The overall response of the wealthy nations towards the Ebola crisis in Western Africa has not only been appallingly slow, but short-sighted as well. With over 8000 confirmed cases of the disease, its spread to heavily populated urban areas in at least three very poor nations (Liberia, Sierra Leone and Guinea), and medical resources of every type in short demand in the hardest hit areas, this health crisis is quickly reaching the critical turning point after which it will no longer be possible to contain. As the UN special envoy David Nabarro put it, if we do not quickly contain this epidemic ”the world will have to live with the Ebola virus forever.”
What does a world with a permanent Ebola problem look like? With a mortality rate in the range of 70% and this strain's peculiar ‘infectiousness’, Ebola is different than other scourges which have hitherto had larger socio-ecological impacts (like Malaria, which kills more than half a million people every year). Ebola is different. It is not unreasonable to suggest that this virus has the potential to become a modern plague in the coming years, leading to the deaths of millions if not hundreds of millions of people on the planet (though as I note below the world could easily avoid this fate if it takes major action now). The Centers for Disease Control (CDC) has already estimated that the number of cases could reach 1.4 million by mid-January - three months away. That is an exponential rate of growth (in fact the number of Ebola cases is doubling every three to four weeks). By January the affected health systems will be so overwhelmed in the nations hardest hit that the possibility of political and economic collapse of those countries is very real. The president of Guinea has warned of this possibility already.
The unique nature of Ebola as a highly-infectious-but-not-very-contagious virus, combined with its high mortality rate, the devastating toll it has thus far placed on health care workers in particular, and the fear it sows in the broader population, all work at creating a dangerous cycle which only serves to make containment more difficult. MSF has noted that of its 16 doctors who have thus far contracted the disease, 9 have died. Given these dire statistics, aid agencies of all stripes are having difficulty recruiting medical workers to travel to the region - even those who are highly trained and have the resources available to help avoid infection (ie. protective gear and the knowledge of how to use it properly). Health care workers in Liberia are threatening to go on strike because they are getting paid pittance wages to work jobs which carry inordinate risks. War ravaged nations like the Democratic Republic of the Congo and nations recovering from civil war like Sierra Leone have little capacity to confront basic health issues let alone an outbreak of such a deadly disease.
Of course, the unfortunate part is that most of the devastation will take place in the poorest nations with the least capacity and weakest infrastructure to deal with a health crisis of this magnitude - and presumably mostly in Africa (though officials have outlined the possibility that this disease could quite easily spread to nations as far away as the Philippines and Haiti). Countries facing such tumult and difficulty tend to face high rates of emigration, and the fleeing of these nations’ populace could contribute to the continuing spread of this disease around the world. US Marine Corps General John Kelly has warned of the “mass migration” that could result in the coming months as people try to either avoid the disease or seek treatment. This world is a globalized world - and already we have seen Ebola easily spread to other nations, such as Nigeria (which thanks to quick action and better health infrastructure seems to have contained the outbreak in that nation). But Ebola has already evaded temperature screening at airports, to say nothing of illegal migration which is likely already occurring on a large scale (although we have little capacity to measure this) as people attempt to flee the hardest hit areas - and who can blame them?
But this disproportionate impact upon the poorest nations is not to suggest that the ‘first world’ will not be severely impacted. It is striking to see the toll placed on the regional public health system in Dallas after just one individual was placed in isolation and treated for the virus: Dozens of health care workers and in some cases their loved ones (and even pets) have been monitored and asked to isolate themselves. Two nurses who closely cared for the patient with state of the art protective gear have somehow contracted the virus, raising the question about the potential for airborne transmission of the virus in certain circumstances - when the victim is nearing death and the viral load is extremely high (although now, a spokesperson for Nurses United is speaking out about major breaches in protocols in the treatment of Thomas Eric Duncan, including claims that "staff treated Duncan for days without the correct protective gear, that hazardous waste was allowed to pile up to the ceiling and safety protocols constantly changed"). The CDC even had trouble hiring an agency to enter the victim’s apartment to decontaminate and destroy all his possessions. Now multiply these difficulties by the number of potential new cases of Ebola diagnosed within the U.S. (or any other developed country) and it becomes clear how taxing this virus could be in even a developed nation with robust public health infrastructures.
While it has thus far been relatively contained and isolated (in global terms), we have to recognize the threat that Ebola poses to global security and stability; this is a threat on a scale akin to global terrorism or a major natural disaster. Yet unlike the latter two threats, thus far the response to Ebola has been far too little, too late. This has been one of the most frustrating aspects of the current outbreak - while the rich nations of the world debate how to deal with ISIS, they have (for the most part, and with some exceptions) completely reneged on their global responsibility to commit money and resources to stamping out this epidemic before it becomes a pandemic. This is only now starting to change, months after the outbreak began. As of mid-October only one country which had pledged money to the UN's Ebola fund had actually paid up (Colombia). The world is now in need of a billion dollars to cover the costs of dealing with Ebola on the ground in Sierra Leone, Guinea and Liberia. Field hospitals, protective gear, ambulances, basic sanitation equipment, and wages (truly reflective of the risks) for health workers will all be required - and as the disease spreads these needs (and the associated costs) will only grow. The cost of not being prepared has far outweighed the costs of having a well-funded and prepared agency such as the World Health Organization - an agency which has faced funding cuts at the hands of the UN membership. The world has a moral responsibility to shore up the economies of the affected nations, a cost which will only grow if this outbreak is not contained.
A second frustrating oversight of the rich nations has to do with the inward-looking approach that has gripped the 'West' for the last six months; the analysis is always about the imminent risk to our own lives; the question most often asked is “What are the chances that Ebola will affect me personally?” when clearly it should be “What can I do to help fight Ebola?” The answer to the latter question is so painfully obvious: 1) donate money to relief organizations like MSF, and 2) raise your deep concerns with your respective national government for its unacceptably small and insignificant response. To not do these two simple things is to be complicit in what the WHO has labelled “the most severe acute health emergency in modern times”. If the people of the developed world are serious about wanting to live in a world free of Ebola, they may want to start by reaching for their wallets...
Take quick action now!
There is some good news amidst all the serious bad news: First, we know that we can contain this disease if we only act. We (those of us in the rich nations in particular) must get our governments to delve wholeheartedly into this issue. Major funds must be dedicated, and major resources too. A military response (such as that prepared by the United States Army - which recently spent $700 million and sent hundred of soldiers to West Africa) is in order and warranted. But the hundreds of soldiers pales in comparison to the thousands who have contracted the disease. We need more.
Second, development of a vaccine for Ebola has now entered clinical trials, and could potentially be dispensed to health care workers on the ground in Western Africa by the end of December or early January. Although testing of the vaccine on primates has been promising, we can’t put all our eggs in this one basket, and we still need to get our governments to commit money and resources NOW to confront the problem as it stands. We don't want to end up in a situation where we need to vaccinate millions of people with a relatively untested and unknown vaccine.
Don’t sit and wait for Ebola to come to you: Do what you can to put an end to this high mortality diseases before it becomes a modern plague!
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