Liberia was declared Ebola-free on Saturday, with 42 days gone since the last victim died there. But that doesn’t mean the country’s free of the effects of the deadly disease.
Ebola can come back over the border at any time from Guinea and Sierra Leone. And the disruptive effects of Ebola mean vaccination programs have been suspended. Many people are scared to come to clinics for treatments for malaria, pneumonia and other diseases or even to have babies.
These consequences could mean many more people will die than have been killed in the current Ebola epidemic, health experts predict.
“The interruption of Liberia’s vaccination program has created an alarming immunity gap and a larger pool of susceptible children,” said Dr. Walter Gwenigale, Liberia’s health minister.
“The interruption of Liberia’s vaccination program has created an alarming immunity gap."
The ministry, World Health Organization and United Nations started vaccinating children Monday with the aim of getting 600,000 immunized against polio and measles by the end of the week.
“This vaccination campaign, which will protect children against diseases that can kill or paralyze them, is a crucial step towards recovery and the restoration of health services," Gwenigale said.
He said the number of measles vaccinations fell by 45 percent for August-December 2014 compared to the year before.
In March, experts at the University of Southampton predicted that as many as 5,000 children could die across West Africa if they didn’t get vaccinated against measles soon.
Ebola was stopped without drugs or vaccines. In fact, tests of a new vaccine against Ebola got scaled up the same week that the virus disappeared from Liberia. Drugs and vaccines both are being tested in Guinea and Sierra Leone, also, but those countries are reporting fewer than a dozen new cases a week now – compared to hundreds a week at the height of the epidemic.
WHO admits it was slow in fighting Ebola, which has infected more than 26,000 people and killed more than 11,000 of them in West Africa in the past year. WHO is now re-examining its emergency response structure.
Ebola experts say it doesn’t take anything high-tech to stop outbreaks of the virus. They say identifying cases quickly, getting those people isolated, and carefully watching their contacts can stop it from spreading.
That is because the virus, although highly deadly, only spreads with close physical contact or contact with body fluids.
But in West Africa, rumors, poverty and mistrust of government all combined to allow Ebola to spread quickly and quietly across borders. It wasn’t until health officials persuaded community leaders to help gain the trust and cooperation of local residents that efforts to stop the epidemic could work.
“Local volunteers, who worked in treatment centers, on burial teams, or as ambulance drivers, were driven by a sense of community responsibility and patriotic duty to end Ebola and bring hope back to the country's people,” WHO said in a statement.
“Community task forces were formed to create house-to-house awareness, report suspected cases, call health teams for support, and conduct contact tracing,” it added.
Volunteers stopped people from washing and embracing the bodies of victims -- an unusually efficient way to spread the virus -- and persuaded patients that clinics weren't simply death traps.
"There are still reports of anti-health worker sympathies in many remote areas."
In Lofa, officials figured out one way to stop rumors. “See-through walls around the treatment center replaced opaque ones, allowing families and friends to watch what was happening inside, thus dispelling many rumors. Calls for transportation to treatment facilities or for burial teams were answered quickly, building confidence that teams were there to help.”
But this hasn’t happened elsewhere, cautions Jesse Hartness of Save the Children, one of the charities trying to help.
“What many are saying needs to happen now in Sierra Leone and Guinea is very strict focus on early detection, isolation and referral of new cases,” Hartness said.
“To do this, particularly in Guinea, there has to be much better engagement with remote communities where cases are still coming up to earn the trust and allow for teams to do their work. There are still reports of anti-health worker sympathies in many remote areas."
Last September, eight people who were part of a team trying to educate locals on the risks of the Ebola virus were killed in a remote area of southeastern Guinea and a Red Cross team was attacked while trying to bury the dead.
Such fears have greatly hindered efforts to control the epidemic.
WHO says it now aims to finish Ebola in Guinea and Sierra Leone by June.
In the meantime, it's looking for help from international donors in fixing a system that failed to stop the epidemic in time. "In light of the unpredictable nature of outbreaks and other health crises, and the mounting ecological changes that may trigger them, improving WHO’s response to events such as these is critical," it says in a report issued Monday.