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Reacting Is Not Enough -- Ebola Crisis Demands International Collaboration in Prevention

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The Ebola crisis in West Africa is inflicting unprecedented horrors upon those least equipped to combat the virus. Despite headlines of experimental treatments and vaccinations, these efforts are in their early days. But we know from public health experts that there are concrete steps we can take to stop its spread, and the international response should and must be focused on prevention.

Ebola preventionThe Global Communities Liberia team is conducting interventions to prevent and control the Ebola virus.

As I write this, news reports suggest that 1,700 people have contracted Ebola and nearly 1,000 have died, but experts estimate that the real numbers may be 25-50 percent higher since there are likely many cases we don't yet know about - especially in areas that medical professionals have a tough time accessing, either because communities are remote or are suspicious of health workers. Many people in the affected areas view hospitals and clinics primarily as dangerous places where people get sick and die and even some Liberian physicians have been slow to admit the virus exists.

Ebola used to be rare, especially in West Africa, and its spread has never been this rapid or devastating. Challenges that have hampered the response in Liberia, for example, include a severe physician shortage (about 200 for a population of 4 million), a weak health care infrastructure, more than half its population living in rural areas with even less access to medical professionals, and a country still slowly recovering from years of civil war.

With the increase in global air travel and an incubation period of up to three weeks, getting Ebola transmission under control immediately is critical. There are a number of crucial steps that need to be taken.

The rapid spread reflects the need for effective public outreach. People cannot take preventive measures or get the treatment they need if they don't have timely, accurate information. While getting the current outbreak under control is the topmost priority, we also should look ahead to ensure that people are informed and protected in the events of subsequent health threats. The outreach has to be culturally sensitive and it has to reach people effectively (Liberia only has a 43 percent literacy rate) and in the languages they speak (there are more than 30 languages spoken in Liberia).

We need to implement proven approaches to prevent Ebola from spreading further. For example, Global Communities' USAID-funded Improved Water, Sanitation & Hygiene program (IWASH), which for four years has promoted healthy hygiene and safe water practices, is working closely with communities to impart critical information on the history, signs and symptoms, transmission mode, and devastating impact of the Ebola outbreak. The outreach consists of meetings that target all audiences (county-level decision makers, religious and traditional leaders, town chiefs, community health development committees and others), and are designed to counter high levels of Ebola denial, contacts with sick people, and secret burials of dead bodies that have been identified as a cause of high rates of infection and transmission. The meetings focus on educating people on how to avoid contracting Ebola and where they can get help.

In addition to prevention education, we need to strengthen existing health systems in West Africa so patients can receive the treatment they need before the epidemic surges further out of control. For instance, getting medicine, protective gear and medical equipment to health workers and hospitals must be a top priority.

And for the longer term, the international community needs to make a commitment to build capacities beyond just those needed to combat this epidemic. The current health care system in West Africa has already been overstretched to catastrophic proportions since most medical professionals in the country are dealing with Ebola now, neglecting all other care in already unhealthy, underserved communities. Other public health concerns like malaria and cholera are, for the most part, currently being ignored.

We all hope that soon the prevention efforts will get Ebola under control. But it should be a wake-up call that it is not enough to react after an event. As the international community, we need to work and invest more together to help countries like Liberia put in place appropriate medical infrastructure to prevent future outbreaks of Ebola and other diseases. As Ebola fades from the headlines - either because the crisis starts to become controlled, or because some other crisis elsewhere in the world pushed it off the headline news - the commitments being made now must be kept. Together we - the international community and the countries of Africa - can and must invest in development and prevention so that we do not find ourselves again and again immersed in emergency response.