West African countries show Ebola can be beaten

West Africa, a dynamic belt with nearly a quarter of a billion people and two of the 10 fastest-growing economies in the world this decade, has recently been marred by the Ebola epidemic consuming three of its smallest countries — Guinea, Liberia and Sierra Leone — whose combined populations represent not even one-tenth of the wider region’s inhabitants. And while “West Africa” has become inextricably linked to the dreaded virus and Africans abroad — including in the Washington area, which has the second-largest population of immigrants from Africa in the U.S. — are increasingly feeling stigmatized by fears of its transmission, the good news that two countries there, Senegal and Nigeria, have been declared Ebola-free by the World Health Organization (WHO) needs to be highlighted and the lessons of their success provide some useful lessons amid the growing alarm in the United States about the disease’s spread.

The WHO declarations regarding Senegal last Friday and Nigeria this Monday come 42 days — twice the maximum incubation period for the Ebola virus in a human body — after the last case was diagnosed in each country. These wins in containing the epidemic, which has so far infected more than 9,000 people, taking the lives of some 4,500 of them, are all the more astonishing given that both are developing countries with healthcare systems that struggled even before the outbreak with heavy demand and meager resources.

{mosads}The U.N. public health agency’s assessment about Senegal noted that “The most important lesson for the world at large is this: [A]n immediate, broad-based, and well-coordinated response can stop the Ebola virus, carried into a country in an infected traveller, dead in its tracks.” In fact, months before the first and only case of the disease in the country — a young man who traveled to the capital of Dakar by road from neighboring Guinea — was diagnosed in August, Senegalese authorities, aware of the epidemic gathering steam just across their borders, had a detailed response plan in place, coordinated by the president’s office and involving multiple government agencies. Once the one case was confirmed, 74 persons the patient had come in contact with — some through casual contact, others being healthcare workers eventually involved in his treatment — were quickly identified and subject to close monitoring by government officials and twice daily checkups by medical personnel. At the same time, Senegal closed its 330-kilometer land border with Guinea and banned flights and ships from Guinea, Sierra Leone and Liberia, while opening up a humanitarian corridor through its airport to facilitate the seamless movement of humanitarian personnel and supplies through a key regional hub — thus demonstrating that border security and the prioritization of lowering risks to a country’s own citizens is not necessarily inimical to efficient aid delivery to others.

Senegal’s Minister of Health, Dr. Awa Coll-Seck, told WHO officials that her country’s successful battle to contain the disease’s spread was due not only to its rapid reaction and the support of its international partners, but also to its intentional policy of supporting “the reintegration of the recovered patient into a society that could understand why he posed no risk of contagion to others” as well as providing direct assistance in the form of money, food and counseling to those in contact with the patient as a strong incentive for their cooperation. In the end, Senegal’s single patient survived and all those he had contact with completed the full three-week follow-up.

Ebola came to Nigeria in July when an infected Liberian government official, Patrick Sawyer, arrived in the country’s biggest city, Lagos, literally collapsing in the arrival terminal of the international airport. When he was taken to a hospital and the disease was diagnosed, Nigerian officials at the state and federal levels quickly swung into action, adapting a preexisting contingency plan for a mass polio outbreak. They had to move fast since, as the most recent WHO situation assessment observed, for a disease outbreak, Nigeria “is a powder keg.”

An interagency Ebola operations center was established just three days after the first case was confirmed (in contrast, Ron Klain was not tapped to serve as the Obama administration’s Ebola “czar” until three weeks after the first diagnosed case of the hemorrhagic fever in the United States, Thomas Eric Duncan, was admitted to a Texas hospital and more than a week after the victim died). In what WHO officials hailed as “a piece of world-class epidemiological detective work,” the Nigerian center worked with airlines, travel agencies and hospital administrators to identify nearly 900 at-risk people whom Sawyer and those who had been in contact with him might themselves have possibly transmitted the virus onto. These individuals in Lagos and Port Harcourt (where one physician who had treated Sawyer had gone) were subject to a rigorous protocol, including in-person monitoring twice daily.

According to a report published by the U.S. Centers for Disease Control and Prevention (CDC), working outward from the initial list of at-risk individuals and eventually interviewing neighbors and others in close proximity to them, specially trained Nigerian case management personnel visited some 26,000 homes and conducted 18,500 face-to-face interviews over the course of the following two months. Instead of being allowed to get on a commercial flight like Ebola-stricken nurse Amber Vinson or to embark on a cruise like the technician who handled Duncan’s specimens (much to the relief of the 4,000 other passengers and crew members of the Carnival Magic, she subsequently tested negative), persons in Nigeria found to be exhibiting Ebola-like symptoms or who had likely exposure to the virus were transported to a suspected-case isolation ward at nearby hospitals by the monitors and those who subsequently tested positive for the Ebola virus were moved to the confirmed-case ward at facilities in either Lagos or Port Harcourt. The authors of a study published this month by the peer-reviewed epidemiology journal Eurosurveillance identified three essential elements of Nigeria’s successful approach: thorough tracing of contacts, following by their ongoing monitoring and, if necessary, the effective isolation of those who proved infectious.

Nigerian authorities also embarked on a multimedia campaign to educate the public about the disease, including using billboards, posters, television and radio. Businesses and private groups also contributed to the efforts. One nonprofit research organization supplied healthcare workers with mobile phones and an app that eventually reduced the lag in reporting the onset of symptoms to almost real time. Another group of volunteers, banning together as EbolaAlert, used Facebook, Twitter and other social media to educate Nigerians and also partnered with the government to operate a telephone helpline. Ultimately, Nigeria, Africa’s most populous country with over 175 million people, suffered only 20 confirmed Ebola cases, resulting in eight deaths.

The good news in Senegal and Nigeria is very welcome to the citizens of those two West African countries, although vigilance should be maintained as long as the virus continues to ravage nearby countries. It is also a boost for global health in general, since the removal of the two nations from the list of those suffering outbreaks frees up resources to concentrate on those areas where the Ebola epidemic still rages unabated. Moreover, amidst the outbreak of “Fear-bola” in the United States, these success stories are a salutary reminder, both that the disease’s spread can be arrested with careful planning and rigorous implementation and, as Nigerian President Goodluck Jonathan said about his own country’s efforts, of “what we can achieve as a people if we set aside our differences and work together.”

Pham is director of the Atlantic Council’s Africa Center.