By Kevin McCracken
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Logistically the outbreak posed very difficult challenges. Tracking down people suspected of contact with infected persons, particularly those in remote rural areas, was a daunting task. Poor roads through often densely forested terrain made access to such communities especially difficult. The movement of people in turn compounded the difficulty of contact tracking. The need to monitor vaccinated contacts for three weeks was a further challenge.
Weak technological infrastructure was a further issue. Cell phone and internet coverage limitations for example, made communications and coordination between health workers difficult. Added to this was the lack of electricity in some affected areas, posing difficulties for establishing the ‘cold chain’ capacity (i.e. between -60 and -80o C) necessary for safely transporting and storing vaccine supplies.
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In that earlier outbreak the WHO was slow to act and initially ineffective. This time, in Congo, the need to act fast was appreciated and WHO and other global health players (e.g. MSF, Red Cross) were quickly on the ground in DRC. A symbolically significant signal of commitment in this regard were personal visits by the new Director-General of the WHO, Dr. Tedros Adhanom Ghebreyesus, to DRC and the Central African Republic
Two important medical technology developments were also crucial, an effective experimental vaccine (rVSV-ZEBOV) and the genetic testing of cases with GeneXpert, a machine widely used in Africa for diagnosing tuberculosis. This made diagnosis of Ebola far faster and isolation of infected persons more rapid, significantly reducing the risk of infectious spread.