Dr. Luis Gomes Sambo, WHO Regional Director for Africa, discusses the outbreak during a recent visit to Washington, D.C.
Washington, D.C., 5 August 2014 (PAHO/WHO) -- The application of appropriate preventive measures are key to bringing the Ebola epidemic under control, says Dr. Luis Gomes Sambo, Director of the World Health Organization’s (WHO) Regional Office for Africa, where he leads technical cooperation efforts for 47 Member States.
Since the first case was reported in Guinea in March of this year, the virus has spread to Sierra Leone and Liberia, where 1,369 cases and 759 deaths had been reported as of 1 August 2014. The three countries had never previously experienced Ebola, a highly infectious disease that is spread by contact with the blood, bodily fluids, or tissue of infected animals or humans.
Sambo has been leading WHOs regional response to the outbreak, mobilizing experts and resources, and convening emergency meetings of the African countries’ ministers of health to discuss the situation and develop strategies at the national and regional levels to address the epidemic, the largest to affect Africa to date.
The Pan American Health Organization (APHO), WHO’s Regional Office for the Americas, interviewed Sambo during his recent visit to Washington, D.C., to attend the U.S.-Africa Leaders Summit.
How complex is the Ebola epidemic in Africa?
The epidemic is a serious public health problem, and we are concerned that it can spread to other areas or territories. Yet we believe the situation is still controllable if we apply the necessary preventive measures. There has been an unusually high number of health workers affected (123 cases and 70 deaths as of 1 August), which complicates our ability to control the epidemic. At the same time, there is significant community resistance to adopting preventive measures, mainly due to traditional beliefs and rituals related to the burial of the dead.
What are the strategies being used to control the disease?
The transmission is from person-to-person, within communities, and also within health facilities. Interventions focus on the provision of relevant information to enable people to protect themselves and thus break the chain of transmission. Contact tracing is also important to prevent the disease’s further spread. At the health facility level, it is important to train health staff on infection control measures and to provide them with tools and protective equipment to avoid infection.
What does the latest information regarding the Ebola situation indicate to you about the potential duration of the epidemic?
The timeframe is very difficult to predict. The virus’s incubation period is from 2 to 21 days. In order for WHO to declare the epidemic over, 42 days must pass without a confirmed case.
Is this epidemic a threat to other countries of the world?
We are dealing with a disease that is caused by a highly infectious virus, and the risk or threat to any part of the globe is there. In fact, another country—Nigeria—has been affected, due to one case traveling back from Liberia. This example shows that the risk of threat exists. On the other hand, measures are available to contain the epidemic in the three countries currently affected and we need to apply these at the right time and place.
What are the recommendations for other countries to prevent Ebola?
WHO is not currently recommending any travel restrictions, border closings, or quarantines. This may change, however, depending on how the epidemic evolves.
On 6–7 August 2014, WHO is convening a meeting of the International Health Regulations Emergency Committee on Ebola Virus Disease. The outcome will be a decision as to whether or not the Ebola event constitutes a “public health emergency of international concern” and the recommendation by WHO of special measures to be taken by countries to prevent or reduce the disease’s spread. Some countries, such as the United States, have already issued recommendations urging travelers to avoid nonessential travel to the affected countries, while others are investing in passenger temperature screening controls at airports. According to the International Health Regulations, governments may take any measures they consider necessary to protect their respective populations and territories. WHO is recommending that people be informed about the existence of this disease and the epidemic and about the means of prevention and protection, and that governments minimize activities that encourage mass gatherings, which can increase risk of the disease’s spread.
What can the international community do to help?
The seriousness of the situation calls for emergency action on the part of all stakeholders. The international community can provide valuable assistance. The three countries affected by this latest Ebola epidemic have very weak health systems; community-level capacity is very weak; and transmission is occurring at this level. So it is at this level that we need to strengthen health services delivery, information, and disease prevention and protection measures. There is also great need for strengthened technological capacity in terms of laboratories, treatment, and logistics, which is not readily available even under more normal circumstances.
What are the most urgent needs in the affected countries?
I visited the three affected countries, and the primary need is for more health personnel trained in case management at the treatment centers. Currently there is only one international agency, Doctor without Borders, which is strongly involved in case management. The current number of treatment centers, likewise, is not sufficient to cope with actual demand. We also need to strengthen laboratory capacity, particularly in Liberia and Sierra Leone, as well as logistics at the health ministries to enable them to better address emergency needs. Logistical capacity in the three countries is extremely limited, and here I am referring to trucks, motorbikes, and other means of transportation for health personnel, equipment, and needed medications. Other important needs are for the provision of accurate information, using the best ways to communicate to people, addressing resistance and denial of the disease’s existence, and changing behavior to encourage people to adopt protective measures that can save their lives.
What role can the community play in halting this epidemic?
We can not win this epidemic without the active involvement of communities, because transmission in most cases occurs within the community. Communities must be aware of the disease’s existence, of the risks of transmission, and of the measures to take to prevent Ebola’s further spread. It is important that community members believe that if they go to a health facility and seek care in time, they can survive the infection, which has a mortality rate of around 62% during this current outbreak.
How is WHO’s Regional Office for Africa assisting its Member States in bringing Ebola under control?
Our interventions reflect and respond to our mandate and core functions. Within the context of an epidemic such as this one, we must be more aggressive in terms of mobilization of expertise. We are redeploying WHO staff in the Region, and WHO Director-General Dr. Margaret Chan is mobilizing resources and providing expertise to governments and other involved stakeholders. We held an emergency meeting with ministers of health to develop a regional response strategy, and countries have developed their own response plans for the next six months. WHO is providing support for the training of health workers to improve their knowledge about infection control, because these three countries are experiencing the disease for the first time and have no previous experience with Ebola.WHO has also created a Sub-regional Ebola Outbreak Coordination Centre in Conakry, Guinea, which facilitates harmonization of work between WHO, Doctors without Borders, UNICEF, and other partners.
What are your expectations about the end of Ebola?
I hope we will see this epidemic over as soon as possible, because there are many health challenges in Africa and this epidemic is diverting valuable resources, including time, that could be used to prevent other serious health issues—such as maternal and child mortalities, as well as other diseases.
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