“There’s no question the disease did get away from us all, collectively, and in retrospect, there are a number of things that we would have done better and sooner . . .” Dr Rick Brennan, Director, Emergency Risk Management and Humanitarian Response, WHO
Calling this “a good day . . . an important day,” representatives of the World Health Organization declared an end to Liberia’s third outbreak of Ebola, and with it an end, for the first time in the nearly two years since the epidemic was recognized in three West African countries, to all known chains of infection transmitting the virus.
While warning that the persistence of the virus, particularly its potential to be found for up to 12 months in semen, will likely lead to further “flare-ups,” representatives of the WHO, during a Geneva press conference this morning, expressed confidence that re-emergence of the virus in Guinea, Sierra Leone or Liberia will be detected and contained swiftly. In addition, they said, efforts will continue to extend health services, including semen testing and preventive counseling to survivors. That counseling will include recommendations to use condoms and for attention to hand-washing until at least two tests of semen, at least a week apart, find no evidence of virus. For people in remote rural areas, for whom regular testing is not accessible, it will include condoms and greater attention to hygiene, including in disposal of condoms and hand-washing for 12 months.
At least 28,500 people fell ill from Ebola, according to WHO, including more than 800 health workers, and at least 11,300 people, more than 500 health workers among them, died in the course of the outbreak, which is believed to have started in December 2013 with a transmission of the virus from a bat to a child in a Guinean village. The WHO estimates that the three most affected countries, where the epidemic devastated already fragile and resource-limited economies and health systems now are home to more than ten thousand survivors — about half of them male. The great majority of those survivors, however, recovered from the virus at least 12 months ago, representatives said this morning. Ten “flare-ups,” resulting from transmission of persisting virus have occurred, they said. Another would lead to another 42-cycle of monitoring before the country where it occurs would once again be considered Ebola-free.
“We hope it will be picked up quickly. We trust it will,” Dr. Peter Graaff, the WHO’s newly appointed Ebola response leader said. Graaff’s title is a work in progress, because he also will work on reforms to the organization’s emergency response process, he said. At the same time Graaff noted that logistics to reach intimate partners and household contacts of Ebola survivors, as well as the money needed to establish the disease detection, prevention and response capacities needed, remain uncertain.
The agency, which is charged with the responsibility of noting, declaring and responding to public health crises of international concern did not do so during the West Africa outbreak until August 2014, months after the virus had spread to the capitals of all three affected countries, and after a Liberian-American lawyer who was sick with the virus had traveled to Lagos, Nigeria, the most populous city in Africa, sparking a chain of transmission there.
“I think there’s been general acknowledgement that WHO and the international community were slow at the start of this outbreak,” WHO Emergency Risk Management and Humanitarian Response, director Dr. Rick Brennan said in response to a question about criticisms of the organization’s delay. “There’s no question the disease did get away from us all, collectively, and in retrospect, there are a number of things we would have done better and sooner.”
WHO, “as an organization and the international community,” he added, have since undergone “soul-searching,” and “major, major course corrections.”
Last month members of a panel assembled by Harvard’s Global Health Institute and the London School of Hygiene and Tropical Medicine cited repeated failures on the part of a “mediocre, dysfunctional and unaccountable” WHO to recognize the gravity of the Ebola outbreak, and called for international attention to systemic reforms to counter the influence of politics on the organization’s emergency responses.
Médecins Sans Frontières, the international humanitarian nonprofit organization that responded to the Ebola crisis in early 2014 and warned that it was unprecedented in its potential to spread devastation in March 2014, urged global health advocates and policy makers to take heed of what happened during the last two years, to maintain vigilance and to prepare for future outbreaks.