10 years after the 2014–16 Ebola epidemic in west Africa: advances and challenges in African epidemic preparedness

• Published in: The Lancet (British edition) 2024-06, Vol.403 (10444), p.2573-2575
• Main Authors: Keita, Mory, Boland, Samuel T, Okeibunor, Joseph, Chamla, Dick, Gueye, Abdou Salam, Moeti, Matshidiso
• Format: Article
• Language: English
• Subjects: Capacity development; Collaboration; COVID-19 vaccines; Disease transmission; Displaced persons; Ebola virus; Ebolavirus; Emergencies; Emergency procedures; Epidemics; Health surveillance; Hemorrhagic fever; Hygiene; Industrialized nations; International regulations; Outbreaks; Pandemics; Politics; Public health; Public policy; Resilience; Viral diseases
• ISSN: 0140-6736; 1474-547X; 1474-547X
• DOI: 10.1016/S0140-6736(24)00583-X

Much was done by countries, with support from partners, including work to identify and address gaps in International Health Regulations (2005) core capacities, and to develop national health security action plans informed by the findings of Joint External Evaluations.13 For example, the Ministry of Health and Public Hygiene of Guinea implemented reforms, ranging from the scaling up of integrated disease surveillance to establishing a network of decentralised public health emergency operations centres.14 When in January, 2021 another Ebola outbreak occurred in Guinea, it took 3 weeks to identify and declare it and 4 months to contain it, during which time 12 people are known to have died—a remarkable improvement compared to the 2014–16 Ebola epidemic.15,16 This evidences how informed national action plans for health system strengthening initiatives are critical for epidemic preparedness and response. There are also contextual factors that impede response efforts, including insecurity and conflict, as was seen during the 2018–20 outbreak of Ebola virus disease in North Kivu and Ituri, Democratic Republic of the Congo, when treatment centres were attacked and the presence of armed groups alongside displaced populations and general distrust in the government challenged response efforts.20 Additionally, health systems across much of the resource-limited continent remain fragile and often still lack sufficient resilience, which results from various factors including insufficient institutional and human resource capacities, accountability issues, and inconsistent government policies.21 However, the problems facing the continent can also, at times, result from global dynamics. [...]AFRO is finalising a capacity building roadmap for countries to better prepare for viral haemorrhagic fever risks (figure) that conceptualises better preparedness as a continuous process within and between each of these axes.26 This approach and other improvements must continue to be built upon, including as part of the WHO Fourteenth General Programme of Work 2025–2028.27 Much remains to be done to strengthen public health surveillance, preparedness, and resilience across Africa, and the shadow of the west Africa Ebola epidemic looms large.