With all epidemic responses, it is important to be calm and focused. This is, however, Ebola and that is always concerning. This is why we have mobilised a team of some of MSF’s most experienced Ebola specialists who will travel to Guinea as soon as the administrative and visa processes allow. We may find that this is a small outbreak – easy to control and contain – or we may find that the problem is bigger and more complex.
First of all, you need a clear picture of the problem. An epidemiological surveillance team, with one MSF epidemiologist included, departed Monday 15 February for the affected areas of N'Zerekore and Gouéké, in the far south of the country. They have started to do the epidemiological surveillance work, but we do not yet have full clarity about what we are facing.
Then there are a series of key basic things that have to be done rapidly and well:
- contact tracing (identifying all people who have been in contact with someone who has Ebola, in order to be able to monitor their health and stop that chain of transmission);
- having medical facilities with the right set-up for isolating and treating Ebola patients;
- ensuring there are safe funeral practices for anyone who dies of Ebola or suspected Ebola;
- passing good, clear, health education information;
- making sure there is a good triage set-up in all health facilities, to minimise the chances of Ebola having knock-on consequences on the rest of the health system; and
- above all else, community engagement.
Community engagement is particularly vital. You need to invest time and energy in talking – and listening – to the communities in affected areas. You need to adapt the response according to what they say, and you need them to adapt to the risks of Ebola. It has to be a two-way conversation.
It is certainly true that the existence of Ebola vaccines is one of the key differences from the outbreak in 2014 – 2016. And this is great news – but we need to be careful in how expectations are set. It is unlikely there will be enough vaccines to cover entire regions or prefectures. This will mean the choices about the use of the vaccine need to be very clearly explained, to avoid misunderstandings and potential distrust in communities affected by Ebola.
It all comes back again to community engagement. We have seen this many times in the past. If a community feels involved, heard and empowered, then an Ebola response will likely go well, with or without vaccines. But if a community feels side-lined, unheard and becomes nervous or distrustful, then an Ebola response will likely face multiple difficulties, with or without vaccines.
It is true that Ebola treatments did not exist at the start of the 2014 outbreak, and so this is a significant difference today. We do not yet know which of the treatments will be used in this response in Guinea, but the very fact of having a treatment option is good for two reasons:
1. it significantly increases a patient’s chances of survival – particularly if the patient starts treatment reasonably early; and
2. it means we have better chances of encouraging people to come early for isolation and treatment. Before there was a treatment available, it was understandable that people would stay away from Ebola treatment centres, which often became feared as places of death. But with a treatment available, that could change substantially. This matters for outbreak control, because when someone with Ebola is isolated, they are not spreading the virus to others.
We will have a small Ebola-expert multidisciplinary team, able to turn their hand to pretty much all aspects of the response. We already have an initial advance-team that moved to the area, to help with the epidemiological surveillance and to start understanding the communities’ knowledge of Ebola, so that health education information can be adapted appropriately.
When the dedicated Ebola team arrives, they will combine forces and make quick decisions about where and how MSF can be of most help. The team will have the skills and equipment to do whatever is most needed; from Ebola medical treatment to epidemiological surveillance work, health education, contact-tracing, community engagement or vaccination.
There is an essential thing to keep in mind, for MSF and for all other teams engaged in the response. You need to bring your technical skills (medical or epidemiological or infection-control or health education, etc…), but you also need to bring your soft community engagement skills. Both are needed in an Ebola epidemic response.
It all comes back to community engagement. We have seen this many times in the past. If a community feels involved, heard and empowered, then an Ebola response will likely go well.
Anja Wolz, MSF emergency response coordinator