16 January 2015 As efforts to tackle the devastating Ebola outbreak, which has infected over 21,000 people and killed 8,500, finally start to bear fruit, responders are now shifting focus from providing treatment and safe burials, and mobilizing communities to tracing and isolating people at risk of developing the virus. The aim is to move towards zero cases and to try to get essential services and other basic needs of life back in place again.
David Nabarro has served as Special Envoy on Ebola since August 2014, providing strategic and policy direction for the UN response to Ebola and galvanizing essential international support for affected communities and countries. He works closely with the new Special Representative and Head of the United Nations Mission for Ebola Emergency Response (UNMEER), Ismail Ould Sheikh Ahmed, supporting the region’s Governments in their efforts to eradicate the disease.
Dr. Nabarro spoke with the UN News Centre in New York between his latest visit to Liberia, Guinea and Sierra Leone and a trip around Europe where he will visit the World Economic Forum and national capitals, seeking more resources to continue the fight against the outbreak. He described the reducing intensity of the outbreak, the shift in focus of responders and his growing confidence that the outbreak can be beaten. He also stressed the need for continued vigilance and more international support – in the form of people, materials and money – and looked forward to approval of a potential vaccine for the disease.
News Centre: Good afternoon, Dr. NabarrWe need resources at all times. People, materials, money. And, in order to get those resources, we have to ask Governments and Foundations to contributeo. Can you please give us the latest on where the emergency response to Ebola stands today?
David Nabarro: Thank you very much. I’d like to start by describing the outbreak as it appears right now, and then I’d like to talk about the way in which the national Government and local communities are responding and the ways in which the international community is helping them.
Let me quickly describe the outbreak. In September, we were seeing the numbers of cases in the region rising towards 150 per day and we were watching the daily tally increase day by day in an exponential fashion. That means the outbreak was accelerating ahead and we were very worried that the outbreak was outstripping the response. As I sit with you today, we have a daily figure for the numbers of new cases nearer to about 50 per day altogether. And in some days it’s less. But most importantly, if we look week by week, the numbers of new cases is gradually reducing. It’s the first time we’ve seen, in all three of the affected countries, signs that the outbreak is reducing in intensity. Now, we’ve not completed the job as responders until every last case has been identified and under treatment, and so we’ve still got some way to go.
The response is being led by the Governments of the affected countries. It covers a huge area, almost the size of France. It’s broken down into about 60 sub-areas – districts, counties and prefectures. And, in recent weeks, the response has become much more focused on these local levels. It’s shifted from just focusing on providing treatment or safe burials or mobilising communities, to a very focused effort to identify people at risk of Ebola, people who’ve got Ebola, to make sure they quickly come under treatment and isolate themselves from their families, and then at the same time to follow-up everybody with whom they’ve recently been in contact. That phase that we’re involved in right now is called ‘case finding and contact tracing’. It’s like detective work. And that’s where we are right now with the absolute goal of reaching the point where there is no more Ebola infection in the region, and at the same time where we’re seeing a recovery of the normal aspects of life, like schooling, like healthcare, and like agriculture, and like markets, all the things that represent normal life coming back and getting things going again. So that’s the phase we’re in at the moment. Moving towards zero cases and trying to get essential services and other basic needs of life back in place again.
News Centre: And as that focus shifts to reaching zero cases, how do we reach that figure exactly and how will that level eventually be maintained?
David Nabarro: So, reaching zero cases involves identifying anybody who’s at risk of the infection and keeping an eye on them for about 20 days to see if they’ve got it. And to be at risk, you have to be somebody who’s been in contact with a person who’s known to have had the infection. That’s called ‘contact tracing’. When we are moving towards zero cases, our contact tracing is so good that any new cases that emerge come from the lists that we have of people who’ve had contact with somebody who has Ebola. If we’re still some way away from reaching zero, then we’re seeing surprises; suddenly we’re getting notifications of a case here and a case there. But once the surprises stop, once the cases come from people we know have been affected, then we have a pretty good sense that we’re getting toward zero. Now, are we there yet? Well, in some parts of the region, I’m happy to tell you, that we really do understand the chains of transmission and the contact tracing is very good. In other parts, we’re still getting the surprises. Flare-ups suddenly occur. I went to places on my most recent visit just a few days ago where there had been flare-ups and where there was quite rapid action to get people under treatment and to try to find out the cause of the flare-up. But it’s gradually reducing day by day and week by week. And that’s why we’ve got a general sense that we’re in the right direction. We’re not there yet and we have to remain vigilant and avoid any kind of complacency.
News Centre: And during those visits to the worst affected countries, what had changed since the last time you had been there?
David Nabarro: Well, I’ve been on six visits to the region. When I started in August, it was frightening. We really didn’t know what was going on. I would say to people: ‘We don’t know what the next few weeks are going to be like,’ ‘We don’t know how many cases there will be altogether,’ ‘We don’t know how much suffering and misery we’re going to see.’ and we were bracing ourselves for some very bad news. And there was bad news. September was worse, and October was difficult. But in the last few weeks, we’ve seen a big shift, a sense of self-confidence a sense that it can be beaten. It started in early December in Liberia, some parts of the country which had been so badly affected beforehand reporting near zero or zero cases; other parts of the country at least beginning to feel better. But even in early December it was scary. And in Sierra Leone in early December was very scary indeed.
But the big shifts in Liberia and Sierra Leone and even in Guinea have really only been since the new year started and I feel an incredible sense among everybody of ‘Yeh!’ not we’ve done it but ‘Yeh, we can do it!’ And that is the sense around the place – a feeling that it’s a doable job, it’s achievable. It can be done but we’ve just got to maintain focus and attention and complete the job. To use an expression in sport, if we take our eye off the ball, then it will come back very, very quickly. We’ve seen that with other outbreaks. So there’s absolute need to maintain focus, vigilance and discipline and that was very much my main message as I was travelling. It wasn’t so much me saying it, it was people saying it to me and me repeating it back to them: maintain the vigilance, maintain the rigour and make certain the job is done.
News Centre: In the region and internationally, what are the main things needed in order to maintain that vigilance?
David Nabarro: To maintain a situation where we’re keeping a lookout for disease and where we’re able to respond quickly, the most important requirement is to have experienced people, people who know about disease. They’re called epidemiologists. And that means they study epidemics. But because this disease is very much driven and spread through the way in which people behave, particularly around the time of sickness or death, we also need to have another group of people working on it called anthropologists. The people who study behaviour. Taken together, teams of epidemiologists and anthropologists need to be scattered throughout the affected countries, keeping a close watch on the levels of disease and on what’s happening in the population to respond to it. We need them everywhere. We need hundreds of them because we need to be able to find every single person who has Ebola and keep them under surveillance and get them under treatment if they get sick and when they get sick. So it’s getting a broad spread of experienced people, supporting them with supervisors, enabling them to communicate together through very effective IT, having transport systems so we can supply them with what they need in places that don’t have good roads or good communications of any kind. And that is our focus.
News Centre: And as you embark on a trip around European capitals, what will be the focus of that trip?
David Nabarro: In order to maintain the effort, the Governments, partners from Non-Governmental Organizations, people from within the UN system, have to maintain regular programming, have to have cash in order to be able to deal with any problems that arise, have to have the transport so they can move around. We need resources at all times: people, materials, money. And, in order to get those resources, we have to ask Governments and foundations to contribute, and so I will be travelling to countries, to big conferences like the World Economic Forum, I will also go to the African Union, who’ve been fantastic contributors of people – volunteers especially – just to make sure that those who are giving resources understand how useful their gifts are, and those who are thinking about giving are actually encouraged to be as generous as possible.
News Centre: The WHO recently said that a new vaccine offered ‘signs of hope’ and I just wondered how and when is any vaccine likely to reach people in those worst affected countries.
David Nabarro: During the last few months, there has been a lot of effort to try to identify a vaccine that would prevent people who are exposed to Ebola from getting ill with the disease by building up antibodies inside a person’s body. And this latest outbreak has provided a massive impetus to manufacturers to develop candidate vaccines and then to find ways to test them, first of all on individual volunteers and then on communities that have a risk of disease. Two candidate vaccines are under test right now. If they can be developed and found to be safe, and to work, then they will have a big impact, not so much on the overall response but on the safety of health workers and others who are encountering people with Ebola and who are at risk of disease.
You know, in the last few months, hundreds of health workers have got sick with the disease and too many of them have made the ultimate sacrifice and died. I think that’s a tragedy. And I would like to be sure that the moment the vaccines becomes available, it’ll be the health workers who are most at risk who are protected. And that’s why I’m anxiously awaiting them and I’m told that they should become available, if all works, in the middle of 2015.
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