While West Africa is still struggling with new cases of Ebola, Liberia, Guinea and Sierra Leone must also rebuild their health systems to reach children with life-saving vaccines and prevent outbreaks of other dangerous diseases.

Photos by Kate Holt

  • An Ebola emergency centre stands empty at the entrance to the district hospital in Magburaka in Sierra Leone’s Northern Province, 200km from Freetown. Magburaka saw its last outbreak of Ebola in January, when a 22-year-old girl died from the disease.
  • “The time of Ebola was very horrible. For us it was as bad as being at war. We saw people we knew taken away in the ambulances.” Mohamed Conteh, a 25 year-old student, recalls the fear in his district of Tonkalili in the Northern Province of Sierra Leone during the height of the 2014 Ebola outbreak, which killed more than 11,000 people.
  • In January, Mohamed received the new Ebola vaccine. He was one of 126 people vaccinated after having been in contact with Jalloh, a 22-year-old student who died from the disease in January – three months after the country was declared Ebola free by WHO.
  • This vaccination was part of the first large-scale efficacy trial of the Ebola vaccine. The coordinated trial targeted 30,000 people across the worst-hit West African nations involving many international agencies with the World Health Organization (WHO) acting as the study’s regulatory sponsor. Forty-year-old Isatu Fornah also received the vaccine.
  • “I was very fearful because I was told that I was going to be injected with Ebola. I wasn’t confident but my uncle had already taken the vaccine and this gave me courage. In the end I decided to have it because I thought it was better than falling sick with Ebola,” says Isatu as she shows her vaccination certificate.
  • District medical officer Dr Augustine Limissa says overcoming negative perceptions proved the single biggest challenge to the Ebola vaccine trials. “People are scared that a substance is being given to them to make them be sick. Using community mobilisers we explained the process, but it wasn’t easy for people to accept it.”
  • In health centres where babies are regularly weighed and measured and receive routine vaccines, medical doctors also monitor the Ebola vaccine trials. Tamba Manye, a Sierra Leonean doctor working for WHO in Tonkolili, says logistics need to be vastly improved before the still unlicensed vaccine can be made more widely available.
  • With recent Ebola flare-ups, the challenge now for Liberia, Guinea and Sierra Leone is to prevent further outbreaks of both Ebola and other dangerous diseases, such as measles. Children need to be guaranteed the basic package of childhood vaccines, while health services must rebuild trust among parents and carers.
  • Gavi, the Vaccine Alliance has already invested US$ 12.5 million as part of a projected US$ 90 million package to help countries rebuild their immunisation systems in the wake of Ebola.
  • Last October, a measles vaccination campaign targeting more than 1.3 million children took place in Sierra Leone, while a similar campaign in Guinea reached 750,000 children.
  • With WHO estimating that more than 600,000 children have missed their routine vaccinations in the three Ebola-affected countries since the beginning of the outbreak, there has been tremendous emphasis on tracking their identity.
  • Gavi’s support has also been targeted at strengthening cold chain capacity. “I look after 66 fridges in this district,” explains David Awaray, operations officer in the Moyamba District in Sierra Leone. “Each fridge will be visited once per month. My challenge is that most of the spare parts – such as compressors – are not found in Freetown. The last time we needed them we had to order them from Guinea.”
  • In Guinea, Gavi also supported the upgrade of cold storage facilities, with solar fridges to be installed across all districts. In Liberia, new vaccinators were recruited and trained alongside those returning to their previous posts. In total, Ebola claimed the lives of 200 health workers in Liberia. The recruitment and training programme will enable clinics across the country to reopen their immunisation programmes.
  • Ibrahim Sesay is a community leader. In February he took part in a polio vaccination drive. “Some communities are hard to reach because they are deep in the bush and the roads are bad. We have to help the vaccinators find these communities and go there to vaccinate the children,” he says.
  • “They do not come forward because of fear,” explains Ibrahim. “I know at least three children with polio. It’s sad but it shows what a big challenge we have in getting communities to agree to the vaccine.”
  • In total, more than 28,500 people across West Africa were infected with Ebola. At least 17,000 survivors must still cope with on-going health complications and the social stigma associated with the highly infectious disease.
  • According to the United Nations Development Programme (UNDP), the Ebola outbreak will cost West Africa up to US$ 3.6 billion per year from 2014 to 2017 through lost trade, cancelled business and reduced foreign investment.
  • The Ebola vaccine offers a new sense of optimism. “My hope now is that nothing like this will happen to us again. I hope that through the power of vaccines we are protected from this disease and Sierra Leone can have a brighter future,” says Mohamed Conteh.
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Last updated: 27 Sep 2019

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