Ebola response roadmap

The roadmap aims to guide and coordinate the international response to the outbreak of Ebola virus disease in west Africa.

The goal is to stop Ebola transmission in affected countries within 6-9 months and prevent international spread.

Download the roadmap

What is Ebola?

Ebola is a rare and deadly disease caused by infection with one of the Ebola virus strains (Zaire, Sudan, Bundibugyo, or Tai Forest virus). Ebola viruses are found in several African countries. Ebola was discovered in 1976 near the Ebola River in what is now the Democratic Republic of the Congo.

Current Outbreak

The outbreak of Ebola in West Africa is unprecedented in its scale, severity, and complexity. The severely affected countries are struggling to control the escalating outbreak against a backdrop of weak health systems, significant deficits in capacity, and rampant fear.

What can be done?

Strengthen human resource, and response capacities in areas of intense and widespread transmission. Ensure emergency and immediate response in countries with an initial case(s) or with localized transmission. Strengthen preparedness of all countries to rapidly detect and respond to an Ebola.

Where is the outbreak?

Countries most affected

The map below shows the West African countries of Guinea, Liberia and Sierra Leone which are the most severely affected. New cases are now appearing in Nigeria and Senegal. All countries with land borders to the affected countries are at risk.


Countries with widespread and intense transmission

The map below shows the location of cases throughout the countries with most intense transmission, differentiating the cumulative number of cases to date in each area from the number of cases that have occurred within the past 21 days. The dark red circles show that a large percentage of cases occurred in the 21 days preceding 14 September 2014. Nine districts in which previous cases were confirmed have reported no cases during the 21 days prior to the end of 14 September (six districts in Guinea, one in Sierra Leone, and two in Liberia). Two previously uninfected areas reported initial cases during the seven days prior to the end of 14 September. In Guinea, there has been one suspected case and one confirmed case in the Dalaba area. In Liberia, four probable and two suspected cases have now been reported in the Maryland area, which borders Côte d’Ivoire.

How many people are affected?

The total number of probable, confirmed and suspected cases in the current outbreak of Ebola virus disease (Ebola) in West Africa was 6553, with 3083 deaths, as at the end of 23 September 2014. Countries affected are Guinea, Liberia, Nigeria, Senegal and Sierra Leone. The charts below show the total number of cases by country that have been reported in each epidemiological week between the start of 30 December 2013 (start of epidemiological week 1) and end 21 September 2014 (end of epidemiological week 38). The latest information on cases and deaths can be found on the WHO Disease Outbreak News.


Cases by country as of 23 September 2014



Current assessment


  • 6553 (probable, confirmed and suspected) cases and 3083 deaths have been reported in the current outbreak of EVD as of 23 September 2014 by the Ministries of Health of Guinea, Liberia, and Sierra Leone.
  • In Guinea, the district of Kindia has reported its first confirmed case. In Liberia, six confirmed cases of EVD and four deaths have been reported in the district of Grand Kru, a rural area near the border with Côte d'Ivoire. This is the first time EVD cases have been reported from the area.
  • Exposure of health-care workers (HCWs) to EVD continues to be an alarming feature of this outbreak. As of 23 September 2014, 375 HCWs are known to have developed EVD (67 in Guinea, 184 in Liberia, 11 in Nigeria, and 113 in Sierra Leone). 211 HCWs have died as a result of EVD infection (35 in Guinea, 89 in Liberia, five in Nigeria, and 82 in Sierra Leone).
  • Two countries, Nigeria and Senegal, have now reported a case or cases imported from a country with widespread and intense transmission. In Nigeria, there have been 20 cases and eight deaths. In Senegal, there has been one case, but as yet there have been no deaths or further suspected cases attributable to Ebola.
  • Contact tracing and follow-up is ongoing. In Nigeria, 847 contacts (out of 872 total contacts) have now completed 21-day follow-up (349 contacts in Lagos, 498 contacts in Port Harcourt). The last confirmed case in Lagos was reported on 5 September. The last confirmed case in Port Harcourt was reported on 1 September; all contacts in Lagos have now completed 21-day follow-up. Of the 25 contacts (out of 523 total contacts) who are still being monitored in Port Harcourt, 24 (96%) were seen on 23 September.
  • In Senegal, all contacts have now completed 21-day follow-up, with no further cases of EVD reported. The last confirmed case in Senegal was reported on 28 August.
  • Ebola Response Roadmap updates will now be issued on Friday evening, and will replace the updates usually issued on Monday evening until further notice.

What needs to be done?

1

Achieve full geographic coverage with Ebola response activities in countries with widespread and intense transmission

  • Apply full Ebola intervention package to the extent of available resources
  • Develop and apply complementary approaches for intense transmission areas
  • Assess short-term extraordinary measures to limit national spread
  • Implement WHO’s Temporary Recommendations under IHR to prevent international spread
  • Ensure essential services and lay the foundation for health sector recovery and strengthening of national core capacities for outbreak response
2

Ensure emergency and immediate action in countries with an initial case(s) or with localized transmission

  • Initiate emergency health procedures
  • Immediately activate Ebola response protocols and facilities, in keeping with WHO IPC guidance and universal precautions
  • Implement IHR Temporary Recommendations to prevent international spread
3

Strengthen preparedness of all countries to rapidly detect and respond to an Ebola exposure

  • Establish active surveillance for clusters of unexplained deaths or febrile illness
  • Provide the general public with accurate and relevant information to reduce the risk of exposure
  • Establish a protocol for managing travellers who arrive at major land crossing points with unexplained febrile illness
  • Identify isolation units where any suspect Ebola case can be properly investigated and managed
  • Arrange a process for rapidly shipping diagnostic specimens to a WHO-recognized laboratory

Response operations

Countries with widespread and intense transmission

In countries with widespread and intense transmission the objective is to achieve full geographic coverage with complementary Ebola response activities. The key milestone is to reverse the trend in new cases and infected areas within 3 months, stop transmission in capital cities and major ports, and stop all residual transmission within 6-9 months.

The map below shows the status of the emergency response operations in the countries with widespread and intense transmission as at 14 September 2014. The map shows for each affeted location the status of the relevant Ebola intervention activities such as treatment centers, contact tracing, safe burial, laboratory testing and social mobilisation.



Current response status

  • Three laboratories are active in Guinea, and currently have sufficient capacity to meet demand in terms of quantity of cases and geographical coverage. Laboratory capacity in Liberia will need to be reassessed when new Ebola treatment centres open in Monrovia. In Sierra Leone, the high case load in Bombali and the western part of the country may necessitate the deployment of an additional mobile laboratory. In Kailahun district, the Public Health Agency of Canada has resumed its activities in coordination with the MSF ETC in the area. In Kenema, the CDC team-1 laboratory is testing samples from Kenema and Bo districts. In Freetown, the NICD Mobile Lab is testing samples from Freetown and the western part of the country.
  • Efforts are being made to increase the number of safe burial teams, but the workload remains too high. In Liberia, the workload is overwhelming, with teams having to carry out around between 10 and 15 burials each day. Six new teams are being trained to add to the existing six teams.
  • Social Mobilization teams continue to be actively engaged in implementing Ebola response strategies in the three intense-transmission countries. In Sierra Leone, the focus is on providing intense training to outreach teams (about 28,500 people) that will be going house-to-house covering 1.5 million households between 19 September and 21 September 2014, to listen to community concerns, provide appropriate knowledge about Ebola transmission, prevention, care and treatment, and to encourage families to take sick patients to treatment or observation facilities.
  • In Liberia, the renewed focus is on community engagement strategies as part of the planned Ebola/Community Care Units that will be set up at a district and sub-district level. The social mobilisation teams are also assessing common indicators to monitor and map related activities in each country.
  • In addition to the domains above, work is ongoing to provide short-term capacity to address critical gaps in essential services. The World Food Programme (WFP) has delivered 3000 metric tonnes of food for 147,500 people since April 2014. The United Nations Humanitarian Air Service (UNHAS), managed by WFP, has so far transported 290 responders with two planes and one helicopter. WFP and the logistics cluster facilitated the transport of 400 m3 of medical cargo. WFP is also providing engineering and logistics support to WHO for the construction of new Ebola Treatment Centres (500 beds in total).

Countries with initial cases or localized transmission

In countries with initial cases or localized transmission the objective is to ensure emergency and immediate application of comprehensive Ebola response interventions. The key milestone is to stop all transmission within 8 weeks of index case.

  • In Nigeria, all cases in the transmission chain are linked to a single person who travelled from Liberia to Lagos on 20 July. Among the contacts of this case, one person travelled to Port Harcourt and was the source of further local transmission; this transmission is at present limited to four cases. As a top priority, contact follow-up, supported by the highest authorities, has been implemented in Lagos and Port Harcourt.
  • In Senegal, one person, who travelled by road from Guinea to Dakar on 20 August, tested positive for EVD on 27 August. 67 contacts are being followed-up; none of these have tested positive so far.

Strengthen preparedness

A second meeting of the Emergency Committee convened by the Director-General under the International Health Regulations (2005) [IHR (2005)] regarding the 2014 Ebola outbreak in West Africa has begun discussion via email this week. The meeting will review the status of the outbreak as a public health emergency of international concern, and assess the impact of current temporary measures to contain the outbreak and reduce international spread.

WHO and a range of partners are supporting the development of Ebola surveillance, preparedness and response plans in all non-affected African countries. Priority activities include active surveillance for clusters of unexplained death due to fever; provision of information to the general public and travellers; the identification of isolation units; provision of verified access to a WHO-accredited laboratory; and the establishment of a strategy for identifying and monitoring contacts of any suspected case.

Work is ongoing to strengthen laboratory capacity in the WHO African region, including a collaboration between all members of the Emerging and Dangerous Pathogen Laboratory Network in the WHO African region that has now mapped the location and capacity of all laboratories able to test for Ebola infection. Logistical systems for sample shipment and the procurement of essential reagents and supplies, including Ebola-positive controls, are now in place at key locations.

WHO is monitoring daily travel, trade, and transport measures adopted in response to Ebola, and together with international partners has established an international travel and transport task force to provide a coordinated international response, and to monitor the situation and provide timely information to the maritime and aviation sectors.

Funding and resource requirements

Estimated costs

On 16 September OCHA presented a US $975 million summary of the collective requirements – and activities and plans of all UN agencies and other stakeholders – to defeat the ebola outbreak and mitigate the immediate and longer-term social, economic, development and security consequences in ebola-affected affected countries and the region. These requirements – outlined in the Overview of Needs and Requirements document – depicts the shared plans and financial requirements of the growing number of international partners involved in the response.

WHO’s ebola response roadmap presented here summarizes a consolidated view of the estimated US $570 million global resources required over the next six months – by national governments, WHO and other partners – for the core health response to stop Ebola transmission.

Updated as of October 7, 2014



Mission Critical Action Total Estimated Resource Requirements (USD) WHO Roadmap Estimated Resource Requirements (USD) Estimated Resources to be Implemented through WHO (USD)
1. Identify and trace people with Ebola 189,500,000
2. Safe and dignified burials 23,800,000
3. Care for persons with Ebola and infection control 331,200,000
4. Medical care for responders 14,000,000
5. Provision of food security and nutrition 107,000,000
6. Access to basic (including non-Ebola health) services 97,100,000
7. Cash incentives for workers 2,500,000
8. Recovery and economy 64,800,000
9. Reliable supplies of materials and equipment 42,600,000
10. Transport and fuel 23,400,000
11.  Social mobilization and community engagement 45,800,000
12. Messaging 3,200,000
Multi-Facted/Preparedness 30,500,000
Total 975,400,000

Resources available to WHO

Contributions and Firm Pledges to WHO, as at 26 September 2014 (USD)
Funding shortfall 136,401,000
Projected funding 54,450,000
Funds received 69,149,000
260,000,000

Contributions to the response

Contributors Total
Funds received (USD)
Member State contributions
Andorra 8,021 12,032 20,053
Australia - Department of Foreign Affairs and Trade 466,853 2,334,267 2,801,120
Canada - Department of Foreign Affairs, Trade and Development (DFATD) 367,309 550,964 918,274
Canada - Public Health Agency of Canada (PHAC) 67,952 101,928 169,881
Estonia 26,350 39,526 65,876
Germany 5,339,844 8,009,765 13,349,609
India 500,000 500,000
Japan 340,000 510,000 850,000
Kuwait 2,000,000 3,000,000 5,000,000
Luxembourg 53,476 80,213 133,689
Norway 638,570 957,854 1,596,424
Republic of Korea 180,000 270,000 450,000
United Kingdom of Great Britain & Northern Ireland – the Scottish Government 337,838 506,757 844,595
The Slovak Republic 8,021 12,032 20,053
The United States of America - USAID 2,558,870 3,838,305 6,397,175
US - Department of Defense 13,063,018 13,063,018
Non-Member State contributions
African Development Bank - Strengthening West Africa’s Public Health Systems Response to the Ebola Crisis (SWAPHS) 12,778,900 19,168,350 6,700,000 38,647,250
African Development Bank - Liberia 572,000 428,000 1,000,000
African Development Bank - Sierra Leone 550,600 449,400 1,000,000
African Development Bank - Nigeria 604,100 395,900 1,000,000
African Development Bank - Guinea 411,500 588,500 1,000,000
BHP Billiton 160,000 240,000 400,000
Bill & Melinda Gates Foundation 2,029,570 3,044,355 5,073,925
CERF - Guinea 554,766 554,766
CERF - Nigeria 1,063,443 1,063,443
European Commission - Directorate-General Humanitarian Aid and Civil Protection (ECHO) 267,380 401,069 668,449
OPEC Fund for International Development (OFID) 200,000 300,000 500,000
The UnitedNations Development Programme (UNDP) 17,688 17,688
World Bank – Guinea 2,300,000 2,300,000
World Bank – Liberia 19,121,406 19,121,406
World Bank – Sierra Leone 2,800,000 2,800,000
Sub-total funds received 30,000,299 65,347,976 6,700,000 16,478,416 118,526,691
Firm pledges (USD)
Member State contributions
Australia - Department of Health 466,853 466,853
China 2,000,000 2,000,000
Denmark 3,500,000 3,500,000
Finland 267,379 401,069 668,448
Germany - the German Federal Foreign Office 267,380 267,380
India 2,000,000 2,000,000
Japan 1,000,000 5,000,000 6,000,000
Netherlands 6,684,492 6,684,492
New Zealand 418,760 418,760
Norway 1,117,497 1,117,497
Qatar 400,000 600,000 1,000,000
Russia 50,338 50,338
Sweden 2,865,330 2,865,330
Slovenia 40,107 40,107
South Africa 232,079 232,079
Thailand 156,495 156,495
US - Department of State 1,200,000 1,200,000
Non-Member State contributions
African Development Bank - Strengthening West Africa’s Public Health Systems Response to the Ebola Crisis (SWAPHS) Future tranches 17,352,751 17,352,751
African Union 700,000 700,000
World Bank – Guinea Bissau 500,000 500,000
Sub-total firm pledges 667,379 5,406,834 41,146,317 47,220,530
Total funds received and firm pledges 30,667,678 70,754,810 6,700,000 57,624,733 165,747,221

*Estimated current distribution of funds which can be of used flexibly to address the response needs

Funds received for the Ebola response March to August 2014 prior to launch of roadmap