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21 Jun 2017

The 9th of June 2017 marked the first anniversary of the last diagnosed case of Ebola in West Africa.  The devastating epidemic killed over 11,000 people in 2013-2015, including a significant number of health workers [1], and severely affected the already weak health systems of the three most affected countries (Guinea, Sierra Leone and Liberia). The World Health Organization (WHO) and leading public health experts insisted on the importance of rebuilding responsive health systems in these three countries, however, the scale of the epidemic provoked the collapsing of health systems while unleashing new medical crises.

Today, all three countries are failing to provide the appropriate level of basic healthcare to their respective population, let alone more specialised services. Health needs of over 17,000 Ebola survivors that still today suffer from a range of psychiatric, neurological, musculoskeletal and visual complications, stretch the remaining services [2]. The epidemic has also had major economic consequences, further affecting the ability of the local governments to fund and sustain health services [3].

The consequences of debilitated health systems

Routine vaccination in Guinea was drastically reduced during the Ebola epidemic, partly because attention and most resources were focused on Ebola management but mainly due to fear, and the inability of the health system to overcome this factor: people stayed away from health facilities, and vaccination activities were suspended because of infection risks. This left thousands of young children unprotected against easily preventable diseases. The authorities organised a nationwide vaccination campaign a year ago. Despite this catch-up effort, a measles epidemic was declared on 8 February 2017. Since the beginning of the year, there have been 3,468 confirmed cases of measles in Guinea and it has caused 14 deaths and an estimated 3.7 million children remain in “urgent need” of vaccination nationwide. Médecins Sans Frontières (MSF) launched in April 2017 a large-scale measles vaccination campaign in Conakry aiming at vaccinating all children aged between 6-9 years old, in collaboration the Guinean Ministry of Health.

“The fact that a new epidemic occurs barely a year after a massive vaccination campaign is a worrying sign of the weakness of health care in Guinea,” says MSF’s Guinea representative Ibrahim Diallo. “Major problems remain in the health system, undermining its capacity to prevent and respond to outbreaks effectively and timely.”

“If Ebola was a wake-up call, since then the world seems to have fallen back asleep. As shown by this measles outbreak, the concrete impact of the promises of funding, support and training made during and after the Ebola crisis remains to be felt by ordinary Guineans,” says Dr Mit Philips, MSF health policy analyst. “Access to good healthcare was clearly lacking before Ebola struck and today, the country is still facing the same problems that it was facing then, largely alone, despite the international public commitments to build better and more responsive health systems.”

Further, inability of the health system to manage Ebola survivors poses serious risks to the countries’ efforts to prevent a recurrence of the epidemic: there are possibilities of sexual transmission of the diseases even months after negative blood tests [4]. MSF is operating dedicated survivors’ clinics in all three countries.

According to WHO, only 18 per cent of the funds disbursed to support the countries during the Ebola epidemic were meant for recovery. International donor commitments to strengthening health systems have mainly focused on improving disease surveillance to ensure the early detection and response of outbreaks, such as Ebola, leaving current healthcare capacity and ability unattended.

Positive outcome

Despite the late and insufficient response of the international community to manage the spread of the epidemic, there has been some positive results of unprecedented scale due to the international attention brought during this crisis. An experimental Ebola vaccine was developed in very short time against the deadly virus with highly protective results in a major trial in Guinea [5]. The vaccine was led by WHO, together with Guinea’s Ministry of Health, MSF, and the Norwegian Institute of Public Health, in collaboration with other international partners in 2015 and still being tested.

Are we ready for the next epidemic?

Infectious diseases are emerging faster than ever before. Outbreaks of disease are among the ultimate tests for any leader who wants to play on the global stage. They demand diplomacy, decisiveness, leadership, humility, and expertise. Last month, WHO confirmed a new outbreak of Ebola in the Democratic Republic of Congo, the first one after the epidemic in west Africa in 2014-2015. The  local authorities, MSF, and other actors reacted promptly deploying a medical response to contain this outbreak rapidily. But each outbreak of Ebola is a test of what we have learned, and how ready we are for the next time. Because despite all the uncertainty around this disease, we can be sure there will be a next time.

MSF opened a survivors’ clinics in 2015 in Liberia, Guinea and Sierra Leone to provide outpatient and mental health consultations, which were handed over to the respective local Ministries of Health by the end of 2016. MSF continues to support the three countries with services that lapsed during the epidemic, such as treatment for HIV and TB, preventative services for which coverage remains low. Additionally, MSF has opened a paediatric hospital in Monrovia and a maternal unit in Conakry. 


[1]  Sierra Leone deaths amounted for 3,100 - of which 221 are medical personnel
[2] More than 17,000 people have survived the Ebola epidemics. A year after being discharged from hospital care, many of them suffer from a range of psychiatric, neurological, musculoskeletal and visual complications. These problems form what experts loosely call the "post-Ebola syndrome" or PES , and currently present a further burden for the local health system to address.
[3] Sierra Leone was on a trajectory of sustainable development with real GDP growth of 15.2 and 20.2 percent in 2012 and 2013, with improved macroeconomic stability, and progress in poverty reduction. The poverty headcount dropped from 70 percent in 2003 to 52 percent just before the Ebola outbreak. The epidemic, along with the sharp decline in commodity prices, has reversed many of these trends. The GDP growth rate for 2014 has been revised from 11.3 percent in early 2014, to 6 percent (0.5 percent excluding iron ore). For 2015, GDP growth rates have been revised down to -13 percent and -2 percent excluding iron ore.