Improved blood systems in Ebola-affected countries expected to be positive outcome
Improved blood systems could result from work being done as part of the fight against the outbreak in Guinea, Liberia and Sierra Leone, the 3 countries most severely affected by Ebola. Although national blood systems in those countries have limited capacities, the potential of using blood and plasma transfusions from recovered Ebola victims to treat infected patients has drawn international attention and funding. Phase II and Phase III convalescent blood and plasma trials are now underway in all 3 countries.
A blood plasma research trial is running in Guinea with the support of Belgium, France and the United Kingdom. In Liberia, the US is supporting a plasma trial. Whole-blood and plasma trials are being conducted in Sierra Leone, with support from the United Kingdom and the United States.
Prior to the Ebola outbreak, the national systems that collect, test, process, store and distribute blood in Guinea, Liberia and Sierra Leone were struggling, but had been making progress since the end of civil unrest. The countries had old, insufficient equipment and shortages of personnel. During the Ebola outbreak, these already fragile blood systems virtually collapsed.
But today, thanks to the spotlight focused on West Africa, and the potential of use of convalescent whole blood and plasma in the context of Ebola, there is new hope and energy to rebuild national blood systems and expand capacities to meet general domestic needs.
Leaders in blood transfusion systems in West Africa recently gathered for a meeting in Geneva to develop strategic plans to rebuild their countries’ blood systems above their pre-Ebola capacities.
Currently, 26 people are employed at the National Blood Service in Guinea, while the ideal number would be twice as many, said Haba Nyankoye, Director of National Blood Service in Guinea. In addition, screening of blood is only done in Conakry, simply because other centres in the country don’t have the equipment or trained staff to do it. The current objective of the Guinean Ministry of Health is to refurbish the National Blood Transfusion Centre and 4 existing regional centres.
“We have received new equipment for the collection of plasma from the Bill and Melinda Gates Foundation, and we have received training, but there is still a lot to be done,” Mr Nyankoye said.
Even though this donation will contribute to the country’s efforts to rebuild the blood service, there is enormous work to be done, especially on community engagement to encourage people to donate blood and plasma. Before the Ebola outbreak, 10% of collected blood in the country came from voluntary non-remunerated donors. After Ebola, those donations went down to 4%. “People became very scared of contracting Ebola,” Mr Nyankoye said.
WHO advises that blood collected from volunteers is more likely to be safe; therefore, a national programme needs to be established in Guinea to promote voluntary participation and the collection of blood from such donors.
Liberia has high rates of maternal and childhood death. Before Ebola struck, the focus of the national blood service was to ensure safe blood for hospitals, maternal and child health and emergencies. Liberia used to be active in blood drives to increase voluntary blood donations. Even though the number of voluntary non-remunerated donations remained low, about 10% of all donations, the small progress made was entirely wiped away by the Ebola epidemic.
“The blood service completely ceased during Ebola,” said Dr. Saye Dahn Baawo, Assistant Minister of Health in Liberia. “We don’t know exactly what was happening in the county hospitals, but in Monrovia everything stopped. People were afraid of coming near the hospitals.”
During the Ebola outbreak, all of the scarce blood resources Liberia had in its 2 donation centres were used to fight the epidemic. Now the country is making plans to ensure the availability of safe blood by leveraging and expanding its experience in community engagement during the epidemic.
Baawo stressed that Liberia needs to build upon partner efforts made during the epidemic. Currently, they are partnering with Grifos and the University of Massachusetts to build the infrastructure and revamp the programme for routine healthcare.
Before Ebola struck, Sierra Leone organized blood drives, becoming the most successful in the area compared to its neighbouring countries.
“When we started implementing blood drives in 2010, our voluntary donors accounted for 10% of all blood donations,” said Dr Samuel H. Baker, Programme Manager of the National Safe Blood Transfusion Service in Sierra Leone. “By 2014, it was up to 44%, and when Ebola came, it dropped drastically, back to 10-15%.”
The reason for this significant drop was suspended community blood drives. Now, however, with Ebola finally receding, Dr Baker said they are considering a resumption of community drives to replenish blood resources.
“We started offering patients the option of treatment with convalescent whole-blood transfusions and soon ran out of the supplies of whole blood,” Dr. Baker said. “It means the demand is high. We have done over 50 transfusions so far and 45 of the patients were discharged and were declared Ebola free.”
In addition, many health care practitioners were dying due to unsafe practices. This contributed to the closing of all public hospitals except the primary health care facilities.
Now, Sierra Leone needs to establish a blood-donor database and partnerships with blood donors and non-governmental organizations, and build well equipped new regional blood centres in Freetown, Makeni, Bo and Kenema, he added.