Ebola Threats Anywhere are Health Threats Everywhere
How the simple (handwashing) and the complex (big data) work in concert to prevent the next outbreak
This year on Global Handwashing Day, we want to acknowledge all of the global actors who partner with USAID to prevent the spread of infectious disease. Especially in the era of transatlantic flights — where a disease threat anywhere is a disease threat everywhere — working together to accelerate prevention efforts has never been more important.
From the survey data collectors to civil society organizations, to primary school teachers and the private sector, everyone has a role to play to improve disease prevention efforts, such as handwashing, to help create healthier, more self-reliant communities.
To acknowledge those behind these prevention efforts, my story takes place in Liberia with a USAID team on the ground in the aftermath of the country’s devastating Ebola outbreak.
The Mysterious, Invisible Threat
Ebola had never been seen in West Africa, and then in 2014, in its first documented appearance outside of the Congo rainforest, the disease killed 11,000 people, more than 4,800 from Liberia.
Last year, I traveled there to work alongside the Ministry of Health to establish proactive, preventive measures that ensure invisible epidemic threats, like Ebola, are contained and can’t become a threat to our nation’s security.
I was in Liberia last year to support USAID’s demographic and health survey (DHS) program, which has sometimes been the only source of data for countries to monitor population growth, health knowledge and infectious diseases, like Ebola or HIV. Famed demographer Hans Rosling once even said that USAID should get the Nobel Peace Prize for funding the DHS program — a USAID funded survey that makes national data available to policy makers and provides actionable health data in low-resource settings.
The Challenges
I’ve been to 48 countries, worked in Iraq and Northern Nigeria, and of them all, Liberia was the toughest.
While there, I saw three bushmeat markets in a week, none of which were legal. Bushmeat provides one source of protein and income for rural Liberians and urban-dwellers alike, people who badly need food and employment. Its consumption, however, is linked to the spread of diseases, such as Ebola, and its over-harvest is a major threat to many wildlife species.
Additionally, growing human activity and deforestation in previously untouched forests has brought humans into closer contact with disease strains viral enough to precipitate an epidemic.
The Prevention Opportunities
There are many global actors with extraordinary achievements working alongside USAID to empower communities and safeguard global health security. Our Agency is supporting innovative work by West Africa Biodiversity and Climate Change, Fauna & Flora International, the Convention on International Trade in Endangered Species of Wild Fauna and Flora master’s degree students program, and Sapo National Park.
As a steering committee member in the Global Handwashing Partnership, USAID and our partners bring together ideas, resources, and the reach of the public and private sectors around the world to promote handwashing with soap. In this coalition, our Agency collaborates with a diverse set of partners, including Colgate-Palmolive, the London School of Hygiene and Tropical Medicine and the World Bank.
Sanitation and Hygiene. Hand hygiene is a crucial and cost-effective part of a comprehensive water, sanitation and hygiene program to help contain the spread of Ebola. It was simple actions like rigorous hygiene, contact tracing and data monitoring, in combination with more high-profile activities like intensive hospital care, that finally halted the epidemic. In many remote Ebola Treatment Centers, having adequate water, sanitation, hygiene and prevention control was often a significant gap that USAID programs helped fill quickly. USAID’s life-saving water, sanitation and hygiene programs and response teams work to reach affected and at-risk communities and households with key messages on how to properly wash their hands. As such, behavior change communication is particularly important.
Demographic and Health Survey Program. My team’s role in USAID’s Demographic and Health Survey Program is to equip the Ministry of Health with data to inform health policy, program planning, and monitoring and evaluation. Equipping the Government of Liberia with essential Ebola and bushmeat data will help prevent and contain the next potential outbreak, and protects our national security interests, as well as those of the global community. The Demographic and Health Survey also collects data on crucial but less flashy topics, such as handwashing. There is a huge need for rapid progress in reducing demand for bushmeat at least to sustainable levels, and the first step here is reliable data.
Community Forestry. Community forestry in Liberia doesn’t just combat deforestation, and thus diseases like Ebola. It also empowers communities, develops sustainable businesses and promotes community-based natural resources. Our partnership with local governments and communities is strengthening infectious disease fighting efforts by building forest management capacity, developing new regulatory frameworks and improving the technical capabilities of community forest managers.
Hope
The 2014 Ebola outbreak, which was finally brought to a halt in 2016, was a defining moment for Liberia’s health system. It highlighted the key role that community members and international partners can play in transforming health outcomes.
Through simple behaviors like handwashing with soap or intensive logistical and methodological undertakings like the Demographic and Health Survey program I was a part of, and many things in between, we must work with country governments to establish policies and preventions using evidence-based solutions.
Using data and lessons learned from the 2014 outbreak that devastated Liberia, we are able to support the Government of the Democratic Republic of Congo (DRC) in responding to and containing the current Ebola outbreak. In the DRC, an elite team of disaster and health experts from USAID and our partners are expanding life-saving health care, water and sanitation and other critical assistance to prevent the spread of the disease.
We must still do much more, and fortunately, we can.
About the Author
Rob Cohen is a public health physician and epidemiologist who serves as USAID’s senior adviser for monitoring and evaluation for maternal and child health. Follow @USAIDGH.
