The World Health Organization's declaration that West Africa is free of Ebola transmission does not mean that Ebola is no longer present.
Ebola likely remains with us in humans and in nature, requiring ongoing commitment from the international community to help protect the healthcare workers on the frontline.
Sustained investment in the health systems of the affected countries is the only way to ensure that Ebola does not amplify and spread throughout the region again.
New York, NY, January 14, 2016 — Today, the World Health Organization declared that Liberia joined Sierra Leone and Guinea in being free of transmission, marking the official end of the worst Ebola epidemic in history. But the international community must not respond as though the region is Ebola free: the virus remains in humans and in the environment. The International Rescue Committee (IRC) calls on donors, governments and aid organizations to protect against future epidemics by ensuring that the critical weaknesses exposed in the health systems of Liberia, Sierra Leone and Guinea are addressed.
“No matter what declarations are made, we’ve not freed ourselves of Ebola,” said Emmanuel d’Harcourt, IRC’s senior health director. “We have just controlled, and stopped, an epidemic. That is reason to celebrate. This milestone was made possible by the bravery of millions who responded to the epidemic. But we owe it the victims, as well as to future generations, to prevent such tragedies.”
Reaching the status of transmission-free means that 42 days, or two incubation periods, have passed since the last active case of Ebola was discharged or buried. WHO’s declaration does not mean that Ebola no longer exists in the hardest hit countries in West Africa.
- The natural reservoir for Ebola is likely in animals, and has existed before this epidemic, and continues to exist. Serological studies indicate that the virus has been in the West Africa for more than 20 years. This empirical evidence also supports stories shared by our staff in Sierra Leone about villages dying from “a strange disease” that caused families to die quickly in past years.
- There is increasing evidence that Ebola persists much longer in human bodies than previously thought. Survivors, who already faced a terrible disease and the stigma surrounding it, appear to be, for the most part, immune to another infection once infected. But the Ebola virus can remain in the semen of survivors after recovery, likely up to 9 months or more, and can spread to others, on rare occasions. Survivors may also experience a reactivation of the disease. It’s unclear if those reactivations lead to the same set of symptoms, but there is some suggestion that there may be a low risk of renewed transmission, as may have happened in Liberia’s recent cluster of cases within a family. Reactivation, even if it doesn’t recreate the original illness, can cause harm to certain body parts, such as the eyes and the nervous system. We also increasingly recognize that some people may have had the virus without knowing it, experiencing mild symptoms or none at all. We do not know yet what impact these facts will have on the affected countries.
- Health workers in Liberia, Guinea, and Sierra Leone must remain ready to deal with the disease. Countries like Nigeria and Senegal with better health systems — more paid workers, more supplies and working surveillance mechanisms — were able to stop the spread of the virus quickly. Ebola exposed these critical weaknesses in the health systems of Liberia, Guinea and Sierra Leone, most of which have not been adequately addressed. The international community must commit to sustained investment in the affected countries so Ebola will never amplify and spread within a healthcare system again.
Funding and actions to support recovery must ensure that:
- Qualified health workers, who have faced this tragedy and remain on the frontlines to prevent the next, receive training, supervision, and payment,
- Health centers and providers have resources for infection prevention and control and medications,
- Facilities have water and systems to manage waste, and
- Communities are recognized as key change agents, equipped and supported to build confidence in the health system and implement solutions.
“There may be some mysteries about the Ebola virus, but there is no mystery about how to stop it,” d’Harcourt said. “Health workers cannot be ready for Ebola if we don’t address the problems that made the countries vulnerable in the first place. We know that stronger health systems were able to stop the spread of the virus quickly. It is up to us to act.”