Liberia is declared Ebola free

The World Health Organization announces the end of Ebola in Liberia, but the epidemic continues in nearby Sierra Leone and Guinea.

By Declan Butler & Erika Check Hayden

Liberia is the first of three main countries affected by Ebola to be free of the disease, the World Health Organization said today, marking the end of the 15-month-long epidemic in the country. But the epidemic continues in nearby Sierra Leone and Guinea, and the WHO is warning against complacency, highlighting the risk of further flare ups and geographical spread.

The last person in Liberia known to be infected with the disease died on 27 March and was buried the following day. That means that as of today, 42 days have elapsed since the burial — the delay that the WHO uses to declare a country Ebola-free and twice the maximum incubation period for the disease.

Data suggest that an end to the epidemic across West Africa is also in sight. In the week up to 3 May, Guinea and Sierra Leone each reported just nine new cases — a far cry from the later months of last year, when the epidemic was peaking and hundreds of cases were being reported every week.

Ebola is also more geographically contained now. Back then it was a widespread disease that raged like a forest fire. Now it consists a few burning embers confined to the Forécariah prefecture in western Guinea, the neighbouring district of Kambia in Sierra Leone, and a region around Sierra Leone’s capital, Freetown.

But there are reasons for caution. Forécariah itself is a large district, and borders between countries in the region are porous, meaning that there is always a risk that an infected person might travel and spark new outbreaks elsewhere. With the rainy season underway, outbreaks in more remote regions could prove difficult to control as dirt tracks — often the only means of access — are transformed into muddy swamps.

There is an urgent need to learn from the mistakes and weaknesses that Ebola exposed. Bruce Aylward, who leads the WHO’s Ebola response, recently remarked: “Ebola was not an exception. Ebola is a precedent.” Panjabi, for example, highlights the need to remove “blindspots” in rural healthcare. If professionally trained and supported healthcare workers had been stationed in remote villages throughout Guinea, Liberia and Sierra Leone, he says, when the first patients grew sick, they could have sounded the alarm before a small outbreak became a global crisis. “We may have stopped the hotspots,” he says, “but the blind spots – remote villages with little or no access to healthcare – still exist.”

Nature | doi:10.1038/nature.2015.17513