NEW YORK — The World Health Organization declared Liberia free of Ebola on Saturday, making it the first of the three hardest-hit West African countries to bring a formal end to the epidemic.
“The outbreak of Ebola virus disease in Liberia is over,” the UN health agency said in a statement read by Dr. Alex Ntale Gasasira, its representative to Liberia, at the emergency command center in Monrovia, the capital.
Just before Gasasira’s statement, Luke Bawo, an epidemiologist, showed a map depicting all of Liberia in green with the number 42 superimposed on it. This indicated that two maximum incubation periods of the virus, a total of 42 days, had passed since the safe burial of the last person confirmed to have had Ebola in the country, fulfilling the official criteria for concluding that human-to-human transmission of the virus has ended.
The room was packed with reporters, workers from Doctors Without Borders, and other aid agencies and dignitaries, including the American ambassador to Liberia, Deborah R. Malac, who burst into applause, according to health officials present.
The president of Liberia, Ellen Johnson Sirleaf, held a moment of silence for those who had died. She thanked Liberians who had fought Ebola and expressed her gratitude to the country’s international partners and others around the world “whose hearts were with us.” Johnson Sirleaf added, “Let us celebrate but stay mindful and vigilant.”
Then she began shaking hands, a mundane act that seemed monumental in a country where people have been cautioned for months not to touch one another.
Throughout the morning, the president, wearing sneakers and a baseball cap, paid visits to hospitals and met with orphans, widows, and survivors of Ebola.
“The health workers are dancing and clapping and singing ‘no more Ebola,’ ” Gasasira said by phone as he traveled with Johnson Sirleaf.
According to the WHO, there were more than 3,000 confirmed Ebola cases in Liberia, and a further 7,400 suspected or probable cases, with more than 4,700 deaths estimated to have occurred since the outbreak was declared there in March 2014. Among the dead were 189 health care workers.
“I’m particularly struck by the significant progress we have made as a country and as a people,” Tolbert Nyenswah, a senior Liberian health official who leads the country’s Ebola response efforts, said Thursday in an interview. The end of the epidemic was, he said, “a victory for Liberia and Liberians.”
“The only caution is that our subregion is not free yet,” he added, “and we are very much concerned about Guinea and Sierra Leone.”
The White House echoed those worries, congratulating the people of Liberia and pledging to help rebuild the country, but adding in a statement that “we must not let down our guard until the entire region reaches and stays at zero Ebola cases.”
In the past week, Guinea and Sierra Leone, which share borders with Liberia, each reported nine cases of the disease, the lowest weekly total this year.
Nyenswah said Liberia would continue many of the control measures that helped the country vanquish the epidemic, including surveying border areas for sick travelers, testing all dead bodies for the virus, and conducting burials with specially trained teams wearing full protective gear.
“We are being extremely cautious,” Dr. Bernice Dahn, the country’s incoming health minister, said Friday in an e-mail. She added that the country’s priority now was to build its critically deficient health care workforce to provide Liberians with a higher standard of care and help guard against future outbreaks.
A critical question for Liberians is whether the end of the outbreak will draw foreign companies back to the country, whose economy has been battered. British Airways, which came under fire from aid officials after it and several other airlines stopped flying to Liberia and Sierra Leone last August, has not resumed services.
“We keep our global route network under constant review and always take a range of factors into account before we make any changes,” a spokeswoman for the airline said Friday in an e-mail. Kenya Airways restored flights to Liberia several weeks ago. Only Brussels Air and Royal Air Maroc, the Moroccan national carrier, continued commercial air service to the country during the epidemic.
Last week, the Centers for Disease Control and Prevention stopped advising US citizens to avoid nonessential travel to Liberia, instead recommending that they “practice enhanced precautions” when going there.
“The country can get back to business,” Dr. Thomas R. Frieden, director of the disease centers, said Friday in an interview. “It’s a tribute to the enormous hard work done by Liberians, by the CDC, by partners throughout the US government, and the international community.”
For the time being, however, travelers from Liberia to the United States will still be subject to a 21-day monitoring program. “That’s something we’ll be discussing in the coming days with other parts of the US government,” Frieden said.
The WHO has recommended that Liberia maintain an additional three months of “heightened surveillance” for Ebola because of the continuing outbreak in neighboring countries, as well as the possibility that Ebola could re-emerge via sexual transmission from survivors.
On Friday, the WHO revised its guidelines for survivors, urging men and their partners to abstain from sex or to practice protected sex for at least six months or until two semen tests have been negative for traces of the virus. That advice follows recent scientific evidence suggesting that the last patient to fall ill and die of Ebola in Liberia may have caught the virus from her boyfriend many months after his recovery. Studies have shown that Ebola can persist in semen for some time, even after a man has completely recovered and poses no risk to the general public; studies of the phenomenon are planned.
The origins of the outbreak in West Africa remain undetermined, and some scientists believe Ebola is likely to be circulating in wildlife in the region. According to the WHO, four of six countries that suffered previous Ebola epidemics had a recurrence of the disease within three years.
There are signs that some hygienic habits that were adopted during the epidemic may be sustained in Liberia, including handwashing programs at schools. “That practice should become a way of life for us,” said Iris Martor, a nurse and the program director for the nonprofit organization More Than Me, which runs an academy for girls in the West Point slum area of Monrovia. “If we forget ourselves and go back to the careless way of life, there could be another outbreak,” Martor added.
One of Martor’s students, Benetter Kun, 18, is the daughter of Liberia’s last Ebola patient, Ruth Tugbah, who died at a treatment unit in late March. For Kun, as with many family members who lost loved ones, the end of the epidemic was bittersweet.
“It’s a sad moment for me and my family because we are not complete,” she said.
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