The Gambia mounted an impressive response to its first outbreak of bird flu in 2023. Bolstered by a subsequent SEEG deployment, it has become a showcase for neighbouring countries.

In late March 2023, Binta Sambou, Senior Wildlife Conservation Officer in The Gambia’s Department of Parks and Wildlife Management, received a call from a guide in the Tanji Bird Reserve. He had noticed a number of dead birds in the wetlands and along the water line. Avian influenza had been taking up increasing column inches in Europe’s newspapers since late 2022 and given The Gambia’s key position on avian migration routes from Europe to Southern Africa Ms Sambou was justifiably concerned.

Acting quickly, she alerted colleagues in the Department of Livestock Services of the Ministry of Agriculture and, with limited resources at her disposal, set about looking for a vehicle and boat to visit the area. Thinking ahead, she made a mental note to look at opportunities for external support, which led to her team’s later collaboration with the German Epidemic Preparedness Team (SEEG). 

The rising global threat of avian influenza

Highly pathogenic avian influenza (HPAI) is a highly contagious and adaptable viral disease which causes massive loss of life among infected bird populations. Infected migratory birds can transfer the virus to domestic poultry, as well as to captive and wild birds in the countries they pass through. This chain of infection has lead to the world’s largest ever documented wave of HPAI in recent years, both in terms of the number of disease outbreaks and their geographical distribution.

The current strain of avian influenza (H5N1) is affecting a far wider range of avian and mammalian species than ever before recorded, including foxes, seals and mink. And in January 2024, the first polar bear died of the disease.

Because the avian influenza virus does not respect geographic or species-related boundaries, an interdisciplinary and multisectoral approach is critical for managing and maintaining outbreaks. Dr Anja Globig of Germany’s Friedrich-Loeffler-Institut explains,

HPAI is a good example of an infectious disease that really calls for a One Health approach – it is about tackling this disease which has not yet become a huge burden on public health, but which has this potential.

H5N1 arrives on The Gambia’s shores

Lying on the East-Atlantic flyway for migratory birds, The Gambia’s coastline is dense in wildlife parks and natural animal habitats, which play host to many species of migratory bird that come to feed on the rich marine life. After some delays in securing the necessary equipment and supplies, Ms Sambou and colleagues from the Department of Livestock Services made their way to the coastline to assess first hand what was going on.

Of the ten rapid tests they conducted, one showed the presence of avian influenza. Mr Saidal Ali Bah, Principal Scientist and Director of the Central Veterinary Laboratory immediately sent the samples to the Food and Agriculture Organization (FAO) collaborating centre in Dakar, Senegal for further testing. The PCR tests confirmed everyone’s worst expectations – The Gambia was in the grip of an avian influenza outbreak, of the type H5N1.

The Gambia activates its One Health platform

Ms Sambou – who is also The Gambia’s One Health Focal Point for Wildlife – activated the One Health platform. Jointly with Mr Bah, they called an emergency meeting of key members, including the Epidemiology and Disease control (EDC) Unit at the Ministry of Health and the National Public Health Laboratory, as well as colleagues from the Ministries of Environment, Climate Change and Natural Resources and Agriculture. 

As the death toll among wild birds continued to grow rapidly, the One Health members met every 2 – 3 days to manage and monitor the outbreak. The largest threat lay in the potential for the virus to cross over to The Gambia’s domestic poultry. With its potential to generate income and create jobs and food, poultry farming plays a critical role in The Gambia’s economy. ‘There was a feeling of great urgency among the One Health members to strengthen bio-security measures’ says Ms Sambou.

Sensitisation efforts were quickly rolled out using, for example, radio broadcasts and Friday prayer meetings to communicate key messages. A designated call line was set up to provide advice on dealing with deceased and sick birds, and to keep information flowing between the affected communities and those coordinating the response. Members of the pubic were urged to remain calm, to report dead or sick birds and, above all, not to touch the birds. Farmers were advised on measures such as disinfecting feet and the soles of their shoes.

Limited resources pose a major challenge

A serious challenge for managing infectious disease outbreaks in The Gambia lies in the lack of dedicated resources. ‘When the outbreak took off’, continues Ms Sambou, ‘we were really worried because we do not have the capacity to do critical things like testing and using PPEs, and this delays our response’. Such delays carry very real risks for citizens, particularly fishing and farming communities. Women are at higher risk of exposure because they do the farming and slaughter the animals, while children sometimes play with the dead birds, greatly increasing the risk of animal to human transmission.

The shortage of human resources is particularly acute. In 2012, an assessment by the World Organization for Animal Health (WOAH) estimated that The Gambia needed 22 vets to manage its livestock. Currently, there are only 3 or 4 trained vets in the country, all of whom are working in management positions like Mr Bah. And The Gambia’s livestock is much larger today than it was ten years ago. Saidal Ali Bah puts it plainly,

in The Gambia’s Central Veterinary laboratory, we have no trained microbiologists or virologists, and the Department of Parks and Wildlife does not have a single vet. How are we to manage outbreaks like this?

Saidal Ali Bah

SEEG helps both to build capacities…

In May, SEEG was contacted by Abdoulie Sawo, Principal Wildlife Conservation Officer at Department of Parks and Wildlife Management, and Binta Sambou’s boss. SEEG began to put together an interdisciplinary team of scientists, drawing on SEEG’s coordinating institution Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, as well as partner organisations, the Friedrich-Loeffler-Institut, Robert Koch Institute, and the Wadden Sea Secretariat. 

In September, the SEEG team arrived in The Gambia, bringing with them supplies of personal protective equipment (PPE), test kits and much more. Although the acute phase of the outbreak had by then passed, the timing was in fact spot on, as Dr Norman Nausch, Head of SEEG explains,

Often it’s not the acute phase when support is really required, but a couple of months later when you identify the gaps in the acute response and can use the momentum developed to press forward and address them.

The deployment kicked off with a round of formal meetings with ministers and ministry representatives. During these meetings, SEEG team members were able to highlight the critical efforts of their Gambian colleagues during the early stages of the avian influenza outbreak, and to underline the importance of a collaborative One Health-led approach involving all sectors to address future outbreaks. As Lisa von Stebut, Coordinator for the deployment, explains, ‘it is really essential to have ongoing governmental support for One Health, in addition to emergency funding for situations such as the one in The Gambia’.

Training on diagnostic capacities was provided for scientists at the public health and central veterinary laboratories, and The Gambia’s rangers learned how to use PPE and to safely dispose of the carcases, among other things.

…and to plan for future outbreaks

A three-day risk assessment exercise brought together stakeholders from different disciplines and sectors to assess The Gambia’s risk profile for avian influenza. Participants analysed the entry points for the virus, ranked the different risks and agreed how best to mitigate them. In this way, the workshop provided a much-needed opportunity to revitalise communications between The Gambia’s different One Health stakeholders and to plan for future outbreaks.

A focus on resilience

Although its own resources are limited and visits are often short, SEEG aims to help partner countries build resilience to infectious disease outbreaks. During the Gambia deployment, recommendations developed by One Health partners with support from SEEG were shared with senior government officials. These included the development of a binding, intersectoral response plan for future outbreaks, and renewed efforts on awareness raising and advocacy with government decision-makers.

Over the years, Binta Sambou, Saidal Ali Bah and their One Health colleagues have worked hard to put The Gambia’s One Health platform on a more formal footing. However, as so often happens, these efforts came to nothing when the government changed in 2022 and the supported One Health ‘champions’ moved out of office. The SEEG visit served to revitalise these discussions and, as Mr Ali Bah says, ‘I am confident we are on the right track regarding One Health now. In 2024, I am sure we will get this thing done’.

Achieving a lot with very little

Jan Matern, GIZ Advisor for Pandemic Preparedness and One Health, who led the SEEG deployment to The Gambia, was really impressed with the levels of expertise of Gambian colleagues. With limited experience of dealing with avian influenza and even more limited resources, they responded successfully to the acute phase of the outbreak. In December 2023, Ms Sambou was invited to participate in the SEEG deployment to Guinea, to share lessons from tackling Gambia’s avian influenza outbreak and promote learning between the two countries. Summing up SEEG’s contribution, Jan Matern says, ‘thanks to our engaged Gambian colleagues, we were able to build a solid foundation for intersectoral collaboration, which will help The Gambia to tackle future avian influenza outbreaks’.

Corinne Grainger, February 2024