The current Ebola outbreak, the most severe and complex in history, is now making its impact felt worldwide. The deadly disease has killed over 960 people so far in Guinea, Liberia, Sierra Leone and Nigeria. Seven additional West African countries (Guinea-Bissau, Senegal, Mali, Ghana, Benin, Burkina Faso and Niger) are on alert.

Communities in West Africa have witnessed horrific scenes of infected people dying with symptoms of severe bleeding. Suspected case or cases under medical care are now in Africa, Europe and North America. Liberia, Sierra Leone and Nigeria have declared Ebola as national emergencies. The military has been deployed in an attempt to quarantine people and stop their movements and therefore the spread of the disease. These are not scenes from fictional Hollywood movies such as ‘Outbreak’ or ‘Contagion’ - this disaster is unfolding in real time.

The World Health Organization (WHO) has declared the outbreak an international public health emergency demanding an “extraordinary” response. We are in a situation where the deadly outbreak is threatening to kill more people in West Africa and beyond. What is needed now is not a speculative prediction, but collective global action to invent Ebola’s future.

This is a decisive moment in the battle against Ebola. Time is running out fast, millions of lives are at stake and the world needs to act now. Investing in public health systems and disaster preparedness measures is the best way to invent the future trajectory of the Ebola outbreak.

No vaccine or cure

Ebola is one of the world’s most virulent diseases and it spreads through contact with an infected person's bodily fluids. Initial symptoms are the sudden onset of fever, intense weakness, muscle pain, headache and sore throat. Such common symptoms make it hard to detect Ebola easily. There is no vaccine or cure and Ebola kills up to 90% of those infected, making it a ‘doctor’s nightmare’.

Complementary care such as rehydration can help to save lives in some instances. Stopping the spread, through public health promotion and better awareness, is the best way to reduce infection rates and reduce deaths.

The easy movement of people across porous borders between countries; the initial gross under estimates about the ability of the disease to spread; the lack of information;  risky burial practices and above all weak public health systems and poverty have all contributed to Ebola’s steady spread.

Over 160 health workers are reported to have been infected, half of whom have died. Rumours are also rife on the ground making an already challenging response even more complicated. In some cases, local mobs have attacked health workers forcing emergency centres to close. Until now, Ebola has been one-step ahead of the response and unfortunately, it is not showing any immediate signs of slowing down.

World responsibility

The WHO declaration is expected to bring much needed public health specialists and financial resources to fight the crisis in the impacted countries. The current outbreak is an unprecedented crisis with global dimensions - it is both the longest and largest outbreak in terms of deaths, infected cases and the number of countries affected.

In addition to precious lives, psychological and economic impacts can be catastrophic. The World Bank estimates that the outbreak will reduce economic growth in Guinea, where the outbreak originated, from 4.5% to 3.5% this year.

Well-prepared health workers can fight not just the Ebola outbreak, but other epidemics and disasters too

Local health workers and aid agencies such as Plan International, Médecins Sans Frontières (Doctors Without Borders) and International Medical Corps have been on the frontline, fighting a battle with limited resources and increasing challenges. Turning the tide of this deadly disease is now the collective responsibility of the world. Better and humane care for those that are infected as well as building strong public health systems are fundamental - not only to deal with this outbreak, but also to respond to future shocks.

The next phase

Dr. Thomas Frieden, Director of the Centers for Disease Control and Prevention, testified before the US government’s senate committee last week. He warned that it will be a ‘long and hard fight’. He described a worrying picture which he called a best case scenario: it will take at least 3 to 6 months to end the outbreak. “If you leave behind even a single burning ember, it’s like a forest fire,” he said. “It flares back up.”

To invent the future of this outbreak, rather than just to make a prediction, here are the first steps that need to be taken.

• Intensify care and support (including emotional care) for infected people, their families, health workers and caregivers through additional isolation care and support units across the impacted countries. 
• Reach out to the most vulnerable people, such as children and women, who are often in far-flung remote pockets. This step must be complemented by reassurances to save lives of those who come forward to such healthcare units, preferably through appeals by heads of nations and local leaders. There are distressing reports of infected people being left in the streets to die for fear of contamination. 
• While the 4 West African countries with confirmed cases should be the first priority, it is time to shift gears and step up surveillance and public health promotion in the other 7 countries that are on alert. 
• The outbreak has exposed the underbelly of weak health infrastructure in the impacted countries on alert. Most of them are at the bottom of the human development index and have some of the weakest public health systems in the world. Conflict destroyed most of the healthcare facilities in Liberia and Sierra Leone. Both countries have approximately 1 doctor per 35,000 to 40,000 people. WHO recommends 1 doctor for every 10,000 people. 
• Rich nations and emerging economies need to be generous and deploy all possible resources to intensify the battle against Ebola. Despite the recent injection of funds by the WHO, the World Bank and European Commission, the response has been massively underfunded. It is in the best interest of the world to intensify the battle against Ebola and stop its spread. Neglected tropical diseases continue to cause significant death and health complications in the developing world. Yet, only a tiny portion of the total funds for research globally is spend for diseases such as Tuberculosis, Malaria and HIV. In 2012, an estimated 627,000 malaria deaths was recorded worldwide - 90% occurred in sub-Saharan Africa and 77% in children under 5 years of age. Investments are needed for research and to develop cures.

The outbreak is a wake-up call to build strong public health systems, including disease surveillance measures; early warning systems and improved epidemic preparedness measures. Well-prepared health workers can fight not just the Ebola outbreak, but other epidemics and disasters too. Investing in public health systems and disaster preparedness measures is the best way to invent the future trajectory of the Ebola outbreak.

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