THE Centres for Disease Control and Prevention (CDC) pronounced emphatically on the 2014 Ebola as the largest epidemic in history, and indicated that at October 10, 2014, there were 8,399 total cases with 4,033 total deaths from widespread transmissions in West Africa (Liberia, Guinea, and Sierra Leone); and one travel-associated death in the USA (CDC, 2014). Experiencing this huge epidemic certainly requires strong health systems to withstand the disease impact.

The health care delivery systems all over the world have to always be in a state of preparedness and readiness for any eventuality. And it is not sufficient for health officials to say that a virus is unlikely to reach some countries. This kind of statement invariably is a camouflage for not having proactive prevention infection measures in place.

‘The health care delivery systems all over the world have to always be in a state of preparedness and readiness for any eventuality. And it is not sufficient for health officials to say that a virus is unlikely to reach some countries. This kind of statement invariably is a camouflage for not having proactive prevention infection measures in place.’

Again, such a remark is typically devoid of any supporting evidence that the virus would not touch any country. Such an observation fails to internalise that the ease and rapidity of people travelling the world over implies the ease and rapidity of the virus travelling globally, too. Prevention, therefore, becomes the name of the game in the battle to ward off infections, thus the necessity for planning for prevention infection programmes for the general public as well as health practitioners.
In 1981when the AIDS virus was first identified in the U.S., health officials were caught with their pants down. There was not even a semblance of preparation for the AIDS onslaught that was to come. In those early days of the AIDS pandemic disaster, the U.S. health care delivery system was not in a state of preparedness, with no well-defined sense of direction, and had no short and long-term planning (Bartlett, 1987, p.3).
But although in those early years in the U.S., there was problematic planning and preparedness for the AIDS pandemic, the scientific advances were well ahead of the planning and prevention mayhem, thus (Bartlett, 1987, p.3): AIDS was first identified in 1981; the etiologic agent was recognised in 1983; the building blocks of HIV’s DNA and RNA were stated in 1985; the Retroviral treatment was made public in 1986; and vaccine clinical trials started in 1987. These dates show that there was some reasonable control and treatment over the AIDS pandemic between 1981 and 1987 in the U.S., largely because of sensible health systems in place in that country.
Today, it is difficult to conclude that there is some reasonable control and treatment over Ebola. Ebola was first identified in 1976 when two concurrent outbreaks, in Nzara, Sudan and the other in Yambuku in the Democratic Republic of Congo (alongside the Ebola River from which the disease crafted its name) (WHO, 2014a). There is still no approved vaccines or medicines for Ebola, 38 years after its discovery. Indeed, the AIDS pandemic has had more favourable treatment than Ebola, for today there still is no approved anti-Ebola vaccines or medicines.
Given the unavailability of anti-Ebola medicines, strengthening health systems must become a number one health priority and a mandatory prerequisite for planning for prevention infection programmes, especially in the case of the Ebola virus. And strengthening health systems must be part of any national preparedness strategy in any country.
Head of the CDC, Dr. Thomas Frieden recently compared Ebola to AIDS, indicating that without much work, Ebola could easily become the world’s next AIDS (Sherwell, 2014). Much work must include planning for prevention infection programmes, illustrated through proactive health activities in Telimele, a small town in Guinea, a country already ravaged by Ebola. There is a heart-warming story of how a small town, well away from the epicenter of Ebola, fought back against great odds to become certified as free of Ebola (WHO, 2014b). Here is that story drawn from the World Health Organisation (WHO):
Even in the face of multiple economic adversities, how did Telimele rid itself of Ebola? Telimele, with a population of 300,000, is about 270 kilometres from Conakry, the capital of Guinea. Some type of national preparedness plan was activated as Ebola started to spread across Guinea. And so the staff of the 44-bed district hospital in Telimele then presented themselves for training in infection prevention. This hospital already had quality certification for prevention infection and control.
In May 2014, a woman from Sogoroya near to Telimele went to see her sick uncle in Conakry. When she returned, she went to the Telimele Hospital with symptoms akin to typhoid fever. In a few days, she returned to the hospital and died after the hospital admitted her. In that same fateful week, her mother and one family member came to the hospital with symptoms similar to hers, and they, too, died a few days later. Two other family members went to the Sorogoya Health Centre with similar symptoms.
At that point, the Telimele district hospital then moved into action, suspecting the presence of Ebola at Sorogoya, and so its laboratory team visited the village to acquire samples. The laboratory tests confirmed that Ebola had arrived in the Telimele area.
Medécins Sans Frontières (MSF) took swift action and created an isolation section in the Sorogoya health centre, and quickly constructed a treatment facility not far from the health centre. The WHO then made available some experts for coordination, surveillance, and data collection.
The Telimele people established a crisis committee comprising of Telimele’s leaders, and this committee promoted this message: “Come early for treatment – you survive; you come late – you die.” The local health workers had strong rapport with the community and thus people trusted them. Rapport of health workers with the community was critical for people to comply with the public health advice. There also was a 14-person contact tracing team that monitored the health status of 250 contacts. By the end of July 2014, Telimele was certified Ebola-free.
In developing proactive prevention infection programmes and applying the lessons from Telimele’s ground-breaking fight against Ebola, health officials should define what prevention is. In a restricted sense, prevention entails stopping a disease in its tracks before it becomes a reality; but today, prevention also is used to present measures that would suspend or reduce disease progression; and so there is now primary prevention (susceptibility stage where a vulnerable person has less disease exposure), secondary prevention (preclinical and clinical stage where there is quick detection of disease and treatment), and tertiary prevention (advanced disease stage where there is relief to disability arising from the disease) (Mausner and Kramer, 1985).
Health officials do not have to wait for something like Ebola, to plan for and establish prevention infection programmes. Such activity must be a number one health priority.

References:
BARTLETT, J. G. 1987. Point of View: Planning Ahead. AIDS Patient Care, 1, 3-5.
CDC. 2014. Ebola (Ebola Virus Disease) [Online]. Available: http://www.cdc.gov/vhf/ebola/ [Accessed October 11, 2014.
MAUSNER, J. S. & KRAMER, S. 1985. Epidemiology-An Introductory Text WB Saunders Company. Philadelphia.
SHERWELL, P. 2014. Ebola compared to Aids epidemic by top American health official. The Telegraph, October 9, 2014.
WHO. 2014a. Ebola virus disease [Online]. Available: http://www.who.int/mediacentre/factsheets/fs103/en/ [Accessed October 11, 2014.
WHO. 2014b. The Guinean town that overcame Ebola [Online]. Available: http://www.who.int/features/2014/telimele-ebola-free/en/ [Accessed October 11, 2014.

(By Dr. Prem Misir)