The number of new Ebola cases has quadrupled over the last week in Guinea and Sierra Leone, with a total of 35 infections reported after weeks of reports of the virus' decline and a sense that it may finally be close to burning itself out, according to the World Health Organization (WHO).
Just over a week after Liberia — the other West African nation hit hard in the past year by the Ebola outbreak — was declared free of the deadly hemorrhagic fever. Bruce Aylward, the WHO's special representative for Ebola, announced the rise in cases while meeting with local health officials, Reuters reported.
For the week leading up to May 17, a majority of the new infections occurred in Guinea, and there were only nine cases reported in the countries during the previous week. University of Reading virologist Ben Neuman told VICE News that despite the increase in cases, international medical charity Doctors Without Borders (MSF) has been able to stamp out the virus throughout the country — except for the area around the capital Conakry, which lies along the border with Sierra Leone.
"It's pretty well contained, but still a majority of cases are coming from unknown sources, which means the contact tracing is not what it should be," Neuman explained to VICE News, referring to the practice of tracing all of an Ebola patients contacts to ensure they are monitored during the virus's 21-day incubation period.
International Rescue Committee's (IRC) senior health director Emmanuel d'Harcourt told VICE News that the situation in Sierra Leone differs from Guinea, however, in that all the new cases are coming from known contacts. This means all of the new infections in the country are people who were under surveillance, making it likely they will get treatment faster and reduce the possibility of further spread. He explained that Liberia experienced similar periodic flare-ups as the outbreak waned there earlier this year.
"If anything, it's a sign that the surveillance system is working and catching the people it's supposed too," d'Harcourt said. "We are on the road to or in the right direction to ending the epidemic."
During the meeting on Tuesday, Aylward stressed that continued infections further prove that Ebola "will not go quietly."
"It will take an extraordinary effort to finish the job," Aylward told a briefing attended by health ministers. "With the start of the rainy season today, the doubling of effort will be that much more difficult, that much more important."
The deadline of the upcoming rainy season has been looming in conversation for months, both among locals and health experts, as rainy conditions could hinder response efforts, making it particularly challenging for health workers to travel and transport goods over muddy roads in order to reach communities in need.
Aylward addressed these concerns directly in January, as the agency's financial future was in question with concerns that the WHO would run out of money by February. At the time, a WHO representative said it would be months before the outbreak would be brought down to the crucial zero cases.
"It really depends on the progress they can make between now and the wet season," he said. "Because if you go into a real wet season with this disease you're looking at another hard year of work or plus."
The news that cases are up in Guinea and Sierra Leone comes on the heels of WHO's 68th annual World Health Assembly on Monday. During the event, Director-General Margaret Chan announced major reforms and funding changes developed in direct response to challenges the agency faced during the Ebola outbreak, which began in December 2013 in Guinea before spreading to neighboring countries.
"The world was ill-prepared to respond to an outbreak that was so widespread, so severe, so sustained, and so complex," Chan said. "WHO was overwhelmed, as were all other responders. The demands on WHO were more than 10 times greater than ever experienced in the almost 70-year history of this organization."
Chan announced a set of five changes to the agency, most notably the creation of a single program to respond to health emergencies, which she said was specifically designed for speed, flexibility, and rapid impact. The program will coordinate a global health emergency workforce and is expected to report directly to Chan, but in theory will run independently of some of the political mechanisms of the WHO.
"The Ebola outbreak shook this organization to its core," Chan said. "This was a defining moment for the work of WHO and a historic political moment for world leaders to give WHO new relevance and empower it to lead in global health."
The director-general, who has found herself in the crossfire of criticism against the agency for failing to mount a sufficient and timely response, also said she would be establishing a $100 million contingency fund. The money, which would come from voluntary contributions by member states, would aim to ensure that the necessary resources are available for WHO to respond immediately. Chan said all of the changes are set to be implemented by the end of 2015.
"I do not ever again want to see this organization faced with a situation it is not prepared, staffed, funded, or administratively set up to manage," she said.
While these reforms may be a step in the right direction, d'Harcourt said IRC is concerned they don't address some of the critical problems that arose during the outbreak. He explained that the changes seem to focus mostly on the pace of the response, which is an enticing narrative, but it doesn't necessarily fit the facts of the outbreak. According to d'Harcourt, WHO could have declared the international public health emergency earlier than it did in August, but regardless, there were already international teams on the ground. Instead, the focus should be on the efficiency and capabilities of the response, particularly the failure to gain public trust early on in the outbreak — something that continues to contribute to the spread of the virus in Guinea.
"It's not the failure of the international community to respond, but the fact that when they did respond, [they] did not connect to people they were responding with and that's what drove the epidemic," he said. "If we don't address the central problem, more money and more people won't help. We're in danger of repeating the same mistake."
D'Harcourt said it is crucial to understand why international and local response teams struggled to connect with communities in Guinea, Liberia, and Sierra Leone. He also stressed that WHO needs to make sure it has its top teams on the ground during public health emergencies, prioritizing quality over quantity, especially when it comes to country representatives stationed around the world.
"You can have the entire WHO staff located in Guinea right now and that wouldn't help if we couldn't connect with the population," d'Harcourt said.
Earlier this year, the United Nations said the outbreak would likely be over by August — which would be over a year and a half after the virus showed its face in Guinea, infecting a 2-year-old boy in the country's Gueckedou prefecture. After a country reports no cases within its borders, a 42-day period is required before the country can be declared officially Ebola-free. Guinea and Sierra Leone would need to reach zero infections by the end of June in order to meet this goal.
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