INTRODUCTION
The Ebola outbreak is presenting the world with an extraordinary public health challenge with consequences for millions of people and far beyond the health sector. We have also seen an extraordinary response, primarily by people in communities living with the outbreak. It has been distressing to witness the individual suffering but at the same time it has been encouraging to see how local communities, governments in the affected countries, and the international community at the highest possible level have come together to stop the outbreak.
There has been significant progress in the last three months. The outbreak is coming under control in some areas: transmission remains intense in others. The only way forward is to eliminate transmission—to get to ZERO.
We have been working on the basis the Ebola outbreak could develop in several different ways. The most extreme of these scenarios that were considered possible in October have not materialized: the number of cases and deaths has not accelerated at the rate it was thought could be possible. This is a result of outstanding efforts by the people and governments of affected countries and the support of the international community through financial contributions and the hard work of many international responders.
We are all grateful for all the efforts and resources that have made our collective success in reducing the Ebola outbreak possible. Looking forward we will need additional financial and in-kind resources and human capacity to sustain this success.
The present picture is not of a single outbreak but of a number of smaller and quite diverse outbreaks each with its own epidemiological characteristics. In some areas the situation is not yet under control; in other areas the disease incidence is extremely low and elimination is feasible. Life is getting ready to return to normal. We are all being expected to work together and manage a complex and diverse situation.
We can see that the strategy we are working to (the STEPP Strategy) can stop the outbreak but the implementation of the strategy will now evolve – to be even more nimble and flexible. The approach is to adapt the response at local level to reflect local realities and local needs. Thus, where the numbers of cases are high or where a re-importation of the virus is expected, access to treatment and to safe burials are the top priorities Where the incidence is lower, ambitious contract tracing must be implemented. The overall aim is to find all cases, stop transmission chains and get to zero.
It is also time to focus even more on re-establishing and reinforcing essential services (non-Ebola health services, education, WASH, social protection and legal services) and to plan for recovery at the right moment.
However no effort must stand in the way of Getting to Zero as that is the only way forward – 100% Ebola free countries must be our goal!