We don’t hear much (read: anything) about it here in the United States but the world at large has, at long last, engaged in the fight against Ebola in West Africa. Below the orange virus scroll, a lengthy but incomplete timeline tour of the rise of the worst Ebola outbreak in recorded history and what is being done to bring the epidemic to an end.
December 2013
Start of a hemorrhagic fever outbreak in Guinea. Ebola is not suspected because it has never been seen in West Africa before.
March 22
Guinea confirms that the virus that has killed 50 of its citizens is Ebola.
March 25
In collaboration with CartONG and Médecins Sans Frontières/Doctors Without Borders (MSF), Humanitarian OpenStreetMap (HOT) establishes a crowd-sourced effort to fill in inadequate maps of the affected region. The initiative starts in Guinea but later spreads to Sierra Leone and Liberia.
March 28
The Economic Community of West African States (ECOWAS) calls for a regional response to the outbreak calling it a threat to regional security. Reports indicate that the bloc also disburses US$250,000 at this time to aid in the fight to contain the outbreak.
March 30
Liberia confirms two cases of Ebola. Reports come in that that the virus may have spread to Sierra Leone as well. Senegal shuts its border.
March 31
MSF announces that Guinea is facing "an epidemic of a magnitude never before seen in terms of the distribution of cases in the country" and warns that the virus will be difficult to contain. The organization confirms that by the end of the week it will have roughly 60 international field workers experienced with addressing hemorrhagic fever divided between Conakry and in the southeast of the country.
April 1
A World Health Organization (WHO) spokesman downplays the alarm raised by MSF saying, "We need to be very careful about how we characterize something which is up until now an outbreak with sporadic cases… What we are dealing with is an outbreak of limited geographic area and only a few chains of transmission."
April 4
UNICEF announces that Japan has given US$520,000 to support the Ebola outbreak response in Guinea. The NGO also reports that it has “sensitized” 23,805 people in Conakry in person, distributed 301,648 bars of soaps, 77,392 bottles of chlorine, 150,000 pairs of gloves, 370 sprayers and 1,650 kg of calcium hypochlorite since the beginning of the epidemic.
April 7
International Medical Corps begins implementing Ebola awareness programs in Sierra Leone in case the virus crosses the border with Guinea.
May
China delivers a shipment of supplies to Guinea, Liberia, Sierra Leone and Guinea-Bissau.
June 17
Liberia reports seven dead from Ebola in its capital, Monrovia.
June 23
MSF says the situation is “out of control” and calls for massive deployment resources. At this point, the death toll stands above 350, making it the worst Ebola outbreak on record.
July 2nd & 3rd
The WHO convenes an emergency strategy meeting in Accra, Ghaha. Present are:
• Ministers of Health from Cote d’Ivoire, Democratic Republic of Congo, Gambia, Ghana, Guinea, Guinea Bissau, Liberia, Mali, Senegal, Sierra Leone and Uganda.
• Representatives from partnering groups including extractive industry personnel from companies operating in the region, UN agencies, the CDC, DFID (the UK version of the US State Department), the EU, the European Commission's Humanitarian Aid and Civil Protection department (ECHO), Institute Pasteur, the International Federation of the Red Cross and Red Crescent Societies (IFRC), MSF, United States Agency for International Development (USAID), and the West African Health Organization (WAHO).
July 10
ECOWAS establishes a Special Fund for the Fight Against Ebola. Nigeria donates US$3.5 million.
July 25
Nigeria confirms that a man who traveled to Lagos from Liberia has died of Ebola. It is the first Ebola death in the country.
July 31
The WHO and West African nations request US$100 million in aid to help contain the virus.
July 31
The Government of Sierra Leone declares a State of Emergency.
August 6
CDC announces that it is “is rapidly increasing its ongoing efforts to curb the expanding West African Ebola outbreak and deploying staff to four African nations currently affected: Guinea, Sierra Leone, Liberia, and Nigeria.”
August 8
WHO, at long last, declares the outbreak an international public health emergency. Director-General Dr. Margaret Chan calls it the "most complex outbreak in the four decades of this disease".
August 10
China announces that it is sending three medical teams of epidemiologists and disinfection/protection experts as well as medical supplies worth US4.9 million to Guinea, Liberia and Sierra Leone. Supplies include protective gears, chlorine and medicines.
August 11
BBC announces that Uganda is deploying 11 Ebola experts to JFK Hospital in Monrovia, Liberia. The team has "strong experience" working with the Ebola virus.
August 12
The WHO approves using drugs and/or vaccines that have seen promising lab results but have yet to be tested on humans. The death toll in West Africa now stands at more than 1,000.
Canada’s Public Health Agency announces that the country will donate up to 1,000 doses of an untested vaccine (VSV-EBOV) to the WHO.
August 13
African Union pledges US$1 million in Ebola response.
August 14
China Kingho Group, Oceta and African Minerals, exploration and mining companies working in West Africa, donate approximately US$90,000 to Sierra Leone to help halt the spread of the virus.
August 18
MSF says it will take at least six months to bring the outbreak under control.
A UN World Food Programme (WFP) situation update reveals that the agency has delivered an estimated 3,000 metric tons of food (enough to feed 147,500 people) to the worst affected areas and helped transport 400 cubic meters of medical cargo. The agency announces plans to increase food assistance exponentially in order to reach the estimated one million people living in now restricted access areas. It will also continue to use its supply chain to distribute much needed medical equipment.
The UK approves US$8.3 million to support Ebola response in Liberia and Sierra Leone. This brings the total UK financial commitment in both countries to nearly US$10 million.
The African Development Bank (ADB) announces that it is stepping up efforts to curb the outbreak with a US$210 million response. "package which includes $150 million in both loans and grants, along with the $60 million grant, which has been awarded to the World Health Organisation’s (WHO) sub-regional Ebola Outbreak Coordinating Center located in Conakry, Guinea, given their extensive experience with global epidemics. The $60 million sum includes four emergency assistance grants of $1 million to each of the four countries affected by Ebola to help them contain the disease."
August 25
Japan announces that it is willing to provide access to up to 20,000 doses of favipiravir to try to treat Ebola patients. Favipiravir is an anti-influenza drug currently under development.
August 27
Brazil ships five supply kits to Sierra Leone. Each kit can keep 500 people served for three months.
August 28
The WHO publishes a roadmap to guide and coordinate the international effort to stop the spread of the virus. The estimated time required to reach this goal is six to nine months. Cost estimates are revised to up $490 million.
August 30
Ghana announces that it is making Accra available to serve as a support base for supplies and personnel coming in and out of the affected countries.
September 2
International President of MSF, Joanne Liu, criticizes UN member countries for their lack of assistance in fighting the outbreak.
September 5
Nigeria reports its last case of Ebola.
September 8
US President Barak Obama announces that the US government will deploy military personnel to the epidemic area to assist in setting up of isolation units and providing additional safety to health workers in the area. The military will also assist in providing transportation of medical equipment. On the same day, the US Department of Defense announces a US$22 million allocation to set up a 25-bed field hospital in Liberia to treat healthcare workers affected by the virus.
September 9
USAID announces that it will support the African Union’s deployment of approximately 100 health workers to West Africa to manage and run Ebola treatment units.
September 10
Cuba announces that it will send 165 doctors, nurses and infection control specialists to Sierra Leone on a six month rotation starting early October.
The Bill & Melinda Gates Foundation releases US$50 million to the United Nations and other international aid agencies and donates an additional US$2 million to the CDC. Previous donations include US$5 million to the WHO and US$5 million to UNICEF to buy medical supplies and fund support efforts in the region.
September 11
The Paul G. Allen Family Foundation pledges US$9 million to the CDC. The funds will be appropriated to build treatment co-ordination centers and assist in training programs. This follows an August donation of US$2.8 million to the Red Cross.
September 15
The International Medical Corps opens an Ebola Treatment Unit (ETU) in Bong County, Liberia, approximately 120 outside the capital city of Monrovia. The facility has 70 beds and 200 specially-trained staff, 90% of whom are Liberians. It is one of only two ETUs operating outside the capital and one of only six available in the country as a whole.
September 16
The WHO again revises the dollar amount required to stop the outbreak. This time up to US$1 billion.
President Obama announces that 3,000 US military command and control, logistics and engineering experts will be deployed to West Africa over the next six months. As part of the commitment, 17 100-bed treatment centers will be built in Liberia. An additional facility dedicated to training up to 500 health-care workers a week will also be built. The cost of the US commitment could reach US$750 million.
UNICEF appeals for US$200 million as part of a broader six-month appeal for $987.8 million that governments and humanitarian agencies require to fight the disease. “Of the US$200 million, nearly US$65 million will go to UNICEF’s programmes in Liberia, around US$61 million to Sierra Leone and more than US$55 million to Guinea. An additional $10 million will help neighboring countries be prepared for a potential spread of the disease within their borders. The remaining US$9 million [is] required for regional coordination efforts.“ The organization estimates that “8.5 million children and young people under the age of 20 live in areas affected by Ebola in Guinea, Sierra Leone and Liberia. Of these, 2.5 million are under the age of five.”
The World Bank approves US$117 million in funds to be made immediately available. The breakdown is US$58 million for Liberia, US$34 million for Sierra Leone and US$25 million for Guinea.
September 17
Australia announces that it will commit an additional US$6.1 million dollars to fighting outbreak. This brings the country’s total commitment up to US$7 million. Funds will be divided between the British government's response, the WHO and MSF. MSF declines the donation saying that what it really needs are specialized civil and military assets.
September 18
The United Nations Security Council (UNSC) declares the outbreak a "threat to international peace and security" and unanimously adopts Resolution 2177 which urges member states to provide more resources to the fight. The resolution is unprecedented in the history of the UNSC in that it is the first to deal with a public health crisis. Sponsored by 131 countries, it is also the most broadly supported of the 2,176 Security Council resolutions adopted since 1945.
With the passage of the Resolution, the United Nations Mission for Ebola Emergency Response (UNMEER) is created to coordinate the vast resources of various UN agencies, national governments and other humanitarian organizations. UNMEER is the first emergency public health body ever established by the UNSC.
September 19
Germany announces that its contributions to the fight against Ebola have reached a total of US$21.3 million including material contributions of air transport to the region and a treatment station for Liberia.
September 20
The CDC warns that there may be a shortfall of medical staff to man all the new treatment facilities being built by the international community.
Direct Relief, in coordination with Clinton Global Initiative Members, charters a 747 to transport 100 tons of supplies, worth US$6 million, to the affected regions in West Africa. The shipment includes 2.8 million surgical and exam gloves, 170,000 coverall gowns, 120,000 masks, 40,000 liters of pre-mixed oral rehydration solution, and 9.8 million doses of essential medications.
September 22
The German Defense Minister asks for military volunteers to assist in staffing a clinic in West Africa.
September 23
The Wellcome Trust announces a US$4 million grant to fast-track trials of promising Ebola treatments.
International Medical Corps announces that, thanks to funding from Qatar Charity, it will build and manage an additional Ebola Treatment Unit in Lunsar, Sierra Leone.
The UK confirms that "More than 40 military personnel and humanitarian staff have arrived to oversee the construction of [a] medical facility and [to] assist with the UK’s response." At this stage, the UK commitment includes "support for 700 Ebola treatment beds" in Sierra Leone.
September 25
The World Bank makes additional funding of US$170 million available to purchase medical supplies and increase the number of healthcare workers on the front lines.
China delivers a second mobile lab to Sierra Leone (the first was delivered the previous week). “This second lab will also be set up at the same hospital so that the 29 CDC experts from China will be able to work very effectively and help to stop the Ebola chain.”
September 26
The New York Times reports that “Doctors and nurses are finally volunteering to fight the Ebola virus in West Africa after a long period of paralyzing fear in which almost none stepped forward.” The article reveals that a 100 bed facility requires “a staff of 400, about 40 of whom are foreign doctors or nurses”.
September 27
Cuba announces that it is sending an additional 296 healthcare workers to Liberia and Guinea.
October 1
Samaritan's Purse airlifts 100 tons of supplies to Liberia. The shipment includes tents, infection control kits and caregiver kits for community care centers and home-based care support.
October 2
Following special training, the first team of Cuban doctors and nurses arrives in Freetown, Sierra Leone.
Samaritan’s Purse sends 100 tons of protective equipment and supplies to Liberia on a charted 747 cargo jet. Among the critically needed supplies were rubber gloves, face masks, rubber boots, disinfectants, buckets, and inflatable tents for the set-up of Community Care Centers.
The UK partners with the government of Sierra Leone to host an international conference in London to rally the global community. Attendees include more than 20 governments, a dozen charities and NGOs, the UN, World Bank, health experts and the private sector to pledge funds, equipment and health workers.
October 3
Japan provides an emergency grant of US$22 million to the WHO, WFP, UN Children’s Fund and other international organizations. The grant is part of US$40 million pledged by the country.
October 8
The UK announces that 750 Ministry of Defence personnel will be deployed to help with the establishment of Ebola Treatment Centres and an Ebola Training Academy. The deployment includes 250 personnel and 3 Merlin helicopters, aircrew and engineers in the region to provide crucial transport support to medical teams and aid experts. More than 200 military staff to run and staff a WHO-led Ebola training facility. Three hundred military personnel delivering support to the Sierra Leone government.
October 9
The International Charter on Space and Major Disasters is activated by the United States Geological Survey to monitor the outbreak in Sierra Leone. This is the first time space assets have been applied to a public health.
October 12
The UK announces that aid supplies delivered so far include: 20 vehicles; 75 water tanks; 3 incinerators for disposing of clothing and other materials; 12 generators; personal protection equipment; radio equipment; lighting sets; chlorine for sanitation; latrine slabs; temporary warehouse tents; 14 air conditioning units, and isolator equipment.
October 14
Facebook founder, Mark Zuckerberg and wife, Priscilla, donate US$25 million to the CDC.
October 15
After being criticized for its slow response, Germany announces that it is increasing its contribution to US$128 million. A 'six-fold' increase of its previous commitment.
October 17
The Guardian (UK) reports that "More than 800 NHS doctors, nurses and paramedics have signed up to work in Sierra Leone as the spread of Ebola continues to outpace efforts to contain the virus."
Aliko Dangote, a private citizen of Nigeria, donates US$1 million to the fight to stop the outbreak.
October 18
Portugal announces that it will set up a medical base at the Hospital Militar in the capital of Guinea-Bissau. This base will compliment Guinea-Bissau’s own preparedness efforts and serve as a first response if the virus crosses the border from Guinea.
October 19
The The New York Times editorial board says that Cuba "stands to play the most robust role among the nations seeking to contain the virus." Cuba has earned this status because of the number of health professionals it has sent to the field.
October 20
Canada pledges US$58 million to the fight including the deployment of two mobile diagnostic laboratories in Sierra Leone and donations of an experimental Ebola vaccine to the WHO in Geneva.
October 22
The Telegraph reports that several countries are not living up to their pledged commitments to the UN Emergency Fund. The story includes a graph of commitments and what has actually been paid over.
October 23
Paul Allen, co-founder of Microsoft Inc., pledges US$100 million to UNICEF, MSF, American Red Cross, and CDC Foundation. Funds are intended to provide for medevac facilities, medical personnel and training and supplies.
October 24
The European Council announces that contributions by the European Commission and individual member states come to a combined total of US$1.3 billion.
China announces a fourth round of emergency funding bringing its total commitment up to US$80 million. The funds will be used to introduce more Chinese medical staff into West Africa and to establish a treatment center in Liberia.
Ethiopia announces that is sending approximately 200 volunteer health workers to West Africa to help contain the outbreak. The country additionally pledges US$500,000. AU chief Nkosazana Dliamini Zuma adds that other African countries have pledged to send some 1,000 volunteer health workers to the stricken countries.
October 25
The UN announces that “New pledges of financial aid to a UN Ebola fund have reached $118 million with Britain and Sweden offering sizeable contributions after UN chief Ban Ki-moon pleaded for more money. Britain pledged US$32 million and Sweden US$15 million to the fund set up by Ban to fight the Ebola outbreak, that has now killed nearly 4,900 people…[The} US$1 billion appeal for financing by UN agencies has raised US$491 million [to date].
October 27
Uganda announces that it is sending an additional 30 health workers to affected countries.
October 30
The WHO says that while the number of reported Ebola cases has risen to more than 13,700 — a 30% spike over a four-day period, most likely due to under-reporting – Liberia might be seeing a decline.
October 31
China announces that it will send and elite military unit to Liberia. The unit is tasked with building a 100-bed treatment centre and is slated to be open for operation in a month's time. China also pledges to deploy 480 military medical staff to treat Ebola patients.
Mali reports two suspected cases in connection with an infected two year old who traveled to the country from Guinea.
Liberia opens its largest treatment center yet. The center currently has capacity to treat 200 patients but is being scaled up to treat 300. "With the opening of the center, an Ebola treatment unit at JFK Medical Center has been closed. Many people with other diseases had been nervous about going to the nation's largest referral hospital, and officials hope they will now come back."
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This rundown is incomplete and I welcome any and all additions from expats outside the US and others in the know within the US.
The above said, it is clear that while late in coming to the table, the world has finally arrived. At least in dollars. The critical component, however, is medical workers. If we want to be safe at home we need to encourage skilled personnel to go to the front lines. In fact, we need to beg them to and then treat them like heroes when they return. If we don't stop this virus today, when it is more or less centrally located, we invite a much larger and more global crisis tomorrow.