Ebola-free Liberia: Scrutinizing the Efforts of Public Health Sector and International Agencies.

Abstract

DEAR EDITOR, The 2014–2015 outbreak of Ebola virus disease has been acknowledged as a global health priority, not only because of the number of cases, but also because of the prolonged duration for which it persisted, the number of nations affected, and associated high case-fatality rate.[1] In fact, since its emergence in March 2014 to mid-June 2015, almost 27,341 cases and 11,184 associated deaths have been reported among the 10 affected nations worldwide.[2] However, in Liberia alone, 4716 (42.8%) number of deaths have been reported (case-fatality rate – 44.6%), which is highest among all the involved countries, and is even the second leading nation with regard to the total number of cases (10,564), next only to Sierra Leone.[2,3] On the May 9, 2015, Liberia was declared free of Ebola transmission by the World Health Organization (WHO), because of no detection of any laboratory-confirmed cases since last 6 weeks, with the last confirmed case being buried on March 28, 2015.[4] Although, the start of the outbreak in Liberia was misleading, with the scarce number of cases being reported in March–May 2014, and not an alarming trend even in June (when compared with Guinea and Sierra Leone), the scenario became very serious in August and September 2014 (as 300–400 new cases were being reported each week).[4] In these couple of months, day-to-day lives of people were significantly affected as no vacant beds were available in the treatment centers, patients started to succumb within the hospital premises, corpses were not buried for days together, most of the flights were cancelled, shortage of food supply, and fuel was widely seen, the major proportion of institutions, including health facilities were closed, and a sense of fear and uncertainty prevailed among families and communities.[4,5] However, the health professionals continued to exercise their duties even in periods when there was a scarcity of personal protective equipment, and in the process around 375 health workers were infected, of whom 189 died.[4] Anyway, in response to the concerted efforts by the WHO in the form of establishing the treatment center, the outbreak began to subside in late October, with case-fatality rates remarkably reduced, and since late March this year no cases were reported.[4,5,6] The critical review of the efforts made in Liberia in response to an Ebola outbreak highlighted the role of multiple factors which eventually enabled the nation to defeat the disease. These factors include strong leadership and clear vision by the policy maker by declaring the disease as a public health priority to all the concerned departments; active involvement of the stakeholders (viz., village heads, religious leaders, women associations, youth groups, etc.) of the community by developing a sense of need among them; increasing the level of faith and neutralizing any rumors about the disease among the local people – by building see-through walls in treatment centers so that people can watch the proceeding or developing mechanism to respond promptly to transport calls or by sensitizing the health professionals to build confidence among local residents; strengthening of the treatment facilities (by creating medical units, treatment centers, logistics support) and laboratory network by establishing five dedicated Ebola laboratories; courageous attitude of the local volunteers; enormous support from the international community (viz., monetary assistance, human resources – deployment of foreign medical teams, etc.); and well-coordinated national and international response.[4,6,7,8] Even though, Liberia has been declared Ebola-free, nevertheless, the Government of Liberia should remain on high alert and continue their surveillance and contact tracing activities, as the Ebola outbreak still persist in neighboring Guinea and Sierra Leone, and there is a potential risk of re-emergence of the disease across the borders.[4,5] Further, there is a significant need to strengthen the other health care services (like maternal and child health including immunization), as all of them took a back seat, while the outbreak of Ebola was ongoing in the nation.[9] To conclude, achievement of the Ebola-free status by Liberia is a remarkable achievement for the local people, public health sector, and the international agencies which have assisted the nation in conquering all the existing challenges, and finally interrupting the endemic transmission of the disease. This accomplishment represents only half a battle won and should serve as a learning lesson for other Ebola affected nations to work in an effective manner to completely eliminate the disease completely from the West-Africa.