Why Ebola Continues to Re-Emerge: Systemic Failures, Emerging Challenges, and Innovative Strategies for Sustainable Prevention and Control

Eric Kwasi Elliason; Arti Thakur

Abstract

Background: The rapid surge in the Ebola Virus Disease (EVD) seems to have overwhelmed a seemingly resilient healthcare system, especially in countries that have recorded high numbers of infections in recent times. There is no doubt that there have been advances in diagnostics, improved vaccines, therapeutics, and better outbreak response, yet recurrent outbreaks of the virus persist. What could be wrong? With this pattern, it will not be far-fetched to suggest that important structural and systemic gaps and drivers of Ebola transmission remain unresolved. Objective: This review is motivated by our quest to answer three questions related to the Ebola outbreak. First, why does Ebola keep coming? Second, what are we missing in our prevention efforts? Third, can we build a more resilient framework for Ebola preparedness? Methods: The nature of this review demanded a robust and systematic approach. We envisaged that adoption of an integrated review framework could fulfil our aspirations. We therefore adopted an integrated review framework to help us answer our basic review queries as outlined in the objectives. The conclusions were not drawn out of a vacuum. We derived evidence from major and credible scientific databases and international public health organisations. The findings were synthesized according to major themes relevant to the review. Results: Interesting results emerged from our review. We found that interconnected factors drive persistent and recurrent Ebola outbreaks. Some of these identified factors are zoonotic spillover, weak surveillance systems in vulnerable countries, weak health systems, ecological disruption, community mistrust, misinformation, and many others. To answer how we can be prepared to fight Ebola or prevent future occurrences, we examined the potential of artificial intelligence, digital health technologies, genomic surveillance, community-based surveillance, and One Health approaches. These have the potential to strengthen preparedness and response. Conclusions: We conclude that Ebola prevention requires a drastic shift from the current reactive outbreak response to proactive preparedness response. There is a need to strengthen surveillance systems across nations. We also need to improve our health system resilience, community engagement, and regional coordination to reduce future outbreak risks. Our proposed Integrated Ebola Preparedness and Resilience Framework provides a practical systems-based approach for advancing long-term Ebola prevention and improving global health security.

Why Ebola Continues to Re-Emerge: Systemic Failures, Emerging Challenges, and Innovative Strategies for Sustainable Prevention and Control

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