Are Ebola response investments making an impact? CDC Epidemiologist reflects on West Africa then and now

August 7, 2017 by John T, Redd, MD, MPH, FACP, CAPT, US Public Health Services, CDC

John T, Redd, MD, MPH, FACP, CAPT, US Public Health Services, CDC

The first time I deployed to West Africa was in September 2014, at the height of the Ebola epidemic in Sierra Leone. I have witnessed many disease outbreaks in my public health career, but this one was more devastating than I could ever have imagined. It eventually took more than 11,000 lives.
What was happening then?

What was happening then?
The impact of the Ebola outbreak in Sierra Leone was monumental. Prior to the outbreak, Sierra Leone had a weak public health and medical infrastructure. Shortly after the start of the outbreak, this limited infrastructure was completely overwhelmed. Across Sierra Leone, and in neighboring Guinea and Liberia, hundreds of people infected with Ebola were dying in the streets, in hospitals, and in their homes. Fear and panic were widespread, as people had limited experience with Ebola and didn’t know how to protect themselves and their families from this highly infectious disease.

I was assigned to Makeni, a city of 434,000 people in the northern district of Bombali. As a medical epidemiologist, my role there was not to treat individual patients, but rather to look at the overall picture and support the system of outbreak control so that there would ultimately be fewer patients to treat. While individual treatment is very important, you need wider public health interventions to truly stop outbreaks. As public health experts, we look at ways to improve surveillance systems, laboratories, emergency management, and the strength of the workforce – all of which are critical and make the difference between life and death when an outbreak strikes.

Although Sierra Leone did have some public health systems in place prior to the outbreak, the sheer magnitude of the outbreak and the country’s unfamiliarity with Ebola made it difficult for the nation to respond effectively. For instance, the national surveillance system had never been used for Ebola before. There was no emergency management system in place. The country suffered social and economic breakdowns, leaving it to rely on resources from CDC, other U.S. agencies, and international partners.

January 18, 2015, Monrovia, Liberia – A woman waits to have her temperature taken by contact tracer Dorissa Bestman in the New Cru Town section of Monrovia. Bestman was trained by CDCF partner agency EHealth Africa and uses a tablet provided by the CDC Foundation to record her results, part of a pilot program.

Our on-the-ground work included sending disease detectives from house to house to find cases, educating the community about Ebola, and getting samples and patients to labs and treatment centers that were sometimes hours away over long dirt roads, which had often been turned to mud by the rains. The work was grueling and made more challenging by the ceaseless heat, the need to find fuel for vehicles, and frequent power outages. Nevertheless, while I was there, we investigated more than 800 suspected Ebola cases.
At that time, CDC had about 60 employees working throughout Sierra Leone; seven were staying in Makeni and working in Bombali and the adjacent district, Tonkolili. We all supported each other and became very close. The experience was psychologically draining and often very sad, especially when patients didn’t make it. By the end of the outbreak, more than 14,000 people in Sierra Leone were infected with Ebola and almost 4,000 died.
I still marvel at the dedication of the doctors, nurses, surveillance workers, and other Ebola responders who, day after day, put themselves in danger of contracting the deadly disease, which killed about 6 of 10 healthcare workers who became infected. They are our heroes.

What’s happening now?
We learned many lessons from the Ebola outbreak in West Africa. I’m happy to say that, because of CDC support and commitment from host governments, in less than two years the region has developed stronger surveillance systems, improved the safety and quality of its national laboratories, trained its public health workforce, and established emergency operations centers that can quickly launch a coordinated response to a public health threat.

Earlier this year, Liberia faced a major test of its systems when local health officials reported the emergence of a mysterious illness in a remote town. On April 25, 2017, ten patients, five of whom died, were admitted to a rural hospital with symptoms including headache, confusion, abdominal pain, vomiting, and diarrhea. Their illnesses had started shortly after attending a funeral event.

Leaving nothing to chance, the Government of Liberia, supported by CDC and other partners, quickly activated a public health emergency response using their newly developed systems. The emergency operations center coordinated efforts to stop the outbreak. Disease detectives and surveillance officers, trained by the country’s new Field Epidemiology Training Program, immediately began to track and investigate cases. Samples from patients were rapidly collected and tested, quickly ruling out Ebola as the cause and instead confirming meningococcal disease as the culprit.

The country’s improved ability to prevent, detect, and respond to outbreaks helped limit this outbreak to 31 cases and 13 deaths, with the last case reported on May 7, 2017. The outbreak response was successful because the public health systems put in place as a result of the Ebola outbreak were strong, and the people trained to use them were ready to act.

Why it matters to America
In May 2017, U.S. Department of Health and Human Services Secretary Tom Price visited Liberia to honor the Ebola-affected countries for their progress in developing stronger public health systems. The visit emphasized the importance of partnership between the U.S. and West African countries in advancing global health security.
Global health security is a key part of our national security. Keeping America safe means ensuring that not only countries in West Africa but all other countries have the ability to stop outbreaks at the source, before they can reach our shores.

We don’t know when or where the next epidemic will occur, but these recent experiences reinforce two critical things we do know. One is that when countries can’t respond effectively, outbreaks can quickly cross borders and grow into global epidemics. More critically, stronger public health systems can and do stop the spread of diseases and save lives.

The work to build needed systems and meet global health security goals is ongoing, but we have already seen significant progress. With West Africa’s demonstrated commitment to staying the course and working with CDC and other partners to meet global health security goals, I believe we will succeed in making the world healthier and more secure.

August 7, 2017 by John T, Redd, MD, MPH, FACP, CAPT, US Public Health Services, CDC