Coming to terms with Ebola
The UN Security Council and its Secretary General, Ban Ki-moon, have declared the outbreak of the Ebola virus in West Africa a "threat to international peace and security," according to the BBC (http://www.bbc.com/news/world-africa-29262968).
Ebola continues to trouble not only the five African countries where an epidemic has led to nearly 3000 deaths since February this year, but the World Health Organisation is deeply worried on behalf of its 194 member states.
After a puzzling five-month delay following the alarm raised by Médecins Sans Frontières, WHO declared Ebola to be an international public health emergency in early August, a category not used lightly.
Today's travel means that the Ebola incubation period of two to 21 days can easily coincide with the movement of infected persons from afflicted countries. Their illness would declare itself only after arrival at their destination country. Fortunately, Ebola sufferers are not infectious during the symptom-free incubation period.
The Ebola epidemic began in February in Guinea, when 75 people were infected and 41 died. According to the WHO, from there it spread to Liberia and Sierra Leone, then to Nigeria and, most recently, to Senegal. WHO reports that “as of September 6, 4293 people had contracted Ebola in the West African outbreak, resulting in 2296 deaths, a mortality rate greater than 50 per cent”.
Are we safe?
The threat posed by Ebola to affluent western nations is low. Ebola is not spread by airborne fomites – blood and vomitus can transmit it, but the potential patient must have direct contact with body fluids or parts. In countries with scant resources, such as in the five affected West African states, decontamination is too costly for fully effective implementation for all patients and contacts.
As a young Sierra Leone health student visiting Sydney recently told me, the cost of disposable cups for patients requiring oral rehydration fluids was prohibitive. This unimaginable destitution is why Ebola takes hold. It also explains – because we are so affluent with massive health resources – why it is a low risk for us. Public campaigns in the Ebola area are distributing soap.
When considering the risk of a global pandemic, we need to know how lethal the biological agent is and how readily it is transmitted. A highly lethal agent such as the Spanish H1N1 influenza strain that caused between 20 and 40 million deaths at the end of World War One was transmitted easily by airborne droplets. It was especially lethal among people aged between 20 and 40 years. In an account of the outbreak, Stanford University researchers noted that “of the US soldiers who died in Europe, half of them fell to the influenza virus, and not to the enemy” (https://virus.stanford.edu/uda/).
Ebola mortality is about 50 per cent, but varies by place. There is now an urgent pursuit and trial of antiviral agents that might be used against it. Vaccines are also being tested.
Because Ebola is so rare on the world stage, the commercial possibilities of a new drug are few, certainly compared with the profits that would accrue from a drug effective against obesity.
Controversy swirls around who has a moral obligation – government or private enterprise – to support the development of new drugs and vaccines for conditions like Ebola.
If the countries in which it is rife cannot afford disposable cups they will never meet the cost of new drugs.
International aid may be part of the solution, perhaps through a rejuvenated Global Fund to Fight AIDS, Tuberculosis and Malaria that “mobilizes and invests nearly US$4 billion a year to support programs run by local experts in more than 140 countries” (http://www.theglobalfund.org/en).
What can we do? President Obama has, according to the ABC, promised 3000 troops, including engineers and medical personnel, to build 17 treatment centres with 100 beds each, train thousands of health care workers and establish a military control centre for coordination of the relief effort, including a major deployment in Liberia, the country where the epidemic is spiralling fastest out of control.
The Federal Government has announced it will provide a further $7 million to support the international response. The funds include $2.5 million to support the WHO's response, $2.5 million to Médecins Sans Frontières, and an additional $2 million to support the UK's delivery of front-line medical services in Sierra Leone. The commitment brings the Australian total contribution to $8 million.
Current estimates from the WHO suggest that it will cost $1 billion to bring Ebola under control. This may be a vast underestimate.
If poverty is an important factor in its spread, then only substantial economic development will be the cure.
We can applaud Australia’s contribution to this fight, advocate for more and make personal contributions through agencies such as International Red Cross Ebola Outbreak 2014 Appeal. http://www.redcross.org.au/ebola-outbreak-2014-appeal.aspx
Published: 30 Sep 2014