Lessons and Strategies in Responding to the Ebola Crisis

Harvard Chan Faculty and Students Lead the Response to Ebola

The first lesson was that a response to ebola must go beyond emergency funding. This includes addressing the need for long-term advocacy with governments and donors to set up sustained multi-year funding streams to prevent, mitigate and respond to recurrent outbreaks.

Another lesson was that good outbreak control relies on many types of interventions, including 100 per cent contact tracing, safe and dignified burials, laboratory services, and community engagement.

Community engagement and social mobilisation

In the weeks after the outbreak began, Harvard Chan faculty and students stepped up efforts to address the crisis in West Africa. This included convening a meeting of international leaders and experts, providing advanced database software to track the epidemic, and sharing expertise with governments in Guinea, Liberia, and Sierra Leone.

A crucial lesson of the response to Ebola is that it is impossible to manage a public health emergency without a cooperative community. Contact tracing, adherence to recommended protective measures, and safe burials all depend on a willingness by communities to cooperate with officials.

In West Africa, community engagement and social mobilisation proved critical to tackling the outbreak. But the approach was misunderstood, with communities seen as barriers rather than partners. Top-down medically oriented messaging fostered stigma and triggered treatment avoidance, and the emphasis on quarantine exacerbated community tensions. Local cultural behaviours, including traditional eating and burial practices, also pose challenges for infection control.

Reinforcing disease surveillance

Although advances in zoonotic disease surveillance have occurred globally in recent decades, many LMICs have not yet implemented these approaches and continue to prioritise urban areas over rural communities, which are exposed to zoonotic diseases on a regular basis and do not have access to comprehensive health services. Further, most active zoonotic disease surveillance programmes are short-lived and are often guided by research priorities (eg, emerging pathogens) rather than community needs.

The current Ebola response is a wake-up call to strengthening disease surveillance in remote rural areas. This will require sustained, long-term support, including training and funding to enable health workers to use new tools (eg, telemedicine), develop their expertise, and integrate these into their everyday practice.

Health care worker surveys in northern Ghana revealed that existing surveillance systems were not well functioning during the outbreak. Specifically, screening and case detection were difficult due to lack of specialised equipment such as infra-red thermometers and overlapping signs and symptoms that mimic other conditions such as malaria. Further, a shortage of health care workers in the region contributed to delayed case detection.

Detecting and preventing resurgence

When a person shows early signs of Ebola, a blood test can detect the virus. If health care workers are notified and isolated, they can prevent the virus from spreading to others.

CDC public health specialists worked closely with community, political and medical leaders to identify places where patients could be isolated until Ebola Treatment Units (ETUs) were built, as well as safe and dignified burial teams who followed technical specifications established by CDC (22).

During the outbreak, CDC worked with airport authorities in Guinea, Liberia, and Sierra Leone and international airlines to set up screening for travelers leaving affected countries to ensure that sick or potentially exposed people weren’t boarding planes to other destinations. This, combined with travel restrictions and effective quarantine strategies, helped reduce the number of cases and deaths. But more work remains. It’s critical that we improve the ability of all countries to respond quickly and effectively when a threat emerges.

Investing in prevention

When Ebola hit the US in early October, it was met with reactions that ranged from fearmongering to factual. Harvard Chan faculty, students, and alumni are on the frontlines of this global health emergency—in the field and in the lab.

In addition to strengthening healthcare worker safety, interventions must be focused in the general population. This includes education, risk communication, and access to safe burials. It also includes enhancing risk mitigation among people who travel to or from countries with intense outbreaks.

Throughout the epidemic, Chan pressed leaders of the affected countries to take high-level responsibility for what she believed was a public health emergency of unprecedented severity. She argued that WHO could provide technical guidance and scale up material support, but these measures would never compensate for strong government action. She also pushed back against restrictions on air travel and trade, which can have severe economic consequences for fragile economies. The IHR emergency committee mechanism she established to assess the situation has helped safeguard against such recommendations in the future.

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