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West Africa: Ebola might be here to stay, warn WHO experts

Red Cross volunteers engage in social mobilization, contact tracing and body management in Guinea. (Credit: ECHO)

The outbreak of the Ebola virus in West Africa is now slowing down and it might not completely go away. An article published today in The New England Journal of Medicine warns, “we must…face the possibility that EVD will become endemic among the human population of West Africa, a prospect that has never previously been contemplated.”

Projections based on the current response to the outbreak show that it will continue to spread. The authors, a panel of 60 World Health Organization (WHO) experts, say that it is possible the region will see “thousands of cases and deaths each week” if things don’t change.

The report is one of the most stark warnings about the devastating potential of an outbreak that has claimed 2,811 lives in West Africa. Findings concentrate on Guinea, Liberia, and Sierra Leone, the countries bearing the greatest burden of infections. Neighboring countries including Nigeria and Senegal have witnessed infections, but say that it is under control. However, the projected increase in cases poses a threat to people in the three main countries and the entire region.

People infected tend to be between 15 to 44 years-old (average age was 32), found the experts. Further, men and women are infected at roughly the same rate. The confirmed cases are seeing a 70.8% fatality rate, with people faring slightly better (64.3%) when admitted to a hospital.

Ebola infections are estimated to reach 20,000 people by early November, says the WHO experts. That is more than three times the number of cases (5,864) that have been confirmed since the outbreak started in December 2013.

The findings fly in the face of the general trend for Ebola outbreaks. The terrible virus catches worldwide for being a horrific killer, but it eventually dies out. Since Ebola is spread through contact with bodily fluids, healthcare workers and governments can cut off new infections when they work together with an affected area.

 UNICEF delivers essential supplies to Sierra Leone on September 5, 2014. Photo: Francis Ato Brown / World Bank

UNICEF delivers essential supplies to Sierra Leone on September 5, 2014. Photo: Francis Ato Brown / World Bank

It ends nearly quickly as it started. At least that is how it is supposed to go. In the case of West Africa, the Ebola outbreak has become increasingly worse. The possibility of it becoming endemic, meaning that it is a regularly occurring disease, is alarming.

“The disintegration of the health care systems in the affected countries is already having a profound impact on the populations’ health beyond Ebola, as clinics close or become overwhelmed or nonfunctional,” write Dr Jeremy Farrar and Dr Peter Piot, in an accompanying editorial.

The blame for the continued spread of Ebola lies with the response, says the WHO experts in the report. “Control efforts have been insufficient to halt the spread of infection,” they wrote.

That alone is not the problem. Poor health systems and the public response to health messaging about the outbreak have also made for a difficult response. Changing the course of the outbreak will require a re-doubling of what is currently being done and the use of new drugs and vaccines, they say.

USAID's DART team procures hygiene items for ebola response.  (Sarah McElroy, USAID)

USAID’s DART team procures hygiene items for ebola response.
(Sarah McElroy, USAID)

Farrar and Piot take a decidedly longer view on the Ebola outbreak. Their editorial points to three ‘transformations’ needed to ensure that something like this does not happen again. They include:

  1. Not having health systems in order can make an outbreak worse.
  2. The traditional ‘outbreak control’ efforts no longer cut it.
  3. More priority must be given to developing treatments and vaccines to rare, deadly and inevitable diseases, like Ebola.

Doing whatever is possible right now is the priority. Improvements have been made in areas like disease surveillance, but that is not nearly enough.

“We have become better at picking these things up; we now must also learn to act more effectively,” conclude Farrar and Piot.


About Author

Tom Murphy

Tom Murphy is a New Hampshire-based reporter for Humanosphere. Before joining Humanosphere, Tom founded and edited the aid blog A View From the Cave. His work has appeared in Foreign Policy, the Huffington Post, the Guardian, GlobalPost and Christian Science Monitor. He tweets at @viewfromthecave. Contact him at tmurphy[at]