At least one African country has been able to fight back against Ebola: Nigeria, West Africa’s largest and most developed nation, has set the tone for a successful public health response to the frightening and often-misunderstood disease.
Faisal Shuaib is a Nigerian physician and public health expert who works for the Nigerian Health Ministry as the deputy incident manager of the country’s polio eradication program supported by the Gates Foundation. When the Ebola outbreak in the region became a pressing issue, the Foundation decided to shift resources to combat that disease—a somewhat surprising decision, given the global philanthropy’s focus on illnesses that affect a much broader population over the long term. But after public health experts told Gates Foundation CEO Susan Desmond-Hellman, herself an epidemiologist with experience in Africa, that this outbreak was different and frightening, the organization moved $50 million, literally overnight, to support an anti-Ebola campaign.
Faisal Shuaib: It must have been right around March, when they continued to have cases and there seemed to be community-level transmission that was going on. That was the point when the [World Health Organization] escalated the problem to a global level. Knowing that the virus is very infectious ... I knew we would be here for a long time. A place like Lagos, the commercial heart center of Nigeria, if we were to have widespread outbreaks, it would rapidly move out to other parts of the country that do not have the resources that Lagos has to combat such an outbreak.
Fernholz: What were you afraid of?
Shuaib: Clearly, we had learned in the past about the aggressive transmission that takes place, with Ebola outbreaks in Uganda. Looking at the trajectory of the outbreak in West Africa, this is an outbreak that could quickly overwhelm a health system. By the time we had a case in Nigeria with several potential contacts it became clear that if we did not act rapidly, the whole system could be overwhelmed and even the gains we had achieved with polio eradication would be quickly reversed. This is what has happened in other West African countries. The kind of effort that is being scaled up right now is commendable, but it is still clearly behind the curve, it is still too slow.
Fernholz: Talk about how Nigeria responded.
Shuaib: A war-like approach is devised; the federal government leads the Emergency Operations Center, but working with international development agencies like the WHO, UNICEF, the U.S. [Centers for Disease Control], [Doctors without Borders], and the Red Cross. Together with these organizations, we sit in one place, co-location in a designated facility, and we do joint planning, agree on strategies to be used, and implement these strategies based on a clear understanding that people are comfortable to deliver on specific tasks.
Ferholz: And it worked?
Shuaib: At this point, we’ve gone a month since the last case of Ebola virus disease was discharged from the treatment center, [and have] followed up almost 900 contacts until they’ve exited the stage of developing the disease. We’ve continued to conduct enhanced surveillance in the health facilities and the communities as well. We feel pretty confident that we’ve got a handle on this, on the outbreak, but from an epidemiological point of view, we cannot declare the outbreak is over until 42 days, equivalent to two incubation periods, after the last case was discharged from the hospital.
I am back really to the polio eradication program already as of last week, I handed over the reins back to the other incident manager that has been appointed to sustain the program.
We are not letting our guard down, we are not under any illusion whatsoever that we don’t continue to remain at risk as long as we continue to have an outbreak in the West African sub-region. [There's been] a doubling of cases every three to four weeks in Sierra Leone and Guinea and Liberia. The fact that [there are] now reported cases in the U.S. shows that there is no country that is free of the outbreak until every country is free of the outbreak.Fernholz: How do you deal with panic?
Shuaib: You need to rapidly counterattack misinformation, because panic and fear tends to decrease the chances of people reporting to the health facilities. People are concerned they might be stigmatized. [It requires] communication ... to the society around the fact that getting Ebola virus disease is not a death sentence. The key is reporting early to the health authorities who know how to manage care. One of the reasons why people succumb is that without reporting to the health facility, once people get vomiting or passing stool, it's hard to replace fluids and electrolytes.
Fernholz: What more has to be done to protect people?
Shuaib: One thing that can change the outbreak is for nations to come together and deploy resources. Rapid action is required; delay is very dangerous; people need to move. There is a need for countries to train, prepare ahead, to implement their epidemic preparedness plans, and do simulations or table-top exercises just in case you do have an outbreak. It’s not enough to have the resources, it’s not enough to say you are done training.