UN envoy upbeat on progress against Ebola

An end to the Ebola epidemic in Liberia and Sierra Leone is within sight but the outbreak is volatile in Guinea and all three face more hard work.

David Nabarro, the UN special envoy on Ebola, says he is "upbeat" about progress but not yet ready to declare victory over an epidemic that has killed more than 10,000 people in the past year in west Africa.

"People think that as we get towards the end it gets easier," he told the Financial Times. "It doesn't. It gets harder the closer you get to zero. The fewer cases you have, the harder it is to find them."

Liberia appears closest to ending its Ebola nightmare having not recorded a new case since the last known infected patient died on March 27. It is now counting down the 42 days it must wait to be declared free of Ebola by the World Health Organisation.

This marks a remarkable turnround from last September, when the Liberian government warned that its "national existence" was under threat as Ebola spread at a rate of up to 400 new cases a week through Monrovia, the capital, and beyond.

"Liberians came to understand what aspects of their behaviour were leading to infection and communities changed their behaviour quite quickly," said Dr Nabarro, citing factors such as basic hygiene and more careful handling of infected bodies. "They have shown that you don't need a massive change of behaviour to make a big difference."

Sierra Leone saw its epidemic peak later in the year when it reached Freetown, the capital, but it, too, now appears to be bringing the virus under control. New cases have been on a downward trajectory for the past month, with just 25 in the week to March 29, compared to a weekly peak of over 500 in November.

"The Sierra Leonean president has really stepped up," said Dr Nabarro, referring to a three-day lockdown last week ordered by President Ernest Bai Koroma when the country's 6m people were ordered to stay home while health workers went door-to-door looking for undetected cases.

In a radio address after the curfew, Mr Koroma said: "The battle to get to zero cases is truly on."

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Guinea has had fewer cases overall than either of its neighbours - about 3,500 compared with 9,700 in Liberia and 12,000 in Sierra Leone - despite it having been the first country hit by the outbreak early last year. Yet, Guinea seems to be finding it harder to extinguish its slower-burning epidemic, with 57 cases in the past week and no clear downward trend.

Dr Nabarro says there is greater mistrust of government and health workers in Guinea, making community engagement more difficult. But he reported signs of change after attending a meeting in the country last week where leaders of different religious and political factions agreed to work together to stamp out the disease.

The push for eradication could be helped by two experimental vaccines being rushed through clinical trials by GlaxoSmithKline and Merck, the drugmakers, together with the World Health Organisation and the US National Institutes of Health and others. Both have cleared mid-stage safety trials, but proving their efficacy has become more difficult as case numbers decline.

A third vaccine, from Johnson & Johnson, entered initial trials in recent days.

Dr Nabarro, a British medic who has tackled a succession of thorny health and development challenges in senior roles at the UN and WHO, says the potential benefits of these vaccines will not be fully tested until future outbreaks.

"We will be ready next time to start production and carry out further trials at a push of a button rather than having to invent a response in the heat of a crisis, as we did this time," he says.

He warns that vigilance is still required against fresh flare-ups and urges donors to keep supporting the $100m monthly cost of the international response.

While praising foreign aid workers, Dr Nabarro says the greatest "courage and endurance" have come from local responders. "These countries are the new Ebola universities for the world," he says. "We need to make certain that the memories and experience built up over the past year do not get lost."

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