Nature
Volume 516 Number 7531 pp287-444 18 December 2014
http://www.nature.com/nature/current_issue.html

Comment
Infectious disease: Mobilizing Ebola survivors to curb the epidemic
Joshua M. Epstein, Lauren M. Sauer, Julia Chelen, Erez Hatna, Jon Parker, Richard E. Rothman & Lewis Rubinson
17 December 2014
Scaling up the recruitment of individuals who have recovered from infection deserves urgent consideration, argue Joshua M. Epstein, Lauren M. Sauer and colleagues.
Multiple governments and non-governmental organizations have called on health-care personnel the world over to help control West Africa’s Ebola outbreak; these include Médecins Sans Frontières (MSF), the World Health Organization (WHO) and United Nations children’s charity UNICEF. But the demand for labour far exceeds the supply1. UN estimates, which may be low, suggest that approximately 5,000 international medical, training and support personnel are needed in the coming months.
While foreign assistance must continue, a nascent local strategy is a candidate for broad adoption. We call it MORE, for MObilization of REcovered individuals. The idea is simple: those who have recovered from Ebola could be engaged to reduce transmission, helping to bring the epidemic under control.
Examples of the approach can be seen in Sierra Leone, Guinea and Liberia. For instance, the UN is training survivors to support children who have had contact with infected individuals and are within Ebola’s 21-day incubation window (the time it takes to develop symptoms after being infected with the virus). MSF is similarly employing survivors to work in their Ebola treatment units in Guinea and Liberia.
There are uncertainties about the ultimate size of this cadre and, crucially, about the immunity of recovered responders to reinfection, both immediately and in the longer term (because immunity may wane). Nonetheless, the potential of MORE to shift the epidemic’s dynamics makes its consideration imperative…