Ten months ago the perfect storm of weak public health policy, poverty, and the Ebola virus transformed Liberia into a bloody battleground. The epicenter of the disaster was the Logan Town clinic, where workers without gloves or running water tried by candlelight to try to save their first patient in the crisis. Now, less than a year later, the Logan Town Clinic and its employees-like the rest of Liberia-is equipped to handle Ebola and any similar disease epidemic.
The New York Times reports that workers in the Logan Town clinic are now confident.
"From the improvements, and how we examine the patients now, Ebola will not come back," said Bessie Johnson, a 32-year-old nurse. "It won't happen again."
The past ten months have seen Liberia become the core of the deadliest Ebola epidemic in history. But they have also given birth to a remarkable paradigm shift.
Today Liberia has been declared free of the Ebola virus by the World Health Organization (WHO). It has been 42 days since the last Liberian victim was buried-twice the virus's maximum incubation period.
This is a historic moment for the beleaguered country. In months of burial pits, paralyzed hospitals, and mobs, this has been the ultimate goal.
"I am thrilled by the significant progress made by the people of Liberia," said deputy health minister Tolbert Nyenswah. "But we still need to keep up vigilance."
Medecins Sans Frontieres (MSF) agrees. "For Liberia to record 42 days with zero cases of Ebola is a real milestone," says MSF's head of mission in Liberia, Mariateresa Cacciapuoti. "But we can't take our foot off the gas until all three countries [Liberia, Sierra Leone and Guinea] record 42 days with no cases."
Cases in Sierra Leone and Guinea are still being reported. Officials seem to think at least small breakouts will continue in those countries, making Liberia remain vulnerable.
The weak health systems in all three countries not only failed to heal the sick; they actually made the situation far worse. As clinics failed to follow proper protocols, misdiagnosed patients, and allowed infected healthcare workers to pass on the disease, the local public health systems spread the disease and deepened the crisis.
But Liberians today have hope.
"I don't want to call Ebola an opportunity, but we're using the experience of Ebola to try to rebuild our health systems," said President Ellen Johnson Sirleaf of Liberia.
According to WHO, when the outbreak began, there were around 50 doctors serving the entire population of 4.5 million. Rates of immunization against standard childhood diseases were high, but this sort of simple, protective care was the strongest feature of the system. Even in the country's capital of Monrovia, the most sophisticated hospitals lacked basic protective gear like gloves, electricity, and even running water.
As more than 500 healthcare workers in Liberia, Guinea, and Sierra Leone died-almost 200 in Liberia alone-the shortage of healthcare professionals became more acute. At the most dire point in the crisis, fewer than half of all healthcare facilities in Liberia shut down. Facilities that remained open often turned Ebola sufferers away.
All of this hurt what had previously been the country's public health strong points: maternity care disappeared, immunization rates fell again, and incidence of common illnesses like diarrhea and malaria-not to mention more serious diseases like measles-were on the rise.
MSF also points out the failing of the international public health community including the slow aid response.
"Quite simply, we were all too late. The world-including MSF-was slow to start the response from the beginning," says Henry Gray, head of MSF Ebola operations in Brussels. "That lesson has been learnt, at the cost of thousands of lives, and we can only hope it will prevent the same thing happening again in the future."
Even without Ebola devastating the country, Liberia faces an uphill battle on the public health front. Dr. Bernice Dahn, Liberia's new health minister, indicates that the country intends to improve its health work force and move towards better prevention of disease and effective triage and isolation facilities.
Sadly, hard-won progress can easily be lost. A February outbreak in one neighborhood caused clinics to shut down again as workers were quarantined-and even those efforts proved to be improperly conducted.
"It's difficult to change behavior. It requires a lot of coaching and mentoring, which need to go on," said Dr. Dahn.
According to various public health experts, the West Africa Ebola virus outbreak highlighted a deadly lack of political support for public health. David L. Heymann, professor of Infectious Disease Epidemiology at the London School of Hygiene and Tropical Medicine, was the lead author of a Lancet review on the Ebola epidemic's impact.
"The crisis has also highlighted a second, equally important but less appreciated aspect of global health security - ensuring personal access to health services and products around the world," Heymann says. "This needs to be better recognized as part of the scope of global health security."
Certain review essayists indicate there has been an ongoing political neglect of global health security; this was the result of uneven attention to different countries by the WHO and others. In fact, WHO leaders have admitted their flaws in a statement addressing their various mistakes in their management of the Ebola outbreak.
"The Ebola outbreak that started in December 2013 became a public health, humanitarian and socioeconomic crisis with a devastating impact on families, communities and affected countries," the WHO statement said. "It also served as a reminder that the world, including WHO, is ill-prepared for a large and sustained disease outbreak."
Other Lancet review authors argue that "adopting a system that prioritizes development according to unmet health needs rather than financial gain would be best for boosting global health security."
Perhaps even more sobering is the fact that inequitable public health policy will, in the end, be dangerous for everyone.
"If the WHO fails to lead an effective, well-funded and coordinated response when the next epidemic strikes, it could have devastating consequences in rich and poor countries alike," warn Professors Eric Friedman and Lawrence Gostin of Georgetown University Law Center's O'Neill Institute for National and Global Health Law.
