Regional Office 2016 Requirements: US$20,026,000

Children and women in West and Central Africa remain vulnerable to multiple threats, including insecurity, conflict, drought, flooding and epidemics. In the Central African Republic and the Lake Chad basin, widespread violence and armed conflict characterized by grave human rights violations have led to mass displacement both internally and across borders. Insecurity prevails in northern Mali, especially in Kidal, Gao and Timbuktu. In addition to the influx of Burundian refugees, the eastern Democratic Republic of the Congo is facing resurgent armed groups that continue to commit grave human rights violations, which may result in increased humanitarian assistance needs. In the Sahel countries, children under 5 years continue to suffer from crisis levels of acute malnutrition, respiratory infection and other childhood illnesses. Outbreaks of cholera continue to affect the Mano River, Lake Chad, Congo River and Niger River basins. Although the risk of Ebola is much reduced, getting to and staying at zero cases will be difficult. Continued response, prevention and preparedness efforts are needed in Guinea, Liberia and Sierra Leone. Flooding is a recurring risk throughout the region and may be exacerbated by the El Niño weather phenomenon. Elections planned for 2016 in the region may create further civil unrest.

Regional humanitarian strategy

The West and Central Africa Regional Office (WCARO) will continue to provide coordination and support to country offices for emergency preparedness and response. Cross-border coordination and response is especially needed for children affected by conflict, separated from their families and/or recruited by armed groups. Integrated approaches to the nutrition crisis require reinforcement through the incorporation of treatment and prevention of severe acute malnutrition (SAM) into a package of interventions for health, water, sanitation and hygiene (WASH), education, promotion of essential family practices and psychosocial support. WCARO will continue to support country offices to respond to cholera, meningitis, measles, Ebola and other epidemics. Regional rapid response mechanisms to support country office humanitarian response include mapping and rapid assessment, surge staff deployments and regional supply hubs that pre-position supplies, enabling timely and cost-effective response. The Regional Office will also support country offices on humanitarian performance monitoring, information management and knowledge sharing across sectors and emergency response evaluations. Building resilience with risk analysis and mitigation plans for protracted humanitarian crisis remains a priority.

Ebola: UNICEF will work with governments and communities to support the Ebola response and achieve and sustain a ‘resilient zero’ Ebola cases. Focus will be on on maintaining surveillance, rapid response capacity and support for Ebola survivors. Priority areas include working with communities, raising alerts on potential Ebola cases, tracing missing contacts and enabling safe and dignified burials. Campaigns will maintain vigilance and awareness by supporting community leaders and traditional healers. UNICEF will maintain its rapid response capacity to ensure qualified teams can be deployed immediately in the case of a new Ebola event. In coordination with governments, partners and communities, rapid response teams will conduct active surveillance, social mobilization and early isolation and will provide basic services, including child protection, psychosocial support and WASH. With more than 23,300 children having lost one or both parents or primary caregivers, UNICEF will continue to support efforts to find family members willing to care for children in need. Families will be supported with cash and care packages. UNICEF will also continue to monitor adherence to safety protocols in schools and provide schools with hygiene kits and infection prevention supplies. Infection prevention and control through the provision of hygiene kits, clean water and sanitation to communities and health centres will remain central to the response. UNICEF will support Ebola survivors with specific medical and basic needs and psychosocial support and address stigma and discrimination against survivors.

Results in 2015

As of 31 October 2015, UNICEF had received 56 per cent (US$27.8 million1) of the US$50 million appeal, in addition to US$9.9 million carried forward from 2014. In 2015, WCARO reinforced regional rapid response mechanisms designed to support country offices to launch emergency preparedness and response and supported coordination, WASH, nutrition, health, child protection, education and Communication for Development for the Ebola response, Boko Haram-affected countries, and the crisis in the Central African Republic. Regional supply hubs continued to play an important role in the provision of support to emergency responses. The Regional Office also facilitated information management, data collection and evidence generation, as well as humanitarian results reporting across all programme sectors. In the area of child protection, WCARO provided technical support to countries2 affected by conflict/displacement, nutrition crises and Ebola.3 Cross-border coordination was reinforced to promote a harmonized approach to programme interventions, including for separated and unaccompanied children, conflict-affected children and children affected by Ebola. For nutrition, more than US$18 million was mobilized for ready-to-use therapeutic food and essential nutrition and health supplies in nine Sahel countries. Support was also provided for the Central African Republic and the Ebola response. In the area of WASH, WCARO supported cholera prevention and response and provided training to country offices and partners for WASH in emergencies and WASH in nutrition. The Regional Office also provided technical guidance and support for radio education programming in Ebola-affected countries, training on disaster risk reduction and peacebuilding in education and psychosocial support in schools in various countries across West and Central Africa.

Ebola results for 2015:

As of 31 October 2015, UNICEF had received nearly US$420.2 million out of the US$507,439,889 appeal for Ebola in West and Central Africa.4 More than 8,000 metric tons of supplies were delivered in the largest single supply operation in UNICEF’s history, to date. A total of 64 community care centres (CCCs) were established in Guinea, Liberia and Sierra Leone. UNICEF and partners reached more than 3.6 million households with interpersonal communication and skills training on Ebola prevention across the three affected countries. Daily Ebola prevention and awareness messages were broadcast in local languages on 142 radio stations. Some 3.2 million households in Ebola-affected areas received WASH kits from UNICEF. Water and sanitation services, as well as waste management, were provided in 133 Ebola treatment centres and CCCs. Nearly 1,600 health centres were provided with hand-washing stations and WASH support. More than 9,000 Ebola patients received nutrition support and over 2,700 infants (aged 0 to 6 months) who could not be breastfed received ready-to-use infant formula. More than 12,000 community health workers in 2,188 health centres received training on Ebola prevention and case management and related supplies. Nearly 12,900 children who lost one or both parents or their primary caregiver received a minimum package of support and more than 191,200 children received psychosocial support. UNICEF equipped 15,000 schools with a minimum hygiene package, which includes infrared thermometers, soap and hand-washing stations; 36,400 teachers were trained on Ebola prevention; and more than 1.9 million children benefitted from learning kits. While schools were closed, UNICEF supported distance learning programmes through community radio that reached an estimated 1 million children. Even after schools reopened, distance learning programmes remained an important tool for boosting educational standards and reaching out-of-school children. More than 2.1 million children were vaccinated against measles. Over 37,100 children suffering from SAM were admitted for treatment. UNICEF also worked to maintain HIV and AIDS services during the Ebola epidemic, providing 1,807 exposed newborns and 5,639 HIV-positive pregnant or breastfeeding women with antiretroviral therapy to prevent mother-to-child transmission of HIV. UNICEF supported Ebola preparedness and prevention activities in 18 countries in West and Central Africa, including Benin, Burkina Faso, Cameroon, the Central African Republic, Chad, the Congo, Côte d’Ivoire, the Democratic Republic of the Congo, Equatorial Guinea, the Gambia, Ghana, Guinea Bissau, Mali, Mauritania, the Niger, Nigeria, Senegal and Togo. Working closely with traditional healers, religious leaders, teachers and health workers, UNICEF country offices scaled up social mobilization activities to raise Ebola awareness. Public awareness campaigns took place in markets, border posts and bus terminals. Mass communication activities through radios and television segments were carried out and communication materials (flyers and banners) were widely distributed. UNICEF was active in providing training to health workers and distributing protective equipment to health centres to improve infection prevention and control measures.

Funding requirements

For 2016, UNICEF is requesting US$20,026,000 to address humanitarian crises throughout West and Central Africa through technical support and coordination. This will enable WCARO to continue to respond to the ongoing Ebola response, with the aim of reaching and maintaining zero cases in affected countries, as well as to the Sahel nutrition crisis and the conflicts in the Central African Republic, the Democratic Republic of the Congo, Mali and Boko Haram-affected areas. WCARO gratefully acknowledges donors’ support in 2015 and welcomes their continued commitment to meeting the humanitarian needs of women and children across the region. In addition, regional funding may be used to respond to situations elsewhere in the region that are not included in a separate chapter of Humanitarian Action for Children 2016 and may not benefit from inter-agency flash appeals to respond to small- or medium-size emergencies.

Genetic diversity of livestock can help feed a hotter, harsher world

Despite growing interest in safeguarding biodiversity of livestock and poultry,genetic erosion continues

27 January 2016, Rome - Livestock keepers and policy makers worldwide are increasingly interested in harnessing animal biodiversity to improve production and food security on a warmer, more crowded planet, according to a new FAO report issued today. The agency nonetheless warns that many valuable animal breeds continue to be at risk and calls for stronger efforts to use the pool of genetic resources sustainably.

According to The Second Report on the State of the World's Animal Genetic Resources for Food and Agriculture, some 17 percent (1,458) of the world's farm animal breeds are currently at risk of extinction, while the risk status of many others (58 percent) is simply unknown due to a lack of data on the size and structure of their populations. Nearly 100 livestock breeds have gone extinct between 2000 and 2014.

Country data shows that indiscriminate cross-breeding is considered as the main cause of genetic erosion. Other common threats to animal genetic diversity are the increasing use of non-native breeds, weak policies and institutions regulating the livestock sector, the decline of traditional livestock production systems, and the neglect of breeds considered not competitive enough.

Europe and the Caucasus, and North America are the two areas in the world with the highest proportion of at-risk breeds. In absolute terms, the highest number of at-risk breeds can be found in Europe and the Caucasus.

Both areas are characterized by highly specialized livestock industries that tend to use only a small number of breeds for production.

Why biodiversity matters

Genetic diversity provides the raw material for farmers and pastoralists to improve their breeds and adapt livestock populations to changing environments and changing demands.

"For thousands of years, domesticated animals, like sheep, chickens and camels, have contributed directly to the livelihoods and food security of millions of people," said FAO Director General José Graziano da Silva, "That includes some 70 percent of the world's rural poor today."

"Genetic diversity is a prerequisite for adaptation in the face of future challenges", according to the Director-General, who added that the report will "underpin renewed efforts to ensure that animal genetic resources are used and developed to promote global food security, and remain available for future generations."

Among the future challenges are climate change, emerging diseases, pressure on land and water, and shifting market demands, which make it more important than ever to ensure animal genetic resources are conserved and used sustainably.

Currently, some 38 species and 8,774 separate breeds of domesticated birds and mammals are used in agriculture and food production.

Rise in national gene banks and improved management

A total of 129 countries participated in the new global assessment, which follows nearly a decade after the release of the first global assessment of animal genetic resources in 2007.

"The data we've collected suggests there's been improvement in the number of at-risk breeds since the first assessment," says Beate Scherf, Animal Production Officer at FAO and co-author of the report. "And governments overall have definitely stepped up efforts to halt genetic erosion and more sustainably manage their national livestock breeds."

The study finds that governments are increasingly recognizing the importance of sustainably using and developing the genetic resources embodied in livestock.

When FAO published the first global assessment in 2007, fewer than 10 countries reported having established a gene bank. That number has now risen to 64 countries, and an additional 41 countries are planning to establish such a gene bank, according to the new report.

And these efforts are bearing fruit, experts say: "Over the last decade, countries across Europe have invested heavily in building shared information systems and gene banks as security measures," according to Scherf.

Regional collaborations like the new European Gene Bank Network (EUGENA) are key to managing and improving breeds in the future, she says, and should be supported by in situ conservation of live animals in their natural habitat.

In situ conservation also recognizes the cultural and environmental value of keeping live populations of diverse animal breeds.

Some 177 countries additionally have appointed National Coordinators and 78 have set up multi-stakeholder advisory groups to aid national efforts to better manage animal genetic resources.

Increasing global trade in animal genetic resources

This comes at a time of expansion in the global trade in breeding animals and livestock semen, often for cross-breeding purposes, with many developing countries emerging as significant importers and some also as exporters of genetic material.

Increasingly, farmers and policy makers in developing countries have embraced imports of genetic material as a way to enhance the productivity of their livestock populations - growing their milk output, for example, or decreasing the time needed for an animal to reach maturity.

But if not well planned, cross-breeding can fail to significantly improve productivity and lead to the loss of valuable characteristics such as the special ability to cope with extremes of temperature, limited water supplies, poor-quality feed, rough terrain, high altitudes and other challenging aspects of the production environment.

Challenges to management of genetic resources

In order to better manage livestock diversity going forward, animal breeds and their production environment need to be better described, according to the report, which shows genetic resources are frequently lost when limited knowledge leads to certain breeds going underused.

More also needs to be done to monitor population trends and emerging threats to diversity, according to the report.

Trendspotting will be critical

Among the major changes to the sector over the last decades has been the rapid expansion of large-scale high-input livestock production systems in parts of the developing world, accompanied by growing pressures on natural resources.

South Asia and Africa -two very resource-constrained regions that are home to many small-scale livestock keepers and a diverse range of animal genetic resources - are projected to become the main centres of growth in meat and milk consumption.

Trends like these are grounds for concern because similar rises in demand in other regions have come with a shift away from small-scale production that supports local genetic diversity to large-scale production that is more likely to use a limited number of breeds and can create major challenges for the sustainable use of animal genetic resources.

Changes in food systems are among trends that should be carefully tracked to predict their impact on demand for particular species and breeds, according to the report, along technology, climate changes and government policies.

Need for greater international collaboration

At the same time, the report stresses that international cooperation remains an area requiring improvement in order to support future livestock biodiversity.

Since 2007, countries have been implementing the Global Plan of Action for Animal Genetic Resources, the first internationally agreed framework of its kind.

But international collaboration remains relatively underdeveloped among countries implementing the Plan, the report cautions. Cooperation should be stepped up to move beyond the limited number of bilateral and regional research programs that are currently in place.

CENTRAL AFRICAN REPUBLIC
HALF THE POPULATION FACES HUNGER

Nearly 2.5 million people, or half the entire population, are facing hunger - a twofold increase in one year, WFP announced on 20 January. One in six people is grappling with severe or extreme food insecurity, while more than one in three people are moderately food insecure. Families have adopted coping mechanisms such as selling their belongings or pulling t heir children out of school.

CHAD
MORE IDPs REPORTED

Thousands of internally displaced persons (IDPs) have been identified following an inter-cluster mission in Liwa and Daboua localities of Lac region where insecurity had so far hampered access. The exact figures are currently being verified. The IDPs, spread out in 22 sites, are faced with harsh living conditions and deprivation as they are unable to farm, fish or raise livestock.

CAMEROON
SUICIDE ATTACK CLAIMS 32 LIVES

Four suicide bombers on 25 January struck Bodo village in the Far North region, killing 32 people and injuring 66 others. The attack, in which the assailants hit a busy market and the town’s main entrances, was one of the worst in recent months. No one claimed responsibility, but Boko Haram gunmen who have carried out multiple attacks in the region before are suspected to be behind the assault. Separately, on 25 January, humanitarian partners launched the 2016 Humanitarian Response Plan, requesting for US$282 million to assist 1.1 million people affected by conflict and other crises.

NIGERIA
REPORTED LASSA FEVER DEATHS REACH 82

As of 23 January, 82 people were reported to have died of Lassa fever. Of the total, 34 have already been confirmed to be due to the viral haemorrhagic fever, according to Nigeria’s Centre for Disease Control. The disease, which first broke out in November, has spread to 10 states. Lassa fever is endemic in Nigeria and causes outbreaks almost every year in different parts of the country, but more in some states than others particularly during the dry season.

EBOLA VIRUS DISEASE
SIERRA LEONE REPORTS SECOND EBOLA CASE

Health authorities in Sierra Leone on 20 January confirmed a new case of Ebola, the second death after another patient died of the illness on 12 January. As of 21 January, 121 contacts had been identified, including 47 considered to be high risk. Investigations into the origin of the infection in the index case are ongoing. Following the flare up, IOM and its partners in Guinea have reactivated border health screening and reinforced surveillance in Forécariah prefecture which is close to the border with Sierra Leone.

REPUBLIQUE CENTRAFRICAINE
LA MOITIE DE LA POPULATION SOUFFRE DE LA FAIM

Près de 2,5 millions de personnes, soit la moitié de la population, souffrent de la faim, soit deux fois plus qu’il y a un an, a annoncé le PAM le 20 janvier. Une personne sur six est aux prises avec une insécurité alimentaire sévère ou extrême, tandis que plus d'une personne sur trois est en insécurité alimentaire modérée. Contraintes d’avoir recours à des stratégies d’adaptation, les familles ont vendu leurs bien ou retiré leurs enfants de l'école.

TCHAD HAUSSE DU NOMBRE DE PERSONNES DEPLACEES SIGNALEES

Des milliers de personnes déplacées internes (PDI) ont été identifiées suite à une mission inter-cluster dans les localités de Liwa et de Daboua dans la région de Lac où l'insécurité avait jusqu'ici entravé l'accès. Les chiffres exacts sont actuellement en cours de vérification. Les personnes déplacées, réparties dans 22 sites, sont confrontées à la privation et des conditions de vie difficiles car ils ne sont pas en mesure de cultiver leurs terres, pêcher ou élever du bétail.

CAMEROUN 32 MORTS DANS UNE ATTAQUE-SUICIDE

Quatre kamikazes ont frappé le 25 janvier le village de Bodo dans la région de l'Extrême Nord, tuant 32 personnes et en blessant 66 autres. L'attaque, dans laquelle les assaillants ont frappé un marché très fréquenté et les entrées principales de la ville, a été l'une des plus meurtrière de ces derniers mois. Celle-ci n’a pas été revendiquée, mais des hommes armés de Boko Haram qui ont effectué plusieurs attaques dans la région récemment sont soupçonnés d'être à l’origine de l'assaut. Séparément, le 25 janvier, les partenaires humanitaires ont lancé le Plan de réponse humanitaire 2016, demandant 282 millions de dollars US pour venir en aide à 1,1 millions de personnes touchées par les conflits et autres crises.

NIGERIA 82 MORTS SIGNALEES LIEES A LA FIEVRE DE LASSA

En date du 23 janvier, 82 personnes seraient mortes des suites de la fièvre de Lassa. 34 de ces décès ont déjà été attribués à la fièvre hémorragique virale, selon le Centre nigérian pour la lutte contre les maladies. La maladie, qui a éclaté en novembre, s’est étendue à 10 états. La fièvre de Lassa est endémique au Nigeria et provoque des éruptions presque chaque année dans différentes parties du pays, mais plus dans certains états que d'autres en particulier pendant la saison sèche.

MALADIE A VIRUS EBOLA 2EME CAS D’EBOLA SIGNALE EN SIERRA LEONE

Les autorités sanitaires de la Sierra Leone ont confirmé un nouveau cas d’Ebola le 20 janvier, le second décès après un premier décès des suites du virus le 12 janvier dernier. En date du 21 janvier, 121 contacts avaient été identifiés, y compris 47 considérés comme à haut risque. L'enquête sur l'origine de l'infection se poursuit. Suite à ces nouveaux cas, l'OIM et ses partenaires en Guinée ont réactivé le dépistage de santé aux frontières et renforcé la surveillance dans la préfecture de Forécariah, qui se trouve à proximité de la frontière avec la Sierra Leone.

January 27, 2016 by Minna Højland

Sierra Leone has suffered an unfortunate recurrence of the Ebola outbreak early this year, with two confirmed cases just days after the World Health Organization officially declared West Africa free of the virus. While authorities will again be occupied with eradication, another lingering problem requires attention: continued marginalization of those who have survived the epidemic threatens the stability of some communities, many of which remain fragile after a decade of civil war ending in 2002.

Nearly 4,000 people have died from Ebola in Sierra Leone since the start of the outbreak in May 2014, while about as many have survived contracting the virus. As I discovered during a visit to the country this month, stigmatization and societal rejection often add to the joint ache, impaired vision, and extreme fatigue that are common after-effects of the disease.These personal accounts confirmed findings from a study from nearby Guinea, in which 97% of survivors reported being rejected by former friends, and 60% a lack of acceptance from former communities.

Sierra Leone authorities have seemingly encouraged this practice, with widespread public information urging citizens to avoid physical contact and alert authorities to those suspected of infection.The reemergence of the virus shows that such caution is necessary, particularly in areas near the Liberian border such as Kailahun and Kenema, where most people lost their lives.

There is, however, a stark contrast between the advice on avoiding infected persons and the limited public information provided on how citizens should adapt to the post-Ebola situation. Particularly outside the capital Freetown, updated advice on how to relate to survivors is rarely encountered.Even as survivors are issued official certificates to prove they can no longer transmit the disease, many are met with fear and mistrust when returning to their homes, jobs, and communities. Likely exacerbating the problem is the way that restrictions on bodily contact, as well as traditional practices around caring for the sick, funeral rituals, participation in secret societies, and public gatherings have challenged traditional national values such as trust, openness to strangers, and hospitality.

The aftermath of the Ebola outbreak exposed the fragile state of social cohesion in many communities and has triggered several cases of conflict and violence. Pel Koroma, National Director of Play 31, an NGO that facilitates mediation and reconciliation in rural communities, told me that some survivors were accused of having introduced the virus to their communities, or even of practicing witchcraft.

Some have struggled to find work or been blocked from practices such as using water pumps or visiting markets, because their money is thought to be infected. Others still have returned to their communities to find that neighbors have destroyed their belongings or even blocked them from their homes. Meanwhile, some have tried to blend into new communities, only to be forcibly removed when their identities were revealed.

The situation threatens to create wider instability, particularly if new cases of Ebola continue to be reported. This would be particularly disappointing in the context of the gains made during the decade following the civil war. When the United Nations Peacebuilding Commission left Sierra Leone in March 2014, Secretary General Ban Ki-moon declared it one of the world’s most successful stories of peacebuilding and post-conflict recovery.Despite this, large parts of the population are still traumatized by the war and its aftermath, and even small disputes can quickly turn violent.

Koroma and other civil society members have also identified growing discontent with the country’s extensive unemployment, poverty, and corruption, which is eroding patience with the government and its handling of the post-conflict recovery process.Relations between civil society and the government have dramatically soured as the attention and presence of the international community has diminished. A particular sticking point is the ongoing constitutional reform process, which is being used to pave the way for President Ernest Bai Koroma to run for a third term at elections in 2017.

Third-term movements in fragile post-conflict countries such as Burundi have led to widespread violence in recent years. Interestingly enough, the fact that the Ebola outbreak interrupted the president’s supposedly strong performance has been cited as one of the motivations for supporters of another term.The UN Development Program has recognized that the reintegration of Ebola survivors poses an imminent challenge to maintaining the country’s hard-won progress toward stability.

Responding to this threat, the West African Network for Peacebuilding (WANEP) in Sierra Leone has expanded its peace and mediation work to also include Ebola-related conflicts. However, its ability to create meaningful change has suffered since the departure of the Peacebuilding Commission, because it now reports solely to the national government, which has limited capacity to respond to its warnings.

“Relapse into conflict is not at all an unlikely scenario,” WANEP National Coordinator for Sierra Leone Edward Djombla told me. “Trust in the communities is still a big issue after the war, and renewed suspicion and fear could easily lead to public disorder and conflict.“We see so many warning signs, and on top of it all comes the constitutional review process. If the president pushes through with a third term, there surely will be unrest.”Sharing this concern about the cumulative effect that another social trauma could have on an already distressed population, Pel Koroma called for a new national reconciliation commission.

This would be modeled on the body that addressed issues of mistrust and fear in the population at the national level after the civil war.The proposal would go some way toward restoring the lost trust between the government and communities in the wake of the Ebola crisis. However, it is unlikely that the government in Freetown, which is hard-pressed to respond to the medical and economic consequences of the epidemic, will agree._Minna Højland is United Nations Liaison Officer for the Global Partnership for the Prevention of Armed Conflict._

Originally Published in the Global Observatory

Rome workshops focus on tackling and containing animal-borne diseases such as Ebola and MERS

28 January 2016, Rome - Infectious animal-borne disease threats such as Ebola and the Middle East Respiratory Syndrome coronavirus (MERS-CoV) are here to stay, and further painful outbreaks are likely to flare up or new disease threats will definitely emerge in the near future, said Juan Lubroth, FAO's chief veterinarian, querying whether the world is prepared to detect them and prevent their spread. 

To better assess and manage such outbreaks in the future, policy makers must foster an integrated research program mapping out both what is and what is not known about the transmission dynamics and spillover patterns of the two recent epidemics, as well as promoting collaboration and stronger surveillance and diagnostic networks, according to FAO, which with USAID as funding partner and sponsor, hosted researchers and policy makers from around the world to technical meetings on Ebola and MERS in Rome this month. 

"Critical gaps remain in our knowledge of how these diseases are transmitted, both to humans and potential animal host species, as well as their epidemiology and the risk they may pose to food safety as well as food security for populations that depend on livestock or hunting," according to Lubroth.

FAO has long urged intensification of collaboration and information sharing. This month's meetings pushed further, covering issues ranging from epidemiology and laboratory diagnostic methods to supply chains and behavioural studies. Participants contributed to an integrated map of ongoing and planned activities in the fields of laboratory research, test development, surveillance, training, understanding risk practices and identifying preventive measures. 

Research is key to understanding and mitigating the risk of emerging infectious diseases in animals and humans, said Andrew Clements, Senior Technical Advisor with the United States Agency for International Development's Global Health Bureau.  "A key part of understanding risk is coordinating the use of animal and human diagnostics and surveillance and understanding how animal value chains may contribute to disease spillover from animals to people," he said. 

"At the same time, country capacities need to be strengthened to prevent, detect, and respond to infectious disease threats.  FAO and USAID have successfully worked together over the past 10 years to conduct these kinds of activities," Clements added, pointing to the response to H5N1 avian influenza in Asia. 

FAO's animal health service is promoting concerted effort to identifying exactly which animals serve as reservoirs or intermediate hosts of a virus, its geographic distribution, human and animal behaviors that favour transmission, as well as the mechanisms of viral transmission, ecological and social factors that support or mitigate outbreaks.

Ebola virus 

The 2014-15 outbreak of Ebola virus (EBOV) in West Africa claimed more than 11,000 human lives and infected more than twice as many, according to WHO. While the increase in Ebola outbreaks since 1994 is widely understood to be related to increased contact between people and infected wild animals in the wake of encroachment into forested parts of Africa, the question remains whether the virus ecology has changed in the context of urbanization and land-use policies. 

It is also unknown if domestic animals can be infected with the virus in field conditions. Experimental studies show that pigs infected with EBOV can transmit the disease to other pigs and non-human primates, while dogs are known to develop an immune reaction in areas affected by outbreaks but their role in contagion networks has never been demonstrated. 

These questions and other pertinent issues will be addressed in the coming years and the meeting paved the way for future collaboration between research and the field. FAO will contribute through a significant field programme to better understand the disease dynamics at the interface between humans, animals, and their shared environment - including wildlife, as hunting activities are widely seen as a major risk factor for contact with Ebola, as bushmeat is an important source of quality nutrition for millions of communities. In this regard, FAO is also developing a Risk Communication Toolkit allowing for a rapid and culturally appropriate approach with local people. 

MERS-CoV

Middle East Respiratory Syndrome coronavirus (MERS-CoV), an emerging global public health threat that causes severe viral pneumonia in humans, was first detected in Saudi Arabia in 2012. More than 500 people have since died from the disease and almost three times as many human cases have been confirmed, most recently in an Omani citizen visiting Thailand.

Several studies have indicated that dromedary camels or their products are the main spillover path for human infections, although- as with EBOV - bats cannot be excluded as a possible reservoir. 

MERS-CoV mainly affected people in Saudi Arabia, but also in nearby Qatar, Jordan, Oman and Yemen. Cases were also reported among people in Europe, Asia and North America who had travelled to the Near East region. Concern is large due to the potential link to camels, whose largest populations are found in Somalia, Sudan, Kenya and Niger and are very important domestic species to people's livelihoods, culture and way of  life. 

However, the meeting participants urged for more attention to be given to the camel sector including enhanced health care and trade regulations. 

The FAO meeting resolved to pursue comparative studies of Africa and the Middle East to understand why there have been no reported human cases of MERS in Africa despite the presence of camels that test positive for the virus. 

Building on past declarations, it was also agreed to promote more active field surveillance to better grasp transmission patterns, the duration of immunity, host range and the different ways camels are raised and involved in trade and value chains.  It was also decided to develop more serological tests, set up biobanks to hold multiple sample types, engage in experimental infections with various strains to determine phenotypes, and to develop molecular tools. 

As a follow-up of the meeting, FAO and the World Organisation for Animal Health (OIE) will explore setting up a MERS scientific and technical network. 

| read this story online |

Contact

Christopher Emsden
Media Relations (Rome)
(+39) 06 570 53291
christopher.emsden@fao.org

News

• On 12 January, IOM deployed materials and equipment in Boke in the context of launching Community Event-Based Surveillance activities (CEBS).

• By January 15, the National Coordination for Ebola response asked IOM to restart its health screening activities at Points of Entry (PoE) in the areas bordering Sierra Leone.

• On 12 January, a 22 year-old woman died in Tonkolili, in the Northern part of Sierra Leone. Two days later, an analysis of a sample taken from her body confirmed that she died of the Ebola virus disease (EVD).

Resurgence of Ebola virus disease in Sierra Leone

On January 12th, M. J. , a 22 year-old student from the town of Lunsar, died in the town of Magburaka, the capital city of Tonkolili District, in the Northern part of Sierra Leone. Two days later, analysis of samples taken from her body proved that the cause of death was EVD. Investigations have revealed that she had stayed at various places in the sub-region and was in contact with many people, some of which have been identified, others not. Efforts are ongoing to trace her route in order to identify all the people with whom she had been in contact and thus restrict the spread of the disease.

This resurgence of EVD in neighboring Sierra Leone reminds us that we are not yet definitively out of the risk of a resurgence of the epidemic. As soon as January 15, the Government of Guinea asked its partners, including IOM, to revive health screening activities along the border with Sierra Leone, particularly at the point of entry of Pamelap.

Since the official declaration of the end of the Ebola epidemic in Guinea on 29 December 2015 by the World Health Organization (WHO), no new cases have been reported. However, authorities continue to stress the need for eightened vigilance throughout the country.

IOM Guinea Ebola Crisis Response - External Situation Report (4 to 20 January 2016)

COMMUNIQUE

Le Conseil de paix et de sécurité de l’Union africaine (UA), en sa 570ème réunion tenue le 21 janvier 2016, a adopté la décision qui suit sur l’épidémie à virus Ebola (EVD) dans les trois pays les plus affectés de l’Afrique de l’Ouest, à savoir, la Guinée, le Libéria et la Sierra Leone:

Le Conseil,

1. Prend note de la communication faite par la Commission et du rapport général final de fin de mission de la “Mission de soutien de l’UA à la lutte contre l’épidémie à virus Ebola en Afrique de l’Ouest (ASEOWA), ainsi que du rapport d’évaluation de l’action de l’UA contre l’épidémie à virus Ebola en Afrique de l’Ouest. Le Conseil prend également note des déclarations faites par les représentants du Sénégal, pays assurant la présidence en exercice de la Communauté économique des Etats de l’Afrique de l’Ouest (CEDAO), de la France, du Royaume-Uni, de l’Union européenne, des Etats-Unis d’Amérique, ainsi que celle du représentant des Nations unies;

2. Rappelle toutes ses prises de position antérieures sur l’épidémie à virus Ebola (EVD) et plus particulièrement, son communiqué de presse PSC/PR/BR. (DLXV) adopté lors de sa 565ème réunion tenue le 17 décembre 2015;

3. Félicite la Commission de l’UA et le Département des Affaires sociales, en particulier, pour leur leadership dans la réussite de la lutte contre l’épidémie à virus Ebola (EVD), ainsi qu’en faveur du redressement socio-économique en cours dans les pays les plus affectés de l’Afrique de l’Ouest, à travers l’ASEOWA. Le Conseil félicite plus particulièrement les Volontaires de la santé déployés par l’ASEOWA, qui ont mis en péril leur vie pour en sauver d’autres. A cet effet, le Conseil demande à la Commission de marquer sa reconnaissance des efforts déployés par tous ceux qui ont participé à la lutte contre Ebola dans le cadre d’ASEOWA, y compris le personnel de la Commission;

4. Félicite les autorités et les populations des trois pays les plus affectés de l’Afrique de l’Ouest, pour leurs efforts qui ont permis de parvenir à maîtriser, avec succès, l’épidémie à virus Ebola (EVD). Le Conseil les félicite en outre pour les efforts qu’ils déploient actuellement en vue de leur redressement socio-économique, et les exhorte à faire preuve de persévérance. A cet effet, le Conseil réitère la nécessité pour ces pays d’adopter une approche globale qui permettra de répondre à l’ensemble des conséquences sociales, psycho-sociales, économiques et politiques de l’épidémie à virus Ebola et d’investir davantage dans le renforcement des systèmes de santé en vue de promouvoir la résilience nécessaire contre les menaces futures en matière de santé publique;

5. Souligne l’impérieuse nécessité pour la Commission de continuer d’assurer le suivi étroit de la situation post-Ebola dans les trois pays les plus affectés, même si l’Organisation Mondiale de la Santé (OMS) les a déjà déclarés exempts de l’épidémie d’Ebola. Le Conseil exhorte par conséquent les trois pays les plus affectés à continuer de faire preuve de davantage de vigilance, compte tenu du risque d’une nouvelle éruption de la maladie et des cas de rechute, ainsi que de maintenir des mécanismes de surveillance efficaces, y compris la surveillance transfrontalière;

6. Souligne la nécessité d’accélérer la mise en place du Centre africain de contrôle et de prévention des maladies (CDC africain). A cet égard, le Conseil s’est félicité des efforts en cours par la Commission dans ce sens, ainsi que des démarches actuelles en vue de la mise en place du Corps des jeunes volontaires africains de la santé;

7. Souligne la nécessité pour l’OMS, dans le cadre des efforts de l’Afrique en matière de prévention, d’accélérer le processus de certification en vue de la production du vaccin contre Ebola;

8. Exprime sa profonde appréciation à tous les Etats membres de l’UA pour leur appui multiforme aux trois pays les plus affectés, et les exhorte à maintenir cet esprit de solidarité panafricaine qui sera déterminant dans la lutte efficace contre les épidémies de cette nature, ainsi que contre d’autres situations d’urgence complexes à l’avenir. Le Conseil exprime également sa profonde appréciation aux acteurs du secteur privé africain pour leurs nombreux gestes de générosité à l’endroit des trois pays les plus affectés par l’épidémie à virus Ebola (EVD). Le Conseil exprime en outre sa sincère appréciation aux partenaires de l’UA, ainsi qu’à l’ensemble de la communauté internationale, pour leur soutien inlassable à la lutte contre cette épidémie, et les exhorte à poursuivre leur appui aux efforts de redressement socio-économique post-Ebola dans les trois pays les plus affectés;

9. Entérine toutes les recommandations contenues dans ces deux rapports qui lui ont été soumis par la Commission. Le Conseil demande à cet effet à la Commission d’adopter toutes les mesures de suivi nécessaires et de lui faire des mises à jour régulières sur la mise en œuvre de ces recommandations;

10. Décide de rester activement saisi de cette question.

Des experts internationaux réunis à Rome pour affronter les virus Ebola et MERS, entre autres

28 janvier 2016, Rome – Les menaces de zoonoses telles qu'Ebola et le Coronavirus du syndrome respiratoire du Moyen-Orient (MERS-CoV) sont là et le resteront, et d'autres épidémies douloureuses éclateront vraisemblablement ou de nouvelles menaces de maladies naîtront dans un avenir proche, a déclaré Juan Lubroth, vétérinaire en chef à la FAO, en s'interrogeant sur la préparation du monde à leur détection et à leur maîtrise.

Pour mieux évaluer et gérer ces épidémies à l'avenir, les décideurs doivent inciter à un programme de recherche intégré établissant ce que l'on sait et ce que l'on ignore de la dynamique de transmission et des mécanismes de retombées des deux récentes épidémies; et favorisant le renforcement de la collaboration et des réseaux de surveillance et de diagnostic, selon la FAO, qui a organisé, avec le concours et l'appui financier de l'USAID, des réunions techniques sur Ebola et MERS rassemblant des chercheurs et des décideurs du monde entier à Rome ce mois-ci.

«Il subsiste des lacunes importantes dans nos connaissances sur la transmission de ces maladies, à la fois chez l'homme et les espèces animales hôtes potentielles, ainsi que sur leur épidémiologie et le risque qu'elles constituent pour la sécurité sanitaire des aliments et la sécurité alimentaire des populations qui dépendent de l'élevage ou de la chasse», a souligné M. Lubroth.

Depuis longtemps, la FAO préconise vivement d'intensifier la collaboration et l'échange d'informations. Les réunions de ce mois vont plus loin en couvrant des questions allant des méthodes épidémiologiques et de diagnostic laboratoire aux chaînes d'approvisionnement et aux études de comportement. Les participants ont contribué à une carte intégrée des activités en cours et prévues dans les domaines de la recherche de laboratoire, la mise au point de tests, la surveillance, la formation, la compréhension des pratiques à risque et l'identification des mesures de prévention.

La recherche est fondamentale pour comprendre et atténuer les risques de maladies infectieuses émergentes chez l'animal et chez l'homme, a souligné Andrew Clements, Conseiller technique principal au Bureau de la santé mondiale de l'Agence des Etats-Unis pour le développement international (USAID). «Il s'agit notamment de coordonner l'utilisation des diagnostics animaux et humains et la surveillance et de comprendre comment les filières animales sont susceptibles de contribuer à la propagation du virus de l'animal à l'homme», a-t-il ajouté.

«En même temps, les capacités des pays doivent être renforcées pour prévenir, détecter et réagir aux menaces de maladies infectieuses. La FAO et l'USAID ont coopéré avec succès au cours des 10 dernières années pour mener ce type d'activités,» a ajouté M. Clements, se référant à l'intervention face à la grippe aviaire H5N1 en Asie.

Le service de santé animale de la FAO incite à un effort concerté pour identifier exactement quels animaux servent de réservoirs ou d'hôtes intermédiaires d'un virus, sa répartition géographique, son comportement humain et animal favorisant la transmission, ainsi que les mécanismes de transmission virale, les facteurs écologiques et sociaux qui favorisent ou atténuent les épidémies.

Virus Ebola

L'épidémie de 2014-15 du virus Ebola (EBOV) en Afrique de l'Ouest a emporté plus de 11 000 vies humaines et infecté plus de 2 fois plus de personnes, selon l'Organisation mondiale de la santé (OMS). Si l'on sait que la multiplication des foyers Ebola depuis 1994 est liée au contact plus étroit avec les animaux sauvages infectés suite à l’empiétement sur des zones boisées d'Afrique, il reste à savoir si l'écologie du virus a changé dans le cadre des politiques d'urbanisation et d'utilisation des terres.

On ignore aussi si les animaux d'élevage peuvent être infectés avec le virus en conditions réelles. Les études expérimentales montrent que les porcs infectés avec le virus Ebola peuvent le transmettre à d'autres porcs et à des primates non humains, tandis que les chiens développeraient une réaction immune dans les zones touchées par une épidémie, mais leur rôle dans les réseaux de contagion n'a jamais été démontré.

Ces problèmes seront au nombre des questions qui seront abordées au cours des prochaines années. La réunion a permis d'ouvrir la voie à une collaboration future entre la recherche et le terrain. La FAO y contribuera par le biais d'un important programme de terrain visant à éclaircir la dynamique de la maladie à l'interface entre l'homme, l'animal et leurs environnements communs – y compris la faune sauvage. En effet, la chasse est considérée comme un facteur de risque majeur pour le contact avec Ebola, la viande de gibier étant une importante source de nutrition pour des millions de communautés. A cet égard, la FAO met également au point une boîte à outils de communication du risque permettant une approche rapide et culturellement appropriée avec les populations locales.

MERS-CoV

Le Coronavirus du syndrome respiratoire du Moyen-Orient (MERS-CoV), une menace de santé publique émergente qui provoque une grave pneumonie virale chez l'homme, a été décelé pour la première fois en Arabie saoudite en 2012. Plus de 500 personnes en sont mortes depuis, et près de trois fois plus de cas humains ont été confirmés, plus récemment chez un ressortissant d'Oman en visite en Thaïlande.

Plusieurs études ont indiqué que les dromadaires ou leurs produits sont les vecteurs principaux de la transmission à l'homme, même si (comme dans le cas d'Ebola), on ne peut exclure que les chauve-souris soient un réservoir éventuel.

Le MERS-CoV a principalement touché des habitants d'Arabie saoudite, mais également des pays voisins du Qatar, de la Jordanie, de l'Oman et du Yémen. Des cas ont également été signalés en Europe, en Asie et en Amérique du Nord chez des personnes qui s'étaient rendues au Proche-Orient. Toutefois, la préoccupation dérive du lien potentiel avec les camélidés, dont les plus grandes populations se trouvent en Somalie, au Soudan, au Kenya et au Niger, et qui sont des espèces essentielles pour les moyens d'existence, la culture et les modes de vie des communautés.

Les participants à la réunion ont néanmoins appelé à accorder une attention accrue au secteur des camélidés, notamment en matière de soins de santé et de réglementation des échanges.

La réunion de la FAO a décidé de mener des études comparatives de l'Afrique et du Moyen-Orient pour comprendre la raison pour laquelle aucun cas de MERS chez l'homme n'a été signalé en Afrique malgré la présence de camélidés testés positifs au virus.

Sur la base des déclarations passées, il a été convenu de renforcer la surveillance de terrain pour mieux saisir les mécanismes de transmission, la durée de l'immunité; la variété des hôtes et les différents modes d'élevage des chameaux et leur participation au commerce et aux chaînes de valeur. Il a été décidé en outre d'intensifier l'élaboration de tests sérologiques, de mettre en place des bio-banques propres à détenir de multiples types d'échantillons, à effectuer des infections expérimentales avec diverses souches afin de déterminer les phénotypes, et à mettre au point des outils moléculaires.

Comme suivi de la réunion, la FAO et l'Organisation mondiale de la santé animale (OIE) envisagent la création d'un réseau scientifique et technique MERS.

Contact
Christopher Emsden
Relations presse, FAO (Rome)
(+39) 06 570 53291
christopher.emsden@fao.org

Simon Wright

At the World Health Organization’s Executive Board in Geneva this week, the first two days show that the Ebola crisis continues to be a traumatic and defining experience for global health.

Ebola was a terrible crisis for families and communities in Liberia, Sierra Leone and Guinea. As we in Save the Children know, fighting a virus with a high death rate and which is relatively easily transmitted, including by contact with dead bodies, was hampered by terror and fear. There are countless stories of the bravery of health workers, burial staff and communities themselves, which took a stand, facing personal risk and stigma to turn around the outbreak and save their communities.

We also saw global terror and fear, with much less justification. The USA and Spain only had one case of transmission each; their health systems have plenty of nurses, doctors and money and were able to cope. Even so, there was terror that these cases might cause huge outbreaks of Ebola. While this global panic helped to get funding for what was happening in West Africa, it also led to stupid decisions such as the cancellation of flights to affected countries. This was in contravention of the International Health Regulations, which are supposed to guide global responses.

At the WHO Executive Board there is review of the International Health Regulations and how the WHO should reform to be better able to lead global responses to future outbreaks. The IHRs are thought to be fit-for-purpose but were not implemented properly. WHO’s delay in declaring a crisis was been heavily-criticised and there is strong support for building its capacity, although few member states are echoing the call for an increase in WHO’s membership core funding.

While Ebola killed thousands, it did not come close to the millions of unnecessary deaths and illness happening every year in countries with inadequate health services. Maternal and child mortality, for example, does not get on a plane but has the same root problem, the lack of universal health coverage. The lesson that good health systems are needed is getting some mention but not the main attention.

I have argued elsewhere that a panic about transmission of a virus (HIV) helped to build political attention for health in developing countries. Our hope, as part ofNo More Epidemics, is that the legacy of Ebola can be not just to identify and respond better to infectious disease outbreaks but to be a wake-up call to end the scandal of the denial of healthcare in poor countries.

There are eleven weeks to go until the globally synchronized switch from the trivalent to bivalent oral polio vaccine, an important milestone in achieving a polio-free world. Read more here.

The WHO Executive Board is meeting this week, reviewing the report on polio eradication.

On 21 January, Syria passed two years without a reported case of polio despite the conflict which has affected the delivery of health services, including childhood vaccinations.

• Violent clashes have occurred between security forces and civilians in Kambia district following the enforcement of an order to close markets.

• The government carried out the closures in response to a perceived lack of cooperation in its effort to trace 50 missing Ebola contacts linked to the recent new cases.

• In one incident, a UNICEF vehicle was attacked and severely damaged. At least three people have been injured. The UN has banned all travel to the district for the time being.

28 January 2016

Tackling malnutrition in Sierra Leone

Use of basic health services drastically reduced at the height of the Ebola outbreak. The population was hesitant to approach the health centres due to fears of either contacting Ebola or being labeled as someone affected by it. Getting mothers and children back to the health centers to access critical maternal and child health services has been challenging. In partnership with the Government of Sierra Leone, The World Food Programme (WFP) is supporting the Ministry of Health and Sanitation (MoHS) to increase uptake of services.  Through the treatment of moderate acute malnutrition in children age 6-59 months and pregnant and nursing mothers at Peripheral Health Units (PHUs), WFP is also helping to improve the nutrition status of vulnerable groups, reaching more than 43,000 children and mothers across the country.

Twenty-year-old Mariatu Kargbo is a mother of three children. She has come to the Sierra Leone Church Health Centre in Port Loko district, in the northern part of the country. Here she receives food assistance, maternal and child health services for herself and her eight-month-old child, Ibrahim.

Just a few months ago, whilst Ebola was still terrorising the people of Sierra Leone, this center like most others in the country, was abandoned by mothers. “The women here did not come to the health centre because they were afraid that if they took their children [there], they will get Ebola,” said Ernestine Wilson, the nurse in charge.

“Now the mothers are no longer afraid to come to the health center to access services and to receive food,” she adds. “The food attracts them to come to the centers and every mother wants her child, malnourished or not, to be in the programme.”

Like many mothers, Mariatu carries the responsibility for caring for her three children all by herself. Support from programmes like these is vital for ensuring the health of Mariatu and her children.

With limited resources derived from selling cooked food in her community, Kargbo admits that before she did not have enough food for Ibrahim. As a result, he became severely malnourished and sick at the age of six months.

After a month of treatment through the health center’s Outpatient Therapeutic Programme, he was enrolled in the center’s WFP supported targeted supplementary feeding programme, designed to provide continued support for children and mothers with moderate acute malnutrition. Through this programme, children like Ibrahim receive rations of SuperCereal Plus—a fortified blended food enriched with micronutrients—and specifically designed to meet the nutrition needs of moderately malnourished children.

“Ibrahim likes the food and it has helped him to gain weight and to be strong,” Kargbo proudly recalls. “I feel happy when I receive assistance from WFP especially since I have no one else to support my children.”

The Sierra Leone Church Health Centre is one of 106 PHUs in Port Loko District where supplementary feeding programmes are being provided by WFP thanks to funding from the Government of Japan. Like many of these centers, Sierra Leone Church Health Centre provides health and nutrition education in addition to vaccination, deworming, growth monitoring and supplementary feeding activities.

More than 26,000 children and about 17,000 mothers are benefiting from the supplementary feeding programme in five districts of Sierra Leone with the highest levels of food insecurity and malnutrition. The programme is vital to reducing undernutrition and attracting mothers to health centres again. At the same time, enriched foods provide vulnerable children the nutrients they need to thrive, helping to curb the inter-generational cycle of hunger.

To find out more about how WFP and its partners tackle malnutrition in Sierra Leone, click here.

Question

Review of literature and identification of case studies for evidence on youth mobilisation and technology. What mobile phone interventions or social media have been used by young people effectively to improve development outcomes for: a) accountability and transparency such as through the collection, monitoring and use of data b) improving delivery of essential services for young people (such as education or SRHR) c) promoting positive lifestyle choices and behavioural change, and d) supporting humanitarian service delivery in crisis situations.

Summary

This rapid review identifies recent literature and lessons learned from interventions that leverage mobile phone technology and social media to improve youth development outcomes.

Information and communication technologies (ICT) have had a profound impact on the political, economic and social sectors of many countries. The increasing ability of communities to access information via mobiles can be used to address political or social concerns, with youth playing a leading role. Young people are often ‘first adopters’ of new technologies particularly broadcast technologies such as mobile phones. Mobile phones create channels of cooperation, dialogue and information exchange between young people and their communities.

This report particularly draws on case studies from Kenya, Uganda, Nigeria and West Africa. In order to put the lessons learned into context, each section provides a brief overview of the situation in the reviewed countries and a snapshot of mobile phone or social media interventions that have been initiated. The review draws on reports and evaluations published by international institutions, evaluations of projects, reports by think tanks and research centres, and papers from academic journals.

Despite widespread support for the utilisation of mobile phone technology and promising early findings from various projects, there has been little comprehensive research or rigorous evaluation of the causal influence of mobile phones and social media on youth development outcomes. Similarly, few evaluations of youth programmes in developing countries unambiguously identify the causality from policy to programme to effect with many (youth) programmes falling into the promising but unproven. There is a need for more dedicated research in this area alongside the provision of mentoring and training for those keen to exploit the potential of ICTs, particularly mobile phones. Further to this, more exploration is required on how best to mitigate issues regarding access and the potential role advances in data collection can play in facilitating responsive, adaptive and participatory policy making and programming.

Summary

The deadliest outbreak of Ebola virus disease in history, and the first to hit epidemic levels, struck the West African countries of Guinea, Liberia and Sierra Leone in 2014, killing 11,315 people. Despite being diagnosed in March 2014, there was a slow initial response to the epidemic. This was attributed by many witnesses to our inquiry to delays in WHO sounding the alarm and declaring a Public Health Emergency of International Concern (PHEIC), something which WHO must carry primary responsibility for. As a result, the international community did not fully mobilise until September, in the wake of the World Health Organization’s designation of the outbreak as a Public Health Emergency of International Concern in August. We praise those who risked their lives to bring the epidemic under control and pay tribute to all those who lost their lives in the fight against Ebola.

The Department for International Development (DFID) played a strong leading role in co-ordinating the response in Sierra Leone, but it responded late due to the WHO designation delay and an over-reliance on the international public health system to sound the alarm. Médecins sans Frontières raised serious alarm as early as June 2014.

We recommend that DFID in future should be able to react to warnings from a wider range of sources, not just the established international system.

DFID, in collaboration with the Ministry of Defence, Public Health England and the NHS, operated effectively once its response began in earnest. We commend this coordinated response, which represents a fine example of cross-Government working.

We nevertheless wish to see improvements in DFID’s flexibility, especially in its ability to disburse small amounts of money early on in a crisis when it could be more costeffective.

We were told throughout the inquiry about the importance of community engagement in achieving an effective response. Two significant factors in the spread of the disease were cultural practices, such as unsafe burial, and distrust in the authorities and health sector. We recommend therefore that DFID engage communities earlier in future outbreaks, especially through trusted local, tribal and faith leaders, established voluntary organisations and civil society. DFID could also use anthropologists to facilitate this. Now that the Ebola crisis is over, it is vital that every effort is made to eradicate FGM in Sierra Leone and worldwide.

The Ebola epidemic exposed serious deficiencies in the international public health system. The World Health Organization has acknowledged its shortcomings in dealing with the crisis and that it requires radical reform to improve its outbreak capacity. We agree and urge DFID to lead efforts and make this reform a priority. The International Health Regulations have also been shown to be inadequate. Many countries are not taking their legal obligations under the regulations seriously; and there are differences in understanding over the purpose of the designation of a Public Health Emergency of International Concern. We support the creation of a transparent and clearly understood grading system for public health emergencies.

Summary

Ebola is a rare and deadly disease. It is spread through direct contact with the bodily fluids of infected people and with objects and materials contaminated with these fluids. Since late 2013, West Africa has experienced the largest Ebola outbreak ever recorded. It was, first and foremost, a human tragedy. We pay tribute to all those who worked tirelessly to tackle this outbreak, some of whom gave evidence to this inquiry, and many of whom continue working to avert similar crises in the future. We also commend the Government on its leading contribution to the fight against Ebola, and the financial, and personnel, commitments that it made, from constructing and staffing Ebola treatment centres in Sierra Leone to deploying troops, helicopters, aircrew and an aviation support ship to provide much needed logistical support.

Examples of UK successes in tackling Ebola, however, must not allow complacency to set in. Despite this impressive deployment of resources to combat Ebola in Sierra Leone, the UK response—like the international response—was undermined by systemic delay. The biggest lesson that must be learnt from this outbreak of Ebola is that even minor delays in responding cost lives. Rapid reaction is essential for any hope of success in containing an outbreak. Yet delays were evident at every stage of our response, from escalating Public Health England’s disease surveillance data to those with the capacity to act, to convening a Scientific Advisory Group for Emergencies—the main mechanism for channelling scientific advice to Government in an emergency—which failed to be established until October 2014, three months after ‘Cobra’, the Government’s emergency response committee, first met. In the absence of established mechanisms, ad hoc approaches emerged to fill the gaps. Inevitably, these were not as effective, or as targeted, as they should have been.

We recognise the enormous efforts made by governments, universities, regulatory bodies, humanitarian agencies, pharmaceutical companies and others to ensure that clinical trials for Ebola vaccines, treatments and diagnostics were launched in record time. But such efforts do not obscure the fact that the UK and other countries were not ‘research ready’ when the outbreak began, prompting a less than optimal and uncoordinated research response. The failure to conduct therapeutic trials earlier in the outbreak was a serious missed opportunity that will not only have cost lives in this epidemic but will impact our ability to respond to similar events in the future.

Research during an outbreak must be initiated rapidly, while still being designed and conducted to the highest possible standards. While we recognise the difficulties that arose in this outbreak, they are inherent to all epidemics; therefore, if we want to improve our response, we must address the weaknesses in our research readiness that this epidemic exposed. We are not convinced, however, that the Government has looked ahead and considered how a more timely, co-ordinated and robust response could be achieved when the next epidemic emerges.

Rapid and reliable communication is integral to delivering an effective response to a disease emergency. And yet, throughout the Ebola outbreak, we saw that systems to share advice, expertise, epidemiological and clinical data—particularly between the UK and Sierra Leone—were inadequate. We were concerned that this had harmful repercussions including a failure to undertake basic, yet important, research about the efficacy of Ebola treatments, as well as undermining the robustness of transmission modelling work. We recommend that the Chief Medical Officer urgently establishes new processes and protocols to ensure that knowledge and data are communicated effectively throughout an outbreak and that research is embedded into an emergency response from the outset.

The Government’s communications on Ebola with the UK public were accurate and balanced, making it all the more disappointing that the Government failed to explain why it went against guidance from the World Health Organization and Public Health England and introduced screening for Ebola at UK ports of entry. We recommend that when interventions like screening are instigated during an emergency, the Government makes the evidential basis for the intervention explicit.

Ebola also highlighted structural weaknesses in the UK’s capacity to absorb and withstand shocks to the system arising from emergencies. Despite hosting worldleading experts in immunology, epidemiology and tropical medicine in the UK, there are currently no licenced treatments for, and vaccinations against, Ebola. This situation has arisen, in part, due to a long-term market failure to invest in interventions for rare but potentially catastrophic epidemics. While we welcome the Government’s recent announcements of much needed research funds in this area, we recommend that it works with leading experts to publish an emerging infectious disease strategy, setting out the ‘priority threats’ the UK wishes to address, so that these funds can be effectively targeted and their benefits maximised.

We are also concerned that, in the unlikely but possible event of a domestic outbreak, the UK lacks the capability to go further and manufacture enough vaccines to vaccinate UK citizens in an emergency. Existing facilities are degraded and new plant will take years to build, leaving the UK in a vulnerable position. There is a need for the Government to do more than simply encourage inward investment in advanced manufacturing. We recommend that it acts now and negotiates with vaccine manufacturers to establish pre-agreed access to manufacturing capabilities that can be called upon quickly in an emergency.

The willingness of Government agencies, third sector organisations, health and aid workers, universities, and pharmaceutical companies to go above and beyond to help tackle the outbreak was phenomenal. The swift pace at which clinical trials were approved and conducted particularly stood out. The Defence Science and Technology Laboratory’s rapid diagnostic test for Ebola—which was developed, manufactured and latterly trialled on patients in Sierra Leone by January 2015—exemplifies the gamechanging innovations that can be achieved by Government research and development facilities collaborating with private partners and clinicians. We were therefore dismayed to learn that, despite the promise shown by this test, and the production of 10,000 testing kits, it was not released for general use by the Government. Instead, we received different explanations, from different Government departments and agencies, about why the test was not operationalised. We are concerned that this is indicative of a worrying lack of cross-Government co-ordination, as well as an accountability deficit, for key aspects of the UK Ebola response. We ask the Government to clarify urgently why the rapid diagnostic test for Ebola was not released for use.

Prior to the Ebola outbreak, the Government had remained largely silent on its policy towards global health since it published its Health is Global framework in 2011. While we hope that the world will never experience an Ebola outbreak of this magnitude again, it would be naïve to assume that epidemics with the potential to cause death and devastation, and cross national borders, can be consigned to the past. Our global health policy will have a profound impact on the lives of people in the UK and beyond. It is therefore vital that the Government clearly sets out what would trigger an in-country response to a disease emergency and what capability the UK should be able to deploy readily overseas.

The Ministry of Health and Sanitation has reported that two people suspected to have Ebola in the southern district of Pujehun were detected on 27 January. No further information is available on whether these two people are contacts in the recent cluster.

In other news, there has been ongoing community tension in northern Kambia province. Health authorities have been tracing contacts and enforcing restrictions in Barmoi Luma town after a 22-year-old girl, who later died and tested positive for Ebola, had been in the area whilst symptomatic. Following closures of the local market there have been protests, resulting in several people being shot and a police station being burned down.

• UNHRD continues to dispatch operational equipment for its Partners, most recently supporting WHO by sending protective coveralls, gloves and gowns to Guinea and Sierra Leone.

• During the worst of the crisis, UNHRD facilities in Accra and Las Palmas served as regional staging areas and the Accra depot hosted UNMEER headquarters.

• On behalf of WFP, UNHRD procured and dispatched construction material and equipment for remote logistics hubs, Ebola Treatment Units (ETU) and Community Care Centres. In collaboration with WHO, UNHRD also procured and dispatched equipment to establish camps for teams tracing EVD.
  Members of the Rapid Response Team (RRT) set-up supply hubs, an ambulance decontamination bay and ETUs.

En bref

• Le 12 janvier 2016, une jeune femme est morte à Tonkolili, dans le Nord de la Sierra Léone. Une analyse post-mortem a révélé qu’elle était décédée de la maladie à virus Ebola, marquant ainsi la résurgence de la MVE dans le pays le 14.

• Dès le 15 janvier, à la demande de la Coordination Nationale de Lutte contre Ebola, l’OIM a relancé les activités de Contrôle Sanitaire (CS) aux Points d’Entrée (PE) de la zone frontalière avec la Sierra Leone.

• Le 12 janvier 2016, l’OIM a déployé du matériel et des équipements à Boké dans le cadre des préparatifs de lancement des activités de Surveillance à Base Communautaire (SBC).