Ebola. A Bitter Celebration

[This article is written by Adelaida Sarukhan, ISGlobal Communications Officer and Immunologist, and it has been published in Spanish in El País - Planeta Futuro ]

Yesterday, March 17th, Sierra Leone was declared free of Ebola transmission, marking the end for the worst Ebola epidemic in history. However, similar to what happened last January, new cases were reported hours after the announcement (this time in Guinea), postponing the celebration and highlighting the risk due to viral persistence in some survivors.   

This is the story of two epidemics. The epidemic of panic, in western countries, where only three people were infected. The real epidemic, in West Africa (...), that has claimed 11,300 lives

This is the story of two epidemics. The epidemic of panic, in western countries, where only three people were infected. The real epidemic, in West Africa (mainly Liberia, Sierra Leone and Guinea), that has claimed 11,300 lives and has weakened the health systems and socioeconomic prospects of a region that was struggling to leave its past behind.    

The crisis is coming to an end, after two years of pain and efforts, but also of achievements. After the initial mass media frenzy, we are now left with questions that need answers and lessons to be learned.

What do we know now that we did not know before? 

We have learnt more about the disease and its consequences. For example, although the mortality rate varies between and within outbreaks, we now know that it depends on the quantity of circulating virus in the patient. We have also learned that, even without an Ebola-specific treatment, early supportive care with basic measures such as intravenous rehydration drastically improves the chances of survival.  

Although the mortality rate varies between and within outbreaks, we now know that it depends on the quantity of circulating virus in the patient

The large number of survivors in this outbreak (more than 17,000) has allowed to confirm that the virus can persist in semen up to 9 months after overcoming the disease, and that it can remain latent in reservoirs such as the eye and the central nervous system. We have also learned that, unfortunately, the disease is not over when it’s over: even if they clear the virus, many survivors suffer from long-term health effects.   

Do we have new therapies or vaccines?

Not yet. For the first time, Ebola represented a real menace to western countries. This led to the speeding-up of clinical trials for a series of drugs and vaccines that had been developed for bioterrorism reasons but whose efficacy had not been evaluated. For the due to a series of logistical and ethical issues, the clinical trials reached the field too late, when the number of cases was already too low, and did not yield conclusive results. Efficacy results could only be obtained for one of the Ebola candidate vaccines, tested in Guinea.   

What have we learned about the response to outbreaks?

The world was, and still is, poorly prepared to deal with this type of situations. The crisis brought out the worst (unpreparedness, dependence on donors, confrontation with the socio-cultural context) but also the best (dedication, diversity, resourcefulness) of the international response. Much has been said of the efforts of the international community to stop the epidemic. However, the efforts of the healthcare workers and the local communities in the affected countries were key in tipping the balance of the outbreak.  The NGOs also played a fundamental role not only in humanitarian assistance, but also in collaborating with communities, scientists and agencies in the development of research projects and clinical trials.   

The world was, and still is, poorly prepared to deal with this type of situations

In terms of response, one of the main lessons for this and future outbreaks is that the key of success lies in understanding the balance of power and culture in the communities where the outbreaks occur in order to tackle the causes and not only the symptoms of the problem. Another key lesson is that the fight against Ebola and any other threat to global health, such as that of Zika virus nowadays, starts well before the first case is diagnosed. This requires recognizing the development of low-income countries as a matter of mutual interest, the need to promote an alternative system of pharmaceutical innovation and access to medicines, the role of development cooperation as a tool to exert global influence, and the cost of inaction.  Ebola has taught us the hard way why, in health issues, we must forget about borders and tackle the potential threats from a global point of view.   

Ebola has taught us the hard way why, in the field of global health, we must forget about borders and tackle the potential threats from global point of view

It is evident that the international response was too little and too late.  But the grievance of the affected countries and the memory of their victims will be double if we now choose to ignore the lessons to be drawn.  

Special Report: Ebola, two years later

Coinciding with the second anniversary of the declaration of the outbreak, we have prepared in ISGlobal this online report with interactive graphics. In it, we review the evolution of the crisis and its direct and indirect consequences, the scientific questions that remain unanswered, and the urgent reforms that will  avoid having to “celebrate” in the future the end of another epidemic like this one. 

More information

ebola.isglobal.org