Volume 22, Number 12—December 2016
Enhancement of Ebola Preparedness across Africa
Ebola virus disease (EVD) has demonstrated the devastating impact that zoonotic diseases can have on human populations (1,2). The recent EVD outbreak exposed national and international weaknesses in existing systems of outbreak response (3). The ability for this relatively rare virus to quickly spread merits the need for better preparedness plans in at-risk countries. Because zoonotic diseases account for most emerging infectious diseases (4), effective interventions must focus on animal reservoir hosts in addition to human health-seeking behavior and health system effectiveness.
A first step in preparing countries for a potential EVD index case is identifying areas environmentally suitable for zoonotic viral transmission. Previous research defined the spatial limits of the zoonotic niche of Ebola across Africa by considering several environmental co-variates and hypothesized reservoir bat species (5,6), and this niche map was recently updated in consideration of new data (7). The updated zoonotic niche map identified 23 at-risk countries having areas environmentally suitable for Ebola. Additional analyses permitted the mapping of population vulnerability and health system capacity to respond to a spillover event (Table 1).
The Institute for Health Metrics and Evaluation (IHME) in collaboration with INDEPTH network hosted an Ebola risk mapping and preparedness planning workshop for the countries identified as at risk for a possible outbreak. The workshop was held on February 25 and 26, 2016, in Accra, Ghana, and was attended by participants from 19 at-risk countries across Africa (Table 2).
The key objective of this workshop was to provide in-country teams with an evidence-based tool to understand the risk for an Ebola index case and the capacity to respond and manage any subsequent outbreak. A second objective was to encourage discourse and mutual collaboration across Africa and between animal and human health decision-makers. Participants from a range of backgrounds with expertise on different aspects of Ebola epidemiology were invited to provide a well-rounded discussion of preparedness planning efforts. Discussion topics spanned from animal surveillance efforts to health behavior and education to health system strengthening.
The first day of the workshop focused on estimating the zoonotic niche of Ebola. Richard Suu-Ire from the Forestry Commission in Ghana spoke about his experience sampling bat species in Ghana. Although Ghana has not had a case of EVD in humans, Suu-Ire and his colleagues have identified Ebola virus–seropositive bats in Ghana (9), suggesting the potential for spillover infection. Sampling bats is essential for EVD preparedness planning, so an interactive map that could assist in pinpointing sampling sites was presented to workshop attendees (http://vizhub.healthdata.org/ebola/). Using this tool, as well as Google Earth layers, participants determined national sampling sites specific to their region and formed groups with other regional members to discuss their rationale for site selection.
The second day of the workshop focused on the social influences that may affect the scale of any subsequent outbreak. The online map included metrics of travel time, population vulnerability, and infrastructural coping capacity (expanding on a preexisting risk quantification approach) (10), enabling identification of areas at greater risk for an index case, local outbreak, and widespread outbreak. Participants explored these layers to understand where best to focus public health efforts. Afterwards, teams from Sierra Leone, Liberia, Uganda, and the Democratic Republic of the Congo reported how their countries have responded to past outbreaks, lessons learned, and the current systems in place to control future outbreaks. Finally, participants returned to their regional groups to discuss preparedness planning measures.
Persons from a wide range of occupations from countries with varying experiences with Ebola outbreaks were present, which created a culture of knowledge sharing. The collaborative nature of the workshop led to an appreciation for involvement at both the animal and human level and across national borders. To have a sustainable impact on prevention and control of EVD and other zoonotic diseases, countries must integrate into their healthcare systems a one health approach: an approach involving strong interdisciplinary collaboration and an appreciation that animal and human health are interconnected (11). The online visualization tool permitted the participants to observe the areas environmentally suitable for bat populations and compare them with the areas where human populations are most vulnerable.
Although the map cannot pinpoint where the next EVD outbreak will start, participants communicated that the online map was especially helpful in understanding the greatest at-risk areas within their own regions. The online map can be used to translate data into useful information for policy makers, who can now prioritize resource allocation in preparation for any potential outbreak. In the tool, susceptible areas can be visualized at a subnational level within a country. The simplicity and interactivity of this tool was favored by participants, who expressed it would be easy to share with a wide audience. A blog post on the IHME website describes in further detail the participant’s feedback on the online tool and workshop (http://www.healthdata.org/acting-data/mapping-ebola-prepare-future-outbreaks).
The expectation is that participants will return to their countries and use these tools to open up a narrative about Ebola preparedness, leveraging what they learned from both the maps and those countries that have experienced outbreaks. The workshop’s focus on networking fostered a culture of collaboration between animal and human health experts, as well as across countries.
This work opens up an opportunity for broader epidemic preparedness protocols and collaborations to be developed. The West African outbreak showed that there is a potential for these rare and often small-scale outbreaks to spread from local to national and international levels. This workshop laid the foundation for an open dialogue on the best use of geospatial techniques for prevention of pandemics and showed that interactive maps can be useful to decision makers. IHME currently has a publicly available version of the Ebola map (http://vizhub.healthdata.org/ebola/) and plans to expand our work to other zoonoses with pandemic potential (12–15).
This work was funded by a grant from The Paul G. Allen Ebola Program (#11878) to S.I.H.; the program also provided funding for D.M.P. and C.E.M.
- WHO Ebola Response Team. Ebola virus disease in West Africa—the first 9 months of the epidemic and forward projections. N Engl J Med. 2014;371:1481–95.
- Agua-Agum J, Ariyarajah A, Aylward B, Blake IM, Brennan R, Cori A, ; WHO Ebola Response Team. West African Ebola epidemic after one year—slowing but not yet under control. N Engl J Med. 2015;372:584–7.
- Moon S, Sridhar D, Pate MA, Jha AK, Clinton C, Delaunay S, Will Ebola change the game? Ten essential reforms before the next pandemic. The report of the Harvard-LSHTM Independent Panel on the Global Response to Ebola. Lancet. 2015;386:2204–21.
- Taylor LH, Latham SM, Woolhouse MEJ. Risk factors for human disease emergence. Philos Trans R Soc Lond B Biol Sci. 2001;356:983–9.
- Leroy EM, Kumulungui B, Pourrut X, Rouquet P, Hassanin A, Yaba P, Fruit bats as reservoirs of Ebola virus. Nature. 2005;438:575–6.
- Pigott DM, Golding N, Mylne A, Huang Z, Henry AJ, Weiss DJ, Mapping the zoonotic niche of Ebola virus disease in Africa. Elife. 2014;3:e04395.
- Pigott DM, Millear AI, Earl L, Morozoff C, Han BA, Shearer FM, Updates to the zoonotic niche map of Ebola virus disease in Africa. Elife. 2016;5:e16412.
- Mylne A, Brady OJ, Huang Z, Pigott DM, Golding N, Kraemer MUG, A comprehensive database of the geographic spread of past human Ebola outbreaks. Sci Data. 2014;1:140042.
- Hayman DTS, Yu M, Crameri G, Wang L-F, Suu-Ire R, Wood JLN, Ebola virus antibodies in fruit bats, Ghana, West Africa [cited 2016 Apr 14]. http://sankofaonline.com/archives/27390
- Groeve TD, Poljanšek K, Vernaccini L. Index for risk management—INFORM. European Commission Joint Research Committee; 2015 [cited 2016 Apr 14]. http://www.inform-index.org
- Zinsstag J, Schelling E, Wyss K, Mahamat MB. Potential of cooperation between human and animal health to strengthen health systems. Lancet. 2005;366:2142–5.
- Mylne AQN, Pigott DM, Longbottom J, Shearer F, Duda KA, Messina JP, Mapping the zoonotic niche of Lassa fever in Africa. Trans R Soc Trop Med Hyg. 2015;109:483–92.
- Pigott DM, Golding N, Mylne A, Huang Z, Weiss DJ, Brady OJ, Mapping the zoonotic niche of Marburg virus disease in Africa. Trans R Soc Trop Med Hyg. 2015;109:366–78.
- Messina JP, Pigott DM, Golding N, Duda KA, Brownstein JS, Weiss DJ, The global distribution of Crimean-Congo hemorrhagic fever. Trans R Soc Trop Med Hyg. 2015;109:503–13.
- Bannister B. Viral haemorrhagic fevers imported into non-endemic countries: risk assessment and management. Br Med Bull. 2010;95:193–225.
Suggested citation for this article: Morozoff CE, Pigott DM, Sankoh O, Laney S, Hay SI. Enhancement of Ebola preparedness across Africa. Emerg Infect Dis. 2016 Dec [date cited]. http://dx.doi.org/10.3201/eid2212.160642