what was done to prevent more ebola outbreak at western africa

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• Published: 01 August 2018

A humanitarian response to the West African Ebola virus disease outbreak

• Jolene H. Nakao^1,2,
• Sonia Walia¹,
• Justin Pendarvis¹,
• Peter Morris¹ &
• David Townes^1,2

Journal of International Humanitarian Action volume iii, Article number:10 (2018) Cite this article

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Abstract

The 2014–2016 Ebola virus disease (EVD) outbreak in West Africa was of unprecedented magnitude with a full of 28,616 suspected, likely, and confirmed cases reported in Guinea, Liberia, and Sierra Leone.

The international humanitarian customs utilized its expertise in rapid response and scale up in emergency situations to manage a threat different from the more common humanitarian emergencies resulting from conflict or natural disaster.

Unique multisectoral partnerships forged between traditional public health actors and humanitarian actors facilitated mutual learning and opened the door to ongoing working relationships that volition hasten efficient and effective response to futurity global public wellness emergencies.

Introduction

The 2014–2016 Ebola virus disease (EVD) outbreak in West Africa was of unprecedented magnitude with a total of 28,616 suspected, probable, and confirmed cases reported in Republic of guinea, Liberia, and Sierra Leone every bit of June 2016 (WHO Ebola Virus Disease Situation Report 2016). Historically, EVD outbreaks were smaller in scale with limited geographic spread, typically occurring in remote villages in rural areas in Central and Due west Africa, including in the Congo-kinshasa, Uganda, Ivory Declension, and Gabon. For the first time in history, an EVD outbreak affected multiple countries at in one case, including densely populated urban centers. On August viii, 2014, the World Wellness System (WHO) declared the EVD outbreak to be a Public Health Emergency of International Concern (PHEIC), due to the risk of international spread of disease and the demand for a coordinated international response (WHO Ebola Virus Disease Situation Report 2016). We briefly draw the unique features of this outbreak that necessitated an international humanitarian response, including multisectoral partnerships betwixt traditional public wellness actors and not-traditional public health actors, and implications for the future.

Past EVD outbreaks

EVD, previously known equally Ebola hemorrhagic fever, was start documented in 1976 in two outbreaks: one in Yambuku Village, in the Democratic Commonwealth of the Congo (DRC; then Zaire), and a about-simultaneous outbreak in the town of Nzara in Southward Sudan (Peters and LeDuc 1999; Breman et al. 2016; Heymann et al. 1999; Rosello et al. 2015; Kerstiëns and Matthys 1999). In August 1976, the Yambuku Hamlet index case-patient presented with a hemorrhagic fever syndrome to the Yambuku Mission Hospital in DRC. The causative agent was isolated from a blood sample obtained from a second patient, a Belgian nun, and named Ebola virus, after the Ebola River in DRC (Heymann et al. 1999). The strategy developed to control the Zaire outbreak, refined by experience, comprised the basic tenets by which future outbreaks were controlled: early identification, isolation, and instance management; effective infection control; rigorous contact tracing; reliable laboratory testing; rapid, prophylactic, and culturally sensitive burials; and appropriate community appointment (Peters and LeDuc 1999).

Since those initial outbreaks, 21 subsequent EVD outbreaks were recorded worldwide until 2014, including 6 in the DRC and five in Uganda (Peters and LeDuc 1999; Heymann et al. 1999). The 1995 outbreak in Kikwit, DRC, is the nigh studied Ebola outbreak, providing much of the data on the epidemiology of EVD (Rosello et al. 2015). Until the West African outbreak in 2014, the largest recorded Ebola outbreak occurred in 2000 in the northern Ugandan district of Gulu, which borders Sudan; a total of 425 cases and 224 deaths were reported (Bazeyo et al. 2015).

Westward African Ebola outbreak (2014–2016)

In March 2014, hospitals in the Forest Region of Republic of guinea reported clusters of an unidentified illness characterized by fever, severe diarrhea, and vomiting (Baize et al. 2014). On March 21, 2014, Ebola was laboratory confirmed, and the Authorities of Republic of guinea declared its start Ebola outbreak, approximately 3 months after the suspected index case-patient developed symptoms in December 2013 (Baize et al. 2014; Médicins sans Frontières, Stockholm Evaluation Unit 2016). Médecins Sans Frontières (MSF) deployed multi-disciplinary teams to ready an Ebola treatment unit of measurement (ETU) in Guekedou, Guinea, and initiated outbreak control measures (Médicins sans Frontières, Stockholm Evaluation Unit of measurement 2016). WHO's Global Alert and Response Network (GOARN) and the US Centers for Illness Control and Prevention (CDC) deployed staff to support national efforts to stop transmission. WHO also sent a team to Guinea at that time to provide back up for infection prevention and control (IPC) (Key Events in the WHO Response to Ebola 2015).

At the cease of March, MSF notified the international community that this outbreak was non typical of previous outbreaks and additional international support was critical, thus requesting further assistance from the humanitarian community. Though the outbreak appeared to wane in April 2014, cases were detected in Sierra Leone in May. By tardily July, the outbreak had spread to major urban centers in Guinea, Liberia, and Sierra Leone (Médicins sans Frontières, Stockholm Evaluation Unit 2016).

The caseload connected to climb due to multiple factors, some of which distinguished this outbreak from those prior. The disease reached densely populated urban centers where manual occurred rapidly; movement of ill persons and contacts beyond national borders led to broad geographic spread (Alexander et al. 2015; Bell et al. 2016; Dahl et al. 2016a; World Health Organization 2015). In addition, lack of experience treating EVD and responding to an Ebola outbreak, poor infection control in health facilities, dangerous burying practices, limited isolation and handling chapters, the presence of unknown chains of transmission, and lack of strong affliction surveillance systems furthered the spread (Alexander et al. 2015). Community resistance to public health measures, including isolation and contact tracing, as well equally mistrust of the government and ETUs, attempts to hibernate the deceased, continuation of traditional burying practices, and subsequent reluctance to seek care complicated the response.

The humanitarian response

The outbreak connected to intensify, and the crisis evolved into a complex humanitarian emergency, marked by the consummate breakdown of services and significant loss of human life. The response required coordinated international back up across the capabilities of any single agency or ongoing United nations (United nations) country programme and actors to accost both disease transmission and the humanitarian impacts across the region (USAID 2016; Dahl et al. 2016b). Isolation and treatment capacity was overwhelmed and routine health services ceased to function, as health care workers contracted Ebola and human and financial resources were redirected to support the response. Businesses and schools closed; airlines ceased flights into Ebola-afflicted countries, resulting in loss in gross domestic product of $2.two billion according to the World Bank (World Bank Grouping 2015). Isolation of suspected case-patients impacted agricultural product; restrictions on the movement of people and appurtenances resulted in limited labor supply, which led to worsening food insecurity (United National Development Grouping 2015). Significant humanitarian protection needs were identified, including a rise in the number of vulnerable children who had lost one or both parents, and stigmatization of survivors with increased reports of violence both towards survivors and humanitarian responders. Voluntary repatriation of thousands of Ivorian refugees who had fled to Liberia during civil unrest in 2010 was suspended due to the airtight borders and fears of spreading Ebola (Protection and Security, Ebola in West Africa, ACAPS Conference Note 2014).

On June 27, 2014, the Ebola outbreak was declared a Form 3 emergency by WHO, given the scale and complexity of the emergency, urgency of demand for life-saving assistance, and limited chapters of host governments to respond (Central Events in the WHO Response to Ebola 2015). Despite growing awareness of the problem, too few health actors with viral hemorrhagic fever expertise, forth with disjointed coordination mechanisms, challenged an effective scale up of response.

Both traditional public wellness actors and humanitarian actors were obliged to adjust their regular roles in order to provide urgent assistance at the calibration that was required to interrupt transmission of EVD. Nosotros refer to traditional public health actors every bit those who unremarkably work in public wellness or respond to public health emergencies, including national health providers and government, WHO, CDC, and not-governmental organizations (NGOs). We refer to humanitarian actors, on the other paw, equally the entities who typically respond to humanitarian emergencies, including United nations agencies and international organizations, as well including some NGOs. There is some overlap between these two designations, as many humanitarian actors also have feel in public health, including response to disease outbreaks in the context of disharmonize, natural disaster, and complex emergencies. Additionally, several "traditional public health actors" with expertise in responding to VHF outbreaks too have experience in humanitarian emergencies, including MSF and WHO. Traditional development actors, including those working in public wellness, who had a long standing presence in country, also played a meaning function. They had to work within the humanitarian architecture, even so unfamiliar to them, potentially fabricated more difficult in the absence of the cluster approach and a Health Cluster, the typical mechanism which facilitates coordination amongst health actors during an emergency (Reference Module for Country Coordination at Land Level, Interagency Standing Commission 2015). Together, they provided back up to host governments in implementing strategies and edifice disquisitional response infrastructure. With few actors having expertise in EVD, humanitarian and global health partners worked together to constantly re-evaluate and adjust strategies to address the complex and dynamic nature of the epidemic. An unprecedented number of agencies combined their efforts with those of the national governments to assistance contain the outbreak and mitigate second-club impacts.

Every bit the pb coordinator for USG international disaster response, USAID'south Role of US Foreign Disaster Assistance (USAID/OFDA) served as the "backbone" of the United states of america' EVD response, analogous efforts among other USG entities that provided needed expertise, including CDC, the United states of america military, and the Us Public Health Service. USAID/OFDA contributed to the response through financial and operational support to over 30 regional and local implementing partners, technical back up to national response systems, and coordination of these programs with other USG resources committed to the response. Through USAID, the USG deployed a field-based Disaster Aid Response Team (DART) on Baronial 5 and established a corresponding Response Management Team (RMT) based in Washington, D.C. The DART—comprising disaster response, public health and medical experts from USAID/OFDA and CDC—worked on coordinating the interagency response, and identifying key needs stemming from the EVD outbreak, in society to amplify humanitarian response efforts, and lead USG efforts to back up the EVD response. While USAID/OFDA coordinated the USG's overall response, CDC provided vital technical leadership and guidance in the areas of surveillance, epidemiology, and infection prevention and command.

From August 2014 to Dec 2016, USAID/OFDA provided more $809 million across the three countries to UN agencies, NGO implementers, and contractors supporting critical interventions such every bit health and humanitarian coordination, case management, surveillance and epidemiology, restoration of essential health services through infection prevention and control measures, h2o and sanitation hygiene (Launder) interventions, social mobilization and communications, and logistics activities, including the procurement of personal protective equipment and relief commodities (Dahl et al. 2016b). In addition, USAID/OFDA provided support to critical training activities for health care workers focused on example management, infection prevention and control, and contact tracing (Fig. ane).

Fig. i

Suakoko, Bell Canton, Liberia, Oct vii, 2014: health care worker disinfecting boots at the Bong County Ebola handling unit. Photograph past Morgana Wingard, USAID

Total size image

A paradigm shift with new partnerships between humanitarian actors, traditional public health agencies, donors, and multilateral organizations was essential. As an example, in Liberia, this collaboration took the form of a consortium of v organizations, including development actors already on the ground working in public health, supporting county wellness teams and private health facilities, with significant in-country experience and expertise. Some of these organizations engaged their emergency divisions, and all of them adapted to evolving needs. In the absence of a Health Cluster, amidst a nascent national-level authorities-led Incident Management Arrangement, the consortium helped to streamline coordination, especially in Montserrado County, by focusing on gaps including the link between example management and contact tracing. One organization with expertise in h2o and sanitation expanded their purview to address the demand for safe and dignified burials (Fig. 2). Public wellness actors, with existing relationships and familiarity with local communities and their practices, had established trust which facilitated successful programs, especially those with community engagement and education at their core. Humanitarian actors' readiness for activeness and ability to rapidly scale enhanced these programs.

Fig. two

Suakoko, Bong Canton, Liberia: workers conducting safe and dignified burials at the Bell County Ebola treatment unit. Photo past Morgana Wingard, USAID

Full size paradigm

The Guinean National Ebola Coordination Cell launched "micro-cerclage," a strategy consisting of limited movement in and out of affected villages in club to encourage communities to remain within a circumscribed area (home or village) (Dahl et al. 2016b). This was accompanied past the distribution of bags of rice and oil to families, door-to-door case finding, and monitoring of illnesses and deaths within the last 21 days. This strategy was launched in an effort to mitigate community resistance to recommended public health measures and was a prime case of how humanitarian actors partnered with traditional public health actors to contain the outbreak. Traditional public health actors conducted routine surveillance activities, such as contact tracing and agile case finding, while humanitarian actors distributed cash and food.

Humanitarian actors supported the scale up of national disease surveillance; established isolation and treatment capacity; provided safe, dignified, and culturally appropriate burials; implemented infection prevention and control measures; enhanced nationwide community mobilization; and bolstered logistics, including supply chain for health facilities. In-kind food and cash assist to communities in voluntary isolation became critical to prevent disease manual through move of contacts and worsening food insecurity. In gild to facilitate effective coordination of the response across multiple countries with limited air send, the Un Humanitarian Air Service quickly transported personnel and disquisitional supplies. The Globe Food Program (WFP) reapplied their expertise with food delivery to vulnerable populations to target isolated individuals.

In Ebola-afflicted countries, several development partners successfully pivoted from their wellness systems strengthening activities to provide IPC grooming at wellness facilities. Ane example of this is a USAID-funded evolution partner who provided technical assistance for IPC in Guinea, as part of their Maternal Child Survival Program. This partner began to apace deploy staff to provide critical training for health intendance personnel at routine non-Ebola wellness facilities in areas with active EVD transmission, given that poor infection command results in increased transmission among health care workers (Grinnell et al. 2015). Traditional public wellness and humanitarian partners together adopted a ring IPC strategy, which was introduced in areas of agile Ebola manual to aid suspension the chain of manual. Ring IPC aimed to provide intensive, short-term supervision for compliance with normative IPC guidelines in a designated area surrounding recent cases or case clusters and to ensure that facilities had adequate stocks of essential IPC supplies (Nyenswah et al. 2015; Olu et al. 2015). This strategy allowed partners to rapidly provide interventions in areas where there had not been formal training in IPC, in order to mitigate active manual.

Social mobilization had not typically been part of the traditional humanitarian coordination system (Dubois and Wake 2015). This changed during the Ebola response, every bit the need to couple standard public health interventions with community engagement and social mobilization efforts became disquisitional, due to mistrust and increased community resistance towards the response. In September 2014, at to the lowest degree eight officials and local journalists were brutally murdered in the village of Womey, Guinea. They had been sent every bit part of a delegation to conduct education on Ebola (Callimachi 2014). Several rumors near being poisoned at ETUs and false messages about Ebola being a manufactured weapon circulated throughout the outbreak in Republic of liberia, Republic of guinea, and Sierra Leone. During a community meeting in a sub-prefecture in Western Republic of guinea, a survivor described receiving telephone calls from his community while he was admitted to an ETU. Due to the fear of beingness poisoned, he was told to "spit out" prescribed pills and to disconnect intravenous lines when nobody was watching. He instead decided to comply with his medical care and survived, while many of his friends died. After his discharge, he was able to explain to his community that adhering to handling increases chances of survival. Other community members confirmed they had also received messages emphasizing the need to turn down all class of treatment. Therefore, the inclusion of social mobilization as a response pillar became necessary (Gillespie et al. 2016).

An additional unique feature of the Ebola response in West Africa was the integration of the WHO ring vaccination trial conducted in Republic of guinea equally part of an ongoing response endeavor—the first time an Ebola vaccine was used in a clinical trial equally part of an ongoing response effort. Preliminary results from a band vaccination trial conducted in Guinea had indicated that assistants of a single dose of rVSV-ZEBOV to primary and secondary contacts of confirmed EVD case-patients was effective in preventing EVD infection (Henao-Restrepo et al. 2015). The Government of Guinea adopted ring vaccination as an integral part of response activities, when a cluster of Ebola cases emerged in the Forest region of Republic of guinea in 2016, from sexual transmission from a survivor (Ebola ça Suffit Ring Vaccination Trial Consortium 2015; Gsell et al. 2017).The incorporation of a vaccination trial, often on a development timeline, into the ongoing response was coordinated with the National Ebola Coordination cell with other humanitarian interventions.

The rVSV band vaccination entrada was launched on May 21, 2018, as function of the response effort to the Ebola virus disease outbreak in the Democratic republic of the congo (Globe Health Organization, Ebola Virus Illness External Situation Report 2018).

With its experience in rapid response and calibration up in emergency situations, the international humanitarian community galvanized to manage a threat different from the more common humanitarian emergency, resulting from conflict or natural disasters. Leveraging previous feel with humanitarian emergencies and flexible response mechanisms immune rapid scale upwardly and facilitated the development of new operational models for evolving technical guidance, including guidance on the prevention of sexual manual, apply of vaccines, and breastfeeding in survivors.

Conclusion

Given its calibration and telescopic, the 2014–2016 Ebola outbreak in W Africa required an unprecedented commonage response requiring potent and unprecedented coordination betwixt a multifariousness of actors, including traditional public health actors and development and humanitarian actors. While traditional public health actors with previous experience in Ebola response provided their expertise, development actors provided in state feel due to their longstanding presence, along with cognition and the trust of the local communities, and the international humanitarian community provided experience working within the humanitarian architecture and the ability to chop-chop calibration up a response. This combination played a pivotal office in mounting the immense response needed to control the largest Ebola outbreak in history. Operational coordination, the scale and speed of logistics needed, and the need for immediate action were key challenges that the humanitarian framework helped address. The unique multisectoral partnerships forged between traditional public wellness and humanitarian actors facilitated common learning and opened the door to ongoing working relationships that will amend response to future global public health emergencies.

Abbreviations

CDC:

US Centers for Disease Control and Prevention

DART:

Disaster Help Response Team

DRC:

Autonomous Republic of the congo

ETU:

Ebola treatment unit

EVD:

Ebola virus disease

GOARN:

Global Alert and Response Network

MSF:

Médecins Sans Frontières

NGO:

Non-governmental organisation

OFDA:

Office of The states Foreign Disaster Assistance

PHEIC:

Public Health Emergency of International Concern

RMT:

Response Direction Team

Un:

United Nations

USAID:

United states Bureau for International Development

USG:

United states of america Government

WFP:

Earth Food Plan

WHO:

World Health Organization

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Acknowledgements

The authors would like to thank all the unsung heroes of the Ebola response for their sacrifice and delivery to bring an finish to a horrific outbreak that took away thousands of lives.

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Data for this written report can exist found in the USAID Evolution Experience Immigration business firm (https://dec.usaid.gov/dec/domicile/Default.aspx).

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Affiliations

1. Office of United states of america Strange Disaster Assistance, United States Agency for International Evolution, 1300 Pennsylvania Ave, NW, Washington, DC, 20523, USA

   Linda M. Mobula, Jolene H. Nakao, Sonia Walia, Justin Pendarvis, Peter Morris & David Townes

2. Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, 30329, GA, U.s.a.

   Jolene H. Nakao & David Townes

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The views and opinions represented in this article do not stand for the views and opinions of the U.s. Agency for International Development. All authors read and approved the final manuscript.

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Correspondence to Linda M. Mobula.

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Mobula, L.Grand., Nakao, J.H., Walia, Due south. et al. A humanitarian response to the West African Ebola virus disease outbreak. Int J Humanitarian Action three, ten (2018). https://doi.org/x.1186/s41018-018-0039-two

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• Received: 27 December 2017

• Accepted: 13 June 2018

• Published: 01 August 2018

• DOI : https://doi.org/x.1186/s41018-018-0039-two

Keywords

• Ebola virus disease
• Humanitarian
• Due west Africa

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