The current Ebola outbreak is affecting the West Africa region: Liberia, Sierra Leone, Guinea, Nigeria and most recently Senegal. It is the worst outbreak ever of the epidemic. The World Health Organisation (WHO) has declared it a Public Health Emergency of International Concern, calling for a coordinated international response.
Up to 31 August, there have been more than 3 707 reported cases, including 1 848 deaths from the disease.
Liberia is the country suffering the highest tolls from the epidemic, with 1698 cases and 871 deaths. 771 cases have been reported in Guinea, including over 490 deaths. In Sierra Leone, there have been 1216 cases and 476 deaths. In addition, 21 cases and 7 deaths have been reported in Nigeria and one case in Senegal.
Recent cases of Ebola have also been reported in the Democratic Republic of Congo (DRC). Fearing a spread to other parts of the continent, the European Commission is monitoring the situation in the country. However, the Health Minister of the DRC has stated that this seventh outbreak of the disease in the country is of a different strain to the current ongoing epidemic in West Africa.
What are the challenges and needs?
The Ebola epidemic presents major challenges related to transport, coordination, equipment, and the availability of trained medical staff.
Air transport is extremely important, be it commercial air services, air ambulances, or even military airlift; it is indeed essential to maintain connections between the affected countries and the outside world to tackle the epidemic effectively, notably for the entry and free circulation of health workers, for general ingress and egress, or for medical evacuation. Commercial flight connections are equally important to keep EU diplomatic missions operational in the countries concerned.
However, the fear of spreading the disease and exacerbating the problem has led regional and global airlines to limit or even cancel their scheduled flights which means that transporting supplies and personnel is becoming increasingly challenging. Closure of borders, suspension of flights, absence of traffic rights granted for air ambulances for example, are all hampering efforts to solve the situation.
Of course, competence in this area lies with the Member States and the role of the Commission is to encourage cooperation and better understanding of the issues at play. The Commission's services for humanitarian and transport are working with NGOs, airline operators and air ambulance companies for that purpose. We note that WHO/ICAO guidance remains clear – they advise the continuation of international trade and travel to the affected area.
Limited access to some areas in the affected countries also complicates the registration and isolation of patients. Lack of medical equipment to isolate patients and protect medical staff presents a further challenge. The disease has already claimed the lives of more than 120 health workers.
The immediate needs include tracing of people in contact with Ebola patients, supplying treatment centres and equipment and also secure transport for medical staff and supplies. Additional trained medical staff is needed but this is made more difficult by the transport restrictions.
Additionally, there are large associated needs, such as social mobilisation, basic health care, and response to growing food insecurity, especially in the quarantined areas.
What is the EU doing to help?
The European Commission has reacted to the epidemics from the outset. It is active with humanitarian aid, expertise and international coordination. In addition, diplomatic outreach is being done via the Delegations of the European Union and other channels in order to facilitate the humanitarian response in the countries concerned and to sensitize governments not to overreact to the crisis with regard to travel restrictions, trade impediments etc.
As early as March the European Commission gave €1.9 million to help contain the epidemic and ensure immediate healthcare to the affected populations. Since then, the Commission has boosted its humanitarian assistance on two occasions, bringing it to €11.9 million.
This funding provides immediate healthcare to the affected communities and helps contain the spread of the epidemic. It is used for the clinical management of cases, including the isolation of patients and their psychosocial support, the tracing of suspected cases, the training and supply of personal protective equipment, conducting communication outreach on hygiene and disease awareness, as well as providing guidance to national authorities.
On the humanitarian front, the Commission supports organisations most actively engaged in the response: WHO, Médecins Sans Frontières (MSF) and the International Federation of Red Cross and Red Crescent (IFRC).
The Commission has deployed humanitarian experts, including specialists in hazardous diseases, to the affected region, where they are monitoring the situation and liaising with partners and the authorities. MLab – a mobile laboratory funded by the European Commission – is also operating on the ground.
The Commission's Emergency Response Coordination Centre (ERCC) is monitoring the situation on the ground, exchanging information with international organisations which are part of the response and with EU Member States. The ERCC is ready to coordinate the distribution of material European assistance to the affected region.
Longer-term Development Assistance
The European Commission has just announced €140m of funding for the countries currently affected by the Ebola virus in West Africa: Guinea, Sierra Leone, Liberia, and Nigeria.
€38 million of the new package is specifically designed to help those governments bolster their health services (for example through reinforcing treatment centres or support for health workers), both during the crisis and in the recovery phase. It will also provide support in the areas of food security, water and sanitation, which are essential in terms of safeguarding the health of the population. The Commission is very closely following not only the Ebola epidemic but also how it affects the larger development of the countries concerned.
The EU has designed a Regional Ebola Response Package to bolster health care systems and reinforce the governments’ capacity to address the crisis. This €140 million package takes into account the wider development impact of the crisis (including challenges in providing economic stability, food security, water and sanitation in the countries affected) and adopts an "LRRD approach" (Linking Relief, Rehabilitation and Development), seeking to build bridges between the interventions taking place during and after the emergency.
In Guinea, health is one of the focal sectors for our development cooperation; through the European Development Fund. The foreseen budget is €40 million for the period 2014-2020 (total allocation for Guinea is €244 million). Last year, a large-scale project was launched to support the health sector in Guinea. The total amount is of €29.5 million, including a €9.5 million contribution from Agence Française pour le Developpement. The project aims to build the capacities of the Ministry of Health, provide better access to quality basic health services in the Forest Region, with a particular focus on women and children, and ensure the availability of and access to essential medicines in the Forest region, where the Ebola epidemic started.
The Forest region has been identified as the main area of intervention. Health facilities are supported, among other activities, through the training of health workers (midwives, technicians, state-employed nurses) as well as the construction, expansion and rehabilitation of facilities and equipment.
The EU is also currently financing (as part of its €1 billion MDG initiative) a programme in Sierra Leone that focuses on maternal health (€24.2 million). This project, implemented by UNICEF, supports the Free Health Care Initiative of the government of Sierra Leone and community institutions to deliver better health services, especially to pregnant and lactating mothers and to children. It helps to provide drugs and medical supplies, as well as trained doctors and health workers, and deliver food products and micronutrients (such as vitamins), for treating malnutrition.
In Liberia there is an ongoing Health Sector Support programme to help the government to deliver under the government’s wider health plan and assist progress towards MDG 5 on maternal health. Moreover, since 2012 the EU has supported the Government of Liberia in its efforts to reduce maternal mortality, which is among the highest in the world, with a €42 million programme. The EU is also providing support to the governments of Sierra Leone and Liberia to deliver public services and macro-economic stability via general Budget Support.
In Nigeria, €240 million of support to the health, nutrition and resilience sectors is foreseen for the 2014-2020 period (part of the 11th European Development Fund). This support will focus on improving policy and institutional governance to enhance the health and nutrition and strengthen the resilience of Nigeria's most vulnerable households, with a specific focus on the North of the country.
Several European specialist teams of the European Mobile Laboratory project for dangerous infectious diseases have been dispatched to Guinea and Nigeria (and one will arrive in Liberia next week), with mobile laboratories to support with viral haemorrhagic fever diagnostics, rapid analyses of samples and confirmation of cases.
Is the Ebola outbreak in West Africa a public health risk for the EU?
Ebola poses little risk to the EU population. Apart from cases of health workers who contracted the virus in West Africa being repatriated to the EU to receive medical treatment, no cases have been detected among returning travellers in Europe. Previous outbreaks caused by the same family of viruses (filoviruses) have never spread to Europe.
Although the Ebola virus is highly contagious, its spread is limited to very specific conditions involving close contact with the bodily fluids of an infected person or corpse. In the unlikely event that a person with the virus enters the EU, the risk of transmission to close direct contacts like family members or healthcare workers is already quite low. Even in this scenario, further spread would be very unlikely given the high standards of infection control procedures in Europe.
Is the EU prepared for the Ebola outbreak spreading to Europe?
Despite the low risk, the EU needs to be prepared for the possibility of a traveller with the Ebola virus returning to the EU before becoming sick or while sick.
It is important that prevention measures are implemented, including informing and sensitising returning travellers and healthcare providers and ensuring that European health systems are prepared for the diagnosis and treatment of Ebola should the need arise.
To ensure the above, the Commission has been working on preparedness and coordination of risk management together with Member States and with the support of the European Centre for Disease Prevention and Control (ECDC) and the World Health Organisation since the outbreak began. The EU Health Security Committee, established under the Decision of the European Parliament and of the Council on serious cross border threats to health is coordinating the exchange of information and coordination of preparedness, in response to Ebola in the EU. Information for travellers to the affected regions is already available and regularly updated.