Declared a public health emergency of international concern by the World Health Organization (WHO), the Ebola outbreak is far from under control. In between preparations for his visit to Sierra Leone, Guinea and Liberia, ECHO epidemiologist Jorge Castilla takes time to answer a few questions.
Interviewed by Anouk Delafortrie, ECHO Regional Information Officer for West Africa
After you returned from your last visit to Guinea in April, you and other colleagues were optimistic about the evolution of the epidemic?
At the end of May we were positive because we had an epidemiological curve showing a decline in the number of cases. We had hopes the cases would become sporadic and eventually disappear. But the contact tracing wasn’t systematic enough. People who had been in contact with infected patients were lost and continued to spread the virus to new places. People move a lot in this region.
And there is the issue of mistrust. Why would people have confidence in a group of foreigners that come and put their family in a centre that looks like a detention camp? All these factors together generated a second wave of cases.
How are we going to contain this expanding outbreak?
Given the size and complexity we need other actors to come in alongside the World Health Organization (WHO) and Médecins Sans Frontières (MSF). The latter has warned that they no longer have enough human resources. There are very few partners engaged in 'intensive case management', and others probably fear initiating it. At the level of non-governmental organisations there is a limited capacity because the spread and the size are now getting too big. This means we’re looking at the level of governments and international institutions now.
What needs to be improved?
The priority is to improve standard precautions and barrier nursing. Any health system should have good standard precautions to prevent health staff from getting infected. And when faced with a risk like Ebola, you also need barrier nursing with personal protective equipment which has to be worn in a rigorous and systematic way. We also need to strengthen the tracing of patients. Take the example of Nigeria. From the initial case, 177 contacts were traced and put under surveillance. And as the number of cases increases across the region the number of people to trace and follow multiplies. The task is huge.
How have ECHO partners been doing?
We started providing support very early, after the first case was confirmed in March. We had been aware of an outbreak, but initially thought it could be Lassa fever. We supported three partners: WHO, the Red Cross and MSF. The work MSF has done setting up isolation units and treating cases is outstanding but they are really overstretched now. WHO sent the Global Alert and Response Network (GOARN) which is a coordination of all epidemiological resources including the Centers for Disease Control and Prevention (CDC). Their initial work was extraordinary. For contact tracing, the best option because of their network of volunteers was the International Federation of Red Cross and Red Crescent. The EU also sent a mobile laboratory to allow for diagnostics and testing in a very remote place.
A supposedly miraculous serum was given to two American healthcare workers who got infected in Liberia. Why can’t it be used in West Africa?
Research on vaccines and treatments has been going on for years. Some of them were tested on primates, but none are at the stage that they can be used for humans. To develop a medicine one needs to respect a strict protocol to ensure they ‘do no harm’. There is also a practical difficulty. Whatever exists is only available in small quantities. The moment you decide to use it for this epidemic, everything will be gone in a few days. We know that the two people survived, but we can only suspect it was thanks to the serum, we can’t really measure it. And we don’t know what the secondary effects may be. Ethical committees are debating now. As the number of cases increases the pressure to go ahead will also increase, but the quantities will be a limitation. It is unlikely that something can be applied on a massive scale in the coming months.
Are you worried about your own safety when you travel to this region, and how important is it for ECHO experts to do this?
I always carry gloves and a mask with me when I travel. I was in the region in April and applied the required safety measures. Of course, there is always certain angst until you get back and 21 days have passed. But these visits are important. When you provide financial support, you need to be sure that it matches the best possible options. And how would you know? Proposals can be well written, but we have to check whether they reflect the reality in the field and a real capacity by the partner.
The EU has thus far provided €11.9 million to fund immediate healthcare to the affected communities and help contain the spread of the epidemic. The aid is channelled through the European Commission's humanitarian partners on the ground, including UN agencies and Non-Governmental Organisations.