Recent news from West Africa that the number of new Ebola cases continues to fall and that an Ebola vaccine appears to provide protection against infection is heartening. But focusing only on these positive developments overlooks the huge challenges that remain.
The West African epidemic, which has caused at least 11,298 deaths since it was first reported in Guinea in March 2014, is incredibly stubborn and has proved hard to control. With a grave shortage of health professionals in the region, the international community needs to remain committed to rebuilding health care systems in the wake of Ebola’s destruction.
So much of what I hear about Ebola in West Africa is wrong. The most common misperceptions — that the epidemic is almost over; that enough trained personnel are available to combat the crisis and the aftermath; that plans are in place for post-Ebola recovery — will only encourage inaction and harm the response on the ground.
It’s true that the epidemic reached its peak in late 2014, and has declined significantly since then. Even so, the number of new cases since late March alone — more than 500 — would otherwise represent the largest Ebola outbreak in history. We’ve had spells when the number of new cases in both Guinea and Sierra Leone went down steadily — only to be reversed by clusters in new areas, arising from unsafe burials and unknown chains of transmission.
Even the remarkable improvement in Liberia, which went from hundreds of new infections a week in September 2014 to being declared Ebola-free in May, was short-lived — further outbreaks have occurred. Right now, there are no known cases in Liberia, but there is widespread apprehension about whether more will occur.
Liberia is proof that the goal of “Getting to Zero” — the slogan of an anti-Ebola effort led by the Centers for Disease Control and Prevention — will not be enough. Staying at zero will require an enormous input of financial and human resources for many months after the last case is diagnosed. Instead, the international effort has become dangerously fatigued.
The waning effect is felt most by those on the ground. For perspective, before the epidemic, there were more physicians on staff at Bellevue Hospital in New York City, where I was treated for Ebola, than were practicing in the three most affected West African countries combined. The dearth of health care professionals means that for many responders, there has been little respite. And since the start of the epidemic, nearly 7 percent of health care workers in Sierra Leone and more than 8 percent in Liberia have died from Ebola.
I know very well the dangers of being a health care worker in West Africa, as I contracted the virus while caring for Ebola patients in Guinea. I was able to avoid the tragic fate of so many of my West African colleagues because, in New York City, dozens of providers with unlimited resources were involved in my care — whereas, in Guinea, I had been the only caregiver for dozens of patients.
It will be years before these West African countries are able to train nurses, develop and implement a sustainable medical education model, and supply an adequate number of homegrown health care workers. Without sustained assistance from the international community, the nations of West Africa face a losing war of attrition with the epidemic.
Sagging global attention is putting at risk the rebuilding of a post-outbreak West Africa. All three countries are ranked among the lowest in the world in basic preventive and primary health care; the absence of disease surveillance systems allowed Ebola to go unrecognized despite being present in the region for years.
Ebola has virtually shut down clinics and public health infrastructure in many areas. Without a doubt, more people have died from the epidemic’s crippling effect on these hobbled health systems than from the virus itself. Visits for routine health services dropped precipitously. In Guinea alone, health facilities treated an estimated 74,000 fewer malaria cases (compared with previous years) during this outbreak. That will have meant not only more deaths from this treatable disease, but also more patients with symptoms similar to Ebola in the community, placing further stress on treatment centers.
If the epidemic’s immediate impact on the West African health system sounds dire, the probable consequences are even more unsettling. Immunization levels have dropped across all three countries, so that, for instance, a regional measles outbreak could cause hundreds of thousands of cases — and potentially more deaths than Ebola. A recent World Bank report estimated that maternal mortality could skyrocket, setting the entire region back with rates not seen in almost two decades: In Liberia, for example, the previous mortality rate for women in childbirth (of 640 per 100,000 births) could more than double.
We cannot allow Ebola to continue destroying communities even after it’s gone. Instead, we must seize the opportunity to restore and improve the capacity of the region’s health systems.
Strong global commitment, political leadership and access to adequate resources all contributed to the remarkable success of the 1970s campaign to eradicate smallpox, arguably one of mankind’s greatest public health achievements. Will future generations judge us so favorably unless we now make wise commitments and investments in West Africa’s frail health systems that allowed this outbreak to flourish?
Craig A. Spencer is a humanitarian aid worker with Doctors Without Borders and the director of global health in emergency medicine at New York-Presbyterian/Columbia University Medical Center.