The Fight against epidemic of the Ebola virus disease within ECOWAS

Introduction

Health systems in ECOWAS countries face serious difficulties in adequately and efficiently meeting the needs of the people. Weaknesses in governance, economic growth, population control, poverty, resource crises particularly human, socio-political, energy, and security crises, instability, food insecurity and climate change are, among others, the principal causes of this situation.

Furthermore, the region is confronted with recurring cholera, measles, meningitis and Lassa fever epidemics among others, which have undermined our fragile health systems and caused great suffering to the people. These epidemics constitute a heavy burden which impede socio-economic development and the free movement of persons and goods within the community area. 

It is against this backdrop that the Ebola Virus Disease (EVD) appeared and is one of the most virulent and deadly outbreaks ever witnessed since the emergence of the disease in Africa over nearly 40 years ago.

Within ECOWAS, Guinea was the first country to declare the epidemic on 21 March 2014.

Since the epidemic was officially declared in the region, the cumulative number of recorded cases has exceeded 19 000 with more than 7 500 deaths, according to recent data.

Table 1: Cumulative EVD cases and deaths in affected countries as at 28 December 2014.

It is worth noting that among healthcare workers, there have been over 500 cases with more than 200 deaths since the outbreak of the disease.

Countries with recorded cases are Guinea, Sierra Leone, Liberia, Mali, Senegal and Nigeria. It should be pointed out the last three countries were able to contain the disease and have been declared Ebola-free.

The last Summit of ECOWAS Heads of State and Government held in Accra on 6 November 2014, analysed the status of the Ebola epidemic, approved the memorandum submitted to them, and subsequently made several recommendations to Member States, ECOWAS and  the partners.

The Summit also took the important decision of appointing the President of the Togolese Republic to coordinate the ECOWAS response, in order to ensure the effectiveness of all efforts being made.

Summary of the major steps taken: WAHO Warning and Information to countries: Once it was notified of the first cases in Guinea, The WAHO Directorate General sent a Circular to all health ministries within ECOWAS indicating the immediate measures to be taken to prevent and contain the epidemic. In addition, an analysis of the status of the disease was conducted every week and the outcome shared with Member States. Advocacy / Resource mobilisation :

• Preparation of a plan for the fight against EVD. This plan focused mainly on health interventions.
• Signature on 19 May 2014 of a tripartite letter of agreement between WAHO, WHO and AfDB to the tune of USD 3,091,136, for exceptional and urgent assistance for the fight against the Ebola epidemic in Guinea and neighbouring countries (Cote d’Ivoire, Gambia, Guinea Bissau, Liberia, Mali, Senegal and Sierra Leone);
• Presentation of the epidemiological situation to ECOWAS Heads of State and Government at their 45th Summit in Accra on 10 and 11 July 2014. Following this presentation, Nigeria and Cote d’Ivoire respectively gave USD 3.5 million and USD 1 million to support the fight against the Ebola epidemic.
• Formulation of a regional, multi-sectoral plan to include other sectors by WAHO and the Commission in September 2014. The Plan was shared with major partners (AfDB, WB, UEMOA, AU, JICA, European Union, Bill and Melinda Gates Foundation, USAID), and also presented at a partners’ meeting organised by the President of the ECOWAS Commission in Abuja.
• Meetings with AfDB and signature of a grant agreement in October 2014 in the amount of USD 5.9 million to support the deployment of healthcare workers in Guinea, Sierra Leone and Liberia.
• Presentation of a memorandum by the ECOWAS Commission President to the Heads of State Summit held in Accra on 6 November 2014. Following this presentation, several countries announced significant contributions to the regional solidarity fund. Thus, Benin and Niger respectively contributed USD 400,000 and USD 200,000, bringing total Member States’ contributions to USD 5.1 million.  
• A roadmap was prepared and is presently being implemented by the President of Togo following his appointment as the regional coordinator for ECOWAS action.
• Presentation on the status of the Ebola epidemic to the 46th ordinary session of ECOWAS Heads of State.

Strengthening Coordination and national and regional Leadership :

• Detailed presentation on the status of the epidemic at the 15th ordinary meeting of the Assembly of Health Ministers (AHM) which was held in Monrovia on 11 and 12 April 2014. The presentations highlighted the measures to be taken by the region and all Member States to effectively combat the epidemic.

• The Health Ministers adopted a declaration in which they called for the creation of a regional solidarity fund to enable prompt response to public health emergencies including EVD, in Member States.

• An extraordinary meeting of ECOWAS Health Ministers was convened in Accra on 28 August 2014 by decision of the current ECOWAS Chairman and President of Ghana. The aim of the meeting was to enhance the coordination of actions with a view to increasing effectiveness. The health ministers decided, among other things, to put in place a regional monitoring and coordination mechanism with the creation of two bodies, namely, the Ministerial Coordination Group and the Multi-sectoral Technical Group for monitoring and supervision.

• Production, validation and distribution of consensus documents on fundamental aspects of EVD management:
  • support for the preparation of national response plans
  • case detection and treatment strategies
  • biological diagnosis (identification of laboratories in West Africa and/or elsewhere and measures to take to facilitate testing)  
  • contact management, corpse management
  • epidemiological border surveillance
  • negotiation strategy with traditional and religious leaders
• A planning meeting for synchronised trans-border activities of the three affected countries and consultation with different actors in the Ebola fight, particularly WHO, MSF and country coordination and response teams was held in Conakry.

• Deployment of 11 WAHO professionals (Guinea, Sierra Leone and Liberia) to support national coordination efforts and monitor the implementation status of decisions and recommendations from the extraordinary AHM meeting in Accra.

• Technical and financial support for the national coordination bodies put in place (Guinea,  Sierra Leone, Liberia, Gambia, Mali)

• Follow-up missions to all countries to monitor the implementation of decisions and recommendations from the extraordinary AHM meeting in Accra.

• Visit of the ECOWAS Commission President to the three most affected countries (Guinea, Sierra Leone and Liberia) in the company of the UN Representative to West Africa.

• Meeting between ECOWAS and the United Nations mission (UNMEER) based in Accra for more effective coordination in the countries.
• Working visit of the ECOWAS Commission President to present a roadmap for the next six months to the Togolese President in his capacity as the Coordinator of regional actions.

Support for implementation of response interventions for the Ebola epidemic

• Preparation and start of the West African Disease Surveillance and Response project which aims at strengthening the capacity of countries for timely detection of diseases with epidemic potential and formulation of a commensurate response.

• Direct support to countries for:

• strengthening national coordination mechanisms
• training of healthcare workers at all levels
• social and community mobilisation
• acquisition of materials, medical equipment and consumables
• strengthening of epidemiological surveillance mechanisms at entry, exit and treatment points with the setting up of treatment centres.

• Training and deployment of 118 healthcare workers (doctors, nurses and hygiene technicians) in Guinea, Sierra Leone and Liberia to support Ebola treatment efforts, with the support of AfDB and the appointment of a ECOWAS representative in each country to participate in multisectoral coordination at the local level.

Major outcomes

• Existence of national plans on the fight against Ebola in the 15 ECOWAS countries.

• Setting up of functional bodies and mechanisms for multisectoral coordination, monitoring, and evaluation of the fight against the Ebola epidemic in all countries.

• Existence of a regional plan on the fight against the Ebola epidemic.

• Significant contributions from countries to the regional solidarity fund and from partners for the financing of national plans.

• Strengthening epidemiological surveillance and treatment systems for Ebola through:

• communication activities for behavioural change including information on safe burial practices,
• preventive measures to check intra-country disease transmission (markets, places of worship, airports, schools, health centres, etc.) and at borders,
• improving diagnostic mechanisms and research measures (specialised laboratories capable of conducting on-site tests and clinical trials for vaccines),
• gradual improvement in contact monitoring and case treatment.

• End of the epidemic in two affected countries (Nigeria and Senegal) and gradual drop in the number of new cases in the affected countries.

Difficulties and Constraints :

• Weak health systems

• Limited EVD knowledge

• Lack of resources that can be readily mobilised in countries and by WAHO for rapid response at the crucial time the epidemic’s outbreak

• Inadequate financing of the health sector in all countries

• Poor involvement and commitment of communities in healthcare promotion

• Inadequate coordination, monitoring and implementation of regional intervention strategies in emergency situations

• Poor cooperation between countries in the fight against and surveillance of trans-border epidemics.

• Inadequate funds at ECOWAS level to effectively combat epidemics in the region

• Poor communication on the adoption of positive behaviours

• Continued closing of land borders and suspension of air links

• Late and poor level solidarity from the region and globally

Future steps

• Continued working and technical support visits to affected and non-affected countries to monitor the implementation of treatment protocols and preventive mechanisms

• Meeting on procedures for putting in place a model of the ECOWAS  CSREP (regional epidemiological surveillance and disease prevention centre) and implementation steps

• Creation of a mechanism for deploying the rapid intervention team with the human and financial resources and logistics for its operations

• High-level meeting on enhancing health systems (in collaboration with WHO)

• Continued meetings of the technical monitoring and supervisory group and ministerial coordination group, and organisation of a meeting between ECOWAS, AU, UNMEER and other technical and financial partners

• Continued support for coordination efforts in the three affected countries

• Monitoring and evaluation of the deployment of healthcare workers in the three affected countries

• Capitalise on the results of the "West African Disease Surveillance and Response" project in view of upscaling the model to enhance epidemiological surveillance.

• Capacity building for journalists and social and community mobilisation stakeholders

• Advocacy for gradual opening of humanitarian, health and economic corridors and gradual resumption of air links to the most affected countries

• Continued advocacy for the mobilisation of funds for activities relating to enhancing health systems.

Status of the regional solidarity fund

Actual contributions received as follows:

Contribution pledges made at the last Heads of State Summit yet to be received:

All contributions (actual and promised) stand at USD 8,324,409. These contributions led to direct support for the most affected countries: Guinea (1 216 239), Sierra Leone (619 109), and Liberia (500 000), and also other countries in various areas such as training, equipment and consumables, social mobilisation, surveillance, etc.

Out of the USD 5,684,409 received, USD 4,907,819 has been spent and USD 500,000 transferred to the Commission on 5 January 2015, bringing total outgoings to USD 5,407,819, hence the balance of USD 276,590.

Furthermore, ECOWAS has directly contributed to the efforts of the three most affected countries with a sum of USD 3 million, that is, a million per country.

Conclusion

To date, several activities have been carried out to contain the Ebola epidemic with the technical and financial support of several partners and ECOWAS mobilisation.

From the epidemiological perspective, there is a downward trend in the number of new cases. With the exception of Guinea where the fatality rate remains high, downward trends have been observed in the two other countries (Sierra Leone and Liberia).

Again, the epidemic once more points to the fact that:

• rapid mobilisation of additional funds by Member States and ECOWAS for prompt response at critical moments is very necessary.

• enhancing the health systems in member countries and adequate health funding have become priorities hence the importance of advocacy in countries to encourage compliance with the Abuja Declaration by dedicating at least 15% of their annual budget to health.  

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