Ebola Outbreak In West Africa Research Articles

Research ethics preparedness during outbreaks and public health emergencies: Focus on community engagement

Research represents an essential component of the response to infectious disease outbreaks and to other public health emergencies, whether they are localised, of international concern, or global. Research conducted in such contexts also comes with particular ethics challenges, the awareness of which has significantly grown following the Ebola outbreak in West Africa, the Zika outbreak in Latin America and the COVID-19 pandemic. These challenges include the need for implementing meaningful community engagement with the researched communities, not just to build unidirectional trust towards the research team, but to achieve a genuine and mutually respectful partnership before, during and after the research. Here, we describe the real-life experience of 10 well-established research clinics in Nairobi, where a successful experience of community engagement linking prevention and care to research was interrupted during the COVID19 pandemic. We contrast this experience with the concept and processes of community engagement as described in selected scientific manuscripts and guidelines, to formulate some conclusions and recommendations. We contend that more action is needed, from research ethics committees and other key-research stakeholders, to align policies and practices with ethics guidance and with evidence-based recommendations from the academic literature, to achieve meaningful community engagement during emergency research, irrespective of the scale and location of an outbreak or public health crisis. Failure to do so, will aggravate the (postcolonial) asymmetries of power in global health and local systems.

Ebola Virus Disease Outbreaks: Lessons Learned From Past and Facing Future Challenges.

The purpose of this review is to examine African Ebola outbreaks from their first discovery to the present, to determine how the medical and public health response has changed and identify the causes for those changes. We sought to describe what is now known about the epidemiology and spread of Ebola virus disease (EVD) from the significant outbreaks that have occurred and outbreak control methods applied under often challenging circumstances. Given the substantial role that the U.S. Government and the U.S. DoD have played in the 2014 to 2016 West African Ebola outbreak, the role of the DoD and the U.S. African Command in controlling EVD is described. A descriptive method design was used to collect and analyze all available Ebola outbreak literature using the PubMed database. An initial literature search was conducted by searching for, obtaining, and reading original source articles on all major global Ebola outbreaks. To conduct a focused search, we used initial search terms "Ebola outbreak," "Ebola virus disease," "Ebola response," "Ebola countermeasures," and also included each country's name where Ebola cases are known to have occurred. From the 4,673 unique articles obtained from this search and subsequent article title review, 307 articles were identified for potential inclusion. Following abstract and article review, 45 original source articles were used to compile the history of significant Ebola outbreaks. From this compilation, articles focused on each respective subsection of this review to delineate and describe the history of EVD and response, identifying fundamental changes, were obtained and incorporated. We present known Ebola virus and disease attributes, including a general description, seasonality and location, transmission capacity, clinical symptoms, surveillance, virology, historical EVD outbreaks and response, international support for Ebola outbreak response, U.S. DoD support, medical countermeasures supporting outbreak response, remaining gaps to include policy limitations, regional instability, climate change, migration, and urbanization, public health education and infrastructure, and virus persistence and public awareness. The health and societal impacts of EVD on Africa has been far-reaching, with about 35,000 cases and over 15,000 deaths, with small numbers of cases spreading globally. However, the history of combatting EVD reveals that there is considerable hope for African nations to quickly and successfully respond to Ebola outbreaks, through use of endemic resources including Africa CDC and African Partner Outbreak Response Alliance and the U.S. African Command with greater DoD reachback. Although there remains much to be learned about the Ebola virus and EVD including whether the potential for novel strains to become deadly emerging infections, invaluable vaccines, antivirals, and public health measures are now part of the resources that can be used to combat this disease.

Did aid to the Ebola crisis divert aid for reproductive, maternal, and newborn health? An analysis of donor-reported data in Sierra Leone

BackgroundInfectious disease outbreaks like Ebola and Covid-19 are increasing in frequency. They may harm reproductive, maternal and newborn health (RMNH) directly and indirectly. Sierra Leone experienced a sharp deterioration of RMNH during the 2014–16 Ebola epidemic. One possible explanation is that donor funding may have been diverted away from RMNH to the Ebola response.MethodsWe analysed donor-reported data from the Organisation for Economic Cooperation and Development (OECD)’s Creditor Reported System (CRS) data for Sierra Leone before, during and after the 2014–16 Ebola epidemic to understand whether aid flows for Ebola displaced aid for RMNH. We estimated aid for Ebola using key term searches and manual review of CRS records. We estimated aid for RMNH by applying the Muskoka-2 algorithm to the CRS and analysing CRS purpose codes.ResultsWe find substantial increases in aid to Sierra Leone (from $484 million in 2013 to $1 billion at the height of the epidemic in 2015), most of which was earmarked for the Ebola response. Overall, Ebola aid was additional to RMNH funding. RMNH aid was sustained during the epidemic (at $42 m per year) and peaked immediately after (at $77 m in 2016). There is some evidence of a small displacement of RMNH aid from the UK during the period when its Ebola funding increased.ConclusionsModest changes to RMNH donor aid patterns are insufficient to explain the severe decline in RMNH indicators recorded during the outbreak. Our findings therefore suggest the need for substantial increases in routine aid to ensure that basic RMNH services and infrastructure are strong before an epidemic occurs, as well as increased aid for RMNH during epidemics like Ebola and Covid-19, if reproductive, maternal and newborn healthcare is to be maintained at pre-epidemic levels.

Sosuga Virus Detected in Egyptian Rousette Bats (Rousettus aegyptiacus) in Sierra Leone.

Sosuga virus (SOSV), a rare human pathogenic paramyxovirus, was first discovered in 2012 when a person became ill after working in South Sudan and Uganda. During an ecological investigation, several species of bats were sampled and tested for SOSV RNA and only one species, the Egyptian rousette bat (ERBs; Rousettus aegyptiacus), tested positive. Since that time, multiple other species have been sampled and ERBs in Uganda have continued to be the only species of bat positive for SOSV infection. Subsequent studies of ERBs with SOSV demonstrated that ERBs are a competent host for SOSV and shed this infectious virus while exhibiting only minor infection-associated pathology. Following the 2014 Ebola outbreak in West Africa, surveillance efforts focused on discovering reservoirs for zoonotic pathogens resulted in the capture and testing of many bat species. Here, SOSV RNA was detected by qRT-PCR only in ERBs captured in the Moyamba District of Sierra Leone in the central region of the country. These findings represent a substantial range extension from East Africa to West Africa for SOSV, suggesting that this paramyxovirus may occur in ERB populations throughout its sub-Saharan African range.

Scalable gradients enable Hamiltonian Monte Carlo sampling for phylodynamic inference under episodic birth-death-sampling models.

Birth-death models play a key role in phylodynamic analysis for their interpretation in terms of key epidemiological parameters. In particular, models with piecewise-constant rates varying at different epochs in time, to which we refer as episodic birth-death-sampling (EBDS) models, are valuable for their reflection of changing transmission dynamics over time. A challenge, however, that persists with current time-varying model inference procedures is their lack of computational efficiency. This limitation hinders the full utilization of these models in large-scale phylodynamic analyses, especially when dealing with high-dimensional parameter vectors that exhibit strong correlations. We present here a linear-time algorithm to compute the gradient of the birth-death model sampling density with respect to all time-varying parameters, and we implement this algorithm within a gradient-based Hamiltonian Monte Carlo (HMC) sampler to alleviate the computational burden of conducting inference under a wide variety of structures of, as well as priors for, EBDS processes. We assess this approach using three different real world data examples, including the HIV epidemic in Odesa, Ukraine, seasonal influenza A/H3N2 virus dynamics in New York state, America, and Ebola outbreak in West Africa. HMC sampling exhibits a substantial efficiency boost, delivering a 10- to 200-fold increase in minimum effective sample size per unit-time, in comparison to a Metropolis-Hastings-based approach. Additionally, we show the robustness of our implementation in both allowing for flexible prior choices and in modeling the transmission dynamics of various pathogens by accurately capturing the changing trend of viral effective reproductive number.

Building Research Capacity in Low- and Middle-Income Countries and Pandemic Preparedness: Lessons Learned and Future Directions.

Research capacity is a critical component of pandemic preparedness, as highlighted by the challenges faced during the Ebola outbreak in West Africa. Recent global initiatives, such as the Research & Development Task Force of the Global Health Security Agenda and the World Health Assembly's resolution on strengthening clinical trials, emphasize the need for robust research capabilities. This Perspective discusses the experiences of leaders in infectious disease research and capacity building in low- and middle-income countries, focusing on Colombia, Jamaica, and Pakistan. These case studies underscore the importance of collaborative efforts, interdisciplinary training, and global partnerships in pandemic response. The experiences highlight the necessity for rapid pathogen identification, capacity for genomic sequencing, and proactive engagement with policymakers. Challenges faced, including the shortage of trained staff and reliance on imported reagents, emphasize the ongoing need for building research capacity.

591 - Cardiopulmonary dysfunction among survivors of the 2014 West African Ebola outbreak

591 - Cardiopulmonary dysfunction among survivors of the 2014 West African Ebola outbreak

Solusi Eksak Sistem Imun Terhadap Virus Ebola

The Ebola virus is a deadly disease that causes blood clots in the body's organs and is spread through direct contact with the blood or body fluids of sufferers. Based on this, the immune system in the body will continue to decrease and cause Ebola Hemorrhagic Fever. The 2014-2016 Ebola outbreak in West Africa has accelerated the development of several preventive vaccines against the Ebola virus. The goal of the vaccination is to induce immunity against infectious diseases. And also to stimulate the immune system and its ability to store and remember information about specific pathogens, leading to long-term protective immunity. The model equation for the Ebola virus vaccine in this study involves the concentration of the antigen which is a variable , by means of which the vaccine is inserted into the patient's body where it will attach to B memory cells which are variable , which will then be stimulated by the cells short-lived antibodies are denoted by variables or long-lived cells are denoted by variables , while antibodies will prove efficacy denoted by variables on the patient's immune response. The simulation of the exact solution for the Ebola vaccine uses the integration factor method which will later be compared with numerical simulations according to the parameter values from the research of Irene Balelli et al (2020). The simulation obtained has a very small calculation error value for each variable, which means that the exact value of the Ebola virus vaccination model shows that there is no significant difference to the numerical solution using the order 45 Rungge Kutta method, the largest resulting numerical error is 2.29640283510782×〖10〗^9.

Protecting Frontline Nurses: What will it take? A review of policy, practice and lessons learned from High Consequence Infectious Diseases like Ebola and COVID-19

The significance of failing to protect frontline health workers, especially nurses cannot be overstated. Inadequate personal protection, psychosocial support and emergency training put our frontline of defense in jeopardy. When comparing death by occupation early evidence showed that nurses constituted the largest percentage of health workforce deaths. Other severe consequences like high levels of resignation, burnout and other signs of mental distress are a warning that health systems require fundamental change to protect and retain our frontline of health security. This is equally true in settings with both high and lower resources. Those at the frontlines pay a heavy price responding to infectious disease outbreaks, but it does not have to be. This paper outlines key issues and potential strategies to ensure our health workers have the right environment, competence, tools, and support to protect themselves and society when needed most. Using an umbrella review, this paper sought to review the extant literature and identify the best way forward. Failure to learn from recent events such as the 2014-2016 West Africa Ebola outbreak and the COVID-19 pandemic could further exacerbate health worker shortages and our collective ability to prevent, detect and respond effectively. Protecting frontline health workers requires a multi-faceted approach including well-defined policies, adoption of best practices and continuous learning. The focus should move from broad policies and benchmarks to specific, tangible actions, including standard guidelines and protocols that use an All-Hazards Approach. Taking concrete steps to improve protection with national and local accountability that ensures adequate safety standards will be key. Moreover, continuous learning and investment in health system strengthening are needed. The return on investment in preparedness and protection are clear. COVID-19 has shown the devastating economic and social impact of failing to be prepared. Investment is needed in innovation, including new personal protective equipment (PPE) technology, resilient supply chains that move beyond “just-in time” procurements, and competency-based experiential learning that simulates complex emergencies, in “real world” settings as much as is possible. Learning from history, including nursing pioneers, is essential. Outbreaks begin in communities. Close community engagement and understanding of the social determinants of health for which those on the margins pay the heaviest price is central to nursing. Since this paper focuses on protection of frontline health workers, it would be remiss not to revisit nursing’s role in caregiving. This paper presents examples from 19th and 20th century nursing leaders who developed community- and person-centered models of care, led the development of hygiene and sanitation standards and examples which highlight the critical role of nurses at the frontlines. Nursing has historically been community- and person-centered. Serving as the communities’ first line of healthcare, nursing pioneers like Florence Nightengale and Lillian Wald offer guidance which is still valuable in our modern, highly connected world. Applying lessons from both our recent and past experiences to develop robust systems for health workforce protection and preparedness is a health security priority. Now, as COVID-19 becomes an endemic disease for which an effective vaccine is available, is the time to harness these lessons learned, develop more robust standards and accountability for emergency protection and health workforce protection, without which history will repeat itself.

Invisible and undervalued: A qualitative study of laboratory workers' experiences and perceptions of laboratory strengthening in Sierra Leone.

The 2013-2016 West Africa Ebola outbreak highlighted the importance of laboratory capacity to outbreak response while also revealing its long-standing neglect. The outbreak prompted massive international investment into strengthening laboratory services across multiple healthcare settings. In this article, we explore hospital-based clinical laboratory workers' experiences and perceptions of their everyday working environment in Sierra Leone, and how recent investments in laboratory strengthening have shaped these. This qualitative study draws on in-depth interviews with eight laboratory workers and participant observation of laboratory practices at a tertiary referral hospital in Freetown between April 2019 and December 2019. Interview and observational data were coded and analysed using a reflexive thematic approach. The Ebola outbreak prompted international investments in automated devices, biosafety training, and a new dedicated infectious diseases laboratory. However, little investment was made in the infrastructure and supply systems needed to sustain routine laboratory work or keep machines functioning. Laboratory workers perceived their work to be under-recognised and undervalued by the government, hospital managers and clinical staff, a perception compounded by under-use of the hospital's laboratory services by clinicians. Understanding laboratory technicians' views, experiences, and priorities is essential to any sustainable laboratory-strengthening effort. Investments in personnel should match investments in technologies and infrastructure for outbreak response. This study contributes to an understanding of how clinical laboratory personnel in Sierra Leone view and experience their work, and introduces the concept of social invisibility to explain these experiences.

Systems analysis of the effects of the 2014-16 Ebola crisis on WHO-reporting nations’ policy adaptations and 2020-21 COVID-19 response: a systematized review

BackgroundRecent case studies indicate that the 2014-2016 Ebola outbreak, one of the worst pre-2020 global biological catastrophes in modern history, helped some nations to better prepared their responses for the COVID-19 pandemic. While such national case studies explore how specific nations applied EVD-related policies in their domestic battle against the COVID-19 pandemic, there is no known study that assesses how many WHO nations learned from the West African crisis and to what scale.ObjectiveApplying the policy legacies analytical framework and a systematized literature review, this research examines how prior policy experiences with the 2014-16 EVD crisis as a large-scale emergent outbreak helped to inform and to condition WHO nations to proactively prepare their national policies and health systems for future threats, including ultimately COVID-19.MethodsA systematized literature review of 803 evaluated sources assesses to what extent Ebola-affected and non-affected nations directly modified governmental health systems in relation to this warning. The study further evaluates how nations with documented Ebola-related changes fared during COVID-19 compared to nations that did not. We present a categorical theoretical framework that allows for classifying different types of national response activities (termed conditioned learning).ResultsTen (90.9%) of 11 nations that were affected by 2014-16 Ebola crisis have documented evidence of repurposing their EVD-related policies to fight COVID-19. 164 (70.0%) of 234 non-EVD-affected nations had documented evidence of specifically adapting national systems to incorporate policy recommendations developed from the 2014-16 crisis, which informed their COVID-19 responses in 2020.ConclusionsThe shock of 2014-16 EVD outbreak affected most nations around the world, whether they experienced Ebola cases. We further develop a categorical framework that helps characterised nations previous experiences with this biological catastrophe, providing a means to analyse to what extent that individual nations learned and how these EVD-related changes helped inform their COVID-19 response. Nations that demonstrated EVD-related conditioned learning nations tended to have more stringent COVID-19 responses before April 2020 and utilized documented response mechanisms developed out of the West African crisis.

Charting a healthier future: Africa CDC's strategic approach towards strengthening the health workforce of the African continent.

The health workforce plays a vital role in any healthcare system, underscored by the strong correlation between a higher density of skilled professionals and improved health outcomes. Notably, the COVID-19 pandemic, the 2014 Ebola outbreak in West Africa, and other disease emergencies have highlighted the acute shortage of health personnel in Africa. While progress has been made since 2013, but the global healthcare workforce deficit remained at 15 million in 2020, projected to decrease to 10 million by 2030 [...].

Sequence optimized diagnostic assay for Ebola virus detection

Rapid pathogen identification is a critical first step in patient isolation, treatment, and controlling an outbreak. Real-time PCR is a highly sensitive and specific approach commonly used for infectious disease diagnostics. However, mismatches in the primer or probe sequence and the target organism can cause decreased sensitivity, assay failure, and false negative results. Limited genomic sequences for rare pathogens such as Ebola virus (EBOV) can negatively impact assay performance due to undiscovered genetic diversity. We previously developed and validated several EBOV assays prior to the 2013–2016 EBOV outbreak in West Africa, and sequencing EBOV Makona identified sequence variants that could impact assay performance. Here, we assessed the impact sequence mismatches have on EBOV assay performance, finding one or two primer or probe mismatches resulted in a range of impact from minimal to almost two log sensitivity reduction. Redesigning this assay improved detection of all EBOV variants tested. Comparing the performance of the new assay with the previous assays across a panel of human EBOV samples confirmed increased assay sensitivity as reflected in decreased Cq values with detection of three positive that tested negative with the original assay.

Global Health Security

To reduce the risk and effect of sudden incidents of public health that put people at risk across national and international boundaries, it is necessary to take both preventive and reactive measures. These measures are referred to as global health security. Discussions on health security in scientific gatherings have become more prevalent in recent years after the Covid pandemic. Health security is for the whole world, irrespective of age, race, gender, or financial stability. However, it has been noted that there are many different concepts of health security, that the whole purpose of this is to accommodate only the upper-class societies. The disturbed equilibrium of the microbial world due to rapid urbanization, population increase, environmental deterioration, and the improper use of antimicrobials makes people realize the importance of health security that requires a collaborative approach focused on preparedness for any future pandemics and equal access to health care products. 
 The covid-19 pandemic has had a great influence on people’s lives and their ability to think. Now the main race is not about defence systems; it has shifted towards more and better health security and the ability to deal with any future pandemics. The coronavirus outbreak was associated with severe acute respiratory syndrome, the Middle East respiratory syndrome coronavirus outbreak in 2012, the swine flu pandemic in 2009, and the West African Ebola virus disease epidemic in 2013–2016. All these epidemics are primarily caused by the significant travel of infected people across borders. This highlights the need for global health security, which helps coordinate surveillance and policymaking. This limits disease transmission and reduces the damage.
 While infectious diseases have no limits, inadequate health systems in poor nations make them worse and more out of control. Africa and other third-world states face many problems in securing global security. The spread of infectious diseases among susceptible areas is due to inadequate public healthcare fundings, vaccine coverage, poverty, armed conflict, and climate-related disasters, which damage developing countries. This only serves to increase susceptibility to the disease. The continuous transmission of polio and measles in different parts of Africa and Asia, as well as recent Ebola outbreaks in West Africa, highlights the need to overcome this in order to stop the spread of diseases to other areas. No nation can be completely protected from the spread of diseases due to a lack of social services and a strong health infrastructure; hence, global security demands global equality and progress towards health for everyone. 
 To advance global health security in all nations, there is a need for multi-stakeholders and governance, justifiable finance through the proposed pandemic funds, and common goods for health. Future outbreaks can be efficiently managed by funding basic healthcare and enhancing the response systems. Equity in pandemic preparedness and response measures depends on high-level political commitment and global leadership irrespective of colour and gender. False contradictions between countries can be dismissed by focused investments in strengthening health emergency infrastructure, particularly through primary healthcare, ensuring that the world is better prepared to handle complex public health emergencies.

Research ethics during infectious disease outbreaks: A survey of African research stakeholders using the Ebola virus disease outbreak as a case.

Conducting research during disease outbreaks can be ethically challenging as evidenced in the 2014-2016 Ebola outbreak in West Africa and COVID-19 pandemic. Yet, there has been little empirical research conducted for understanding the views and perspectives of different stakeholders regarding ethical issues in conducting research during disease outbreaks. This preliminary study was conducted to empirically explore African public health research stakeholders' views about research ethics issues during infectious disease outbreaks in Africa. We conducted an online survey of 330 participants attending the International Conference on Re-emerging and Emerging Infectious Disease (ICREID) meeting that took place from 13-15 March 2019 in Addis Ababa, Ethiopia to elicit their views on various research ethics complexities experienced in the 2014 Ebola outbreak. Study results revealed some divergent views on several ethical themes including: ethics of using unregistered interventions in outbreaks; acceptable study design; ethics review processes; risks-benefit assessment; exclusion of pregnant women and children; and biological sample and data sharing. Majority (76.3%) of respondents felt that in the absence of available standard treatments or prevention modalities, the use of investigational interventions can be ethically justifiable if there is a strong scientific rationale and favorable risk-benefit ratio. Regarding conventional placebo-controlled trials during outbreaks with high case fatality rates, respondents that considered this unethical were more than three times those that felt such design were ethically justifiable. We were somewhat surprised that a majority (almost 60%) of respondents were satisfied with the exclusion of pregnant women and children in clinical trials during outbreaks. All respondents concurred with the prioritization of informed consent for research during an outbreak. Based on our findings, research ethics guidance is needed to equip research stakeholders in dealing with ethical complexities arising in the conduct of research during emerging disease outbreaks-especially regarding using experimental interventions; placebo trial design; inclusion or justified exclusion of pregnant women and children; and biological sample/data sharing. The findings will be used in ongoing efforts of developing a consultative and coherent African-centric framework to support ethical conduct of research for future emerging infectious disease outbreaks in Africa.

Ebola Virus Disease Sensitization: Community-Driven Efforts in Sierra Leone.

The 2014-2016 West Africa Ebola outbreak was the largest in history, resulting in approximately 11,000 deaths. Despite the outbreak's eventual end, national and international health sensitization and containment efforts were subject to criticism. This study investigates disease-related knowledge and beliefs, as well as trusted sources of health information among EVD-survivors and their family members, highlighting the importance of community-informed public health responses. Participants (n = 134) were adults who were either EVD-infected, affected families/caregivers, or community leaders. In-depth interviews and focus groups explored EVD-related experiences, including health effects, stigma, and community relationships. Using a grounded theory and thematic content analysis approach, transcripts were coded for evidence of health sensitization, as well as compliance with mitigation measures and trusted sources of information. Participants displayed a high level of knowledge around EVD and reported compliance with mandated and personal prevention measures. Levels of health sensitization and subsequent reintegration of survivors were reported to be largely the products of community-based efforts, rather than the top-down, national public health response. Primary sources of trusted information included EVD survivors acting as peer educators; local leaders; and EVD sensitization by community health workers. This study highlights the importance of a community-based response for increasing the effectiveness of public health campaigns. Participants expressed that relying on the experiences of trusted cultural insiders led to a deeper understanding of Ebola compared to top-down public health campaigns, and helped infected and affected community members reintegrate. Future public health efforts should incorporate community-based participatory approaches to address infectious disease outbreaks.

Strengthening COVID-19 pandemic response coordination through public health emergency operations centres (PHEOC) in Africa: Review of a multi-faceted knowledge management and sharing approach, 2020-2021.

The coronavirus disease 2019 (COVID-19) pandemic disrupted health security program implementation and incremental gains achieved after the West African Ebola outbreak in 2016 across Africa. Following cancellation of in-person events, a multi-faceted intervention program was established in May 2020 by Africa Centres for Disease Control and Prevention (Africa CDC), the World Health Organisation, and partners to strengthen national COVID-19 response coordination through public health emergency operations centres (PHEOC) utilizing continuous learning, mentorship, and networking. We present the lessons learned and reflection points. A multi-partner program coordination group was established to facilitate interventions' delivery including webinars and virtual community of practice (COP). We retrieved data from Africa CDC's program repository, synthesised major findings and describe these per thematic area. The virtual COP recorded 1,968 members and approximately 300 engagements in its initial three months. Fifty-six webinar sessions were held, providing 97 cumulative learning hours to 12,715 unique participants. Zoom data showed a return rate of 85%; 67% of webinar attendees were from Africa, and about 26 interactions occurred between participants and facilitators per session. Of 4,084 (44%) participants responding to post-session surveys, over 95% rated the topics as being relevant to their work and contributing to improving their understanding of PHEOC operationalisation. In addition, 95% agreed that the simplicity of the training delivery encouraged a greater number of public health staff to participate and spread lessons from it to their own networks. This just-in-time, progressively adaptive multi-faceted learning and knowledge management approach in Africa, with a consequential global audience at the peak of the COVID-19 pandemic, served its intended audience, had a high number of participants from Africa and received greatly satisfactory feedback.

Conspiracy Theories and Ebola: Lessons Learned Important for Future Pandemics

The public health campaign against Ebola in the Democratic Republic of the Congo faced serious challenges, some due to conspiracy theories and denial. These beliefs were so powerful that they even caused repeated attacks upon health care providers and medical centers. These conspiracy theories were nothing new, as they are a common feature of all frightening epidemics, such as HIV and COVID-19. These narratives also circulated during the 2015 West African Ebola outbreak. Addressing conspiracy theories during an epidemic requires a coordinated campaign involving not only local leaders but also the cooperation of social media organizations.

An infection prevention and control program established in the wake of the Ebola epidemic: Where are we, and how well are we doing?

Background: Infection prevention and control (IPC) is a clinical and public health discipline based on a scientific approach and practical preventive and control measures. During the 2014–2016 West African Ebola outbreak, the high number of healthcare worker infections was attributed to inadequate IPC in Sierra Leone. This stimulated the establishment of national and subnational IPC programs. Since then, IPC has remained a priority to improve the health systems and strategic interventions during public health emergencies. Therefore, we conducted a detailed review to assess the status of the IPC programs. Methods: A descriptive analysis of the status of IPC programs in Sierra Leone was done using data from IPC assessments conducted in 2022 by the national IPC team, reviews of reports on program implementation, and experts’ objective opinions. Results:Performance. The national IPC assessment revealed strengths in 4 of 6 WHO IPC core components, with an overall score of 61% positioned at the ‘intermediate’ level of implementation. The best-performing component was ‘IPC guidelines’ (92%) with evidenced-based guidelines being developed and implemented over the years. Secondly, ‘Education and training’ (71%) made progress in basic and advanced IPC training, including the development of a preservice training curriculum. Also, ‘monitoring and audit and feedback’ (69%) and ‘IPC program’ (61%) met the basic requirements of an established Monitoring & Evaluation (M&E) system. Similar progress was made at the healthcare facility level, but with major gaps in ‘workload, staffing, bed-occupancy’ and ‘safe or built environment.’ Sustainability efforts. Evidence-based data on IPC have always been scarce due to a limited capacity to conduct IPC research. The Structured Operational Research and Training Initiative (SORT-IT) on antimicrobial resistance has helped promote evidence-informed decisions and build OR capacity that is relevant to improving program performance. In 2019, Sierra Leone instituted in-country production of alcohol-based handrub and liquid soap as a strategic intervention for providing hand hygiene products for use in healthcare facilities. This intervention was essential during the peak of the COVID-19 pandemic. Although most aspects of IPC implementation are government led with strong leadership support, stable funding and sustainability planning are yet to be achieved and will be crucial for long-term success. Conclusions: Most aspects of the IPC core components have been well implemented at the national level since the establishment of the IPC program. However, the program should continue improving the scope and quality of implementation and focus on the development of long-term plans to sustain existing gains and further improve on gap areas at the national level and especially the healthcare-facility level.Disclosures: None

Eloise Todd: mobilising civil society for pandemic prevention

Eloise Todd: mobilising civil society for pandemic prevention