Africa APPG- Roundtable with Dr Nabarro, UN Special Envoy on Ebola
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Thursday 2nd July This meeting contributed as oral evidence to the larger Africa APPG Ebola inquiry which resulted in the report- Lessons from Ebola affected communities: being prepared for future health crises. Available here-http://bit.ly/1U4rsef Follow the Africa APPG on Twitter @AfricaAPPG For more information on the Africa APPG visit- http://bit.ly/1SSrIcR and to sign up to the APPG public mailing list register here- http://bit.ly/1oF83Cp The Africa APPG is supported by the Royal African Society.
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Africa APPG- Roundtable with Dr Nabarro, UN Special Envoy on Ebola
- 1. Presentation to The Africa All Party Parliamentary Group 2nd July 2015
- 2. 1Office of the Special Envoy on Ebola | I. Current status of the Ebola outbreak. II. Progress of the response. III. Insights on questions raised by the Africa All Party Parliamentary Group. 1. What lessons can be learnt from the recent Ebola crisis in West Africa regarding the role of communities in response to health crises, and more broadly in relation to health systems at the local level? 2. What, if any, are the barriers to successful and sustainable engagement of communities in health crisis response? In addition, I consider “What are the priorities from now moving forward” Outline
- 3. 2Office of the Special Envoy on Ebola | Ebola outbreak in West Africa 2014-2015 • Zoonotic disease (It came from an animal source) • Impact on People, on Societies, on Economies • Stretching Capacities to Prevent and to Respond • A context of anxiety and concern • Focus on the Risks people face & the Realities they face • Engaging and working with people and their communities • Powerful role of Responders • We always have to anticipate surprises • Different organizations had critical roles • Importance of preparation, coordination, effective crisis response and a capacity to adapt
- 4. 3Office of the Special Envoy on Ebola | Number of new confirmed infections per week 0 100 200 300 400 500 600 700 800 900 1,000 Confirmednewinfectionsperweek Guinea Liberia Sierra Leone Total
- 5. 4Office of the Special Envoy on Ebola | Evolution of the Ebola outbreak and response 0 100 200 300 400 500 600 700 800 900 1,000 Confirmednewinfectionsperweek Guinea Liberia Sierra Leone Total I II III IV
- 6. 5Office of the Special Envoy on Ebola | 1 : The Beginning • Ebola, Cholera or Lassa Fever? • Did it really disappear end-May • What are the disincentives to reporting an unusual set of events? • Do these explain the delay?
- 7. 6Office of the Special Envoy on Ebola | 0 100 200 300 400 500 600 700 800 900 Number of cases 2 : Bending the epidemic curve PHASE 1 Behaviour change Burial teams Treatment Centre Beds Jan05 Feb02 Mar01 Mar30 Apr27 May25 Jun22 Jul20 Aug17 Sep14 Oct12 Nov09 Dec07 Jan04 Feb01 Feb15 Reporting weeks Source: WHO
- 8. 7Office of the Special Envoy on Ebola | 3 : Getting towards Zero PHASE 2 Community Ownership Case finding Contact tracing 0 50 100 150 200 250 300 350 10-Jan 16-Jan 3-Feb 15-Feb9-Feb22-Jan 28-Jan4-Jan Source: WHO
- 9. 8Office of the Special Envoy on Ebola | Communities change attitudes and practices in Sierra Leone 0% 20% 40% 60% Do not participate in burials involving handling of the body Believe that spiritual healers can treat Ebola successfully Believe that bathing with salt and hot water can prevent Ebola Percentage of respondents August 2014 October 2014 December 2014
- 10. 9Office of the Special Envoy on Ebola | 0 50 100 150 200 250 300 350 Numberofpeoplenewlydiagnosed People Diagnosed with Ebola, West Africa, 2015 Information from the World Health Organization 4: The Last Mile
- 11. 10Office of the Special Envoy on Ebola | 4 : The last mile
- 12. 11Office of the Special Envoy on Ebola | Ebola by Chiefdom/Ward, last 21 days Admin 3 Map
- 13. 12Office of the Special Envoy on Ebola | Importance of the role of communities
- 14. 13Office of the Special Envoy on Ebola | Search of at- risk villages
- 15. 14Office of the Special Envoy on Ebola | Forward operations bases Tamene, DUBREKA Kamsar, BOKE
- 16. 15Office of the Special Envoy on Ebola | Where we are on the Ebola Outbreak July 1 2015 • Ending an outbreak is always the hardest part • This outbreak started with one infected person: that is why this time we must not fail to eliminate Ebola from the human population. • To achieve this we need to be clear on the risks that people face and to ensure a “whole of society” response • There is no place for use of force or coercion • It will continue to be a bumpy road
- 17. 16Office of the Special Envoy on Ebola | Looking Forward Whole of Society Prevention, readiness and preparedness The One Health Approach is key to future collaboration It is worth the effort to prepare Coordination, financing, operating platforms, personnel, data systems in advance Recovery is an integral part of the response Prevention Preparedness Response Recovery
- 18. 17Office of the Special Envoy on Ebola | Whole of Society Readiness It requires a concerted effort that brings together the experience and resources of different Government Ministries, businesses, civil society, media and the military to sustain essential infrastructure and mitigate impacts on the economy.
- 19. 18Office of the Special Envoy on Ebola | Five aspects of a “whole of society” response to Ebola Communities are at the centre - involves local government, traditional leaders, faith leaders, politicians and civil society. The highest level of leadership (Presidents) have needed to recognise that the response includes the whole government and civil society with a special role for the health ministry. It all works best when the health sector is seen, as sees itself, as a critical contributor to a “whole of society” response. Including local-level. While vital, implementing and coordinating a whole of society response is not easy. Barriers of language, culture, trust, geography etc. are significant. The health sector is key. It must explain and analyse the situation, design the strategy, and implement the core of the response.
- 20. 19Office of the Special Envoy on Ebola | Conclusions The challenge facing us all is to collectively ensure a healthier and safer world. Undoubtedly new infectious diseases will emerge. But we should put the lessons we learned from previous or current outbreaks to use We must work together on an "All hazards approach" for prevention, detection, response and management of emerging health threats The response must be prompt, swift, effective and efficient We should aim to build back better after outbreaks are over
Editor's Notes
- Thank organisers. Thank audience. Outline presentation: Current status of the Ebola outbreak. Progress of the response. Offer insights on questions raised by the AAPP.
- Current state of the outbreak The Ebola virus has resulted in over 25,000 people being infected with the virus and over 11,000 deaths. The outbreak peaked at over 900 cases per week, falling to around 300 cases per week at the end of 2014. That number plateaued at 100-150 cases per week at the start of 2015, before falling again. Ebola remains most active in Guinea and Sierra Leone. Total of 20 new confirmed cases reported in the 7 days to 21 June. The outbreak in Liberia was initially declared over on 9 May. However, a recent case has been confirmed. This reaffirms the importance of continued vigilance.
- Evolution of the response The Ebola outbreak/response evolved in four stages. Recognition of the seriousness of the outbreak (rise in case numbers initially patchy and uncertain, then very clear). Rapid scale up (in response to rapid rise in case numbers). Taking the heat out of the outbreak (once scale of response moved ahead of the outbreak, case numbers declined). Getting to zero (current phase, finding remaining cases, working with communities, ending transmission chains).
- Behavioural change is a key element of success from a whole-of-society approach is that it leads to durable behavioral change which was a major reason for the fall in case numbers. Once people exposed to Ebola became convinced that if they behaved differently they could mitigate the consequences of the disease, they started to make their lives safer. An unprecedented range of actors—from Presidents to Non-Governmental Organisations (NGOs)—used multiple techniques in their attempts to build trust and persuade people that Ebola was real and to encourage safer behaviours. As communities and their leaders saw sickness in their community and began to believe that Ebola was a disease that both existed and could be prevented.
- This map give a sense of the total geographical impact of the Ebola outbreak since it began (blue shading). It also shows the distribution of recent cases (orange and yellow dots). The current phase of the response is seeking to contain the geographic spread of the virus as much as possible through case finding, monitoring and surveillance.
- Community engagement is the heart of the response. Local leaders were central to this process. We needed a “whole of society” response.
- One of the key recommendations of the TASW process was the value of the whole of society approach. In summary the concept is that the whole of society needs to be prepared for a pandemic – and for other threats that have the potential to affect large swathes of the globe and impact multiple sectors. Effective preparedness requires coordination, integrated planning and the management of complex relationships across different sectors; and between international, national and local actors. What started as collaboration between animal and human health has expanded to all critical sectors that might be affected by the threats or that can help to mitigate their impact.
- A range of local actors involved (government officers, traditional and faith leaders, politicians and civil society). The Health Sector is key. All leaders call on public health professionals to analyse the situation, to establish strategy and review progress. It all works best when the Health Sector is seen (and sees itself) as a critical contributor to the whole-of-society response. This should flow through tight down to the local level. In the current Ebola outbreak this has involved Presidents recognizing the response needs to include the whole Government as well as politicians and civil society. At the same time, the Health Ministry needs a special role. A whole of society approach is not easy. Barriers of language, culture, trust in authority as well as geography must be overcome.