Tolbert Nyenswah, Esq., LLB, MPH, Liberia’s National Ebola Incident Manager and Assistant Minister/Deputy Chief of the Ministry of Health & Social Welfare, updates GHN on the country’s response. Interview by Dayna Kerecman Myers, Associate Editor of Global Health NOW.
Are you concerned that as Ebola cases fall in Liberia, interest and support from abroad will fade and with it hopes for rebuilding the health system?
We are having these conversations with donors as we speak. We have built very strong relationships with organizations… and they understand that the need for donors during the post-Ebola time of rebuilding will be great.
To ensure that plans are in place … the Ministry of Health, along with other government agencies and partners, is conducting an assessment to review progress toward the 10 Year National Health Policy and Plan established in 2011. The assessment will provide updated objectives and short- and long-term cost estimates in terms of the restoration of essential health services and strategies.
Why did health workers and the public distrust the government at the beginning of the outbreak?
Initially, Infection Prevention & Control (IPC) training and materials were slow to roll out to health facilities, leading to infections among health workers who lacked information—or the proper materials—to protect themselves when an Ebola patient presented. This has been addressed through widespread IPC trainings across the country, and by overcoming logistical hurdles to distribute IPC materials to health facilities. As logistics and training have improved, we’ve seen a significant reduction in health care worker infections, with few, if any, being reported at this stage of the outbreak.
In terms of the public, the outbreak was unprecedented and hit us hard, causing panic; other countries in the world could not have been prepared for what Liberia faced, either. We had to work very hard to engage the affected communities, to educate them and to gain their trust as we scaled up our response. That took time and patience, but now we have a sufficient number of Ebola treatment facilities, beds and laboratory capacity to test specimens more quickly and communities are largely pleased.
Currently we are in Phase II of the EVD outbreak in Liberia, emphasizing intense community engagement. We have seen remarkable acceptance and action on the part of the Liberian public. For example, recently we’ve had an average of about 1.4 cases confirmed per day, but an average of about 25 cases reported a day. This is good; this shows that the public is being proactive about reporting illnesses, and that suspected cases are not languishing in communities, potentially infecting others. Now, cases are being isolated sooner, and people are receiving treatment earlier—ensuring a better chance at survival. Thus, I would say at this stage that we have the public’s trust—and are continuing to earn it.
Has the Ebola crisis led to stronger ties with other countries?
To a large extent, the crisis has prompted the development of stronger health communication and surveillance ties with other governments across Africa. With experience in EVD management, East Africa has contributed human resources to Liberia. A Ugandan government team of medical experts has played a key role in the fight against Ebola. Besides the African Union joint support to Liberia, Nigeria, Uganda, Kenya, Egypt, South Africa and Namibia have been tremendously helpful in supporting Liberia.
You’ve been working with colleagues at Johns Hopkins to connect to drug manufacturers for experimental treatments and vaccines. How is that going?
In the past months we’ve been working to reach consensus regarding protocol, ethics and regulation. Phase 1 data from studies conducted in the US, Europe and sub-Saharan Africa shared with the Liberian Technical and Consultative Advisory Groups clearly indicated promising immunogenic responses. [This] led to a proposal to combine the Phase II/III approach in Liberia. Now, Liberia-US Technical Teams are finalizing protocols to submit to ethical and regulatory entities for approval, recruiting and hiring hundreds of Liberians to support the project structure, rehabilitating designated health centers, upgrading lab facilities, developing a clinical research program at the Liberian Institutes for Biomedical Research (LIBR), and providing mentoring and training opportunities to Liberians. Discussions are underway to ensure acceptable liability insurance for Liberian investigators and study volunteers, and the government is developing a legal framework.
Could the (thankfully) dwindling number of cases in Liberia make it harder to prove the efficacy of the vaccine?
Vaccine trials are still set for implementation. The Official Launch of the EVD vaccine trial is expected to commence by the end of January or early February, at either JFK or Redemption Hospital. A reduction in the cases could be a challenge for the vaccine trial, but will not necessarily affect the quality of the study.
Earlier you mentioned that you'd like to see the use of cell phone data and geo-spatial mapping to better understand patterns and boost the government response. Are you seeing that yet?
We’ve been working with partners on several technology-driven initiatives. For example, the CDC analyzed cell phone tower traffic in Liberia to pinpoint potential outbreaks (where clusters of people called the national Call Center), and to gauge the effectiveness of social mobilization campaigns. UNMEER/UNFPA are equipping contact tracers with close to 3,000 mobile phones. And the US National Geospatial Intelligence Agency (NGA) has compiled data through geospatial mapping, placed online to boost the international response to Ebola. We’re confident that many of these initiatives will last beyond the EVD response, and will support the broader health system as we continue to rebuild essential health services.