In: Nursing
WHO immediately mobilized its collaborating laboratory in Lyon, France, together with West African laboratories located in Donka, Guinea, Dakar, Senegal, and Kenema, Sierra Leone, to prepare for the diagnosis of more cases. MSF, which had a well-established presence in the region, rapidly set up isolation facilities.
The first team drawn from institutional partners in the WHO Global Outbreak Alert and Response Network, or GOARN, travelled to Guinea on 28 March. The team was headed by a senior WHO field epidemiologist. As a reporter covering early events in Guinea for Vanity Fair later noted, the international response was “rapid and comprehensive – exactly what you would hope.”
Findings from the investigation were reported on 8 April during a Geneva press conference, where WHO officials alerted reporters to “one of the most challenging Ebola outbreaks that we have ever faced”. The challenges observed included the wide geographical dispersion of cases in both Guinea and Liberia, cases in the capital city, Conakry, and a high level of public fear, anxiety, rumours, and misperceptions.
WHO convened a special ministerial meeting about the outbreak of
EVD. The meeting was held on 2-3 July 2014 in Accra, Ghana. “It
brought together ministers of health and senior health officials
from 11 African countries as well as response partners, Ebola
survivors, representatives of airlines and mining companies, and
the donor communities." The outcome of this meeting was the WHO’s
Ebola Virus Disease EVD) Outbreak Response Plan in West Africa
(“the Plan”).
Its overriding objectives were to:
Clear Objectives
The objectives were clearly defined and maintained throughout the
life of the Plan: to stop transmission of EVD in the affected
countries and prevent its spread to other countries, particularly
neighbouring nations in West Africa.
Stakeholder Engagement
The main stakeholders were the WHO, the UN and the most affected
nations – Guinea, Liberia and Sierra Leone. There were other NGO
stakeholders, including medical NGOs, such as the Centers for
Disease Control and prevention (CDC) and Médecins Sans Frontières
[Doctors Without Borders] (MSF), financial NGOs such as the World
Bank, and aid organisations such as the Tony Blair Africa
Governance Initiative (AGI). All the stakeholders shared a common
interest: eradicating EVD.
Evidence
The Plan developed by the WHO was based upon the collective
experience it had gained in response to similar epidemics: “SARS,
pandemic influenza A(H1N1), and Middle East respiratory syndrome
coronavirus (MERS-CoV) The activities set out in this plan are
based on the ERF grading system." The health NGOs had also learned
lessons from the various outbreaks of Ebola Haemorrhagic Fever in
Africa during the 2000s, especially in the Democratic Republic of
the Congo and Uganda.
Feasibility
The financial feasibility of the Plan, as well as the economic
recovery plans for the three countries most affected, were
addressed by the relevant NGOs. The World Bank’s response was to
mobilise funding from the International Development Alliance (IDA)
and the International Finance Corporation (IFC): “the World Bank
Group has mobilised nearly US$1 billion in financing for the
countries hardest hit by the Ebola crisis. This includes US$518
million from IDA for the epidemic response, and at least US$450
million from IFC, a member of the World Bank Group, to enable
trade, investment, and employment in Guinea, Liberia, and Sierra
Leone.” The feasibility of the health-based response was based on
the fact that it was based on previous initiatives and the
knowledge and experience of the national ministries of health and
the health NGOs.
Management
The WHO has a sound management structure with three levels of
organisation: headquarters and regional and national offices. There
was also a sub-regional operations coordinating center to
streamline the efforts of the WHO: the Sub-regional Operations
Coordinating Center (SEOCC) located in Conakry, Guinea. The SEOCC
was the main operations hub for West Africa and served as a
coordinating platform bringing together WHO and its partners to
consolidate, harmonise, and streamline the technical support to
affected countries. “The WHO and the Regional Office for Africa
will coordinate international and regional deployments and
activities, respectively, and will provide surge capacity to the
SEOCC." Each of the countries managed the Ebola response through a
national task force or committee.
Measurement
The WHO published regular weekly updates of the progress of EVD.
The parameters were principally: Total Cases (Suspected, Probable,
and Confirmed); Laboratory-Confirmed Cases; and Deaths. “The Ebola
response is made up of different activities like contact tracing;
identifying and monitoring people who have been in contact with
those who have Ebola, and burials; ensuring that everyone is buried
safely, quickly and in line with cultural and religious
practices."
Alignment
Apart from the initial delay in taking action, the main actors
collaborated to eradicate the epidemic. The WHO also partnered with
agencies like UNICEF, CDC and MSF to provide clinical and public
health interventions. The WHO also provided technical, normative,
material and operational support to the relevant ministries of the
three main affected nations. “In accordance with the International
Health Regulations (IHR 2005), the Ministries of Health of Guinea,
Liberia, and Sierra Leone, together with WHO and other partners,
are implementing a coordinated response to the outbreak." The IDA
and the IFC cooperated with the World Bank to fund the medical
response and support the economies of the three countries mainly
affected, which suffered significant downturns in economic activity
as a result of EVD.