiology and laboratory aspects of hemorrhagic fever, particularly EVD. The name of the school is “Ecole Doctorale Regionale d’afrique Centrale en Infectiologie Tropicale ( see here ) and the school collaborates with the WHO reference center of emerging Infectious Diseases, Centre international de recherches médicales de Franceville (CIRMF). Since 2012 this school forms specialists in infectious diseases who could be useful for the EVD outbreak and others. This is surely a model to follow elsewhere. It has also been reported that experienced Ugandan medical teams have been dispatched to the West-African region. This is the kind of thing we would like to happen on a larger scale.
I think African countries must team up and align their resources for greater impact: human resources, logistics, … to fight against Ebola. Even if some measures have been taken by African institutions and stakeholders, African people hope for far more effort by the African Union (AU), the West African Health Organization (WAHO), the Economic Community of West African states (ECOWAS) (see for example the recent suggestion for a ECOWAS special envoy, or the case for African leaders to take the lead on an effort for a Framework Convention of Global Health) , …. Put bluntly, people are in expectation of real actions on the ground and not just ‘high level’ meetings in hotels of countries not (yet?) affected by the outbreak. They also demand better governance of public resources, because this could explain – at least partly – the hesitation of many international organizations to contribute financially, as the latter are not sure that the money will be used to fight the EVD epidemic. Well, we know there are other reasons too for the belated international response. But lack of trust in domestic governance has been a key factor in the spread of this epidemic, and perhaps international actors feel likewise ?
Yet, I request more international solidarity and also less international paranoia – for example, the restriction of Occidental flights in west African countries seems not the best way to protect Western populations (even if we know there are also commercial reasons for this). Many European countries seem to have forgotten the vast number of Africans who are trying to reach Europe by the sea…
Obviously, international solidarity is needed to roll back EVD in West-Africa and in the world, but let’s also see what we, Africans, can do ourselves. If we believe Africa is indeed rising, let’s show the world.