Ebola has a case fatality rate of approximately 50 to 70 percent. Although it has been more than 40 years since the first-ever case of the Ebola virus in humans was diagnosed, there is still no licensed, specific treatment for the disease. The 2014 Ebola outbreak in West Africa took the lives of thousands, left many children without one or both of their parents, and devastated health-care systems which were already reeling from a dearth of medical professionals.
Across Africa, limited capacity to harness and deploy technologies in key areas such as health, agriculture, and industrial development exacerbates the socioeconomic challenges posed by such outbreaks. For instance, during this outbreak, samples collected from patients in Guinea had to be flown to either South Africa or Senegal to be tested because Guinea did not have any laboratories with the capacity to accurately test for the Ebola virus. While this is understandable given the competing priorities for the resource-strapped governments of Guinea, Liberia, and Sierra Leone, including food insecurity, maternal and child deaths, lack of safe drinking water, and more well-known infectious diseases such as malaria, these limits in capacity can seriously hinder pandemic response.
When the World Health Organization (WHO) declared this outbreak a public health emergency of international concern, naturally the WHO turned to familiar physicians and researchers who responded to previous outbreaks in different parts of the world. But about 5,000 miles east of Guinea, in Democratic Republic of the Congo and Uganda, were hundreds of local experts who had been involved in stopping several Ebola outbreaks from going beyond local villages. Most had even been trained at the Centers for Disease Control and Prevention (CDC) field epidemiology programs across the continent. At the outset of this outbreak, however, the WHO did not immediately turn to these local experts as the first line of response. Additionally, in far-flung cities in Europe and the United States, there were thousands of trained physicians originally from the affected countries of Guinea, Liberia, and Sierra Leone who had practiced medicine there before emigrating. They were not looked to either as a source of local experience and expertise to help fight the outbreak. On the contrary, as many of them were not practicing as physicians in their adopted countries, they didn’t meet the WHO requirements to go back and help in their home countries even though many wanted to.
Eventually the international community started to mobilize African expertise from the affected countries as well as from all over the continent, such as Democratic Republic of the Congo, Uganda, Cameroon, and Mali, but this happened after the outbreak was already out of control; too late for these doctors to make a significant difference.
To prevent such a situation from happening again, there are four major steps that could be taken continent-wide to ensure preparedness against outbreaks in the future.
Convene African experts and institutions on emergency preparedness
Now in its third iteration, the African Conference on Emerging Infectious Diseases and Biosecurity was founded to bring together experts in the field of infectious diseases, from pathologists to government administrators; as well as specialists in other relevant fields, from bioinformatics to community engagement. Under the leadership of the Global Emerging Pathogens Treatment Consortium (GET), the goal is to share experiences on preparedness and health systems strengthening, collaborate on research, and build collective, continent-wide capacity. This will allow better cooperation among countries in times of need, make it easier to identify experts to call on, and contribute to preventing such outbreaks from ever happening again. To improve collaboration beyond the annual conference and in response to the ongoing menace of endemic Lassa hemorrhagic fever, several African academic institutions, civil society organizations, and their international collaborators came together to form a coalition. This coalition, whose research mandate was conceptualized by GET at the 2016 conference in Lagos, has emerged into the African Biosafety and Genomics Network or ABG-Net. Supporting and expanding these kinds of platforms are crucial to allow stakeholders to showcase their research and improve the readiness of African countries to deal with major disease outbreaks.
Organize regionally to pool health expertise and resources
By taking a regional approach to preparedness, African countries could more effectively prepare for and fight outbreaks of emerging and re-emerging infectious diseases. African countries have already self-organized into regional economic and political communities such as the Economic Community of West African States (ECOWAS), the Economic Community of Central African States (ECCAS), and the Common Market for Eastern and Southern Africa (COMESA). Due to huge operational costs, it’s unrealistic to expect Guinea, Liberia, or Sierra Leone to each have level 3 biosafety containment laboratories like the ones the CDC has in Atlanta, which can house and treat patients with hemorrhagic fevers like Ebola or other infectious diseases with the potential to cause international chaos. However, the 15 member countries of ECOWAS have a combined gross domestic product (GDP) of 1.3 trillion dollars, and the 11 member countries of ECCAS have a combined GDP of 735 billion dollars. Organizing regionally and combining resources would allow for a regional laboratory system in which one country houses a high-level biosafety containment laboratory while the other countries strengthen existing laboratories to test for other less dangerous, more common diseases. One state-of-the-art laboratory per region might not be enough, but it is a step in the right direction. This will also allow regional experts to work together more closely, and improve readiness by consulting and sharing knowledge.
Divide and conquer to research and tackle diseases
While the regions above have many diseases in common, there is regional variation in the prevalence of re-emerging diseases. The Ebola zone was confined to Central Africa (Democratic Republic of the Congo, Angola, and Uganda), until the 2014 Ebola outbreak in West Africa. Similarly, most cases of Lassa fever and Dengue fever are in West Africa (like Nigeria and Togo). Regions could focus on diseases most prevalent in their area to foster specialized expertise in research and development on particular diseases, becoming hubs to share across the continent while similarly receiving expertise from other regional hubs. This would maximize the limited resources available.
Close the health information gap between experts and the local population
The gap in health information communication is huge across most of Africa. In major U.S. cities, there are often public health posters in frequently trafficked areas warning about the flu or HIV/AIDS, with directions to a website or phone number for more information. Health campaigns use similar methods in Africa, as most health information is shared in the form of flyers and posters. Yet this usually takes place during vaccination campaigns or other annual health drives, with little follow-up. Developing African strategies to share health information, which could take advantage of the popularity of social media and mobile phone applications such as WhatsApp, would go a long way in letting local people know that experts and resources are available and how to seek them out. This should go beyond just alerting the population about outbreaks, to include sharing basic hygiene reminders with people, especially those in rural areas, more often and more consistently.
Hopefully there will never be a similar outbreak of Ebola or any infectious disease across the continent again. However if there is one, the continent will have African-led organizations that can quickly mobilize local expertise to respond, before calling on outside experts as reinforcements.