Ebola: 2014 Outbreak in West Africa

Ebola: 2014 Outbreak in West Africa

November 24, 2014
Ebola: 2014 Outbreak in West Africa
Overview
Transmission. Fruit bats are the suspected natural reservoir
of EVD in West Africa, where some people consume bats
In March 2014, an outbreak of Ebola Virus Disease (EVD)
and other potentially infected forest animals. Humans can
began in Guinea. It spread to Liberia in the same month and
contract EVD when exposed to bodily fluids of infected
to Sierra Leone a month later. An EVD outbreak that began
animals and persons, or through contact with contaminated
in Nigeria in July was contained in August. In that same
surfaces or items (e.g., needles). Inter-human transmission
month, a case was detected and contained in Senegal.
is the primary source of infection in West Africa. During
Health officials are working to contain an outbreak that
outbreaks, close associates of infected persons face a high
began in Mali in October. As of November 20, Mali has
risk of infection, as do health care and funeral workers.
reported six cases, including five deaths. The current EVD
Asymptomatic patients are not contagious.
outbreak is the largest, most persistent one ever
documented, and is the first in West Africa. As of
Disease. Symptoms typically include fever; weakness;
November 21, more than 15,000 people had contracted
head, joint, muscle, throat, and stomach aches; vomiting;
EVD and nearly 5,500 had died (Figure 1). Infection rates
diarrhea; and bleeding. Kidney and liver function may be
are declining in Liberia, are stable or rising in various parts
impaired; white blood cell and platelet counts may drop;
of Guinea, and are accelerating in Sierra Leone.
and shock and death may occur. The incubation period (the
time between infection and the onset of symptoms) ranges
Figure 1. Global Ebola Outbreaks: 1976-2014
between two and 21 days, but is usually 8 to 10 days. There
is no cure for EVD, but EVD treatments and vaccines are
being developed. Palliative care focuses on balancing fluids
and electrolytes; maintaining blood pressure and access to
oxygen; and treating complicating infections. Prompt
treatment can extend survival prospects, but those in early
EVD onset stages may delay seeking health care, since
symptoms are akin to those of many common illnesses.
Prevention. In clinical settings, suspected EVD cases are
isolated, health care workers (HCWs) wear personal
protective equipment (PPE), and contaminated objects are
sterilized. In communities, HCWs are working with
community leaders to develop alternatives to cultural
practices (e.g., funeral rites) that might spread EVD, as well
as training safe burial teams.
Source: Created by Tiaji Salaam-Blyther based on WHO data.
There have been 20 medical evacuations of international
Responses
medical workers to developed countries infected in Guinea,
Liberia, or Sierra Leone (the “affected countries”), seven to
The Ebola outbreak has overwhelmed the governments of
the United States and 13 to Europe. Until October, all EVD
the affected countries, where it is exacerbating preexisting
cases outside of West Africa were among medical
social, economic, development, and security challenges and
evacuees. In that month, the United States and Spain
creating new ones. Schools and many health facilities have
experienced their first secondary cases, which occurred in
been closed. Trade and other economic activity have been
health workers who had cared for EVD patients.
disrupted by road and border closures and domestic controls
on population movements. These closures have interrupted
Prior human EVD outbreaks occurred primarily in rural and
access to food, income, and social and health services.
forested areas of Central and East Africa. The current
Public skepticism about political leadership and state
outbreak is occurring in both urban and rural areas. Its
capacity is growing. International pledges of financial and
current size and rate of growth is widely viewed as a
medical support are increasing, but critics allege that the
potential threat to other African countries and the world.
international response to date has been inadequate.
Due to weak surveillance systems, there is uncertainty
about the actual number of EVD cases in West Africa. The
International Response. In September, the United Nations
Centers for Disease Control and Prevention (CDC) and the
(U.N.) established the U.N. Mission for Ebola Emergency
World Health Organization (WHO) both assert that EVD
Response (UNMEER) to coordinate the international
cases are underreported. Actual cases could be two to four
response to the outbreak. That month, the U.N. Security
times larger than reported, according to WHO.
Council and General Assemblies held special meetings on
Ebola at which member states were urged to expedite
support for the affected countries and a U.N. integrated
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Ebola: 2014 Outbreak in West Africa
Ebola response plan. Implementing U.N. agencies include
Inadequate Laboratory Capacity. Efforts to contain the
the WHO, which leads the U.N. health response.
outbreak are encumbered by weak laboratory and
surveillance systems, though the situation has improved.
The six-month, $988 million U.N. plan is designed to halt
Diagnosis backlogs are being eliminated, contributing to
the outbreak and mitigate related health and social impacts.
better targeting of treatment and freeing up capacity in
Roughly 60% the funds would fund health programs and
ETUs. There are bed vacancies in some facilities in Liberia.
the balance would be used to address food insecurity,
On November 14, WHO reported that roughly 40% of
economic disruptions, and international response supply
suspected EVD cases in the country were scientifically
chain needs. As of November 14, 2014, the U.N. Office for
confirmed, up from roughly 20% a month earlier. In Guinea
the Coordination of Humanitarian Affairs reported, donors
and Sierra Leone, more than 80% of suspected EVD cases
had committed more than $1.2 billion to fight the Ebola
were confirmed through laboratory diagnosis.
outbreak and pledged to provide an additional $910 million.
Local Response Challenges. Affected countries have
U.S. Response. The United States is the leading funder of
responded to the outbreak by pursuing the responses
the global Ebola response. As of November 21, combined
discussed above, but such efforts have faced multiple
U.S. Agency for International Development (USAID),
hindrances. Misinformation about EVD and mistrust of
CDC, State Department, and Department of Defense
HCWs have led some communities to resist EVD tracking
(DOD) funding for EVD responses in Africa totaled about
and treatment efforts and, in a few cases, to attack HCWs.
$640 million. This aid supports the goals and activities in
Such factors, and fear of EVD-linked stigma, have
West Africa and other areas of Africa listed below.
prompted some ill persons to avoid health centers or to flee
The U.S. Ebola strategy has four key goals: (1) control the
clinics while being treated, increasing EVD transmission
outbreak, (2) mitigate second order impacts, (3) establish
risks. Social practices (e.g., familial care, socialization with
coherent leadership and operations, and (4) advance global
infectious patients, and local funeral practices) and local
health security. U.S. efforts focus primarily on Liberia,
customs have also contributed to failures to properly
where U.S. investments appear to be contributing to
medically treat EVD, and to further EVD transmission.
declines in new EVD cases. Due to improved conditions in
Containment. The ongoing small outbreak in Mali has
the country, DOD downgraded the number of ETUs to be
heightened concern that the outbreak may spread to other
built in Liberia from 17 to 10, and reduced the bed capacity
countries that lack the capacity to detect and respond to
of the facilities from 100 to 50.
disease outbreaks. The Obama Administration has included
The U.S. response to the Ebola outbreak is coordinated by
funds in the Ebola emergency request for its Global
the USAID. Key agencies play the following roles:
Security Agenda, which aims to bolster pandemic
•
preparedness and other health system capacities worldwide.
State Department: Coordinates U.S. responses with
Some countries are screening travelers arriving from the
affected country host governments, helps to provide
affected countries to detect EVD, and others may follow
public EVD prevention and awareness messaging, and
suit. Others have banned travel from the affected region.
ensures safe evacuation of U.S. government personnel.
• USAID: Oversees U.S. Ebola response, supports the
U.S. Policy and Congressional Actions
creation of ETUs, provides outbreak response
While on an October 25-30 visit to the affected countries,
commodities (e.g., PPE), supplements affected countries
U.S. Ambassador to the U.N. Samantha Power, stressed the
for health worker salaries, and supports training for
strength of U.S. support for the international EVD response
HCWs, burial teams, and community workers.
and called on other countries to increase their support for
•
the effort. Congress has held multiple hearings on Ebola
CDC: Coordinates U.S. medical responses, develops
and Members have introduced multiple Ebola-related bills
protocol and best practices for Ebola care, trains airport
and resolutions. The bills seek to strengthen measures to
screeners and HCWs, and supports Ebola control efforts,
curtail EVD importation into the United States, or fund or
case tracing, EVD testing, and epidemiology.
otherwise support U.S. and international responses in the
• DOD: Constructs ETUs in Liberia, trains HCWs, and
region. Congress has authorized several USAID and DOD
supports international and U.S supply and logistics.
reprogramming requests, including a $750 million DOD
Challenges
request, and provided $88 million to the Department of
Health and Human Services (HHS) for CDC Ebola
Health System Constraints. Poor conditions in health
responses in Africa and EVD-related drug development
clinics, inadequate quantities of health staff and equipment,
under the FY2015 Continuing Appropriations Resolution
and EVD cases among HCWs have discouraged some of
(P.L 113-164). On November 5, President Obama requested
the ill from attending health clinics. Clinic closures and
$6.2 billion in emergency FY2015 appropriations to fund
HCW shortages are also leaving people without health care.
U.S. Ebola responses, of which $3.02 billion would support
Health experts are particularly concerned about
overseas operations. Apart from funding matters, future
interruptions in vaccination campaigns and services for
issues for Congress may include whether U.S. and
pregnant women. Maternal and child mortality rates in the
international responses in Africa are technically appropriate
affected countries are among the highest in the world. Most
and effectively coordinated.
maternal and child deaths in these countries can be
Nicolas Cook, ncook@crs.loc.gov, 7-0429
prevented with improved access to vaccines, prenatal care,
Tiaji Salaam-Blyther, tsalaam@crs.loc.gov, 7-7677
and labor and delivery assistance.

IF00044
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Document Outline

Overview

Responses

Challenges

U.S. Policy and Congressional Actions