Guinea Facing a Double Pandemic as Ebola Resurfaces

Guinea has announced an Ebola epidemic after registering at least 9 new cases and 5 deaths from the deadly disease. It appears that most of the new cases have stemmed from the funeral of a nurse that took place close to the Liberian border over two weeks ago in the second largest city, Nzerekore.

Significance

Contact tracing is underway to identify and isolate potential contacts of the infections that have been identified so far. The government has announced control measures in the affected area such as the closure of markets, a ban on weddings and funerals, temperature screening and a ban on gatherings of more than five people. Concern is obviously high after the previous West African Ebola pandemic caused over 11,000 deaths (over 2,500 in Guinea) between 2013 and 2016 with a case fatality rate of nearly 50%[1]. It also cost the worst-affected countries (Guinea, Sierra Leone & Liberia) an estimated 12% of their combined GDP[2]. 

Guinea has registered around 15,000 Covid-19 cases with 85 confirmed deaths. Whilst health facilities have been extremely stretched (both in infrastructure and personnel), they have not been totally overcome. The construction of a 208-bed field hospital in the capital Conakry, funded by the UAE in November 2020 helped ease the burden. The country has carried out a limited vaccine exercise[3]on 55 people using the Russian Sputnik V vaccine and expects to roll it out further in the first quarter of this year using both Sputnik V and vaccines procured through the Covax scheme. 

Since the 2013-16 pandemic, two different Ebola vaccines have been developed so hopes are that this can be deployed to slow the spread of the disease this time around. However, this will not be a simple process for the following reasons:

●      Only 6,890 doses of the Erbevo Ebola vaccine exist, and they are all stored in Switzerland. This is the vaccine that is used in outbreak response via what is known as ring vaccination. Whilst more are being manufactured, the pace of this is much slower than ideal due to the competing demand from Covid-19 vaccine manufacture.

●      Similar to the Pfizer Covid-19 vaccine, the Ebola vaccine must be stored at -80°C. Whilst some temporary cold storage solutions were deployed in 2013-16, it is unclear what their state of serviceability is after almost five years. 

●      The vaccine was developed to target a particular strain of Ebola and, as yet there is no information on which strain has re-emerged in Guinea.

Outlook

A heightened vigilance on the part of both citizens and health workers due to the Covid-19 pandemic regarding hygiene and disease prevention will likely help slow the spread of the outbreak and has led to officials showing cautious optimism that the epidemic can be contained. Another positive is the learnings that were made from the 2014-16 pandemic – the Guinean Minister of Health, Remy Lamah said “in 2013, it took us months to understand that we were dealing with an Ebola epidemic, while this time, in less than four days, we were able to do analysis and have the results. Our medical teams are trained and seasoned. We have the means to quickly overcome this disease[4].” While the response has been rapid, there is concern that not enough investment has been made in health systems to stop an outbreak on the scale of what was previously seen if containment efforts fail- healthcare spending in 2018 was only 3.9% of GDP compared to a global average of 9.4%[5].

The WHO predicts that vaccines and vaccination teams can be in a country within 7 days of a request for them to be deployed. It is therefore a matter of how much containment can be done until this point. Doctors Without Borders are mobilising staff that are already in the country to help with tracing and confinement efforts. Neighbouring countries have also placed their health systems on high alert, especially given the porous nature of the borders shared by Guinea, Sierra Leone, Cote d’Ivoire and Liberia. Sierra Leone is already investigating a suspected Ebola case, although tests are still outstanding.  

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[1]                For reference, the case fatality rate of Covid-19 is estimated to be less than 1% globally.

[2]https://www.worldbank.org/en/news/press-release/2015/01/20/ebola-most-african-countries-avoid-major-economic-loss-but-impact-on-guinea-liberia-sierra-leone-remains-crippling

[3]                The only low-income country in the world to have administered any vaccines at all.

[4]https://www.reuters.com/article/us-health-ebola-guinea/guinea-tracks-potential-ebola-contacts-says-it-can-overcome-new-outbreak-idINKBN2AF0Y1

[5]https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS