Epidemics

Ebola stands as one of the most deadly viruses known to humanity. If left untreated, it claims the lives of approximately half of those infected. Its transmission occurs through various bodily fluids, including blood and sweat. Even the deceased can spread the disease, often during their own funerals.

On December 26th, 2013, a two-year-old boy fell ill in southern Guinea. Tragically, just two days later, he passed away. It took four months for local doctors, in collaboration with the international community, to identify Ebola as the culprit. This delay was mainly due to the virus never having been detected outside of Central Africa previously.

During those four months, Ebola gained a significant head start, leading to devastating consequences. The outbreak endured for two years and grew into the largest recorded epidemic in Ebola's history. Over 28,000 individuals contracted the disease, resulting in more than 11,000 fatalities.

In 2013, Guinea lacked a formal emergency response system, had few trained contact tracers, and possessed no rapid tests, border screenings, or licensed Ebola vaccines. However, following that epidemic, Guinea underwent a complete overhaul of its epidemic response system, with the support of the United States and other international partners. In January 2021, this system faced its first true test.

The events unfolded when a nurse in southern Guinea developed symptoms such as headache, vomiting, and fever. Within a few days, she tragically succumbed to the illness. As per traditional burial practices, her family prepared her body for the funeral. Within a week, the nurse's husband and other family members began experiencing symptoms. Health officials promptly suspected Ebola and initiated testing.

The test results came back positive, prompting Guinea to activate its epidemic alert system the following day. Rapid actions were set in motion. Guinea's National Agency for Health Security established 38 district-level emergency operations centers and a national center. Teams of epidemiologists and contact tracers diligently worked to determine the exact individuals exposed to the virus and when it occurred, resulting in a list of 23 initial contacts that rapidly grew to over 1,100.

Advanced rapid testing capacity was established in the city where the outbreak originated. Public health workers conducted screenings for over 2 million travelers at Guinea's borders with Liberia and Cote d'Ivoire. A large-scale vaccination campaign was initiated. Additionally, over 900 community mobilizers informed the public about the outbreak and suggested alternative burial practices that both respected the community's customs and minimized the risk of Ebola transmission.

Thanks to these comprehensive measures, the 2021 outbreak ended a mere four months after it began. Only 23 individuals contracted Ebola, and tragically, only 12 deaths occurred. This represents less than 1% of the fatalities from the previous outbreak.

While the cost of controlling the 2021 outbreak reached $100 million, this amount pales in comparison to the global economic toll of the prior epidemic, which amounted to $53 billion. Should every country replicate Guinea's approach? Not necessarily. While responding swiftly to an outbreak is crucial, the specific measures for a successful response can vary significantly depending on the disease and the country. For example, Brazil successfully contained a yellow fever outbreak, primarily through an extensive vaccination campaign, leveraging its position as a major global producer of the yellow fever vaccine and its population's familiarity with routine vaccinations.

Not all diseases necessitate a mass vaccination program. In Burkina Faso, when a truck driver tested positive for cholera in August 2021, healthcare workers promptly alerted the government, leading to immediate contact tracing. Cholera, caused by a bacterium, was addressed through the administration of antibiotics to those exposed or potentially exposed. This swift response swiftly halted the outbreak within a few weeks. In contrast, cholera outbreaks frequently occur in West Africa, resulting in over 100,000 cases and more than 3,700 deaths in 2021. However, Burkina Faso's preparedness ensured zero deaths that year.

In Chiang Mai, Thailand, health officials implemented a community-owned and community-driven outbreak alert system to monitor animal health. This approach is crucial as some animal outbreaks can spill over and pose a threat to human health. Villagers used a mobile app to notify health authorities of animal outbreaks. Over 16 months, 36 animal outbreaks were identified.

For any outbreak response system to be effective, it must gain the trust, value, and active participation of communities. This entails reaching people in their own environment, communicating in their language, and being mindful of their cultural beliefs and practices. Importantly, we cannot expect to remain inactive for years and then spring into action when an outbreak occurs. Investing in sustainable health infrastructure throughout the year, for everyone, especially the most vulnerable populations, represents one of the most effective means of saving lives.

Henrik Leandro