In 2014-15, the Ebola virus was a source of devastation for millions in West Africa. The disease—which quickly causes severe hemorrhaging, organ failure, and death—was primarily found in isolated parts of central Africa until the outbreak. The three nations at the center of the epidemic were Guinea, Liberia and Sierra Leone, all of which share borders. According to the Centers for Disease Control, the World Health Organization confirmed more than 11,000 deaths from 28,000 cases of Ebola through the end of August 2015.
The Ebola epidemic was a major test for crisis responders in the public health field. First responders and crisis response agencies can learn from the way organizations across the globe worked together to ultimately contain the virus. Examining both global and local efforts reveals some key lessons about readiness in any situation. Some of these lessons may be important immediately, as the Zika virus spreads and becomes a global threat.
Global readiness is an ongoing process
In his assessment of the outbreak in The New England Journal of Medicine, Bill Gates compared the global response to that of war. Gates highlighted how countries in the North Atlantic Treaty Organization practice routine drills for fulfilling the logistics of any wartime situation, including what language to speak over which radio channels and how to deliver fuel and food wherever it is needed.
According to Gates, a similar procedure—missing from the most recent Ebola epidemic—needs to be a routine part of any public health response in the future. For example, no organization is responsible yet for coordinating or funding the necessary steps to combat a global epidemic. In fact, many countries have been slow to meet their commitments to International Health Regulations. This resulted in nations and healthcare organizations meeting the Ebola epidemic on their heels, wasting valuable time answering questions about how to treat the virus after the outbreak. That lack of readiness and proactive coordination could lead to even higher infection rates in the event of an outbreak of a more severely infectious disease.
In a separate article published in the science journal PLOS Currents, researchers noted that addressing the Ebola epidemic in full requires a long-term investment in resources and support. The nations that were most affected by the Ebola virus lacked the funding and the infrastructure to properly care for patients.
Per capita spending on healthcare in Sierra Leone was under $250 in 2013, less than one tenth of what Spain spends on its people. Liberia, which had the highest death count, also had the lowest number of properly trained doctors; the New York Times reported that Liberia had at most 250 physicians, or two per 100,000 people, prior to the outbreak. Under normal circumstances, this would be unacceptable and dangerous. The Ebola outbreak only exacerbated an already problematic situation.
From a readiness standpoint, a more standardized response system with fully-funded resources and infrastructure can help organizations work together to streamline all aspects of the treatment process before an epidemic even occurs.
Take immediate action to avoid inflaming an epidemic
Another key lesson learned from the outbreak is that organizational decision-making at the government level can affect the direction of an epidemic. Unfortunately, the governments of the three nations hit hardest made a critical judgment error in mid-2014 by misreading a one-month drop in cases as evidence of containment.
Two issues aggravated this mistake. First, agencies monitoring the outbreak saw only one transmission pattern, when in fact, another appeared in a different location. Second, the dirt-based roadways in these countries became impassable during the regular monsoon seasons due to mud, greatly limiting information exchange.
Inaction by local government and international organizations helped worsen the crisis. The borders of Sierra Leone, Guinea and Liberia were porous, accelerating transmission in rural areas. WHO didn’t declare a public health emergency until August 2015, more than a year after the outbreak began and despite persistent warnings from Doctors Without Borders.
Identifying the epidemic as a public health emergency sooner would have allowed healthcare organizations and responders to work together to establish a common understanding of the urgency of the epidemic. It was only after the WHO declared the emergency and three countries closed their borders that the world saw a marked decline in cases.
Effective care requires local empowerment
Local customs, too, can have unexpected impacts on the spread of disease. Many West African communities, for example, perform burial rites that center on continuous bodily contact. The practice inadvertently served as the primary transmission vector during the Ebola outbreak. Fearful of angering their ancestors, people were hesitant to give up these rituals when a connection with the spread of the virus became clear.
Culture is a factor in any crisis response effort. By working within the context of local beliefs, it is much easier to address behavior that could stand in the way of a response team’s ability to establish safety in a short period of time. The WHO recognized this connection during the Ebola outbreak and engaged with community and religious leadership to discuss the problems of continuous bodily contact while respecting cultural traditions.
While traditions hold sway over locals, cultural norms also include a respect for the leadership and guidance from elders. This allowed local authorities, who had a deep connection with the population, to persuade people to temporarily cease burial rituals until the epidemic passed. Responders cooperatively developed a containment effort to stop the spread of the virus.
Other local behavior enabled a quick and effective counter-response. When local communities realized their governments could not handle the outbreak, they took matters into their own hands by developing their own quarantine zones for travelers, keeping visitors isolated until it was safe to assume they didn’t have Ebola. Devoting resources to educate and empower locals to take an independent approach to emergency response creates an additional layer of collaboration. The result is that all responders then become more readily equipped to manage the problem at hand.
These lessons learned from the Ebola outbreak extend to crisis responders outside of the realm of public health. Emergency preparedness in any situation requires planning, collaboration, and teamwork, both within organizations and across networks of agencies.
Developing a system in which key stakeholders can practice on a regular basis will make it easier to respond to an emergency and mitigate danger. The unique role cultural norms can play demands that first responders be sensitive to local customs. Proper training and understanding of the community impacted by any crisis or disaster ensures that response agencies are able to leverage the help of the community and create a collective effort to establish safety.