Ebola and the Future of Global Health

The 2014 Ebola outbreak has been one of the deadliest in recent memory.  According to the US Center for Disease Control, this outbreak started in March, in Sierra Leone, since then it has spread to 5 West African countries and killed over 2,500 out of 4,700 cases and shows no signs of abating.  Médecins Sans Frontière – who have around 1,900 people on the ground in West Africa – has been calling for an international response since April, but it wasn’t until August that the WHO declared this Ebola outbreak a “public health emergency of international concern”.  Even so, it took until early September for the US and other countries to pledge funds and people in an attempt to contain the outbreak.  This delayed response both from the WHO and the international community is a cause for concern in our ability to contain and deal with public health threats emanating from West Africa.

Ebola is caused by one of four viruses that affect internal tissue, causing endothelial cells to become ‘leaky’ resulting in internal bleeding. Compared to other infectious diseases, it is not as contagious – transmission requires direct contact with infected tissue or fluid – making it relatively easy to contain.  There is, however, no cure for Ebola at this time, and the mortality rate hovers around the 60%-70% mark.  Transmission occurs primarily in health care settings (i.e. doctors, nurses and patients’ families), and can be prevented using appropriate protective equipment (such as gowns, masks and gloves) and correct cleaning and disposal methods of medical instruments.  These procedures are relatively cheap and easy to follow, and yet the meager efforts to contain it have so far have been moot, international aid workers have found themselves lacking in the most basic preventative gear and the epidemic has continued to rage on.

Naturally, lack of equipment is not the exclusive cause for the rapid spread of Ebola; it is also due to limited access to health care in swathes of West Africa, lack of public health education as well as the suspicion that the (usually foreign) health workers are often seen with (in Guinea, five health workers were recently kidnapped and killed).  At the time of the outbreak, it was estimated that there was only 2 doctors per 100,000 people in Sierra Leone (compare that to 245 physicians per 100,000 people in the US), additionally a large part of the initial spread of Ebola was due to burial practice in both Sierra Leone and Liberia, which brought numerous family members into contact with the (still contagious) deceased.  Add this to inadequate supplies, and suspicion of western doctors and you have a humanitarian disaster waiting to happen.

In the wake of news that Ebola had reached Port Harcourt, Nigeria, through one patient who is thought to have infected around 16 people, the international community has finally jumped into gear.  The Obama administration has pledged 3,000 troops and $600 million in an attempt to contain the spread. The UK is also sending troops along with humanitarian experts, and has pledged $40 million in the fight against Ebola. China, the EU and India have all pledged money and personnel and Malaysia plans to donate more than 20 million protective rubber gloves to the 5 West African countries currently affected.  This is a commendable effort, and neatly reaches the $1 billion dollars the WHO stated was necessary to actively contain the outbreak, but it comes a little too late.  At this point the majority of the funding will be used playing catch up with the disease, whereas a quick response could have effectively culled the epidemic and resources could’ve been used for preventative measures.

This is not the first time that the WHO and the international community have had to deal with an epidemic of global prorportions.  In February 2003*, a man in Hong Kong died of previously unknown, atypical pneumonic virus, which quickly spread to Vietnam and Thailand.  In less than a month the WHO had issued a heightened global health alert, and two days later an international network of laboratories was established to find the cause and source of the new virus, and soon after it had been identified.  SARS, an airborne virus, is easily transmissible, allowing it to spread fairly quickly. The WHO’s rapid response meant it was quickly contained, and within a year, the alert was lifted.

This is in stark contrast to the delayed response seen in this Ebola epidemic.  Part of the reason for this can be traced to a downward trend in Global Health funding.  The WHO has been hobbled by a $1 billion cut in funding, leading to a reduction in staffing, particular on-the-ground personnel in areas such as West Africa.  In this case it meant that the WHO, where not the ones able to establish that there was an epidemic (The CDC has nearly triple the funding of the WHO).  During the SARS epidemic, a large chunk of funding came from private contributions as the virus hit hardest in areas with high economic activity.  This is not the case in Sierra Leone.  However, the poverty that plagues many West African countries should not sentence the people to life sans health and security.  In fact, it is because of this that more effort should be focused on constructing a viable health care system in West Africa.

Consider the implications of an emerging infectious disease originating in West Africa, one that is airborne and readily transmitted**.  This Ebola epidemic is already wreaking havoc to the economies of Sierra Leone and Liberia, both the IMF and the World Bank have already warned of the dire effects Ebola is having on the fledgling economies of Sierra Leone and Liberia, predicting that economic growth could be reduced by up to 8.9 percentage points, and cost close to $1 billion by the end of the year.  In an increasingly globalized world, this kind of economic downturn will affect the entire region, potentially destabilizing fragile countries.  Our hypothetical emerging disease would spread like wildfire across the globe; the economic effects would be exponential.

This highlights the importance of investing in a sustainable health infrastructure in West Africa.  The term ‘sustainable development’ has become the most recent catch-all trend in development, nonetheless the merits of a self-sustaining health system are clear.  This is not limited to sending more funds, personnel and equipment; it also means the training and education of local health practitioners as well as increasing public health knowledge among the local population.

In the face of a lagging global economy, high unemployment and increasing unrest in the Middle East, it can be easy to ignore a viral outbreak in an area with little strategic value.  However this Ebola epidemic is a critical warning of what can happen when sustainable and accessible healthcare lacks long-term investment.  On September 19th, the Security Council met and declared Ebola to be a ‘threat to world security’.  It seems that many countries are just waking up to the threat that Ebola poses not just to the African Continent, but also to the stability of the rest of the world.  Here’s to hoping next time it won’t come at the cost of 2,500 people.


*The SARS epidemic was retrospectively traced back to the Guangdong Province in China, starting November 2002.  However, reports of these cases were suppressed by the Chinese government.

** Most emerging infectious diseases are a result from cross over (e.g. bats or birds to humans), otherwise known as zoonosis.  The growing likelihood of cross over infectious diseases are due to the surge in the human population, increasing livestock and deforestation, all of which alter the eco-system and increases human contact with animals.

By Renate van Oosten

Tags: , , , , , ,

Categories: Africa

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