Has Africa actually learned the lessons of Ebola?

The Ebola crisis could be over in the coming months. But what lessons have been learned that could help avoid a similar situation in the future?

Despite a new outbreak in Liberia recently and ongoing efforts to combat the disease in Guinea and Sierra Leone, the current consensus is that the worst in the long-running Ebola crisis is now behind us.

Liberia’s new cases of the disease, seven weeks after the country was declared Ebola-free, point to the fact that mini flare-ups are likely to continue. And there is a still a long way to go to finally eradicate the disease that has killed over 11,000 people since March 2014.

But as the three West African countries worst hit by Ebola continue to address the thankfully diminishing crisis, many are also looking to the future and asking what lessons have been learned.

The US-headquartered RAND Corporation, a global research organisation that develops solutions to public policy challenges, is already trying to answer that question.

It recently developed a tool, known as an Intra-Action report, that systematically captures and evaluates emergency responses. Through this, it comes up with findings that can be applied in future instances to correct failures or replicate successes.

The tool was applied as a proof of concept to the Ebola responses, and one of the key discoveries from the study was the critical role national preparedness plans played in helping to contain the disease – plans that revolve around key pillars of coordination, financing, incident management systems, public awareness and community engagement.

“Countries such as Senegal and the Democratic Republic of Congo both had Ebola-preparedness plans in place and managed to contain the virus fairly easily,” says Adeyemi Okunogbe, assistant policy analyst at the RAND Corporation.

“By contrast, Guinea, Sierra Leone and Liberia which all lacked any such plans, have been the worst-affected countries.”

Indeed, both Senegal and the Congo had detailed response plans in place, with the former moving quickly to set up a National Crisis Committee in March 2014 before any cases of Ebola were even confirmed within the country.

“As the threat from Ebola continues to retreat, what the WHO [World Health Organisation] and its health partners are trying to do now is to ensure that African countries make national preparedness a priority in the long term,” says Okunogbe.

“Yes, financial resources are clearly limited in many African countries, but it is worth investing in preparedness because the long-term costs and problems you can face if you don’t will be far greater.”

The World Bank estimates that Sierra Leone’s economy lost $1.4bn, while the economies of Guinea and Liberia lost a respective $535m and $240m in the one-year period to April 2015.

Looking to tech

Along with the benefits of preparedness, another key lesson from the Ebola crisis points to the potentially invaluable role of technology.

Nigerian health officials attribute their country’s success in containing Ebola to the fast communication and instant tracking made possible by the use of a mobile phone technology known as mHealth.

This helped them halve reporting time of Ebola cases from 12 to six hours and eventually allowed reports to be made in real time. Nigerian contact tracers also used mobile phones equipped with GPS tracking, recording visits to 18,500 homes across the country during the Ebola campaign.

“In every emergency, information communication and technology is critical and potentially life-saving,” says Ivan Thomas, ICT Coordinator for the West Africa Ebola Response at the World Food Programme (WFP).

“What makes a huge difference is that internet connectivity facilitates coordination in a complex environment with many stakeholders.

“For example, when you have Ebola Treatment Units (ETUs) communicating seamlessly with the National and District Ebola Response Centres, with labs, with UN and NGO offices, it goes a long way in getting to zero cases of Ebola.” 

The WFP has served as the leader of the Emergency Telecommunications Cluster (ETC) during the Ebola epidemic.

Comprising a global network of organisations that work together, ETCs provide communications services and voice and internet connectivity to assist humanitarian workers within 48 hours of a disaster.

“Today, the ET Cluster delivers shared ICT services to the humanitarian community. Tomorrow, we hope we will provide much more, starting with the delivery of essential life-saving communications services to affected communities,” says Thomas.

“Ultimately, the goal is for the ET Cluster to create an emergency response environment that provides humanitarians, affected populations and governments with a seamless and resilient communications experience.”

Global responses

The Ebola epidemic has also highlighted the need for a more coordinated response from global health organisations. This was openly acknowledged by Margaret Chan, director general of the WHO, at the organisation’s annual meeting in May.

“The Ebola outbreak shook this organisation to its core,” she said, before announcing that the WHO is to set up a $100m emergency contingency fund for future crises.

Aware of the growing threats posed by disease outbreaks, the epidemic has also prompted the Global Health Security Agenda (GHSA) to fast track the implementation of its targets.

Launched in February 2014, the GHSA comprises 29 partner nations working alongside the WHO with the aim of helping at least 30 countries to improve their ability to prevent, detect and respond to infectious disease outbreaks through the implementation of 11 targets. It has been allocated $800m to go towards such efforts.

“We had previously outlined a five-year time frame for achieving the 11 GHSA targets,” says Jimmy Kolker, Assistant Secretary for Global Affairs at the US Department of Health & Human Services (HHS). “But we are now going to accelerate those plans with the aim that at least 16 countries achieve the targets within the next three years – 12 of those countries are in Africa, including the main Ebola-affected countries.”

According to Kolker, visits to these 16 countries have already been scheduled for August. The purpose of the visits will be to look at how the money allocated to them will be spent over the next three years.

The importance in ensuring both national and international actors are ready should another health crisis occur is clear. And it is crucial the lessons learned from the Ebola crisis – from the importance of national preparedness, to the role of technology, to the need for timely international responses – turn into implementation and action.

But while a degree of urgency is keenly felt now, Okunogbe emphasises the long-term nature of the ongoing challenge.

“Based on previous history, what happens is that once the development partners leave then things tend to go back to status quo,” he says. 

“So African countries need to build a culture of preparedness and take ownership of it…If we can really inculcate the lessons learned from the Ebola epidemic then African countries should be able to ensure they don’t repeat past mistakes.”

Melissa Hancock