Lessons from the Ebola outbreak

Around five years ago, Ebola was regarded as a potential threat to global health, yet even though the lethal virus claimed nearly 12,000 lives, it was restricted mainly to West Africa, where it started. One of the reasons why it did not spread beyond that part of the world was the coordinated efforts of European and American politicians and scientists.

The person who was responsible for managing the epidemic on behalf of the European Union was its commissioner for humanitarian aid and crisis management, Christos Stylianides.

The Cypriot politician speaks to Kathimerini in the midst of the Covid-19 crisis, explaining how the authorities managed to control Ebola.

It was September 2014 and candidates were being interviewed in Brussels to head the Commission under the leadership of Jean-Claude Juncker, with European lawmakers asking a slew of questions before they could assume their portfolios. When Stylianides was asked what he would do to manage the Ebola crisis, the virus had already infected 3,500 people and was spreading at a rate of double that every month.

“If we want to avert a pandemic, we need to deal with the virus where it started and not from our offices in Brussels,” he said without a second thought, vowing to visit the affected countries as one of his first orders of business. A few days later, even before formally assuming the portfolio, Stylianides was appointed coordinator of the Ebola crisis by the European Council and Commission.

“The situation was deteriorating and there were concerns that the virus could come to threaten Europe,” he tells Kathimerini, adding that the World Health Organization (WHO), which was the global response coordinator of the outbreak, was facing a crisis of its own. “There was one frightening scenario going around at the time that foresaw as many as 30 or 40 million victims,” he says, pointing to the fact that Ebola has a much higher death rate than the novel coronavirus, of more than 60 percent.
 
Stylianides was sworn in on November 1, 2014, and by the middle of the month had departed for a tour of Sierra Leone, Guinea and Liberia, the three countries that had been hit by the Ebola virus. “Neither flight attendants nor doctors would go; no one wanted to travel there. The isolation was just incredible. Flights had almost been completely banned,” he tells Kathimerini.

Almost immediately he discovered that there were two main reasons why the virus was spreading so fast. The first was that the three countries were not working together on the issue even though they shared open borders and the river separating two of them was crossed every day by thousands of people. The second reason was that Ebola victims were being buried according to traditional customs, where families touch the bodies.

The situation was complicated even further by the rumor mill, as many in all three countries believed that the virus was the product of an international conspiracy and not real at all. Moreover, with economies depleted by years of war, none of the three countries had invested in their national health systems, which collapsed under the huge influx of patients. “They had no way of isolating them, so sick patients were being mixed with those who had not been infected by the virus,” says Stylianides, who likened the situation to a ticking time bomb that he needed to defuse before it exploded in his hands.

Following a series of meetings, the European commissioner was able to get the leaders of Sierra Leone, Guinea and Liberia to work together on the outbreak. The first priority, though, was bolstering healthcare facilities immediately with mobile labs and care units that could be sent from the European Union, as well as the United States. As coordinator, Stylianides had the authority to be in constant communication with the foreign ministers of Germany, France and the United Kingdom – which had a greater involvement in the effort – as well as the health ministers of all EU member-states and the US, which had also appointed their own coordinators for the Ebola outbreak.

“Putting someone in charge was a drastic and necessary measure for increasing the efficiency and speed of decision-making,” he says.

The European Commission has yet to appoint someone in such a role for the coronavirus pandemic.

“The management of the coronavirus crisis is mostly being handled at the national level right now,” says Stylianides. “This could be bolstered by stronger European coordination. In this experience, like others before it, the European umbrella could really help member-states which, like Italy, are having trouble coping.”

Back in 2014, one of the biggest problems Stylianides faced was that medical and nursing staff could not be sent to the affected countries unless they could be brought back home immediately in the event that they became infected. The answer was to set up a medical evacuation (Medevac) system with airplanes that were specially equipped with intensive care capabilities so that they could fly medical personnel back to the European Union in an emergency. Mobile labs and hospitals were also set up with the help of international organizations and nongovernmental organization like Medecins sans Frontieres.

The world’s response to the Ebola crisis, which first appeared in Guinea in late March 2014, was already overdue, but the appointment of a special coordinator in Brussels also helped speed up decisions on funding that accelerated research into an Ebola vaccination and other drugs.

“A few months later, in March 2015, we convinced the leaders of the three affected countries to come to Brussels for a big international conference, where they would agree to intensify cooperation, but also to be treated as a single unit,” says Stylianides, stressing the importance of this increase in cooperation in restricting the number of new infections.
The number started dropping as early as April of that same year, so that 12 months later, Ebola was considered eradicated from all three countries.

The Ebola crisis and especially the difficulties involved in mobilizing medical units, made Stylianides a staunch supporter of the European Medical Corps, whose aim would be to organize joint responses to health crises both inside and outside the EU. The agency was launched in February 2016, while three years later, the EU strengthened its civil protection response with the creation of the mechanism rescEU. This provides an additional safety net when member-states’ operational and funding resources are unable to deal with a natural disaster. The mechanism was activated for the coronavirus pandemic as well, with the European Commission saying that it would cover 90 percent of the cost of an additional 50 million euros’ worth of medical supplies like respirators and masks to help member-states.

“International cooperation under the aegis of the WHO, effective coordination and solidarity between member-states are the keys to dealing with this crisis,” Stylianides tells Kathimerini. “We have to act collectively as Europeans, but also on a global scale, putting aside our political differences and expediencies. We need to act as one on the basis of the scientific evidence and with the purpose of saving lives.”