Here in Liberia, the goal of zero Ebola cases is tantalizingly close. Only one new case has been recorded since 19 February, and 13 of the country’s 15 counties have not reported any new cases for over 42 days. But Ebola’s impact will be felt long after the last case has been treated.
As the battle against Ebola continues, the threat of outbreaks of measles, whooping cough and other vaccine-preventable diseases remains high. Given the mobility of Liberia’s population, the danger is that these diseases could spread with the same devastating rapidity that Ebola did.
Malnutrition rates have also increased, and a large proportion of the population is still not using health facilities for fear of contracting Ebola. Malaria, which accounts for one in five deaths of children under five in Liberia every year, is likely to claim the lives of even more children when the annual rainy season begins in the next few months.
These preventable diseases are likely to affect more people than Ebola, and lack of regular healthcare, including immunization, could reverse the gains Liberia has achieved in the past decade.
Liberia is still recovering from 14 years of protracted civil war that devastated not only its health and education systems, but also its social fabric. In the relative peace that has followed the civil war, Liberians, their government, and the international community have worked with very limited finances to restore damaged social services.
These partners were making headway. Before Ebola, routine immunization coverage for diseases such as measles was increasing, due to government commitment and the strong support of the UN and donor partners. More children were being vaccinated, both through routine immunization services and nationwide campaigns, and more mothers had begun seeking prenatal and early childhood care.
Basic childhood immunization rates in Liberia almost doubled between 2007 and 2013; access to essential health services was increasing, and community-led sanitation campaigns led to people adopting safe hygiene practices, reducing the risk from diarrheal illnesses.
Liberia had set a target of reducing under-five mortality from 227 deaths per 1,000 live births in 1990, to 76 deaths per 1,000 live births in 2015. Progress has been made, and official data in 2013 put the under-five mortality rate at 94 per 1,000 live births – a 60 per cent reduction since 1990.
This notable progress is now under threat. The Liberian Ministry of Health reports 372 healthcare workers infected by Ebola since the outbreak was declared in March 2014; more than half did not survive. Only half of the country’s 500-plus healthcare facilities were functioning during the outbreak, due to contamination or fear, and there has been a loss of trust in the entire health system.
Preliminary figures in 2014 suggest a 16 percent decline in measles vaccination coverage since last year, with the deepest dip during the Ebola emergency. Little more than half of children under the age of one were vaccinated against measles in 2014.
Measles, polio, whooping cough, and malaria can all be prevented. Routine immunization, provision of treated bed nets, screening and treatment of acute malnutrition can save thousands of lives every year and the costs of prevention are a fraction of response efforts.
These measures can only be put in place through continued investment by the government and its development partners: investment that strengthens essential services and basic community health care. This is a long-term solution requiring years of sustained effort and external support. But we can also learn from the fight against Ebola. Building on the local solutions and leadership that have shaped the response to Ebola, the flexible approaches that took into account local contexts, the commitment of local health workers and the survivors who never stopped giving, the renewed focus of families on the importance of protecting their health, and the partnerships between government, the private sector, development agencies, donors and people that has proven to be so critical.
If we do not build on what Ebola has taught us, and provide Liberia with the support it needs to restore and improve public health services, a decade of progress in maternal and child health stands to become Ebola’s next victim, threatening the survival and development of an entire generation.
Ebola has stolen enough lives. Now we must prevent it from robbing Liberia of a decade of gains for children.