Ten years ago, Ebola swept through Sierra Leone. Can a vaccination campaign prevent history from repeating itself?

OOn a concrete platform on a steep hill in a Freetown slum, dad Hassan Kamara points to the tin-roof hut behind him. “I lived here with my father, mother, wife and brothers,” he says. “I lost all my family members within a month.”

Ten years ago, the Ebola virus swept through West Africa, with deadly consequences more than 11,000 people, including nearly 4,000 in Sierra Leone – about 40% of those infected in the country. When the outbreak started, there was no vaccine yet.

Today the world has one stock of half a million doses. This is sufficient for use in preventive vaccination programs for frontline workers in countries with a history of Ebola, some of which are being held in reserve as emergency jabs in the event of an outbreak.

Sierra Leone this week becomes the first country to launch a nationwide preventive Ebola vaccination campaign for people at highest risk. In three weeks, officials aim to deliver 20,000 doses of Merck’s Ervebo vaccine in a campaign that will be repeated every two or three years.

Doses will be offered to health workers, as the country lost 7% of its medical workforce to the 2014-2016 outbreak, as well as soldiers and motorcyclists, who are the main mode of transportation for many Sierra Leoneans. Village hunters will also be involved, looking for bushmeat, as Ebola circulates among animals and can spread to humans.

The program is being greeted with optimism as a step toward creating a stronger health care system that can better withstand any future outbreaks, but it’s clear that memories of 2014 remain raw.. “Sometimes, when I’m in my bedroom, I just sit and cry,” Kamara says.

On October 30, 2014 – five months into the Sierra Leone outbreak – his mother started feeling ill. The family was reassured by a doctor that she had diabetes and heart problems, and not Ebola.

“I said, ‘Oh thank God,’” Kamara recalls. “So all of us – my wife, my father, all those who died (later), started hugging our mother. I fed her and used my bare hands to wipe away her tears when she cried. She died on the second day.”

He clutched her body to his chest, he says. Two days later, lab results showed she died of Ebola.

Kamara noticed his own symptoms in early November 2014: “weakness, diarrhea, pain all over my back.” He was taken by ambulance to a treatment center. While he recovered, his family members succumbed. His father was taken several hours away to another treatment center, where he died.

Two of Kamara’s brothers were taken to his treatment center. “They died before my eyes,” he says. Kamara was released, but when he returned home he discovered that his wife, son and stepmother had all died.

Kamara later became spokesperson for the Sierra Leone Association of Ebola Survivors, and was sent abroad by the government as ambassador to seek support for survivors. He urged support for Ebola orphans and for widows who in some cases have been forced to turn to sex work.

Today, he says, that support has evaporated. Kamara, a former professional footballer who once dreamed of playing abroad, now has 13 younger relatives. Like many survivors, he says he can’t find well-paying, regular work. For him, this is due to care responsibilities. For others, persistent health problems or stigmatization play a role.

The cemetery where Kamara’s family is buried is now overgrown with weeds, he says. The government no longer funds offices for the association, and he is unsure what happened to the promised social investment funding.

At least 23 health complications have been recorded in Ebola survivors, ranging from eye problems to impotence and deafness. Ministers promised them free healthcare in government hospitals, but Kamara says patients there faced “a lot of stigma” and were told they had to pay for medicines.

However, he is “100% behind” the new vaccination program. The vaccines are supplied from the global stockpile funded by Gavi, the vaccine alliance, which is also providing funding for the implementation of the campaign. Participants will be part of research into long-term responses and how the vaccine compares to other vaccines previously given in studies and pilot programs.

The arrival of a new outbreak is “only a matter of time,” said Dr. Desmond Maada Kangbai, manager of the expanded vaccination program at the Ministry of Health. “We don’t want to go back to where we were in 2014, when healthcare workers were dying and patients were left in treatment centers and hospitals.”

Ebola came to Sierra Leone when an infected person from neighboring Guinea crossed the border to consult a traditional healer. That herbalist became ill and died, and people who came into contact with the corpse during the funeral brought the virus back to their community.

Dr. Donald Grant, a district doctor in Sierra Leone’s second-largest city, Kenema, was studying in the US when the outbreak reached his city. But his wife, also a doctor, worked in the hospital’s maternity ward and cared for their eight-month-old son. “She said she had been caring for a patient (who started bleeding) in the IV line,” Grant recalled.

When blood tests showed the patient had Ebola, Grant’s wife had already gone home, so the lab called him with the results. When he called his wife to report it, she said their son was breastfeeding – a possible route of infection. “I was empty,” he says. “Thank God everything went well – she wasn’t infected.”

Many colleagues were less fortunate. Near an isolation ward in the Kenema hospital complex lies the grave of Dr Sheikh Humarr Khan, the country’s expert on viral haemorrhagic fever. Khan contracted Ebola and died in August 2014.

At the entrance to the hospital there is a monument that lists forty employees who died in the fight against Ebola, from doctors to guards. More than a quarter of the health workers killed were based in Kenema.

TThe vaccine will not be a panacea. There are obvious gaps in the country’s armor against a new outbreak. As we travel around the country, it becomes clear that many people still do not have reliable access to sanitation and clean water. In the early afternoon, people on the road between Kenema and the capital Freetown hold freshly killed bushmeat to passing cars in the hope of selling something.

In the border town of Kailahoun, 30-year-old Yusuf Marrah, a herbalist, says he will encourage people who seek his advice to take the vaccine, but his profession needs more support. During the Ebola outbreak and again during Covid, traditional healers were ordered to stop their work but left without “any source of funding”, he says. And they lack the protective equipment given to medical workers.

Without that help, he fears that “they will just continue to work the way they worked before.”

Dr. Mohamed Alex Vandi was district doctor in Kenema during the 2014 outbreak and is now deputy director of the National Public Health Agency. The country is in a much better position today, he points out. Community health workers have been provided with tablet computers, which allow for real-time reporting and monitoring of suspicious symptoms.

“We don’t take any risks,” says Vandi. Lassa fever, another viral hemorrhagic fever (VHF), is endemic in the country and is being detected in new areas. Marburg, a third VHF radio, caused a recent outbreak in Rwanda.

One or two possible cases of VHF are reported every week and tests are being conducted for Ebola, Marburg and Lassa, Vandi says. Usually they are negative.

“Had it not been for the vaccine, it would have become very difficult for our employees to comfortably handle cases that they suspect could likely be one of the VHFs,” he said. “Of course you’re going to take precautions. But at least this gives you some confidence.”

• This reporting trip was paid for by Gavi, which is partly funded by the Bill and Melinda Gates Foundation, a philanthropic organization that also contributes money to support the Guardian’s editorially independent global development department.