In public health, the difference between a contained Ebola outbreak and a regional health emergency often comes down to how quickly we recognize the first signal.
That signal rarely emerges from a sophisticated laboratory or a major hospital. More often, it comes from a community member who notices that several people have suddenly fallen ill, an unusual death, a traveller presenting with unexpected symptoms, or a cluster of illness that doesn’t fit the usual pattern.
The question is whether we recognize it, report it, and act on it early enough.
Over the past two weeks, I facilitated a cross-border Ebola preparedness and response exercise at the Zambia–Democratic Republic of Congo (DRC) Points of Entry, supported by the East, Central and Southern Africa Health Community (ECSA-HC) through the World Bank-funded Health Emergency Preparedness, Response and Resilience Program.
We often say that health emergencies do not respect borders. At this exercise, I saw exactly why that is true.
People cross borders every day for work, trade, education, family and countless other reasons. Goods move across countries, communities interact across boundaries, and diseases can move with the same speed. A strong regional health security system cannot end at the border post.
The first line of defence may be the community
One of the most important lessons from the exercise was the value of Event-Based Surveillance (EBS).
We often think of disease detection as something that happens inside a health facility. But by the time a patient reaches one, valuable time may already have been lost.
Early warning can begin much earlier — with a community member who notices an unusual death, a frontline worker who observes an unexpected cluster of illness, or a border official who encounters a traveller with unusual symptoms. These seemingly isolated observations become critical pieces of information when they are reported, verified and investigated quickly.
This is why communities should not be viewed simply as recipients of public health interventions. They are an essential part of the region’s early warning system.
For EBS to work, people need to know what constitutes an unusual health event, where to report it, and what happens after they do. Surveillance systems must then be equipped to receive these signals, verify them, and translate the information into action rapidly.
The goal is not to create unnecessary alarm — it is to ensure that a potentially important signal is never dismissed until it becomes an outbreak.
Preparedness is a team effort
The exercise also underscored a second lesson: no single institution can deliver health security alone.
Port health officials, surveillance teams, clinicians, laboratory personnel, immigration officers, police, revenue authorities and animal health professionals all have roles to play. This multisectoral approach matters most at Points of Entry, where human movement, trade, public health, animal health and security intersect.
An effective response depends not only on whether each institution understands its own responsibilities, but on whether these institutions can communicate, coordinate and act together when an emergency occurs — and the same principle holds between countries.
A disease detected on one side of a border can quickly become a concern for communities on the other. Preparedness exercises offer something that documents and policies alone cannot: a chance to test how systems actually perform under pressure. They reveal where communication breaks down, where responsibilities are unclear, and where additional capacity is needed — before a real emergency exposes those weaknesses at a far higher cost.
From plans to preparedness
Across the ECSA region, countries have invested significantly in strengthening preparedness and response capacities. But preparedness cannot be measured by the existence of emergency plans alone.
A plan is only as useful as the people expected to implement it — whether they understand their roles, have the resources they need, and can work with counterparts across sectors and borders.
True preparedness means building systems that move from signal to information, information to verification, and verification to action, quickly. It means investing in frontline workers and communities. It means strengthening surveillance systems and ensuring laboratories can support timely confirmation. It means building trust and communication between institutions and neighbouring countries. And it means exercising these systems regularly, so that coordination is not being tested for the first time during an actual Ebola emergency.
Our regional health security is a shared responsibility
The Zambia–DRC exercise was a reminder that the region’s health security is ultimately interconnected.
A strong surveillance system in one country benefits its neighbours. A well-prepared Point of Entry protects not only the country where it is located, but also the communities connected to it. And effective cross-border collaboration can turn what might have become a regional crisis into an event that is detected and contained early.
As countries across Eastern, Central and Southern Africa continue strengthening preparedness for Ebola and other emerging and re-emerging health threats, one principle should remain central:
Preparedness is not only about having a plan. It is about having the people, systems and partnerships to recognize the signal early — and the capacity to turn that information into action.
Because when it comes to regional health security, a border may separate countries, but it cannot separate the risks they face.
Our strongest defence, therefore, is not one country acting alone, but a region prepared to listen, respond and act together.
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