Summary: Ebola is at home in Africa. 22 countries are potential natural hosts and a new outbreak could start there. This article looks at these countries and offers some recommendations on how to handle this risk. For a full experience of the graph included in the text, click here.

• Bye, bye Ebola?

The news comes and goes in the fight against Ebola in Western Africa. It seems that since mid-2015, every week the victory against the disease is announced, preceding

another announce of a new case. When Sierra Leone was declared officially Ebola free on 7 November 2015, the news was celebrated with the song “Bye bye Ebola” by Block Jones featuring Freetown Uncut and its feel-good music video clip. The picture illustrating this article is a screen capture from this clip.

• The Ebola crisis in Western Africa (2013-2016…ongoing?): unprepared countries

At the beginning of 2014, the news about Ebola and Western Africa were not good, not good at all. Thousands of kilometres away from what we thought was its natural niche – in Central Africa – Ebola hit hard 3 unprepared countries. It took months for them and external actors to start acting according to the actual threat. Close to 10,000 men and women died in Guinea, Liberia and Sierra Leone. The disease spread across Africa and the rest of the world with cases in Nigeria, Mali and the USA, among others. There were cases of media-fuelled panic in Western countries. There is a still a debate around the human, social and economic costs of the Ebola outbreak of 2014. Some 8,000 kms down South, a Botswana Tourism Board top staff declared that due to fears of Ebola, tourism was hit hard too in this Southern African state. It seemed that people from Europe and the US – potential tourists to Botswana – are inclined to see Africa as one united territory.

• In Africa Football is stronger than the fear of Ebola

In Africa itself, Ebola had some interesting collateral damage. In September 2014, while a case had been confirmed in Senegal, Botswana hosted the Western African State national football team for a qualifying game to the African Cup Of Nations. The Botswana authorities allowed the Senegalese team to enter its territory, while they banned travel to and from the DRC blocking copper trucks from Katanga to drive through Botswana towards South Africa. This ban prevented also diplomats from the Southern African Development Community (SADC) based in Botswana to meet in Kinshasa, DRC, to discuss peace and security matters. Some Ebola cases were reported and confirmed in the Equatorial Province – more than 2,000 Km from the Katanga Province and around 1,000 Km from Kinshasa. The WHO declared that the Congolese outbreak was unrelated to the one in Western Africa.

• A huge impact

The impact in the three main Ebola-hit countries – Guinea, Sierra Leone, Liberia – has been huge: socially, humanly and economically. Their families will miss the deceased. Schools were closed.

The main reason for the disease to have time to hit these countries so hard is that it took close to 3 months to officially identify Ebola as the cause of the outbreak. The lack of readiness and capacities of Guinea, Sierra Leone and Liberia helped the disease to spread. Since its identification in 1976, Ebola outbreaks and its different stains only took place in Central Africa, mostly in the DR Congo. It seems logical to be surprised, thousands of kilometres from Central Africa to expect such a deadly disease to appear there. DRC manages to handle Ebola outbreak quite well due to its experience – they do not lose months to think that it could be Ebola and let the disease spread – and its poor infrastructure network in a gigantic country make it easier to set up an efficient quarantine zone.

The Western African outbreak is likely to have started in Guinea with a zoonotic transmission to a human and then spreading among humans in the area of Guéckédou close to where Guinea, Liberia and Sierra Leone meet.

This a map published for the French Press Agency (AFP) at the beginning of 2014.

• Back to basics: the first case of transmission to the human

The transmission of a disease from a host animal to a human is entitled “a zoonotic transmission”. The natural reservoir host of Ebola virus remains unknown but there are some suspects. In a study published last year, some Oxford scientists (and others) mapped 22 African countries where there is an environmental context for zoonotic transmission of Ebola. Let’s call that group the Group of 22.

There are 7 countries with recorded cases of zoonotic transmission: Congo, DR Congo, Gabon, Guinea, Côte d’Ivoire, South Sudan and Uganda. Let’s call that group the Group of 7.

According to this study there are 15 African countries zoonotic transmission recorded yet: Nigeria, Cameroon, Central African Republic (CAR), Ghana, Liberia, Sierra Leone, Angola, Tanzania, Togo, Ethiopia, Mozambique, Burundi, Equatorial Guinea, Madagascar and Malawi. Let’s call that group the Group of 15.

• Some recommendations

In order to prevent those 22 countries to have a first undetected case for weeks or months allowing Ebola to spread, here are a couple of recommendations.

• What: to develop a preventive strategy and an action plan to cope with the outbreak and train all medical officers in the countries. Who: the health authorities of these 15 countries.
• What: to develop an African preventive strategy and an action plan and sensitize African national health authorities. Who: the African Union (AU) with the support of the African bureau of the World Health Organization (WHO).
• What: to develop a network of laboratories in the 22 countries with the expertise to identify the stains of Ebola. Who: the health authorities of these 22 countries.
• What: in case of an outbreak, to have international African missions made up of African medical staffs to be deployed in order to build capacity and show continental solidarity. Who: this could be done under the patronage of the African Union.

The post-Western African Ebola outbreak era could be used to promote African solutions to African matters with the support of any willing international actors via their development agencies and support via the World Health Organization (WHO).

It is important to highlight the fact there is a lot of know-how in Africa about how to deal with that matter.