This week President Obama announced plans to bring home most of the 1,300 U.S. troops that were sent to fight the ongoing Ebola outbreak in West Africa. The departure signals that U.S. officials believe the crisis has largely been contained.
Though the number of people with the disease had been falling, the World Health Organization said on Tuesday there has been a recent increase in cases in West Africa. The outbreak has killed more than 9,000 people to date, most in Guinea, Liberia, and Sierra Leone.
The current epidemic began with just a single case in a small village in southeastern Guinea, so officials are quick to avoid overstating the successes of the past few months.
“Good progress is being made, but the outbreak still presents a grave threat,” Dr. David Nabarro, the U.N. secretary-general's special envoy on Ebola, told reporters in Geneva on Tuesday.
Every new case of Ebola that occurs — 221 in the past three weeks alone— has the potential to lead to countless others. So the road to ending the current outbreak is long and littered with many challenges.
“We really hope that there will be no complacency among anybody involved in the response,” said Nabarro. “We have to really work hard to get to what we call zero cases and zero transmission.”
Shifting From Crisis Response to Planning for Future
Although the U.S. will continue to provide funding to the region, only 100 troops will remain behind to assist medical professionals and support staff by the end of April. To date, the U.S. military has spent $400 million on efforts to combat Ebola.
Whether the crisis has really turned a corner as media attention has started to wane, it’s clear the international community has already shifted from managing the crisis to protecting these countries from similar crises in the future.
Nongovernmental agencies like Oxfam, which has supported West African communities in reducing the spread of Ebola, are now calling for a longer-term approach. Part of this includes revitalizing the economies of the countries that were severely hit by the epidemic.
“The world was late in waking up to the Ebola crisis. There can be no excuses for not helping to put these economies and lives back together,” said Oxfam GB’s chief executive Mark Goldring, in a press release.
Right now the multi-million dollar post-Ebola “Marshall Plan” proposed by Goldring exists only as a clarion call to nations and international aid groups.
If implemented, the plan would include providing cash to families affected by the crisis, creating new jobs, and investing in essential services such as water, sanitation, health, and education.
Shoring Up Healthcare in Hard-Hit Countries
Any talk about a plan for the future in West Africa needs to include looking at ways to shore up the healthcare systems in the region.
After the current crisis reaches “zero cases and zero transmission,” Ebola will remain on the continent. Humans are not the only host for the virus. Researchers believe the virus is harbored by animals. Bats are the most likely hosts.
Even before the current epidemic, Liberia, Sierra Leone, and Guinea all suffered from a shortage of doctors, a lack of training and medical supplies, and not enough clinics in the rural areas where many people live.
International aid that poured into the region helped non-governmental organizations and the U.S. military boost the healthcare infrastructure in these countries.
This included the U.S. military building 10 Ebola treatment units and other laboratories to speed up the testing of Ebola samples. In addition, thousands of civilian doctors and nurses set up shop in the area to aid the communities overwhelmed by the outbreak.
But as with the U.S. military, these outside healthcare workers may not stay indefinitely. This leaves these countries with the same low doctor-to-patient ratios they had before the outbreak.
More Healthcare Workers Needed Long Term
Rebuilding the healthcare system in West Africa will require aid agencies to keep future outbreaks in mind, whether it’s Ebola or other contagions. Some officials have already called for agencies to keep an eye toward the future.
“The first thing we can do is do the crisis response in a way that builds real resilience into the health systems of these three countries,” said U.S. Agency for International Development chief Dr. Rajiv Shah at the Brookings Institution on Nov. 12.
More doctors are needed, but they are not the only solution. During the current crisis, members of the community were trained to assist in the Ebola response and to protect themselves from the disease. Community-based approaches like this have been embraced by organizations such as the Bill & Melinda Gates Foundation. Officials say this could work well for future Ebola outbreaks.
“That is going to lead to thousands of trained community health workers that should be able to power a community-based health response in West Africa for years to come,” said Shah.
Catching future epidemics before they reach the magnitude of the current one also requires better ways to identify infectious disease cases earlier. Done correctly, this kind of “contact tracing” can limit the spread of disease.
“If a good contact tracing system had been in place from the start of the outbreak, there would be no reason to put people in quarantine,” epidemiologist Amanda Tiffany, who works for Doctors Without Borders/Médecins Sans Frontières’s (MSF), wrote on the aid organization’s website.
This approach requires an investment in the public health infrastructure, including management centers and ambulance systems. The international community will also need to respond more quickly the next time an outbreak occurs.
“The reason the epidemic is still going on is that we — the international community — didn’t act fast enough at the time,” said Tiffany. “If another outbreak occurs, what should be done differently is increasing the speed of the response.”
Ebola Vaccine Could Provide Relief in Future
In addition to identifying people at risk of Ebola infection, a key strategy for fighting future outbreaks to develop vaccines and medications to fight them.
Currently, no approved vaccine exists for Ebola, although research by several groups is ongoing. The Food and Drug Administration has also added Ebola to its list of neglected diseases, hoping to spur research by pharmaceutical companies.
A successful Ebola vaccine would provide people with long-term immunity against the virus. But some researchers say this type of medical approach is unlikely to be effective on its own.
“It’s largely unrealistic to think that there are going to be broad-scale vaccination programs in areas where Ebola virus occurs,” said Travis K. Warren, a research scientist in the Molecular and Translational Sciences Division at the U.S. Army Medical Research Institute of Infectious Diseases.
Vaccinating everyone in a given region of Africa against any disease is challenging in itself — as seen in issues confronting existing vaccine programs. But the Ebola virus could still crop up in areas where people have not been vaccinated. This means doctors need to have medications available to treat people after they have been exposed to the virus.
“We need the ability to provide people with drugs and therapeutics that will protect them against the virus once they’ve been diagnosed,” said Warren.
Warren is the lead author of a study, published Feb. 10 in the journal mBio, which looked at the effectiveness of synthetic "antisense" molecules that target the genetic code of the Ebola virus. In that study, the drug in development protected 75 percent of monkeys from the Ebola virus when it was administered 30 to 90 minutes after infection.
The drug has not yet been tested in people. So it, and other medical treatments for the virus, are likely months away.
This leaves the international community with the challenge of protecting communities in West Africa from Ebola — both now and in the future. To manage that, they will need to pay special attention to the success and failures of the past year.
“I hope that, because of the lessons learned from the current situation,” said Tiffany, “the next Ebola outbreak will never have the chance to get so out of control.”