Doctors and experts say another Ebola outbreak is “inevitable”, unless the international community unites around a long-term, common approach to combat the disease in the future and substantial investment is made into the health services of affected developing countries.
Although reports of new cases of Ebola have been reduced to around 100 a week in the West African countries so ravaged by the disease that it was declared a health emergency last August, medical and aid organizations are clear that the Ebola crisis isn’t over yet.
There were 9,936 reported cases of Ebola and 4,877 deaths caused by the virus in 2014 according to official figures released by the World Health Organization (WHO).
While health teams have by now managed to control and identify most cases, Dr Jimmy Whitworth, head of population health at the Wellcome Trust says that some people are still out in the community living with the virus. “It’s not over at all. It’s very dangerous to say that it’s over,” he says, speaking from Sierra Leone.
Health officials and NGOs are keen to highlight the precarious point that the fight against the disease has reached, with local health services woefully inadequate to cope if there were to be a further outbreak once the majority of international assistance has dried up.
“Ebola has paralysed the health systems,” says Sophie-Jane Madden, a spokesperson for Médecins Sans Frontières (MSF), one of the aid organizations that set up Ebola treatment centres across Guinea, Liberia and Sierra Leone, adding that “it only takes one case to reignite the epidemic”.
The surveillance systems in place to monitor the spread of the virus are far from watertight. Madden says that half the people that come into MSF treatment centres in Sierra Leone are not on a ‘contact list’, meaning they’re not known to medical staff to have come into contact with anyone with the disease.
In addition to this, Dr Whitworth says the occurrence of the disease somewhere in Africa again is a certainty since Ebola can be transmitted from wildlife. Bats have been named as a main carrier, likely transmitting the virus by dropping fruit that is then eaten by animals, contaminating their meat.
Tarik Jasarevic, a spokesperson for the World Health Organisation (WHO), which has already raised $1 billion to aid the affected countries, says that the organisation needs a further $1.5 billion to continue to combat the disease in the next six months.
Jasarevic says that although WHO has 700 people on the ground in three West African countries, to keep that level of operations up they need more money. “Money is not less needed,” he says, “On the contrary, we need people on the ground and we need donors to honour pledges. It’s important that people keep pledging.”
However, funds are ebbing according to Brendan Paddy from the Disaster Emergency Committee (DEC) in the UK, who says that the organization’s Ebola appeal has all but stopped receiving funds. The organization successfully raised £20mn for the cause in October.
“The vast bulk of income comes in the early weeks of the appeal and trail off very sharply,” he says, adding that “the volume of money coming in now is a trickle”.
Complacency will lead to another uncontrolled outbreak, say experts, and building up poorer countries health systems is the only way to safeguard against the spread of the virus in the future.
“Ebola is an international problem. These epidemics occurred in low resourced countries, and they take quite an effort to be able to control them. These countries need to be able to identify and respond.” In order to do that, Dr Whitworth says West Africa needs a combination of “strong public health measures, group surveillance and health systems”, as well as international aid.
“We need to make sure that we’ve build stronger health systems in the places that Ebola exists. We need funding, organization, health units and hosts around the country,” Dr Whitworth says, stressing the importance of having knowledgeable people in the affected area itself who are in the position to recognize an infection and act upon it rapidly.
Mukesh Kapila, professor of global health and humanitarian affairs at the University of Manchester says that the solution lies in building better infrastructure rather than finding a vaccine.
“Vaccines are not the answer,” he says. “The current outbreak reflected failure in public health system. Even if an effective vaccine is found, outbreaks always happen. It is extremely important that we do not rely on vaccines as a guarantee. Vaccines are a panic reaction.”
Kapila, who travelled to Ebola treatment centres in Sierra Leone last year, highlights broader public health concerns, warning against an “Ebola-centric response” that would be insufficient to tackle any other illnesses.
“It’s not about stopping Ebola from coming back, it’s about how can we make sure that the system is reconstructed. Bad governments and bad investment and resources in these areas keep the system from operating,” he says. “The fact that Ebola found weaknesses in the health system is not surprising.”
Building a sustainable health system could take generations, according to Kapila, and short term international aid projects are not long lasting enough. “20, 30 or 40 years of ongoing work is needed,” he says.
“The international community needs to take a common approach and help the host country work out what the right policy is for that country,” Kapila says. “Or the lottery of life and death will continue”.