When health response leaders gathered in Washington, DC this morning to deliver updates on the Ebola crisis in West Africa, the progress gained in recent months was evident as much in what they didn’t discuss as what they did.
The panel didn’t come to describe overflowing treatment wards, health workers sweltering in protective gear as they struggle to tend to the dying and dead, the toll among the ranks of those caregivers, or the steeply rising costs of inaction — those all remain. But they have been recounted and heard, finally, in the last several months. The continuing existence of those conditions, and the threats they pose globally as well as to people living in Sierra Leone, Liberia, Guinea, went untold, but provided the backdrop for the discussion hosted by the U.S. House of Representatives Africa Subcommittee, as panelists and guests focused on a future that has moved beyond the failures of the past and the present.
“I am very confident we will get to zero,” Dr. Tom Frieden of the U.S. Centers for Disease Control and Prevention said in answer to a question about the “endgame” (he later added “We have no alternative than to get to zero”). The goal, he added, that “we need to leave behind, is staying at zero.”
The magnitude of that goal is highlighted by how far from zero the crisis is now, with still rising rates of infection and death in Sierra Leone, and new outbreaks in Guinea where efforts to control the epidemic appeared close to success several times, but where, as Freiden put it, “it came roaring back.”
The challenges remaining of getting to zero, let alone laying the groundwork for conditions that would prevent an outbreak of the present unprecedented dimensions from recurring also were highlighted by audience members, a number of whom raised questions about disparities between efforts and outcomes in Liberia and Sierra Leone stressing responses from the United States, which began with the establishment of a command center and the deployment of 3000 troops to Liberia’s capital.
Frieden responded that the U.S. is striving to “do what is needed, where it is needed,” adding that the speed with which the epidemic has moved through the region “is frankly humbling.” Agreeing that the crisis “is definitely a regional problem,” he noted that the epidemic’s greatest impact in Sierra Leone came eight weeks after the epidemic’s greatest impact in Liberia. He added that he hopes to see progress resulting from efforts in Sierra Leone soon.
The country also highlights the challenges that lie ahead, audience members, one of who came to the microphone waving Sierra Leone’s flag, said. Ebola has killed 12 physicians — including top infectious diseases experts — in Sierra Leone, home to only about 100 physicians to begin with, Sierra Leone Embassy Head of Chancery Isatu Sema Aisha Silla, said.
In all of the countries, staying at zero will mean building health capacities in countries where fragile care systems already meant high rates of death from preventable and treatable illnesses, to build laboratory and surveillance systems that can note and respond to infectious outbreaks, Frieden said.
Staying at zero will mean replacing, as well as building a health workforce literally decimated by the crisis, rebuilding communities, and families, caring for orphans and restoring education while responding to both national and community level economic impacts, other panelists, who included Rabih Torbay of International Medical Corps and Jeremy Konyndyk, and moderator Gwendolyn Mikell of Georgetown University said.
Staying at zero also will mean revisiting the wisdom of international economic policies that have demanded austerity measures that have weakened health and education systems in already fragile countries, one audience member commented.
And staying at zero will mean incorporating and building the capacities of community members to meet current, ongoing and future responses, said panelist Saran Kaba Jones, the Liberian-born founder and chief officer of FACE Africa, a water and sanitation focused nonprofit. The staff of her organization is entirely Liberian she said, and when they turned their attention to community outreach and education in the epidemic, they found acceptance, she said. “We didn’t look foreign.”
“Not only do we need to address the immediate crisis,” said Rep. Barbara Lee (D-Calif), who attended the event, “but also the impact, and take the opportunity to address other issues.”