The momentous efforts of World Health Organisation (WHO) helped eradicate the West African Ebola outbreak, which claimed more than 11,000 lives in the span of two years. On 29 October 2019, the King’s Think Tank Global Health Policy Centre facilitated a simulation of this response. Iya Saidou Conde and Alexandre Robert, two Ebola healthcare workers, helped conduct the ‘Ebola Outbreak Response: Table-Top Simulation’ at Bush House. 

During the West African Ebola outbreak, Mr. Conde worked for the WHO as a field epidemiologist. Mr. Robert, a public health nurse from France, worked for the International Organisation for Migration during the outbreak. The attendees and I had the pleasure of meeting and interacting with these two healthcare workers, who shared their first-hand experience of being involved in the Health Emergency Operation Centre (HEOC). There is a striking difference between reading Ebola outbreak stories and listening to firsthand accounts from individuals, such as Mr. Conde and Mr. Robert, who saw the extent of the destruction in person. 

Background:

The initial case, or index case, of the West African Ebola virus outbreak was reported in December 2013, involving an 18-month-old child from a village in Guinea. In the two years that followed, the epidemic would prove to be the largest Ebola outbreak ever recorded, due to the high fatality and transmission rate of the disease. A total of 28,616 cases of Ebola Virus Disease (EVD) and 11,310 deaths were reported in Guinea, Liberia, and Sierra Leone. 

EVD is a highly lethal, viral hemorrhagic fever which has a transmission rate of 33-90%, and a fatality rate of 90%. The virus spreads through direct contact with the bodily fluids of the infected, and can transmit through both animal-to-human and human-to-human contact.

On 7 August  2014, seven months after the index case, the WHO declared the EVD epidemic a Public Health Emergency of International Concern (PHEIC), followed by the UN Security Council declaring the outbreak a ‘threat to international peace and security’. The WHO mobilised its regional and international resources to guide and coordinate the response. The combined efforts of international response teams and Ebola healthcare workers prevented  the disease from causing further destruction. On 14 January, 2016, West Africa was declared Ebola-free, marking the official end of the epidemic.

Simulation:

The primary objective of the simulation was to understand the functionality of an Ebola outbreak response team. Attendees participated in a ‘real-situation’ simulation of an Ebola outbreak, giving them the autonomy to make tough decisions based on the information provided.  

The opening remarks were given by Dr. Brian McCloskey, Director of Global Health for Public Health England. He has worked in public health at the local, regional, national, and international levels for over 25 years, including at the UK’s Health Protection Agency. Dr. McCloskey highlighted the importance of critical thinking and decision-making during emergencies, and how prompt planning and mobilisation of resources can help alleviate the crisis. 

Emergency preparedness is a key aspect of a community’s strength and resiliency. For the HEOC to be functional and ready for the next crisis, it regularly organises simulation exercises, one of which is the table-top exercise. Participants are assigned the roles of essential officers, managers, and coordinators who are integral to ensuring the success of the mission. Mr. Conde and Mr. Robert facilitated an identical simulation in which our task was to discuss and devise a plan to mobilise resources for another potential Ebola outbreak in West Africa.

We were first briefed about the scenario, which was very similar to the 2014-16 West Africa Ebola outbreak. To briefly summarise the scenario: three successive and related death cases of Ebola were reported from a town called Zola (fictional) just four months after a major outbreak subsided. We were then presented with the transmission history of the virus, which started from an Ebola survivor. We were then divided into four sub-groups: coordination, surveillance, case management, and communication, where we each took on specific roles concerning our sub-groups.

I was the Finance and Administration Officer for the coordination sub-group. Given my background in business management, I believe it was the right role for me as I had to critically think about sourcing and allocating funds for the Emergency Operation Centre (EOC). Our group’s immediate task was to discuss and deliver ten action points for the short (1-2 days) and medium (1-2 weeks) terms. After extensive discussion about minimising the impact of the outbreak, we agreed that logistics (which falls under coordination) required the highest priority. To contain the disease, EOC workers must have the correct Personal Protective Equipment (PPE) to aid their mobility in affected regions without getting contaminated with the virus. As our primary action point, we collectively decided that PPE should be supplied to all current and forthcoming Ebola healthcare workers. 

The second half of the simulation was a plenary Ebola coordination meeting where all four sub-groups came together for a decision-making discussion. Mr. Conde chaired the discussion, critically questioning every point raised by the committee members. This experience helped me understand the rigor with which each idea is investigated and analysed to ensure that it is watertight. 

Every point was carefully examined and looked at from all angles. As Mr. Conde noted, ‘Any small mistake or omission in the planning stage can prove disastrous to field workers who are heavily dependent on the framework set out by HEOC.’Overall, the event gave an insight into how crisis planning and staging occurs at a global level, particularly during an epidemic. It was an opportunity to learn about the hours of discussion and critical analysis that are put into actionable plans before they are convened into a framework. The Global Health Policy Centre would like to thank our speakers and guests for attending and participating in this stimulating experience.

Bhavya Tripathi
Bhavya Tripathi is editor for the Global Health policy centre.

Bibliography:

‘Cost of the Ebola Epidemic.’ Centers for Disease Control and Prevention. CDC, March 8, 2019. https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/cost-of-ebola.html?CDC_AA_refVal=https://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/cost-of-ebola.html.

‘Ebola Virus Disease.’ World Health Organization. WHO, 2016. https://www.who.int/health-topics/ebola/#tab=tab_1.

‘Key Events in the WHO Response to the Ebola Outbreak.’ World Health Organization. WHO, October 19, 2015. https://www.who.int/csr/disease/ebola/one-year-report/who-response/en/.