At the center of that foundation was the Sierra Leone Field Epidemiology Training Program, known as Sierra Leone FETP. Established in 2016 as part of the country’s post-Ebola recovery efforts, the program was designed to strengthen national capacity to detect and respond to public health threats. The United States Centers for Disease Control and Prevention, the US CDC, provided technical and financial support through the African Field Epidemiology Network, AFENET – a technical implementing partner working with the Sierra Leone Ministry of Health – to establish the FETP as a structured, in-service training program for public health professionals. Years later, when COVID-19 arrived, that investment in people proved invaluable. In their detailed study of the country’s response, the Resident Advisor of the Sierra Leone Field Epidemiology Training Program, Dr. Gebrekrstos Negash Gebru, and his colleagues, describe how Sierra Leone FETP graduates and trainees became central figures in both preparedness and response efforts.

The origins of Sierra Leone FETP lie in hard lessons learned. During the Ebola crisis, Sierra Leone struggled with delayed outbreak detection and limited local expertise in epidemiology. Surveillance systems were weak, data collection was inconsistent, and many districts depended heavily on international experts. Recognizing that sustainable health security required homegrown expertise, the Ministry of Health partnered with the US CDC and AFENET to create a structured field epidemiology training program.

The program was designed around practical service. It offered two levels of in-service training. The Frontline level, lasting three months, targeted district surveillance officers and other local health professionals. The Intermediate level, lasting nine months, focused on strengthening epidemiologic capacity at provincial and national levels. Trainees learned how to investigate outbreaks, manage surveillance systems, conduct epidemiologic studies, analyze data, and communicate findings to decision makers.

By the time COVID-19 emerged, more than 150 public health professionals had graduated from the program at various levels. This growing network of trained epidemiologists was spread across districts and ministries, creating a web of expertise that reached into communities throughout the country. As Dr. Gebrekrstos Negash Gebru emphasizes in his work, this decentralized capacity would become one of Sierra Leone’s greatest assets during the pandemic.

When the World Health Organization declared COVID-19 a Public Health Emergency of International Concern in January 2020, Sierra Leone entered a preparedness phase. Even before the first case was confirmed in the country, Sierra Leone FETP faculty, trainees, and graduates were mobilized. They joined national task forces, participated in readiness assessments, and helped draft preparedness and response plans.

Points of entry became critical lines of defense. At Lungi International Airport and major land borders with Guinea and Liberia, Sierra Leone FETP graduates were deployed to screen travelers, monitor quarantined individuals, and ensure that suspected cases were referred for testing and isolation. Travelers arriving from high risk countries were screened, placed under mandatory quarantine and monitored for symptoms.

This early vigilance paid off. When Sierra Leone confirmed its first COVID-19 case on March 31, 2020, the detection occurred within the quarantine and surveillance system supported by Sierra Leone FETP graduates. By that time, hundreds of travelers had already been screened and monitored. The systems that had been designed and tested during the preparedness phase were now fully operational.

Once community transmission began, the country shifted into full response mode. Training activities within Sierra Leone FETP were suspended so that trainees and graduates could be deployed nationwide. At the request of the Ministry of Health, FETP Intermediate trainees and dozens of graduates were assigned to key roles within the national response structure.

Their involvement spanned multiple pillars of the response. Many served in the technical coordination and surveillance pillars, overseeing case investigations, managing data systems, and supervising field teams. Others worked at district and sub district levels, strengthening local surveillance and ensuring timely reporting of cases.

Contact tracing was one of the most demanding tasks. Sierra Leone FETP trainees and graduates developed training materials and conducted large scale trainings for contact tracers and community health workers. In urban and rural districts, hundreds of contact tracers were trained to identify and monitor individuals who had been exposed to confirmed cases. Because a large proportion of COVID-19 cases in Sierra Leone were asymptomatic, contact tracing became essential in identifying hidden chains of transmission.

Graduates supervised these efforts, ensuring that contacts were followed daily and that data were entered accurately into national systems. Thousands of contacts were identified, monitored, and tested. These efforts helped limit widespread uncontrolled transmission and provided valuable data for decision making.

Surveillance strategies were also enhanced. Sierra Leone FETP graduates supported testing in selected healthcare facilities, where suspected respiratory illness cases were systematically screened for COVID-19. In hotspot communities, targeted testing campaigns were conducted. Epidemiologists analyzed trends, mapped transmission chains, and presented daily reports at national coordination meetings. These analyses guided decisions on lockdowns, quarantine measures, and resource allocation.

Beyond immediate response activities, Sierra Leone FETP also contributed to operational research. Graduates led a study of the first few COVID-19 cases in the country, examining clinical and epidemiological characteristics. This study provided evidence that informed policy adjustments and helped refine the response, ultimately leading to the successful containment of the outbreak.

Importantly, the pandemic did not halt other public health threats. During the same period, Sierra Leone faced outbreaks of measles, mpox, rabies, Lassa fever, and polio. Sierra Leone FETP trainees and graduates responded to these outbreaks as well, investigating cases and supporting containment measures. Their ability to manage multiple threats simultaneously underscored the value of broad based epidemiologic training.

One of the most significant achievements of Sierra Leone FETP was the strengthening of district level capacity. Before the program’s establishment, many districts lacked trained surveillance officers. By the time COVID-19 struck, each district had at least one officer trained through the program. These officers were not only data collectors but also leaders who could coordinate investigations, supervise teams, and communicate findings effectively.

The Intermediate FETP fulfils important international standards. The FETP-Intermediate level has received accreditation from the Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET) for its excellence in field epidemiology training, making it one of the first FETP-Intermediate programs to achieve global recognition. Furthermore, under the International Health Regulations, countries are expected to develop core capacities for detecting and responding to public health emergencies. By establishing both Frontline and Intermediate levels of field epidemiology training, Sierra Leone strengthened its compliance with these obligations. The presence of trained epidemiologists across districts improved the country’s ability to detect, verify, and report health threats in a timely manner.

Looking back, the COVID-19 pandemic was a severe test of Sierra Leone’s public health system. It strained resources and demanded rapid adaptation. Yet it also provided an opportunity to demonstrate the value of years of investment in workforce development. The contributions of Sierra Leone FETP trainees, graduates, and faculty were not abstract or symbolic. They were practical, hands on, and deeply embedded in the daily work of surveillance and response. The program’s impact has continued beyond COVID-19. During the most recent mpox outbreak in 2025, Sierra Leone FETP trainees and graduates were once again at the forefront of preparedness and response efforts. They supported surveillance, conducted case investigations, and strengthened coordination activities that contributed to the successful containment of the outbreak. This milestone underscores a powerful lesson: sustained investment in field epidemiology training strengthens a country’s ability to detect, respond to, and contain emerging health threats – ultimately protecting the health and security of its population.

As new health threats inevitably emerge, the question for every nation is whether it will have the expertise needed to respond swiftly and effectively. Sierra Leone’s journey through COVID-19 suggests that sustained investment in field epidemiology is one of the most effective answers. Through the dedication of its trainees and graduates, the Sierra Leone Field Epidemiology Training Program transformed hard lessons from the past into stronger defenses for the future.

From Ebola to COVID-19 to mpox, Sierra Leone’s experience shows that when countries invest in training skilled field epidemiologists, they invest in a safer and healthier future for all. It reminds us that investing in people – the public health workforce – is one of the most powerful tools we have to prevent, detect, and respond to future epidemics