Five Lessons Learned During Latest Ebola Outbreak in DRC
Four people died in the most recent Ebola outbreak that occurred in a remote, forested area of the Democratic Republic of Congo (DRC).
This small outbreak (five laboratory-confirmed and three probable cases) was quickly curtailed. The international humanitarian organisation Doctors Without Borders (MSF) shares lessons learned from this first occurrence of the deadly virus since the end of the large-scale Ebola outbreak that devastated West Africa in 2014-2015.
Train frontline health teams
The scale of this outbreak was minimised, thanks in no small part to a nurse named Dieumerci. With a name that literally translates to ‘Thank God’ in French, Dieumerci works at a Ministry of Health centre in northeast DRC, where the first Ebola cases started emerging.
He detected the risk of Ebola in a seriously ill man at the hospital, and rang the alarm. This man turned out to be the second confirmed case during the recent outbreak. Unlike in West Africa prior to the last major outbreak, Ebola is known in the DRC: the Ebola River, where the virus was first discovered, runs 100 kilometres away from where Dieumerci works.
That doesn’t mean that it is common disease in the area, but still, Dieumerci recognised the symptoms. His quick actions should not be taken for granted. Healthcare workers play a crucial role not only for patients, but also for general epidemiological surveillance. However, in many developing countries human resources within the health sector remain starkly inadequate.
On that fateful day where the Ebola patient came to the health centre, Dieumerci could have easily been on a sick leave, or visiting family somewhere else in the country. One cannot rely on a single individual to play the crucial role of on-the-ground surveillance.
What is needed are proper surveillance systems in resource-poor countries, which were clearly lacking in West Africa at the time of the epidemic. So all in all: thank you Dieumerci. We should all hope that during the next outbreak – be it Ebola or any other infectious disease – there will be another Dieumerci to ring the alarm bell for everyone’s sake.
Finally, a forgotten disease is taken seriously
The word “Ebola” doesn’t ring the same after 2014-2015’s devastating epidemic. At least 11,300 people were killed, and over 28,000 were infected. As a result, Dieumerci’s alarm bell sent shock waves across the world. Congolese authorities immediately activated their outbreak response team and had strong support from WHO and other organisations.
Henry Gray, MSF’s project coordinator during this recent outbreak, has worked on seven haemorrhagic fever interventions in DRC, Uganda and West Africa, to name a few. “The pressure we felt was very different from previous comparable outbreaks: it was clearly at the top of the agenda,” he says. “When it comes to Ebola, we have all learned that it’s better to be safe than sorry in order not to repeat the disaster of 2014-2015.
“However, it is sad to still see that other outbreaks in countries do not trigger the same mobilisation, even in regards to the main killer diseases like cholera or measles.
“Once the Ebola outbreak was over, we were able to re-assign some of the MSF staff towards a serious cholera outbreak on the other side of the country. Our teams went on to treat 1,100 cholera patients. “Considering the dire health needs in many parts of the country, additional support is always welcome”.
Old tricks are timeless – back to basics
The promise of new drugs or vaccines should not overshadow the necessity of putting in place the basic pillars of outbreak control.
It all starts with good surveillance, followed by the five pillars of outbreak control:
Safely isolating and treating the sick.
Actively looking for potential new cases and surveilling those who have been in contact with them.
Burying the dead safely.
Engaging and mobilising the affected communities.
Offering psychological support.
In West Africa, the havoc wrecked by Ebola on the entire health system created more indirect than direct victims of the virus: children became prone to infectious diseases because they weren’t vaccinated; Childbirth complications led to the deaths of mothers and/or children because there were no healthcare workers to care for them; untreated cases of malaria became fatal…
International health actors need to do more to support local health facilities that often have much smaller means and equipment: training staff, ensuring there is basic protection equipment available, and that their pharmacies are stocked with first aid supplies and basic medicines. Our experience in DRC has shown that training frontline workers, even when done ad-hoc, can bring sustained effects to improve their performance in surveillance.
Location, location, location
Like the majority of haemorrhagic fever outbreaks prior to West Africa, the recent one occurred in a very remote, forested area.
Here, the virus was already known to exist within an animal reservoir (assumed to be fruit bats) that is occasionally transmitted to apes, monkeys or men. Some people are very mobile in the region, but can only go as far and as fast as their available transportation; which is pretty much nothing beyond walking and the occasional motorbike.
Dieumerci’s village is 45 kilometres from Likati, the closest town. It is home to 18,000 people, with a majestic cathedral and large, but under equipped, hospital serving as remnants of a time when a railroad was still linking plantations across the country. Today that railroad has been eaten by the encroaching jungle. By contrast, in Guéckédou, Guinea – where the West Africa outbreak started – people can jump on a motorbike and be in the heart of the capital Conakry and its 2.5 million people within two days.
These contrasting examples show how isolation from major cities can keep the spread of deadly disease under control.
Medical innovations are not the magic bullet
At the time of the latest outbreak, MSF was willing to use Ebola treatments which were still in development. However this window closed as the outbreak stopped before the process to allow the use of the experimental treatments was complete. However, this event acted as a ‘booster’ – speeding up the process of preparing medical protocols so that new drugs (still in the experimental phase) can be used in ways that are as safe and ethical as possible.
The rVsV-ZEBOV vaccine (the most advanced investigational vaccine candidate for an Ebola outbreak today) is in development, and needs to be implemented through a study protocol. This, and a vaccine strategy – including informed consent under good clinical practice – were mandatory requirements needed from us to access them.
Soon enough, a study protocol was developed and approved by the MSF Ethics Review Board a few months ago. It was ready for implementation should an outbreak occur. Additionally, a dedicated MSF research team was ready to be deployed. Unfortunately, our negotiations at the DRC Ministry of Health level only took place when the outbreak had already been declared.
It took some time for us to explain what we were planning to do, and how this would differ from a vaccination campaign. But, we managed to obtain authorisation from all the regulatory bodies to start activities in case of a future outbreak.
It is likely that the next outbreak (and trust us, there will be a next outbreak) will happen in a similar setting. We can continue to learn how to best tackle it, and ensure that the West Africa Ebola outbreak remains an isolated tragedy.
Since 1990 MSF has responded to over a dozen outbreaks in sub-Saharan Africa. During the devastating Ebola outbreak that struck mainly Liberia, Guinea, and Sierra Leone in 2014-2015, MSF launched one of the largest emergency operations in its 44-year history.
MSF admitted 10,310 patients to its Ebola management centres of which 5,201 were confirmed Ebola cases, representing one-third of all WHO-confirmed cases. During the first five months of the epidemic, MSF handled more than 85 percent of all hospitalized cases in the affected countries.
At the peak of the epidemic, MSF employed nearly 4,300 staff—most of whom were from the affected countries—who ran Ebola management centres, conducted surveillance, contact tracing, and health promotion, and provided psychological support.
Ramadan: Ogun Community Gets Free Medical, Household Items
By Modupe Gbadeyanka
Ahead of the annual Islamic fast known as Ramadan starting in the coming days, a group known as the Zenith Pathfinders has organised a free medical screening for a community in Ogun State.
The group also shared free healthcare packages to residents of the Adiyan Muslim Community in Agbodo Oja, Ogun State, to enable them to be medically for the annual Islamic ritual.
According to a statement, the event was held on Sunday at 296 Orodu Road at Ilese Bus Stop, Adiyan in Agbado Oja, and more than 200 persons benefited from this.
The screening involved blood pressure, sugar level tests, as well as specialist consultation, with the required prescriptions and drugs given to the inhabitants of the community.
In a bid to also alleviate the suffering of the less privileged, Zenith Pathfinders also donated household items like shoes and clothes, among other items.
Addressing newsmen, the founder of Zenith Pathfinders, Hajiah Aminah Yahya, expressed joy at seeing the smiles on the faces of people who benefited from the gesture.
She explained that the purpose of the programme was to encourage Muslims to know their medical status before fasting so that can be able to have a hitch-free Ramadan.
“We are at the Adiyan Muslim community for the second edition of Pre-Ramadan Medical Screening. We started last year with over 300 participants, but this year, we have over 200 participants.
“The essence of having this programme before Ramadan is to encourage our people to know their medical status before Ramadan comes in.
“They have to know their health status so that they can take care of themselves before Ramadan so that they can have a hitch-free Ramadan. We also gave free household items like cloth materials, fans, freezers and others to over 150 Muslims,” she added.
On his part, Dr Alabi Olarenwaju Usman of the Nigerian Navy Reference Hospital, Ojo, Lagos, said the majority of the Muslims who participated in the medical services were medically fit to fast in the month of Ramadan.
“We are here for humanitarian services for Adiyan Muslim Community. We attended to over 200 Muslims in the community. A few of the cases here involved hypertension, diabetes and malaria. We have given them the necessary assistance, and most of them are eligible for Ramadan,” the medical practitioner, who was the consultant on the ground, said.
Some of the beneficiaries commended Zenith Pathfinders for the gesture, urging the government to do more to make health services affordable.
“This is good, and we sincerely thank the organisers. They conducted medical screening for us without collecting a dime. We are so grateful,” the Imam of Ajumoni Central Mosque, Mutta Three, Ustadh Usman AbdulRaheem, said.
Russian COVID-19 Vaccines Disappear from Africa’s Radar
By Kestér Kenn Klomegâh
Until recently, Africa has not been high on Russia’s policy agenda. African leaders have to understand that Russia, for the past three decades, Africa was at the bottom of its policy agenda. After the end of the Soviet era, Russia has focused broadly on the United States and Europe, dreaming of becoming part of Europe, part of the configuration of the Global North. The low economic presence of Russia from 1991 until 2019 was a testament to the fact that Africa was at the bottom of its priority list. Of course, the October 2019 summit was symbolic, but after that, Russia has left most of the bilateral agreements undelivered across Africa.
With its “special military operation” on Ukraine that necessitated the imposition of stringent sanctions from the United States, European Union and their allies, the United Nations Security Council, mounting pressure on Russia since February 24 2022, pushes Russia to begin soliciting aggressively for support in Africa. Last July, in an article posted to its official website, Foreign Minister Sergey Lavrov wrote: “The development of a comprehensive partnership with African countries remains among top priorities of Russia’s foreign policy; Moscow is open to its further build-up multifaceted relations with Africa.”
In his Op-Ed article, Lavrov argues: “We have been rebuilding our positions for many years now. The Africans are reciprocating. They are interested in having us. It is good to see that our African friends have a similar understanding with Russia.” Lavrov, however, informed about broadening African issues “in the new version of Russia’s Foreign Policy Concept against the background of the waning of the Western direction” and this will objectively increase the share of the African direction in the work of the Foreign Ministry.
Lavrov consistently displays his passion for historical references. Soviet support for struggles for political independence and against colonialism should be laid to rest in the archives. The best way to fight neo-colonialism is to demonstrate by investing in those competitive sectors and depart away from hyperbolic rhetoric on an endless list of sectors. In practical terms, we rather face today’s development challenges and what is in store for the future generation. Africa today does not need anti-Western slogans; Africa simply needs external players who would passionately and genuinely invest in the critical economic sectors. The fundamental fact is that Africa is making efforts to transform its economy to create employment, modern agriculture, and industrialize the continent, especially with the introduction of the African Continental Free Trade Area (AfCFTA).
Despite criticisms, China has built an exemplary distinctive economic power in Africa. Besides China, Africa is largely benefiting from the European Union and Western aid flows and economic and trade ties. Compared, Russia plays very little role in Africa’s infrastructure, agriculture and industry and makes little effort to leverage the African Continental Free Trade Area (AfCFTA). Our monitoring shows that the Russian business community hardly pays attention to the significance of the African Continental Free Trade Area (AfCFTA), which provides a unique and valuable platform for businesses to access an integrated African market of over 1.3 billion people.
Lavrov’s efforts toward building non-Western ties in these crucial times are highly commendable, especially with Africa. But, the highly respected Minister easily and most times forgot the fact that during these two-three years of a global pandemic, the coronavirus that engulfed the planet, in every corner of the world, Africa was desperately looking for vaccines. Health authorities are still warning that Covid-19 has not been completely faced throughout the world.
Quartz, a reputable global media, reported early this year that “as of the end of 2022, about a quarter of the population of African countries has been fully vaccinated against Covid-19, according to the latest figures shared by Africa CDC. The coverage varies drastically depending on the country. In Liberia, for instance, nearly 80% of the population is fully vaccinated, while only 34% is in neighbouring Sierra Leone. Congo, Sudan, Senegal, and Madagascar all have vaccination rates below 10%.
In his briefing, Ouma said the target for Africa remains to vaccinate 70% of the population. That goal, however, was set by the World Health Organization (WHO) for the overall population. These numbers are about to change – and not because of an increase in vaccinations. Africa CDC acting director Ahmed Ogwell Ouma announced in a video briefing on December 22 that it will modify the way it reports vaccination rates. Rather than reporting coverage of the overall population, it will only report vaccinations of the eligible populations aged 12 or more.
Due to delays in international vaccine deliveries, Africa lags behind the rest of the world in Covid vaccination rates and is the only continent where less than 50% of the population is fully vaccinated. Currently, just more than 800 million doses of vaccines have been administered in Africa, or 80% of the total received. About a third of the vaccinations have been made with Johnson & Johnson’s vaccine, followed by Pfizer (22%), AstraZeneca (17%), China’s Sinopharm (15%) and Sinovac (7%).
Several reports monitored by this author show that Russia has played a minimal role in the entire health sector in Africa. With the Covid-19 vaccination, Russia randomly sprinkled a few thousand as humanitarian assistance among its “Soviet friends”, including Egypt, Ethiopia, Guinea, Angola, Mozambique, Zimbabwe and South Africa. Nevertheless, the worse was Russia’s sudden failure to supply the 300 million vaccines through the African Union (AU), especially during the times of health crisis.
An authoritative policy report presented in November 2021 titled ‘Situation Analytical Report’ and prepared by 25 Russian policy experts headed by Sergei A. Karaganov noted explicitly the failure to supply Sputnik vaccines to the African Union. The report criticized Russia’s current policy and lukewarm approach towards Africa.
“In several ways, Russia’s possibilities are overestimated both publicly and in closed negotiations. The supply of Russian-made vaccines to Africa is an example. Having concluded contracts for the supply of Sputnik V to a number of African states, Russian suppliers failed to meet contractual obligations on time,” says the report in part.
The coronavirus outbreak a pandemic on March 11, 2020. Worth noting that Russia claims that it was the first to find a coronavirus cure. The World Health Organization (WHO), until today, has not certified Russia’s vaccines, though. On the other hand, all the vaccines that have been registered in Russia – Sputnik V, Sputnik Light, CoviVac and EpiVacCorona – are produced in large quantities by Russian pharmaceutical companies and are currently used for vaccination.
Director of the Gamaleya National Research Centre for Epidemiology and Microbiology Alexander Gintsburg has several times highlighted aspects of vaccine production and marketing. He noted to raise the attractiveness of the vaccines on foreign markets, including countries in the Middle East, Africa and Latin America.
The Russian Direct Investment Fund, tasked to engage in marketing the vaccines abroad, got messed up, especially in Africa. Of course, it took steps and speedily registered the vaccines in more than 20 African countries but terribly failed on delivery deadlines. Worse was the Russian Direct Investment Fund supplied, at exorbitant prices, through middlemen in the Arab Emirates to a number of African countries. Russia’s Foreign Ministry has, however, held a series of African Foreign Ministers during this Covid-19 period and desperate moment reiterated to assist with direct supplies to Africa. That is Russia, considered a reliable partner for Africa.
The above thoughts on the part of the Covid-19 business offered the reasons why Russia absolutely refused to join and be part of the Covax facility, which acts as a global collective bargaining initiative to secure vaccine doses for countries who signed up, including those are self-financing their purchases, as well as assistance from donors for poorer developing countries. The first vaccines purchased through Covax were indeed destined to reach Africa. That was, monitored by this author, some 88.7 million doses of the AstraZeneca and Pfizer vaccines distributed to 47 countries, including Africa, during the first half of 2021. This same year, during the virtual meeting of G7 leaders, the European Union announced it had donated a further 500 million euros to the COVAX program. The World Bank also committed $12 billion as concessional loans to assist African countries in accessing foreign vaccines.
That is not all from several reports monitored. In April 2022, writing under the headline: “How Russia’s Hollow Humanitarian Hurt Its Vaccine Diplomacy in Africa,” – the co-authors, Matthew T. Page and Paul Stronski, both noted in 2020 that Russia touted deliveries of medical and protective supplies to several African countries, while the Russian-developed Sputnik V vaccine offered hopes that African countries would soon be able to launch large-scale immunization drives. Russian efforts to promote Sputnik V in Africa have floundered for a variety of reasons, including regulatory worries, production and logistical shortfalls, bureaucratic inertia, and even sticker shock. There is, however, another key factor behind Moscow’s failed vaccine diplomacy: its traditionally diminutive post-Soviet development presence on the continent.
Compared to Australia, Canada, the European Union, Japan, the United Kingdom, the United States, and even many foundations, Russia has provided a tiny share of international development assistance to African countries since the end of the Cold War. Unlike India and Cuba, it has provided scanty medical assistance to – or investment in – African countries.
Suppose Russia wants to be influential on the continent. In that case, African political and economic leaders should demand more of Moscow, not simply settle for the symbolic diplomatic engagements or agreements at which the Russian leadership excels. Indeed, Africa has not ranked high on the Russian foreign policy agenda for much of the past three decades, getting barely a mention in the country’s key security documents except as either a partner in an emerging multipolar world or a source of instability.
Indeed the time has come for African leaders to rally together to ensure that no effort is spared in facilitating and supporting the building of large-scale vaccine manufacturing capacity on the continent. The African Vaccine Manufacturing Summit held in April 2021 was an encouraging start. Focus needs to be on developing real vaccine R&D capacity, which must necessarily lead to health products. This requires substantial investment and a long-term commitment. In a similar vein, under the aegis of the African Union, leaders have to begin looking for inside solutions rather than base hopes on these geopolitical games, great external powers seeking only support for their peculiar or parochial interests.
Understandably, while making efforts to maintain and expand its presence in Africa, Russia simply lacks the capability to deliver on its various promises in Africa. Surely, African countries have to begin to re-evaluate their relationship with Russia. African leaders should not expect anything tangible from meetings, conferences and summits. Since the first Russia-Africa summit held in 2019, very little has been achieved. Given the stringent sanctions imposed following Putin’s invasion of neighbouring Ukraine, it is even more improbable that Moscow would commit adequate financial resources to invest in economic sectors.
In stark contrast to key global players, for instance, the United States, China and the European Union and many others, Russia obviously has limitations. Notwithstanding that, for Russia to regain a part of its Soviet-era influence, it has to address its policy approach, this time trying to shift towards new paradigms – implementing some of the decade-old pledges and promises, and those bilateral agreements; secondly to promote development-oriented policies and how to make these strategic efforts more practical, more consistent, more effective and most admirably result-oriented with African countries.
Fidson Shops For N3.5bn from Series 4 Commercial Paper Issuance
By Dipo Olowookere
A leading manufacturer of pharmaceutical and nutraceutical products, Fidson Healthcare Plc, is planning to get about N3.5 billion from the capital market.
The firm, which operates a World Health Organisation (WHO) compliant state-of-the-art manufacturing facility, is issuing series 4 commercial paper under its N10 billion commercial paper issuance programme.
Subscription for the exercise started on Friday, March 10, 2023, and will close on Thursday, March 16, 2023.
According to details of the sales, the least of the commercial paper of Fidson investors can purchase is N5 million.
Business Post reports that the tranche of this exercise is 268 days, with a yield of 14.50 per cent.
Funds from this series 4 commercial paper sales would be used to support the company’s short-term working capital and funding requirement.
Fidson is one of the top players in the Nigerian health sector and has maintained an organic growth strategy by investing in research, extensive distribution channels, and product innovation.
The organisation also associates with global partners to deliver high-quality products to its customers and insists on these same values across its entire value chain.
Fidson commenced operations on March 1, 1995, as a local distributor of pharmaceutical products and barely a year after, it began importing its brand of finished medicines, introducing Ciprotab and Peflotab brands of quinolones to the market.
By July 2002, the firm set up its first local manufacturing facility and later became the first company in sub-Saharan Africa to manufacture Antiretroviral (ARVs) drugs in March 2005.
In February 2007, Fidson set up a second manufacturing facility and ceded the former manufacturing facility to an international joint venture project, which led to the setting up of Ecomed Pharma Limited. In November of the same year, the company received the NIS ISO 9001:2000 certification for its Quality Management System from the Standard Organization of Nigeria (SON).
Expanding its business further, the company was listed on the floor of the Nigerian Exchange (NGX) Limited to become a publicly quoted company in 2008 and completed its 3rd factory (FPL) in the same year.
Further positioning itself as a leading pharmaceutical manufacturer in Nigeria, Fidson completed its 4th factory, an ultra-modern WHO-compliant plant in Ota, Ogun State, in 2016 and increased its capacity to manufacture more products across various therapeutic categories.
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