Examination of West Africa Ebola crisis highlights fault lines revealed in previous outbreaks, opportunities to expand knowledge

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The threat of Ebola across Guinea, Liberia, and Sierra Leone in 2014 had been recognized about three months earlier when an unrelated outbreak began in an isolated village in the Democratic Republic of the Congo that July, with markedly different impacts and outcomes. Contained by that November, the outbreak in the Democratic Republic of the Congo killed dozens of people, while the crisis in West Africa killed more than 11,000 during the two years before it was contained. The second outbreak had followed the course that seven earlier Ebola epidemics had taken — with from 100 to 200 cases, with transmissions outside their original areas rare, with perhaps 5 to 10 organizations responding, and lasting from two to four months.

Those earlier Ebola outbreaks and the fault lines as well as the opportunities they had highlighted were among the topics discussed in a meeting of clinicians and researchers convened by National Academies of Sciences, Engineering, and Medicine in March 2015, on which a report was released today. Participants included responders to those earlier outbreaks, including Jean Jacques Muyembe -Tamfum of Kinshasa University in the Democratic Republic of the Congo, one of the first physicians to respond to the first recognized outbreak of Ebola in 1976, in what was then Zaire, and who recalled, as well, the 2014 outbreak in  his country.

Outbreaks in villages often were stopped “spontaneously” by community awareness and involvement, the same essential elements that eventually helped turn the trajectory of the West Africa crisis, Muyembe pointed out. But while the West Africa outbreak was spread by frequent cross border travel (driven in turn by both poverty, as well as by the situation of those colonially designed borders across the older lines of tribal and family territories) its surveillance was challenged by those borders, while transmissions were accelerated in hospital settings early on.

For those reasons, resources to fill gaps — in infection control, isolation facilities and public health communications — that had been highlighted in earlier outbreaks were all the more critical. Methods and lessons derived from those outbreaks also would have made a difference, participants noted, but in the largely uncoordinated efforts of more than a hundred responding organizations, those opportunities went unrealized.

In part that is because the cycles of external aid that had responded to those outbreaks, and other public health crises, “often benefits the giver more than the receiver,” as one participant put it, providing foreign experts with settings for research projects, while leaving local scientists “reduced to mere sample collectors.”

The workshop also covered a wide range of information and opportunities to improve future responses gained in the course of the West Africa crisis. The full report can be found here.


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