The World Health Organization (WHO) and the Africa Centres for Disease Control and Prevention launched a joint continental preparedness response plan to address the current Ebola outbreak on Friday, based on 11 pillars and a $518 million budget.

Earlier this week, the two groups reduced their Ebola case projections substantially after testing the backlog of suspected cases in the Democratic Republic of Congo’s (DRC) Ituri province, the epicentre of the outbreak, explained Dr Jean Kaseya, Africa CDC Director General, at a media briefing on Friday.

The previous projection of over 1,300 suspected cases was based on the case definition given to health workers of Ebola Bundibugyo symptoms, some of which are similar to other diseases endemic in the region, such as malaria. 

Once samples from the 1000-plus suspected cases in Ituri had been tested, Africa CDC had been able to confirm a total of 397 cases, 63 deaths and a case fatality rate around 16%, said Kaseya. 

However, both Kaseya and WHO Director General Dr Tedros Adhanom Ghebreyesus stressed at the media briefing that the outbreak is serious. The bodies of some 250 people suspected to have died of Ebola Bundibugyo still need to be tested, for example.

“My trip to the DRC also gave me real hope that together under the government leadership, we can bring this outbreak under control,” said Tedros.

“The only way we will do that is through government leadership, community ownership, and close partnership between the many actors on the ground today. WHO and Africa CDC are expressing that partnership by launching a joint continental preparedness response plan.”

Weak local health systems

The outbreak also faces significant challenges, particularly given the weaknesses of the health systems at its epicentre.

Dr Roseline Belizaire, WHO Africa’s head of emergencies, said that an assessment of the 800-plus local health centres for infection prevention and control (IPC) had rated them at 3-7% “when you need 90% IPC to respond to Ebola”.

In response, the WHO and Africa CDC has prioritised 87 health centres, all had received personal protective equipment (PPE) and all their health workers had been trained in how to use it, said Belizaire.

She said that 34 healthcare workers had been infected DRC, seven had died and six have recovered so far.

Improved IPC, disease surveillance, laboratory testing and clinical care are key aspects of the “One Response” continental response plan, which complements the national response plans of the governments of the DRC and Uganda.

“The only way to beat this outbreak is through close partnership, working together under the leadership of the affected countries in one coordinated effort, guided by a simple principle: one plan, one budget, one team,” said Tedros. 

Dr Mohamed Janabi, WHO Africa’s regional director, stressed that “strong surveillance, rapid testing, timely care, infection prevention, and sustained community engagement” is what works to contain Ebola.

However, Janabi stressed: “Plans do not stop Ebola, people do: protected health workers, decisive leadership, communities that trust the response.” 

Where’s the money?

However, Kaseya said that most pledges for financial support still had to turn into “real money” as less than $3 million had reached affected countries so far.

At a global meeting convened last Monday, pledges of around $498 million, “then some of our partners started to correct the figures”, said Kaseya, briefly sharing an Excel spreadsheet of these pledges which showed that the United States had promised the most – $82 million.

“[This spreadsheet] is what partners they shared with us without changing this figure. Is it real money? No,” said Kaseya, adding that Uganda’s acting health minister had told him that she had not even received $2 million from partners so far and that the DRC’s health ministry is also struggling. 

“We’ll keep our partners accountable. You gave us figures, we want to know where this money, and how this [pledge] is becoming real money.”

Kenya’s US quarantine facility

Kaseya said that he had discussed the controversial US plan to quarantine its citizens suspected of Ebola in a facility in Kenya with senior Kenyan officials.

“We need to recognise the country leadership and the country sovereignty,” said Kaseya, adding that the proposal had developed in discussion between the two countries on how the US could support Kenya’s preparations in case Ebola spread to Kenya.

According to Kenya’s preparedness plan. Kenya, the government planned to set up 23 centres for isolation and treatment, and “then there was an offer made by the US that one of the 23 centres can be used [for US citizens] rather than sending people to Europe”, he added.

“This is the information that we have. We respect the Kenyan authorities for the decision they made. We are supporting them in their preparedness plan, and they know that if they need support from Africa CDC and the WHO on any issue, they can get it.”