The Global Response to Ebola: Challenges and Solutions

The US Ebola Response

Ebola is a complex crisis, upending the social fabric of affected countries. Treating it predominantly as a health emergency underplayed its wider implications.

It also weakened already fragile health systems. The international community must continue its efforts to help Guinea, Liberia and Sierra Leone reach — and remain at — zero cases.

Defining the Outbreak

Identifying the number of illnesses and their distribution over time is essential to determining whether an outbreak is occurring. This requires establishing the expected rate of illness at a given time and location – known as a baseline level of disease.

Outbreaks are identified when the numbers of illnesses exceed that level. Health care workers and people caring for sick relatives are at increased risk of infection because they come into direct contact with bodily fluids, such as saliva, urine, feces, vomit, sweat, semen, breast milk and blood. Proper use of personal protective equipment reduces this risk.

Ebola is a dangerous virus that triggers a severe, often fatal, multi-system organ failure and leads to hemorrhagic fever and shock. It is transmitted through direct contact with body fluids and surfaces and can be spread by handling dead bodies or by eating bushmeat (e.g. monkeys, forest antelopes and rodents, as well as bats). The incubation period is usually between 2 and 21 days.

Defining Needs and Requirements

Our response to the Ebola outbreak required a rigorous and rapid needs assessment to identify desired results, gaps in current practice and barriers and facilitators to the development of solutions. The result is a set of measurable and credible goals for advancing preparedness in the at-risk countries, including vaccinations, expanding access to health services, ramping up community engagement and establishing contact tracing and treatment facilities.

Health care workers must be able to work safely in the most challenging settings and with the highest risk patients. They need access to the right PPE, and be trained to use it properly, to follow standard protocols for infection control in high-risk settings.

Countries must be able to reach—and stay at—zero cases, which will require sustained, comprehensive action by all of the stakeholders. This requires a global partnership that involves governments, international organizations, bilateral donors, private sector partners and non-traditional actors. It will also require commitment to long-term funding streams that mitigate and respond to recurrent outbreaks.

Defining the Role of the United States

The United States continues to play a key role in response to the Ebola crisis. The US military is providing logistics expertise and personnel to support the delivery of supplies to affected countries. In addition, the US Navy has sent a ship with staff and equipment to transport patients from Liberia to Uganda for treatment.

Local health departments are working with state and federal counterparts to ensure that individuals at risk for Ebola are monitored according to CDC guidance and symptomatic individuals are isolated and transported to an appropriate medical facility. They are also working to develop relationships with airports and other transportation providers to enhance readiness to screen incoming travelers.

NLM provides a single, up-to-date source of information for responders to public health emergencies and disasters through its Disaster Information Management Research Center (DIMRC). DIMRC monitors a wide variety of sources of information and creates a Web guide to the most prominent ones, including the World Health Organization and the Centers for Disease Control and Prevention.

Defining the Role of the International Community

In this time of crisis, it is important for the international community to continue its support to West Africa as it works to contain the outbreak and cope with its impacts. We need to help these countries strengthen their health systems and learn lessons so that they can better prepare for future epidemics.

Communities must be involved at the outset, and not viewed as victims, so that they take ownership of the response, monitor their contacts and actively search for those who have dropped out of sight. Communities can become a formidable force against Ebola, but only when they are engaged.

GOARN members, including MSF staff, expressed a desire for WHO to lead the response more forcefully as it has the experience, seasoned senior staff, constitutional mandate and country presence to do so. Similarly, we need to avoid creating new mechanisms and focus on scaling-up existing ones. This includes re-engaging WHO, strengthening infection prevention and control practices, and building capacity for contact tracing and monitoring.

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