Yet recent developments highlight that the fight is not yet over, and remind us that the international community needs to maintain its vigilance or risk the disease becoming endemic in West Africa and a permanent threat to spread beyond the region.
An average of 30 new cases of the disease are still being identified each week in Guinea, Sierra Leone and Liberia, according to the World Health Organization’s (WHO) latest report. These rates are far below what they were during the height of the outbreak, but the epidemic’s tenacity is evidence that more needs to be done to fully eradicate it.
To date, more than 27,500 people have been infected with Ebola and at least 11,246 have died from it. Now, with a surge of new cases in Liberia, the United Nations is warning that the epidemic “has not yet run its course” in West Africa.
“The battle can be won, but it requires sustained effort, very careful negotiation with communities and perfection in follow-up of everybody who has been a contact,” United Nations’ special envoy David Nabarro told a media briefing in Cape Town, according to Reuters.
Of particular concern is that an increasing number of cases cannot be traced back to a known contact. “Probably about one third of these people are not coming from the contact list, which means they are surprise cases, and that’s a big worry,” Nabarro said.
Under normal circumstances, Nabarro said, an infection rate of 30 people a week would be considered “a major, major outbreak.”
New cases in Liberia examined
Ebola’s recent return to Liberia is a significant setback. A 17-year-old’s body tested positive for the virus after he died June 28, six weeks after the country had been declared Ebola-free.
Since then, four more cases have been identified in the teen’s town of Nedowein, all of whom were among the 149 people being monitored after they had contact with the boy, according to the WHO.
Doctors initially weren’t sure how the 17-year-old contracted the disease, but on Friday the WHO reported that genetic testing had confirmed that the strain of Ebola he had was similar to strains in the same area last July and August. That means he probably didn’t catch the virus from an animal or someone who traveled to Liberia from Sierra Leone or Guinea, reported The Associated Press and The New York Times.
Instead, it’s likely he caught the virus through sexual contact with a survivor, experts told both the AP and the Times.
“There are a considerable number of survivors. And we also know that it persists in certain bodily fluids, and that it can subsist for at least six months,” WHO spokeswoman Dr. Margaret Harris told the AP. For instance, scientists believe the Ebola virus can live in the eyeball, testes and placenta for several months after a victim has recovered.
Experts voiced concerns months ago that transmission through sexual activity could reignite the epidemic, or even bring the virus to places free of the disease, while local health officials reported a “disturbing trend” of potentially sexually transmitted Ebola infections among the wives of male survivors. Liberia’s last case before the new cluster was a woman who is thought to have contracted the virus after having sex with a male Ebola survivor.
Meanwhile, the virus has also reemerged in parts of other countries where it was previously thought to be contained, such as the Sierra Leonean capital of Freetown and parts of Guinea.
International Ebola response under fire
Ebola’s persistence is worrying, and so too is the lack of long-term planning to fight the disease when it inevitably recurs, as it has periodically since it was first diagnosed in 1976. Early last month, the G7 leaders discussed increasing support to nations affected by Ebola, but the proposal was criticized by some aid organizations for its lack of urgency and for offering little in terms of concrete plans for action.
Last week, an independent panel of experts offered scathing criticism of the World Health Organization’s handling of the Ebola crisis and called for an overhaul in leadership, organizational structure and procedures. The 28-page report blamed politics and bureaucracy for the mismanaged response. “There seems to have been a hope that the crisis could be managed by good diplomacy rather than by scaling up emergency action,” they wrote.
The experts — led by Dame Barbara Stocking, president of a college in Britain and former chief executive of the charity Oxfam — called for the WHO to establish a new division with new staff and a new director that would coordinate emergency preparation, coordination and response. The changes are needed urgently, the panel said, calling this a “defining moment for the health of the global community.”
“The world simply cannot afford another period of inaction until the next health crisis,” they wrote.
Echoing these concerns, Jerome Mouton, the director of the Guinea division of French medical charity Médecins San Frontieres (MSF, also known by its English name, Doctors Without Borders), described the current state of “semi-denial” about the virus as very similar to the situation a year ago, warning that another major flare-up is possible:
“We are in the same situation where we are overly optimistic, saying that it is almost finished and there’s no problem,” he cautioned, “but in fact it’s a big problem as there is potential for this to again set off a big epidemic.”
If Ebola surges again, the world may be just as unprepared as it was when the outbreak took hold in West Africa, said Joanne Liu, international president of MSF: “The reality today is if Ebola were to hit on [the] scale it did in August and September, we would hardly do much better than we did the last time around.”