Global Ebola Response Coalition Meeting (GERC) - 06 March 2015

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Coalition Meeting Notes - Minutes from the weekly meetings held by the Global Ebola Response Coalition:

Global Ebola Response Coalition Meeting 21 | 6^th March 2015:

Issues Discussed and Next Steps

The twenty first meeting of the Global Ebola Response Coalition Core Group took place on 6 March. The main points covered in the meeting follow.

2.            Participants discussed the status of the outbreak.  The cumulative number of people who have been diagnosed with Ebola in the current outbreak is now 23,983. The number of people newly diagnosed with Ebola in the 7 days to 1 March, is 132; the figure was 99 in the preceding 7 days. This week’s total reflects increases in Guinea (35 to 51) and Sierra Leone (63 to 81) but a fall in Liberia (1 to 0). The volatility in numbers of people newly diagnosed with Ebola each week continues: the figure ranges between 90 and 160 new cases per week.  The majority of new cases are reported from the geographical region around the coastal border areas between Guinea and Sierra Leone.

3.            There have been no new cases in Liberia for the first consecutive 7 days since May 2014. This is an important landmark. It results from intense effort over a long period. But continued vigilance in Liberia is extremely important. In Guinea there is concern about reports of people newly infected in Macenta, although the majority of new cases continue to be reported from the Ba Conakry area. The increased coverage of the response and greater access to affected communities (as those communities engage more with the response) will result in an increase in the numbers of people newly diagnosed with Ebola.  Such an increase should not be seen as a major setback if it is accompanied by an increase in the proportion of people newly diagnosed with Ebola, who have been identified as contacts of persons already known to have the disease. In Sierra Leone there are still multiple sites of transmission over a wide geographic area. A recent flare-up in Bombali has added to the increase in the total number of new cases and is linked directly to the earlier flare-up in the Aberdeen district of Freetown.

4.            There has been a welcome increase in the numbers of people newly diagnosed with Ebola who have been identified as contacts of persons known to have the disease: in Sierra Leone the percentage increased from 19% to 78% in the last week. In Guinea the percentage fell from 49% to 14% during the last week.  The number of persons who have died in their communities and who have been confirmed as suffering from Ebola disease through samples taken at the time of death, has risen in the last week both in Guinea and in Sierra Leone - from 9 to 17 and 11 to 14 respectively. This information suggests that the response is not working in these communities.

5.            Participants discussed the status of the response. There is clear evidence the current strategy is working and needs to be sustained and trusted. But the response needs to continue to be adapted both to the epidemiological situation and to the context in which the response is being undertaken. A major focus continues to be on reducing the geographic dispersal of the outbreak ahead of the rainy season, when access will become more difficult and logistical challenges much greater. Detailed local-level planning of the response – particularly around the capital cities of Conakry and Freetown – is an important part of the response.  This local-level planning was seen as an important contributor to success in the polio eradication programme. The continued scale up of the national and international presence and steady improvement in the coordination of responders, have made important contributions to reductions in the numbers of people newly infected with Ebola.    Cross border work is being scaled up, with responders from Guinea visiting the Kambia District Ebola Response Centre in Sierra Leone, to compare and share experiences.

6.            A strong focus on getting to zero must be sustained, not least because full recovery cannot be achieved without first getting to zero. It is felt that any expanded role for the police and security services in the response needs to be considered carefully: actions which help to encourage trust between Communities, Governments and Responders should be promoted, and activities which might increase mistrust should be avoided.   Rather than increasing the involvement of police and security services, a more effective approach may be to increase capacity for community engagement, in the more reticent communities of Guinea and Sierra Leone, so as to build greater trust.

7.            There was discussion on the series of formal activities, either underway or planned, to identify lessons learned from the Ebola outbreak. There is a strong view that undertaking this work whilst the response is ongoing and the responders are in place, has real virtue, in that the response is both topical and fresh in all minds. There is not a widely held view that lessons-learned work is a distraction. However there are many review processes underway or planned at institutional, country or thematic level and if they are not well integrated they could absorb scarce time of responders.

8.            Ongoing and planned activities discussed were:

- There are two initiatives underway under WHO auspices.  The first is an interim assessment, mandated by the Executive Board Special Session on Ebola and to be presented to the World Health Assembly (WHA) in May. This would involve an independent panel of senior people experienced in the field of outbreak and humanitarian response. It is possible the work might receive direction from the WHA in May and continue thereafter.  The second is based on the outcome of the interim assessment, a longer term assessment to be considered in the context of the International Health Regulations (IHR). This work will commence at the end of the outbreak and will take the form of a Review Committee, to consider whether there are gaps in the IHR, with a view to being better prepared for future outbreaks;

- A piece of work prompted by a letter to the UN Secretary General from the Heads of State of Germany, Ghana and Norway, which recommended the establishment by the Secretary General of a High Level Panel to assess lessons learned from Ebola;

- A series of high level meetings which were initiated by three parties: the Institute of Medicine; the World Bank; and the Rockefeller Foundation. One of the outcomes of this process will be to set up a “Commission” to look at different aspects of the response;

- The World Economic Forum has initiated work which will consider how public/ private partnerships can support future global health emergencies like Ebola. This was an important mechanism in enabling businesses to express their views and play a role in the review process.

9.            It is important to maximise synergy and integration in taking forward these various activities. There are a number of common areas which many of these activities will consider; i) the global governance structure; ii) the system of crisis management; and iii) the progression to more resilient health systems; iv) financing of the response; v) research and development for high impact. Discussions on the issue of reducing duplication and maximising synergy and integration are now underway with a view to streamlining the work where possible.

10.            It is extremely important to ensure that the conclusions of these processes do stimulate the necessary changes for the future.  This has not always happened in the past. And also the views of the communities and their representatives, and those of the implementing agencies on the ground, must be fully considered and inform the conclusions of the various pieces of work. This must be considered in both the design and the implementation of the lessons learned work.

11            It will also be critical that strong linkages are made between the various initiatives to consider global architecture and those identifying lessons learned at a more local level. There is an important distinction between the initial risk management activities and the larger scale humanitarian response which followed; and also between the governance of the response and the more operational components.

12.            The Coalition is an important forum for bringing together the various initiatives for capturing lessons learned and where possible contributing to the alignment of those activities. It will serve as a mechanism to disseminate knowledge about the various initiatives and their conclusions.

13.            Participants shared some reflections on the 3 March Ebola Conference in Brussels. There is an extremely positive sense that the Conference played an important role in establishing a strong consensus about the way forward in getting to zero, and identifying a pathway to early recovery and longer term development. There was a strong sense also of solidarity emanating from the meeting, not just from the Presidents of the affected countries – who stayed fully engaged throughout the meeting – but more widely; and a clear commitment from the responder community to continue the response effort at the required level of intensity. It laid a strong foundation to the upcoming international meetings in Washington DC and New York; all of which are critical steps in the effort to maintain the desired focus on the challenges still faced by Ebola.

14.            In summary, the following issues were highlighted: i) the epidemiology continues to indicate the uneven road to zero; ii) we should not be thrown off course if the numbers of new cases continues to fluctuate,  as the response becomes more established in the remaining areas and case finding improves; iii) enhanced coordination of the response in Guinea was welcomed; iv) within Sierra Leone there is intense and localised transmission, with movements of infected people taking the disease to other areas; v) building trust is critical to the response, as is vigilance around any activities which encourage the virus to go underground; vi) there are various activities underway looking at lessons learned, knowledge of which needs to be shared widely in the interest of integrating those various strands of work as far as possible, and avoiding duplication of effort; vii) it is particularly important that the perspectives of the communities on the ground properly inform those processes; viii) the Brussels Conference was very important in binding everyone together around a set of shared objective as well as providing space for the Presidents of the affected countries to demonstrate leadership; ix) the Brussels event was the start of a series of international meetings which would be built upon in upcoming events and maintain the necessary focus on Ebola; x) the responder community, in support of the affected countries, needs to stay extremely focused, particularly as the additional operational challenges from the onset of the rainy season get closer; xi) consistency and clarity of the messages need to be maintained, given the challenging issues in dealing with Ebola are not easily understood by all.

http://ebolaresponse.un.org/coalition-meeting-notes