Sierra Leone + 2 more

Ebola response phase 3: Framework for achieving and sustaining a resilient zero

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From a peak of over 950 confirmed cases per week at the height of the Ebola outbreak, current case counts in West Africa are the lowest in over 12 months. The geographical extent of the outbreak has been greatly reduced and since July 2015 the vast majority of cases in Guinea, Sierra Leone and Liberia can be epidemiologically-linked to known chains of transmission. There is strong evidence that the strategies and tactics employed to date are working.

Although the incidence of Ebola has significantly decreased, transmission is on-going and the risk of reintroduction due to virus persistence has emerged as a substantive near-term threat to achieving and maintaining zero Ebola in the region. The July 2015 outbreak in Liberia, which was likely due to virus persistence in a male survivor who had recovered months earlier, reaffirmed the possibility for transmission to re-start. While the risk of re-introduction due to virus persistence in some survivors is declining over time, it is significant due to the sheer number of people affected in this outbreak. The purpose of this Phase 3 framework is to incorporate new knowledge and tools into the ongoing Ebola response and recovery work to achieve and sustain a “resilient zero”. Phase 3 of the response builds upon the rapid scale-up of treatment beds, safe and dignified burial teams, and behaviour change capacities during Phase 1 (August – December 2014), and the enhanced capacities for case finding, contract tracing, and community engagement during Phase 2 (January to July 2015)1.

This framework incorporates new developments and breakthroughs in Ebola control, from vaccines, diagnostics and response operations to survivor counselling and care. Many of the operational advances are already reflected in the latest national Ebola response initiatives, from “Operation Northern Push” in Sierra Leone, to the “cerclage” approach in Guinea, and the rapid response operation in Liberia.

As in previous Phases of the response, it is critical that the concerns of affected communities, households, and individuals are well understood and that they are fully engaged in implementation. The framework reflects the need for strong linkages across the response, early recovery and longer term health systems strengthening work outlined in the National Health System Recovery Plans. While Phase 3 activities will require some adjustments to current response operations and recovery planning, it is crucial that the progress made in Phases 1 and 2 - and the underlying capacities - remain in place as the foundation for all response efforts. The scale and geographic prioritization of Phase 3 activities will be regularly reviewed and adjusted based on the evolving epidemiologic situation and understanding of virus persistence.

Phase 3 objectives: Objective 1 - To accurately define and rapidly interrupt all remaining chains of Ebola transmission Objective 2 - To identify, manage and respond to the consequences of residual Ebola risks.